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This exploratory study investigated the effects of early v. delayed time-restricted eating (TRE) plus caloric restriction (CR) on body weight, body composition and cardiometabolic parameters in adults with overweight and obesity. Adults (20–40 years) were randomised to one of three groups for 8 weeks: early time-restricted eating (eTRE; 08.00–16.00) plus CR, delayed time-restricted eating (dTRE; 12.00–20.00) plus CR or only CR (CR; 08.00–20.00). All groups were prescribed a 25 % energy deficit relative to daily energy requirements. Thirteen participants completed the study in the eTRE and CR groups and eleven in the dTRE group (n 37). After the interventions, there was no significant difference between the three groups for any of the outcomes. Compared with baseline, significant decreases were observed in the body weight (eTRE group: −4·2 kg; 95 % CI, −5·6, −2·7; dTRE group: −4·8 kg; 95 % CI, −5·9, −3·7; CR: −4·0 kg; 95 % CI, −5·9, −2·1), fat mass (eTRE group: −2·9 kg; 95 % CI, −3·9, −1·9; dTRE group: −3·6 kg; 95 % CI, −4·6, −2·5; CR: −3·1 kg; 95 % CI, −4·3, −1·8) and fasting glucose levels (eTRE group: −4 mg/dl; 95 % CI, −8, −1; dTRE group: −2 mg/dl; 95 % CI, −8, 3; CR: −3 mg/dl; 95 % CI, −8, 2). In a free-living setting, TRE with a energetic deficit, regardless of the time of day, promotes similar benefits in weight loss, body composition and cardiometabolic parameters. However, given the exploratory nature of our study, further investigation is needed to confirm these findings.
Background: Bathing ICU patients with chlorhexidine gluconate (CHG) decreases bloodstream infections and multidrug-resistant organism transmission. The efficacy of CHG bathing on skin microorganism reduction may be influenced by patient-level clinical factors. We assessed the impact of clinical factors on the recovery of microorganisms from the skin of patients admitted to an ICU who were receiving routine CHG bathing. Methods: We analyzed data obtained from 6 single-day point-prevalence surveys of adult ICU patients between January and October 2018 at 1 medical ICU, in the context of a CHG bathing quality initiative. Demographics and covariates were collected at the bedside and by chart review. Skin swabs were collected from neck, axilla, and inguinal regions and were plated to selective and nonselective media. Standard microbiologic methods were used for species identification and susceptibilities. Multivariable models included patients who received a CHG bath and accounted for clustering of body sites within patients. Results: Across all time points, 144 patients participated, yielding 429 skin swab samples. Mean age was 57 years (SD, 17); 49% were male; 44% had a central venous catheter; and 15% had a tracheostomy Also, 140 patients (97%) had >1 CHG bath prior to skin swab collection, with a median of 9 hours since their last CHG bath (IQR, 6–13 hours). Gram-positive bacteria were more commonly recovered than gram-negative or Candida spp across all skin sites (Table 1). Variation by body site was detected only for gram-positive bacteria, with recovery more common from the neck compared to axilla or groin sites. On multivariate logistic regression (Table 2), presence of central venous catheter was associated with lower odds of gram-positive bacteria recovery among those who received a CHG bath. Presence of tracheostomy was associated with a significantly higher odds of gram-negative bacteria detection on skin. No clinical factors were independently associated with recovery of Candida spp. Conclusions: Central venous catheter presence was associated with lower odds of gram-positive bacteria detection on skin, suggesting the possibility of higher quality CHG bathing among such patients. Tracheostomy presence was associated with greater odds of gram-negative bacteria detection, suggesting that it may be a potential reservoir for skin contamination or colonization. Indwelling medical devices may influence CHG bathing effectiveness in reducing microorganism burden on skin.
We quantified hospital-acquired COVID-19 during the early phases of the pandemic, and we evaluated solely temporal determinations of hospital acquisition.
Retrospective observational study during early phases of the COVID-19 pandemic, March 1-November 30, 2020. We identified laboratory-detected SARS-CoV-2 from 30 days before admission through discharge. All episodes detected after hospital day 5 were categorized by chart review as community or unlikely hospital-acquired, or possible or probable hospital-acquired.
Two acute-care hospitals in Chicago, IL.
All hospitalized patients including an inpatient rehabilitation unit.
Each hospital implemented infection-control precautions soon after identifying COVID-19 cases, including patient- and staff-cohorting, universal masking, and restricted visitation policies.
Among 2,667 patients with SARS-CoV-2, detection before hospital day six was most common (n=2,612; 98%); days 6-14 uncommon (n=43; 1.6%); and, after day 14, rare (n=16; 0.6%). By chart review, most episodes after day 5 were categorized as community-acquired, usually because SARS-CoV-2 had been detected at a prior healthcare facility (68% of cases on days 6-14; 53% of cases after day 14). Incidence for possible and probable hospital-acquired cases, per 10,000 patient-days, was similar for ICU- and non-ICU patients at Hospitals A (1.2 vs 1.3, difference = 0.1; 95% CI, -2.8 to 3.0) and B (2.8 vs 1.2, difference = 1.6; 95% CI, -0.1 to 4.0).
Most patients were protected by early and sustained application of infection-control precautions, modified to reduce COVID-19 transmission. Using solely temporal criteria to discriminate hospital- vs community-acquisition would have misclassified many “late-onset” SARS-CoV-2 positive episodes.
The distribution of the Vulnerable West Indian manatee Trichechus manatus is influenced by physical and environmental factors such as water salinity, temperature and depth, freshwater supply and the availability of food resources. In Brazil, information on the habitat use of this species is insufficient for effective conservation. Here, we monitored manatees that had been found stranded as calves, rehabilitated in captivity and subsequently released, to identify their home ranges and examine their adaptation to life in the wild. The study, which involved monitoring six manatees using satellite and VHF telemetry systems, was conducted during 2016–2019 in the states of Paraíba, Sergipe and Bahia in north-eastern Brazil. Home range size of individuals was 2.56–42.07 km2 and all fidelity sites (areas used most frequently) were within protected areas. The longest distance travelled from the coastline upriver was 14.24 km and the longest distance offshore was 0.93 km. There were no significant differences in home range data between the dry and rainy seasons, but there was significant difference between the sexes, with males travelling across larger areas than females. All but one of the six individuals met the majority of indicators established in the Brazilian Manatee Reintroduction Protocol, and thus were considered to have successfully adapted to the wild. Our study provides information on patterns of habitat use and areas intensely used by manatees, which can assist protected area managers in defining priority areas for manatee conservation in Brazil.
Iridopsis panopla (Lepidoptera: Geometridae) is a defoliator of eucalyptus (Myrtaceae). Iridopsis panopla pupae were collected on a commercial plantation of Eucalyptus grandis, in the locality of Ribas do Rio Pardo, Mato Grosso do Sul, Brazil. After 18 days, the hymenopteran parasitoids Brachymeria annulata (Chalcididae) and Trichospilus diatraeae (Eulophidae) emerged from the I. panopla pupae. This is the first host record of these parasitoids from this important eucalyptus pest. Biological aspects of T. diatraeae were evaluated under laboratory conditions.
Transcatheter aortic valve implantation (TAVI) represents a new treatment option for aortic stenosis. This study aimed to evaluate the cost utility of TAVI, compared with clinical treatment, in patients with inoperable severe aortic stenosis from the perspective of the Brazilian public health system.
A Markov model with monthly cycles and a five percent annual discount rate was constructed. A five-year time horizon was chosen, to minimize the uncertainties inherent with data extrapolations, based on the only randomized head-to-head trial, Placement of AoRTic TraNscathetER Valve Trial (PARTNER B). All costs were obtained from Brazil's official healthcare data. Utilities for clinical treatment 0.6 (range 0.56–0.63) and TAVI 0.71 (range 0.69–0.72) were based on studies that used the EuroQol-5D instrument. TAVI's utility measures were penalized by 25 percent in the first month, based on the estimate of the procedure's impact on quality of life provided by the National Institute of Health and Care Excellence in the United Kingdom. Lastly, deterministic and probabilistic sensitivity analyses were used to evaluate the robustness of the results.
The incremental cost-effectiveness ratio was USD35,880 per quality-adjusted life-year (QALY), a result that was mainly sensitive to TAVI's cost in the univariate analysis. In the probabilistic analysis, all values were above the reference willingness-to-pay threshold of three times the Brazilian per capita gross domestic product (USD18,042 per QALY).
In conclusion, even though there is no established willingness-to-pay threshold in Brazil, the cost of TAVI may represent an obstacle for its incorporation into the Brazilian public health system.
Patient-Reported Outcomes (PRO) are directly reported by the patient without interpretation of the patient's response by a clinician or anyone else and pertains to the patient's health, quality of life, or functional status associated with health care or treatment. It can provide patients’ perspectives regarding treatment benefit and harm, directly measure treatment benefit and harm beyond survival, and are often the outcomes of most importance to patients. This study aims to analyze outcomes reported by Brazilian women diagnosed with breast cancer and rank the most important attributes for these patients.
Observational study composed of interviews and questionnaires applied to a convenience sample of women diagnosed with breast cancer. The instruments were developed taking into account the literature on the topic and the expertise of specialists. The questionnaire was built with close-ended questions using multiple-choice and a Likert scale, in order to rank the attributes and outcomes found in the interviews.
The total sample was composed of 65 women diagnosed with breast cancer. Twelve women were interviewed, in September 2020, to explore the main outcomes and preferences about their treatments, such as the most common side effects and the most impacted aspects of life after diagnosis and breast cancer treatment. Psychological, emotional, and sexual impacts were frequently described as aspects of life affected by the disease and its treatment. Fifty-three women, from all the five Brazilian regions, answered the survey applied in October and November 2020. Following an order of importance ranking, the following outcomes were chosen, respectively: overall survival, progression-free survival; and quality of life. The treatment effects that were considered less important, among this sample, were pain and adverse events.
Thinking about expanding the therapeutic quality of users, it is essential to take into account the experiences of patients. PRO is a trend in current research to achieve this goal, in order to influence the decisions of HTA agencies about the importance of valuing outcomes that affect patients' lives.
Congenital transmission of Chagas disease plays an important role in endemic countries because it is not a diagnosis that is encountered frequently in prenatal care. Due to limited information regarding congenital transmission of Trypanosoma cruzi in Mexico, the present study aimed to investigate protozoan infectivity and modulation of immune responses in human placental explants infected with T. cruzi Ia Mexican strains. The Inc-5 strain showed increased infectivity and modulated IL-1β, IL-10 and TLR-4, decreasing their expression after 24 h of infection. Both strains (Inc-5 and Ninoa) stimulated the production of TNF-α and decreased IL-6 levels 96 h after infection. An important detachment of the syncytiotrophoblast caused by infection with T. cruzi was observed after 24 h of infection. In this study, ex vivo infection of human placental villi was performed to better understand interactions involving parasitic T. cruzi and human placental tissue. It was concluded that the strains of TcIa present parasitism in placental tissue, modulation of the innate immune system of the placenta, and cause intense detachment of the syncytiotrophoblast, a fact that may be more associated with abortion and premature birth events than the congenital transmission itself, justifying the low rate of this transmission mechanism by this genotype.
The interaction between cancer cells and the surrounding microenvironment is determinant for metastasis success. In this study, the ultrastructural relevance of cells in the malignant pleural effusion (MPE) of women with breast cancer history was investigated. In MPE, it is possible to observe single cells and clusters. Women whose MPE presents carcinomas in aggregates have a better prognosis when compared to cases in which metastatic single cells are found. Samples were collected via fine-needle aspiration puncture (US-FNA). Subsequent to the material preparation and ultrathin cuts, they were observed using light and transmission electron microscopy (LM/TEM). LM and TEM images served as a basis for the creation of a digital sculpture using ZBrush® software. Clusters exhibited structural stability, en route vesicles allowing exocytosis of electron-dense fibrous elements, and cytoplasmic protrusions contributing to migratory and invasive skills. Single cells presented different necrotic phenotypes and many displayed leukocyte-like characteristics. Cluster cooperative relationships seem to be related to a long-term permanence in MPE. The absence of a collaborative network presumably triggers a more aggressive behavior of single cells. Its putative fusion with leukocytes can maximize the efficiency for transendothelial migration, increasing chances of metastatic success and, unfortunately, reducing survival of women with recidivism.
With natural hazards increasing in frequency and severity and global population aging, preparedness efforts must evolve to address older adults’ risks in disasters. This study elucidates potential contributors to the elevated older adult mortality risk following Hurricane Maria in Puerto Rico through an examination of community stakeholder preparedness, response, and recovery experiences.
In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities. Interview transcripts were deductively and inductively coded and analyzed to identify salient topics and themes representing participant response patterns.
The hurricane’s detrimental impact on older adult health emerged as a prominent finding. Through 6 months post-hurricane, many older adults experienced unmet needs that contributed to declining physical and emotional health, inadequate non-communicable disease management, social isolation, financial strain, and excess morbidity and mortality. These needs were predominantly consequences of lengthy public service gaps, unsafe living conditions, interrupted health care, and the incongruence between preparedness and event severity.
In a landscape of increasing natural hazard frequency and magnitude, a pattern of older adult risk has become increasingly clear. Study findings compel practitioners to engage in natural hazard preparedness planning, research, and policy-making that considers the multiple facets of older adult well-being.
This study aimed to examine factors that may have contributed to community disaster resilience following Hurricane Maria in Puerto Rico.
In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities (9% of total). Transcripts were deductively and inductively coded and analyzed to identify salient topics and themes, then examined according to strategic themes from the Federal Emergency Management Association’s (FEMA) Whole Community Approach.
Municipal preparedness efforts were coordinated, community-based, leveraged community assets, and prioritized vulnerable populations. Strategies included (1) multi-sectoral coordination and strategic personnel allocation; (2) neighborhood leader designation as support contacts; (3) leveraging of community leader expertise and social networks to protect vulnerable residents; (4) Censuses of at-risk groups, health professionals, and first responders; and (5) outreach for risk communication and locally tailored protective measures. In the context of collapsed telecommunications, communities implemented post-disaster strategies to facilitate communication with the Puerto Rican Government, between local first responders, and to keep residents informed, including the use of: (1) police radios; (2) vehicles with loudspeakers; (3) direct interpersonal communication; and (4) solar-powered Internet radio stations.
Adaptive capacities and actions of Puerto Rican communities exemplify the importance of local solutions in disasters. Expanded research is recommended to better understand contributors to disaster resilience.
The burden of depression is increasing worldwide, specifically in older adults. Unhealthy dietary patterns may partly explain this phenomenon. In the Spanish PREDIMED-Plus study, we explored (1) the cross-sectional association between the adherence to the Prime Diet Quality Score (PDQS), an a priori-defined high-quality food pattern, and the prevalence of depressive symptoms at baseline (cross-sectional analysis) and (2) the prospective association of baseline PDQS with changes in depressive symptomatology after 2 years of follow-up. After exclusions, we assessed 6612 participants in the cross-sectional analysis and 5523 participants in the prospective analysis. An energy-adjusted high-quality dietary score (PDQS) was assessed using a validated FFQ. The cross-sectional association between PDQS and the prevalence of depression or presence of depressive symptoms and the prospective changes in depressive symptoms were evaluated through multivariable regression models (logistic and linear models and mixed linear-effects models). PDQS was inversely associated with depressive status in the cross-sectional analysis. Participants in the highest quintile of PDQS (Q5) showed a significantly reduced odds of depression prevalence as compared to participants in the lowest quartile of PDQS (Q1) (OR (95 %) CI = 0·82 (0·68, 0·98))). The baseline prevalence of depression decreased across PDQS quintiles (Pfor trend = 0·015). A statistically significant association between PDQS and changes in depressive symptoms after 2-years follow-up was found (β (95 %) CI = −0·67 z-score (–1·17, −0·18). A higher PDQS was cross-sectionally related to a lower depressive status. Nevertheless, the null finding in our prospective analysis raises the possibility of reverse causality. Further prospective investigation is required to ascertain the association between PDQS and changes in depressive symptoms along time.
Human–wildlife interactions (HWIs) occur in many rural African communities, with potential impacts on livelihood vulnerability. High livelihood vulnerability may force communities to employ strategies that increase the risk of negative HWIs, yet the extent to which HWIs drive or are driven by vulnerability is unclear. We hypothesized that more vulnerable households are more likely to be exposed to wildlife and experience negative interactions. To test this hypothesis, we calculated the Livelihood Vulnerability Index (LVI) of rural households in and around Quirimbas National Park (north-eastern Mozambique) and assessed whether there is a link between livelihood vulnerability and HWIs. We found a two-way association between LVI and HWIs, with more vulnerable households indeed taking greater risks and encountering wildlife when fetching water from rivers, whereas less vulnerable households tended not to employ strategies likely to increase wildlife encounters. We also observed that HWIs exert a strong effect on livelihood vulnerability, suggesting that HWIs should be included as an exposure factor in vulnerability assessments for rural households. We recommend that livelihood strategies and community vulnerability should be considered when designing HWI mitigation schemes and implementing conservation measures.
In different parts of the world, aphid populations and their natural enemies are influenced by landscapes and climate. In the Neotropical region, few long-term studies have been conducted, maintaining a gap for comprehension of the effect of meteorological variables on aphid population patterns and their parasitoids in field conditions. This study describes the general patterns of oscillation in cereal winged aphids and their parasitoids, selecting meteorological variables and evaluating their effects on these insects. Aphids exhibit two annual peaks, one in summer–fall transition and the other in winter-spring transition. For parasitoids, the highest annual peak takes place during winter and a second peak occurs in winter–spring transition. Temperature was the principal meteorological regulator of population fluctuation in winged aphids and parasitoids during the year. The favorable temperature range is not the same for aphids and parasitoids. For aphids, temperature increase resulted in population growth, with maximum positive effect at 25°C. Temperature also positively influenced parasitoid populations, but the growth was asymptotic around 20°C. Although rainfall showed no regulatory function on aphid seasonality, it influenced the final number of insects over the year. The response of aphids and parasitoids to temperature has implications for trophic compatibility and regulation of their populations. Such functions should be taken into account in predictive models.
The vermetidae fossils of Petaloconchus varians, formed by calcium carbonate, associated with their radiocarbon ages, are the most accurate indicators of paleo sea level due to their restricted occupation in the intertidal zone in the rocky shore. However, the recrystallization of minerals can affect these age calculations and, consequently, the interpretation of the data. The aim of this study is to present new indicators of paleo sea-level changes in Southeast Brazil for the last 6000 years contributing to fill the data gap for the late Holocene. The influence of the recrystallization process was successfully resolved using the CarDS protocol, enabling the separation of the original aragonite fraction by density, prior to radiocarbon dating. This avoids the rejuvenation of ages and ensures greater efficiency for data interpretation. Paleo sea-level indicators were able to show a progressive increase in sea level up to the transgressive maximum of 4.15 m in 3700 BP years, followed by a regression to the current zero. This regression seems to have in addition, here we reinforce the reliability of the use of fossil vermetids as indicators of sea-level fluctuations.
Green tea is a popular drink used for therapeutic purposes to mitigate the consequences of diabetes. In this study, we aimed at evaluating the potential of green tea infusion to ameliorate structural and enzymatic damages caused by hyperglycemia in the testis and epididymis of Wistar rats. For that, nondiabetic and streptozotocin-induced diabetic rats (negative control and diabetes control, respectively) received 0.6 mL of water by gavage. Another set of diabetic animals received 100 mg/kg of green tea infusion diluted in 0.6 mL of water/gavage (diabetes + green tea) daily. After 42 days of treatment, the testes and epididymides were removed and processed for histopathological analysis, micromineral determination, and enzymatic assays. The results showed that treatment with green tea infusion preserved the testicular and epididymal histoarchitecture, improving the seminiferous epithelium and the sperm production previously affected by diabetes. Treatment with green tea reduced tissue damages caused by this metabolic condition. Given the severity of hyperglycemia, there was no efficacy of the green tea infusion in maintaining the testosterone levels, antioxidant enzyme activity, and microminerals content. Thus, our findings indicate a protective effect of this infusion on histological parameters, with possible use as a complementary therapy for diabetes.
Drawing on two online studies among predominantly U.S.-born and lawful permanent resident Latinxs, we developed a self-report scale intended to capture how discrimination related to perceived legal status, as well as perceptions of racial/ethnic marginalization of Latinxs in U.S. society, are experienced among a wide swath of the Latinx population. We also explore how these processes may be associated with psychological distress in this population. In line with the immigration scholarship that has identified a spillover effect of immigration enforcement and the racialization of legal status beyond the undocumented population, our exploratory factor analysis results from Study I (N = 355 Latinxs) collected in fall of 2013 revealed four factors among our study population: Fear of Deportation, Marginalization of Latinxs in U.S. Society, Marginalization Due to Perceived Illegality, and Fear Due to Perceived Illegality. Results from a confirmatory factor analysis from a separate study conducted in spring of 2016 (Study II; N = 295 Latinxs) provided evidence in support of the structure identified in Study I. Results also revealed evidence of the association between the Stigma of Illegality and Marginalization of Latinxs (SIML) subscales and psychological distress, measured as anxiety and depression. Implications of these findings are discussed.
Estuaries in Brazil are highly threatened environments and habitat loss is the main influential factor for the increase in the number of strandings of Antillean manatee (Trichechus manatus) calves in the north-eastern region of the country. The aim of the present study was to analyse and quantify the spatiotemporal dynamics of mangroves in the state of Paraíba and the association with manatee calf stranding events. The study area encompassed 10 remaining mangroves along the coast of the state, four of which were located within protected areas. Information on the mangrove forests was obtained from satellite images from the last four decades. Data on stranded Antillean manatee calves were obtained from a databank with records from 1980 to 2019. The data were analysed using geoprocessing techniques and statistical analyses. The results demonstrated changes in the mangrove forest over time, with larger areas existing during the 1980s, reductions in the following periods but a slight increase in the last decade. The number of stranded Antillean manatee calves increased over the years, with stranding events concentrated mainly on the northern coast of the state. The smallest number of stranding events occurred in the 1980s, when the mangrove forests were larger. Our findings confirm that the integrity of mangroves is of extreme importance to the maintenance and sustainability of Antillean manatee populations.