Abstract The study evaluated the effects of a Social and Educational Skills Program on the repertoire of social skills, educational social skills, and self-efficacy beliefs in teachers. Participants ...included 45 teachers who taught at the final grades of elementary school, in public schools in the state of Rio de Janeiro. Participants were allocated by convenience into 2 groups: intervention (n=22) and control (n=23). The program consisted of 10 meetings, with pre-test and post-test measures. The teachers responded to the following instruments: Social Skills Inventory, Educational Social Skills Inventory-teacher, Teacher Self-Efficacy Scale, and Socioeconomic Questionnaire. Results indicated that the intervention promoted the repertoire of social and educational skills of teachers and increased teaching self-efficacy beliefs. It was concluded that the intervention showed some indicators of efficacy, signaling the interpersonal development of the educators. Future research should include accompanying measures and experimental design.
Resumen El estudio evaluó los efectos de un programa de habilidades sociales y educativas sobre el repertorio de habilidades sociales educativas y las creencias de autoeficacia de los profesores. El estudio incluyó a 45 profesores que enseñaban en los últimos años de la Educación Primaria en escuelas públicas del Estado de Río de Janeiro. Los participantes fueron asignados por conveniencia en dos grupos: intervención (n=22); control (n=23). El programa se compuso por 10 reuniones, con medidas pre test y post test. Los docentes respondieron a los instrumentos: Inventario de Habilidades Sociales; Inventario de Habilidades Sociales Educativas-docente; Escala de Autoeficacia Docente; Cuestionario Socioeconómico. Los resultados indicaron que la intervención promovió el repertorio de habilidades sociales y educativas de los docentes y aumentó las creencias de autoeficacia docente. Se concluye que la intervención evidenció algunos indicadores de efectividad, señalando el desarrollo interpersonal de los educadores. Futuras investigaciones deben incluir medidas de seguimiento y diseño experimental.
Resumo O estudo avaliou os efeitos de um Programa de Habilidades Sociais e Educativas no repertório de habilidades sociais, habilidades sociais educativas e nas crenças de autoeficácia docente. Participaram do estudo 45 professores que lecionavam nos anos finais do Ensino Fundamental, em escolas públicas no Estado do Rio de Janeiro. Os participantes foram alocados por conveniência em dois grupos: intervenção (n = 22); controle (n = 23). O programa foi composto por 10 encontros, com medidas de pré-teste e pós-teste. Os professores responderam aos instrumentos: Inventário de Habilidades Sociais, Inventário de Habilidades Sociais Educativas-professor, Escala de Autoeficácia Docente e Questionário Socioeconômico. Os resultados indicaram que a intervenção promoveu o repertório de habilidades sociais e educativas dos professores e aumentou as crenças de autoeficácia docente. Conclui-se que a intervenção evidenciou alguns indicadores de efetividade, sinalizando o desenvolvimento interpessoal dos educadores. Futuras pesquisas deverão incluir medidas de seguimento e delineamento experimental.
Gonorrhea is the second most common sexually transmitted bacterial infection on the planet and is caused by a Gram-negative cocco,
. Currently, the preferred regimen for the management of this ...disease in Brazil is a combination of antimicrobials, in this case, ceftriaxone and azithromycin. However, over time, the gonococcus developed a decrease in susceptibility to the regimen used, which resulted in frank resistance to antimicrobials, progressively reducing the therapeutic options available. Thus, the study presented here aims to analyze and discuss the current scenario of resistance of
to the antimicrobials used to date, to encourage discussion on the subject in the academic environment. For this purpose, 47 articles indexed in the Bireme, PubMed, Scielo and UpToDate platforms were selected.
The World Health Organization (WHO) estimated that there were 247 million malaria cases in 2021 worldwide, representing an increase in 2 million cases compared to 2020. The urgent need for the ...development of new antimalarials is underscored by specific criteria, including the requirement of new modes of action that avoid cross-drug resistance, the ability to provide single-dose cures, and efficacy against both assexual and sexual blood stages. Motivated by the promising results obtained from our research group with 1,2,4triazolo1,5-apyrimidine and pyrazolo1,5-apyrimidine derivatives, we selected these molecular scaffolds as the foundation for designing two new series of piperaquine analogs as potential antimalarial candidates. The initial series of hybrids was designed by substituting one quinolinic ring of piperaquine with the 1,2,4-triazolo1,5-apyrimidine or pyrazolo1,5-apyrimidine nucleus. To connect the heterocyclic systems, spacers with 3, 4, or 7 methylene carbons were introduced at the 4 position of the quinoline. In the second series, we used piperazine as a spacer to link the 1,2,4-triazolo1,5-apyrimidine or pyrazolo1,5-apyrimidine group to the quinoline core, effectively merging both pharmacophoric groups via a rigid spacer. Our research efforts yielded promising compounds characterized by low cytotoxicity and selectivity indices exceeding 1570. These compounds displayed potent in vitro inhibitory activity in the low nanomolar range against the erythrocytic form of the parasite, encompassing both susceptible and resistant strains. Notably, these compounds did not show cross-resistance with either chloroquine or established P. falciparum inhibitors. Even though they share a pyrazolo- or triazolo-pyrimidine core, enzymatic inhibition assays revealed that these compounds had minimal inhibitory effects on PfDHODH, indicating a distinct mode of action unrelated to targeting this enzyme. We further assessed the compounds' potential to interfere with gametocyte and ookinete infectivity using mature P. falciparum gametocytes cultured in vitro. Four compounds demonstrated significant gametocyte inhibition ranging from 58 % to 86 %, suggesting potential transmission blocking activity. Finally, we evaluated the druggability of these new compounds using in silico methods, and the results indicated that these analogs had favorable physicochemical and ADME (absorption, distribution, metabolism, and excretion) properties. In summary, our research has successfully identified and characterized new piperaquine analogs based on 1,2,4triazolo1,5-apyrimidine and pyrazolo1,5-apyrimidine scaffolds and has demonstrated their potential as promising candidates for the development of antimalarial drugs with distinct mechanisms of action, considerable selectivity, and P. falciparum transmission blocking activity.
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• •Triazolo- and pyrazolopyrimidine derivatives actives against P. falciparum strains.• •The componds has no cross-resistance with drug-resistant P. falciparum.• •The ability to interfere with gametocyte and ookinete infectivity was also evaluated.• •Four compounds demonstrated potential to block the transmission of such parasites.
Objective
Proton pump inhibitors (PPIs) are widely prescribed to treat gastroesophageal reflux disease (GERD) in Systemic Sclerosis (SSc). However, not all patients adequately respond to the ...treatment, and there are frequent concerns about the safety of long‐term use of PPIs. Our aim was to identify the main problems/complaints of SSc patients on PPIs, as well as understand their unmet needs.
Methods
SSc patients treated with PPIs were invited through international patient associations and social media to participate in an online survey.
Results
We gathered 301 valid responses from 14 countries (United Kingdom 19.3% and United States 70.4%). Multiple PPIs use (two: 30% and three: 21% in series) was common. The majority (89%) reported improvement in gastrointestinal symptoms from receiving PPIs. Side effects attributed to receiving PPIs were uncommon (19%); however, most (79%) were potentially concerned. Around half (58%) had received lifestyle information, and most (85%) had searched online for information about PPIs. Only in the minority (12%) had a surgical approach been discussed; however, half (46%) indicated that they would be willing to undergo surgery to resolve their GERD symptoms but had important concerns.
Conclusion
Despite the frequent use of PPIs in patients with SSc, there is significant heterogeneity in prescription, and combination therapy (PPIs plus other medication for acid reflux) is not uncommon (approximately 40%). Patients have significant concerns about PPIs side effects. Education about PPIs is often neglected, and patients very frequently use online sources to obtain information on drug treatment. A surgical approach is infrequently discussed, and patients fear this potential therapeutic approach.
Abstract Background/Aims The gastrointestinal (GI) tract is largely (>95%) affected in systemic sclerosis (SSc) and its involvement is associated with significant morbidity, mortality and huge impact ...on the quality of life. Upper GI tract dysfunction, often presenting with gastroesophageal reflux disease (GERD) is one of the principal complaints. Proton pump inhibitors (PPIs) are widely used to treat GERD in SSc. However, not all patients respond to this therapy, and many remain on long-term treatment. Significant concerns about PPI long-term safety have been raised. Our aim was to identify perspectives and unmet needs of SSc patients on PPIs. Methods An online English survey, targeting SSc patients on PPIs was developed and distributed through social media and international patient associations. The survey was launched on 4th November 2022 and kept open for 4 weeks. Results 301 respondents from 14 countries completed the survey (UK 19.3% and US 70.4%). Most respondents were between 30-70 years and the majority were female (95%). The most frequently reported symptoms were acid reflux (97%), dysphagia (60%), and trouble swallowing or food got stuck in the chest (32%). Multiple PPIs use (two: 30% and three: 21%; in series) was common and the majority (89%) reported improvement in GI symptoms with PPIs. Even though only 19% experienced side effects on PPIs, most respondents (79%) were concerned (Table 1). Half (47%) experienced a flare of symptoms after initial improvement with PPIs and 58% received lifestyle information, while most (85%) searched online for information about PPIs. A minority (12%) reported that a surgical approach was discussed, and 46% indicated that they would be willing to undergo surgery, despite having significant concerns. Conclusion Our survey highlights the importance of upper GI symptoms in SSc patients and the frequent use of PPIs. There is significant heterogeneity in use, and treatment is often not fully effective. Patients have concerns about side effects related to long-term PPI use. There is a clear unmet need regarding patients’ education about PPIs. A surgical approach is rarely discussed, although patients would potentially consider this approach. Further research is needed to optimize the therapeutic strategy concerning PPIs in SSc. Disclosure G. Bandini: None. A. Alunno: None. F. Oliveira Pinheiro: None. C. Campochiaro: None. I. Galetti: None. P. Matucci Cerinic: None. B. Ruaro: None. K. El Aoufy: None. M. Melis: None. A. Moggi Pignone: None. L. Dagna: None. M. Matucci Cerinic: None. Z. McMahan: None. M. Hughes: None.
Adhering to a diet adequate in macronutrients is crucial for the secondary prevention of cardiovascular diseases.
To assess the prevalence of adherence to recommendations for the consumption of ...dietary fatty acids for the prevention and treatment of cardiovascular diseases and to estimate whether the presence of certain cardiovascular risk factors would be associated with adherence.
Cross-sectional study using baseline data from 2,358 participants included in the "Brazilian Cardioprotective Nutritional Program Trial". Dietary intake and cardiovascular risk factors were assessed. Adequate intake of polyunsaturated fatty acids (PUFA) was considered as ≥10% of total daily energy intake; for monounsaturated fatty acids (MUFA), 20%; and for saturated fatty acids (SFA), <7% according to the Brazilian Society of Cardiology. A significance level of 5% was considered in the statistical analysis.
No participant adhered to all recommendations simultaneously, and more than half (1,482 62.9%) did not adhere to any recommendation. Adherence exclusively to the SFA recommendation was the most prevalent, fulfilled by 659 (28%) participants, followed by adherence exclusively to the PUFA (178 7.6%) and MUFA (5 0.2%) recommendations. There was no association between the number of comorbidities and adherence to nutritional recommendations (p = 0.269). Participants from the Brazilian Northeast region showed a higher proportion of adherence to SFA consumption recommendations (38.42%) and lower adherence to PUFA intake (3.52%) (p <0.001) compared to other regions.
Among the evaluated sample, there was low adherence to nutritional recommendations for dietary fatty acid consumption.
An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The ...present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors.
This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant.
In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range IQR) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals CI = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence.
A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.
The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated ...whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic.
An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave.
Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37).
The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making.
The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes.
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•The coronavirus disease 2019 (COVID-19) pandemic had a worldwide impact on liver cancer management.•Screening programmes were modified or cancelled in 80.9% of participating centres.•All but systemic treatments were cancelled or delayed in almost all centres.•Phone call visits were the tools for patient follow-up during the first wave.•The role of the nurses was key to maintaining clinical practice and clinical trials.
Short cervical length measured during the second trimester of pregnancy is an important risk factor for spontaneous preterm birth (sPTB). The aim of this study is to identify the association between ...mid-pregnancy cervical length (CL) and gestational age at birth in asymptomatic singleton pregnant women.
This is a prospective cohort study involving singleton pregnant women who participated in the screening phase of a Brazilian multicenter randomized controlled trial (P5 trial) between July 2015 and March 2019. Transvaginal ultrasound to measure CL was performed from 18 to 22 + 6 weeks. Women with CL ≤ 30 mm received vaginal progesterone (200 mg/day) until 36 weeks' gestation. For this analysis we considered all women with CL ≤ 30 mm receiving progesterone and a random selection of women with CL > 30 mm, keeping the populational distribution of CL. We obtained prognostic effectiveness data (area under receive operating characteristic curve (AUC), sensitivity and specificity and estimated Kaplan-Meier curves for preterm birth using different CL cutoff points.
We report on 3139 women and identified a negative association between cervical length and sPTB. CL ≤ 25 mm was associated with sPTB < 28, sPTB < 34 and sPTB < 37 weeks, whereas a CL 25-30 mm was directly associated with late sPTB. CL by transvaginal ultrasound presented an AUC of 0.82 to predict sPTB < 28 weeks and 0.67 for sPTB < 34 weeks. Almost half of the sPTB occurred in nulliparous women and CL ≤ 30 mm was associated with sPTB at < 37 weeks (OR = 7.84; 95%CI = 5.5-11.1). The number needed to screen to detect one sPTB < 34 weeks in women with CL ≤ 25 mm is 121 and we estimated that 248 screening tests are necessary to prevent one sPTB < 34 weeks using progesterone prophylaxis.
CL measured by transvaginal ultrasound should be used to predict sPTB < 34 weeks. Women with CL ≤ 30 mm are at increased risk for late sPTB.
Abstract This article reports the rationale for the Brazilian Cardioprotective Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter, nationwide, randomized, concealed, controlled ...trial was designed to investigate the effects of the BALANCE Program in reducing cardiovascular events. The BALANCE Program consists of a prescribed diet guided by nutritional content recommendations from Brazilian national guidelines using a unique nutritional education strategy, which includes suggestions of affordable foods. In addition, the Program focuses on intensive follow-up through one-on-one visits, group sessions, and phone calls. In this trial, participants 45 years or older with any evidence of established cardiovascular disease will be randomized to the BALANCE or control groups. Those in the BALANCE group will receive the afore mentioned program interventions, while controls will be given generic advice on how to follow a low-fat, low-energy, low-sodium, and low-cholesterol diet, with a view to achieving Brazilian nutritional guideline recommendations. The primary outcome is a composite of death (any cause), cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, or hospitalization for unstable angina. A total of 2468 patients will be enrolled in 34 sites and followed up for up to 48 months. If the BALANCE Program is found to decrease cardiovascular events and reduce risk factors, this may represent an advance in the care of patients with cardiovascular disease.
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