Novo Nordisk (Mexico)

OBJECTIVE: The goal of this study is to investigate obesity and its concomitant effects including the prevalence of comorbidities, its association with patient-reported outcomes and costs, and weight loss strategies in a sample of Mexican adults. METHODS: Mexican adults (N=2,511) were recruited from a combination of Internet panels and street intercepts using a random-stratified sampling framework, with strata defined by age and sex, so that they represent the population. Participants responded to a survey consisting of a range of topics including sociodemographics, health history, health-related quality of life (HRQoL), work productivity, health care resource use, and weight loss. RESULTS: The sample consisted of 50.6% male with a mean age of 40.7 years (SD=14.5); 38.3% were overweight, and 24.4% were obese. Increasing body mass index (BMI) was associated with increased rates of type 2 diabetes, prediabetes, and hypertension, poorer HRQoL, and decreased work productivity. Of the total number of respondents, 62.2% reported taking steps to lose weight with 27.6% and 17.1% having used an over-the-counter/herbal product and a prescription medication, respectively. Treatment discontinuation rates were high. CONCLUSION: Findings indicated that 62% of participants reported, at least, being overweight and that they were experiencing the deleterious effects associated with higher BMI despite the desire to lose weight. Given the rates of obesity, and its impact on humanistic and societal outcomes, improved education, prevention, and management could provide significant benefits.

OBJECTIVE: To identify fibromyalgia syndrome in patients with sleep disordered breathing. METHOD: We studied 50 patients seeking treatment at a sleep disorder clinic for snoring, apnea and excessive daytime sleepiness. Sleep disordered breathing was diagnosed through the use of polysomnography. To diagnose fibromyalgia syndrome, patients were evaluated in accordance with the criteria established by the American College of Rheumatology. RESULTS: Of the 50 patients, 32 were male. The mean (+/- standard deviation) age of the group was 50 +/- 12 years. The mean body mass index was 29.7 +/- 5.6 kg/m(2). The mean apnea-hypopnea index was 36 +/- 29 attacks of apnea or hypopnea per hour of sleep. Of the 18 women and 32 men evaluated, 9 and 2, respectively, met the American College of Rheumatology criteria for fibromyalgia syndrome. CONCLUSION: Considering the fact that the prevalence of fibromyalgia syndrome in the general population is 0.5% for men and 3.4% for women, the more than ten-fold higher proportion of fibromyalgia cases seen in this sample supports the hypothesis that there is an association between sleep disordered breathing and fibromyalgia syndrome.

Este texto resulta de um diálogo entre um professor universitário (António Nóvoa) e uma professora do Ensino Fundamental (Pâmela Vieira). Através de leituras e releituras, escritos e reescritos, chegou-se a um alfabeto da formação de professores. Não se trata de uma “enciclopédia breve”, mas antes de entradas soltas, fragmentadas, com reflexões cruzadas ao longo dos vários assuntos. Apresentam-se 23 verbetes, deixando em aberto as letras X, Y e Z. No final de cada tema, sugerem-se algumas leituras complementares, para que cada um aprofunde o seu pensamento sobre este alfabeto.

Abstract Tropical studies traditionally describe insect diversity variation throughout the year. The temporally structured responses of insect assemblages to climate seasonality vary across ecosystems due to gradients of resource availability and limiting ecological factors. These idiosyncratic responses might be particularly true across the vast geographical range of the Brazilian territory, including various environments that harbor one of the most diverse ant faunas worldwide. This study addressed the relationship between ant diversity and climatic seasonality, performing a quantitative review of the published data on ant diversity collected in Brazil. We investigated the seasonality effect on ant abundance and richness described in the literature in 47 papers published between 2000 and 2018. These studies were developed mainly in the Atlantic Forest biome and collected ants with pitfall traps on the soil/litter stratum. We initially carried out a vote‐counting procedure by comparing the number of significant results describing seasonal differences in the ant assemblage. We found that most papers described a similar pattern of ant abundance, richness, and species composition between seasons. However, when we performed a meta‐analysis, we observed a clear pattern of higher ant abundance and richness in the wet/summer season compared with the dry/winter season. Our meta‐analysis reveals that the ant diversity decreases in the dry season, strongly in the Cerrado biome. Additionally, we point out differences in the sampling effort across biomes, indicating the need for further investments in studies focused on temporal diversity patterns, including seasonal effects, on the insect assemblage in biomes less investigated so far. Abstract in Portuguese is available with online material.

A cDNA coding for a new member of the 70-kDa heat shock proteins (HSP70) family from the dimorphic and pathogenic fungus, Paracoccidioides brasiliensis, was cloned and characterized. The cDNA-deduced sequence coded for 655 amino acid residues and showed 95% identity to a previously described P. brasiliensis hsp70 gene. Cytoplasmic and typical nuclear localization signals, which indicate induction upon stress, were identified in the deduced peptide. The complete hsp70 cDNA coding region was cloned into a pGEX 4T-3 plasmid and expressed in Escherichia coli as a glutathione-S-transferase-tagged fusion protein. The recombinant protein reacted with a rabbit polyclonal antibody against HSP70. Western immunoblot experiments demonstrated that sera from paracoccidioidomycosis patients recognized the purified recombinant protein, suggesting an immunological role for this protein in the infectious process. The antigenicity analysis of rHSP70 detected three internal peptides that could act as activators of T-cell proliferation.

[*] Resultadosparciaisdesseproje-todepesquisa(aindaemandamento) foramapresentadosnaReuniaoAnual da apsa (American Political Science Association) em Seattle (eua), em setembro de 2011 e no 8o Encontro da abcp (Associacao Brasileira de Ciencia Politica) em Gramado (rs), em agosto de 2012. Nos agradecemos os comentarios e sugestoes de: Barry Ames,GuillemRiambauArmet,Mar-tha Arretche, George Avelino, Ernes-to Calvo, Sergio P. Firpo, Fernando Limongi, Jonathan Rodden e Jona-than Wand a essas versoes anteriores do trabalho. [1] Ha na Câmara dos Deputados cerca de vinte Propostas de Emenda Constitucional com a de responsabilizacao eleitoral, isto e, de finalidade de proibir a possibilidade de reeleicao para presidente da Republica, go-vernadores de estado e do Distrito Federal, e prefeitos, alem de outras propostas semelhantes no Senado Federal, segundo pesquisa realiza-da pelos autores, em 16 de junho de 2012,noPortaldaCâmaradosDepu-tados na pectiva da administracao do governante e decide se ele deve ou nao internet, por meio da ferra-menta de consultas de projetos de lei eoutrasproposicoes.NaCâmaraeno Senado existem ainda outras varias propostas alternativas a reeleicao, como, por exemplo, as que estabele-cem a necessidade de principalmente, de equidade nas condicoes de competicao politica. O desincompati-bilizacao do mandato para concorrer areeleicaodomesmocargo.Informa-coes disponiveis em: . [2] A esse respeito ver, entre outros: Fearon, James. “Electoral accounta-bility and the control of politicians: selecting good types versus sanctio-ning poor performance”. In: Manin, Bernard, Przeworski, Adam e Stokes, Susan (eds.).

OBJECTIVE: The Awareness, Care, and Treatment in Obesity Management-International Observation (ACTION-IO) study (ClinicalTrials.gov identifier NCT03584191) aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care in people with obesity (PwO) and health care professionals (HCPs). This study presents the results from Mexico. METHODS: based on self-reported height and weight. Eligible HCPs had direct patient care. RESULTS: The survey was completed by 2,000 PwO and 400 HCPs in Mexico. Many PwO (71%) and HCPs (94%) categorized obesity as a chronic disease. Sixty-three percent of PwO felt motivated to lose weight, but many HCPs perceived that PwO were not interested in losing weight (76%) or motivated to lose weight (69%). Lack of financial means to support weight-loss efforts was a barrier for PwO (34%) to discussing weight with HCPs. Sixty-five percent of PwO had discussed weight with HCPs in the past 5 years. PwO (80%) and HCPs (89%) considered lack of exercise as the main barrier to weight loss. Few PwO (34%) had successfully lost ≥5% of their body mass over the past 3 years. CONCLUSIONS: This ACTION-IO study in Mexico identified discrepancies in the perceptions of PwO and HCPs, highlighting opportunities for further education and patient-centered approaches.

Um estudo taxonômico de Cactaceae epifíticas foi realizado no Estado do Rio Grande do Sul, Brasil. A revisão inclui chaves de identificação, ilustrações, observações ecológicas e taxonômicas, distribuição geográfica e períodos de floração e frutificação das espécies. Foi encontrado um total de seis gêneros e 13 espécies, sendo duas comumente epífitas acidentais, Cereus alacriportanus Pfeiff. e Opuntia monacantha Haw., e 11 epífitas verdadeiras ou habituais, Epiphyllum phyllanthus (L.) Haw., Hatiora rosea (Lagerh.) Barthlott, Lepismium cruciforme (Vell.) Miq., L. houlletianum (Lem.) Barthlott, L. lumbricoides (Lem.) Barthlott, L. warmingianum (K. Schum.) Barthlott, Rhipsalis campos-portoana Loefgr., R. cereuscula Haw., R. floccosa Salm-Dyck ex Pfeiff., R. paradoxa (Salm-Dyck ex Pfeiff.) Salm-Dyck e R. teres (Vell.) Steud. Uma espécie, R. campos-portoana, é referida pela primeira vez para o Estado do Rio Grande do Sul.

Inherited deficiencies of platelet surface glycoproteins, such as Glanzmann thrombasthenia (GT), occasionally result in severe bleeding episodes. Platelet transfusion is considered standard therapy for securing hemostasis in subjects with GT when local measures and antifibrinolytic agents are inadequate. We describe 4 case studies which suggest that recombinant activated factor VII may be an effective alternative to platelet transfusion in preventing or controlling bleeding, including surgical bleeding, in patients with GT.

INTRODUCTION: The aim of this study was to evaluate the long-term cost-effectiveness of the insulin degludec/liraglutide combination (IDegLira) versus basal insulin intensification strategies for patients with type 2 diabetes mellitus (T2DM) not optimally controlled on basal insulin in the Czech Republic. METHODS: Cost-effectiveness was evaluated using the QuintilesIMS Health CORE Diabetes model, an interactive internet-based model that simulates clinical outcomes and costs for cohorts of patients with diabetes. The analysis was conducted from the perspective of the Czech Republic public payer. Sensitivity analyses were conducted to explore the sensitivity of the model to plausible variations in key parameters. RESULTS: The use of IDegLira was associated with an improvement in the quality-adjusted life expectancy of 0.31 quality-adjusted life-years (QALYs), at an additional cost of Czech Koruna (CZK) 107,829 over a patient's lifetime compared with basal-bolus therapy, generating an incremental cost-effectiveness ratio (ICER) of CZK 345,052 per QALY gained. In a scenario analysis, IDegLira was associated with an ICER of CZK 693,763 per QALY gained compared to basal insulin + glucagon-like peptide-1 receptor agonist (GLP-1 RA). The ICERs are below the generally accepted willingness-to-pay threshold (CZK 1,100,000/QALY gained at the time of this analysis). CONCLUSIONS: Results from this evaluation suggest that IDegLira is a cost-effective treatment option compared with basal-bolus therapy and basal insulin + GLP-1 RA for patients with T2DM in the Czech Republic whose diabetes is not optimally controlled with basal insulin. FUNDING: Novo Nordisk.

The present study aimed to evaluate the physicochemical parameters and the genotoxic potential of water samples collected in the upper, middle, and lower courses of the Sinos River, southern Brazil. The comet assay was performed in the peripheral blood of fish Hyphessobrycon luetkenii exposed under laboratory conditions to water samples collected in summer and winter in three sampling sites of Sinos River. Water quality analysis demonstrated values above those described in Brazilian legislation in Parobé and Sapucaia do Sul sites, located in the middle and in the lower courses of the Sinos River, respectively. The Caraá site, located in the upper river reach, presented all the physicochemical parameters in accordance with the allowed limits in both sampling periods. Comet assay in fish revealed genotoxicity in water samples collected in the middle course site in summer and in the three sites in winter when compared to control group. Thus, the physicochemical parameters indicated that the water quality of the upper course complies with the limits set by the national guidelines, and the ecotoxicological assessment, however, indicated the presence of genotoxic agents. The present study highlights the importance of combining water physicochemical analysis and bioassays to river monitoring.

Abstract Background Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes. Methods 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category. Results The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02–1.97 and 2.78, 95% CI 1.83–4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06–2.74, and 2.62, 95% CI 1.65–4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42–0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03–2.42). In patients with a BMI ≥ 25 kg/m 2 , the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50–3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. Conclusions EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

There are many different forms of debating and analyzing the relationship between science and religion. In this project, we present some of these possibilities and also apply the approach of the history of the sciences as an interesting resource to deal with this subject in the sciences teaching. This research was developed from the concern of the increase of cases of religious intolerance and other types of intolerance, align to its impact on the classroom, possibly caused by a variety of fundamentalism that can be seen in our society. The existence of different historical episodes that associate science and religion in a contextualized and transcendent way to only one conflict allowed the development of this project. We believe that intolerant behaviors may generate cognitive dissonance in students, for example, ones who profess a religious faith and watch their worldview be disregarded or ridiculed in the sciences classes. We consider that the presentation and discussion of historical episodes, in which for different scientists or natural philosophers the science and religion were not in conflict, can reduce this obstacle, creating a favorable environment for guiding science content. Besides, intolerant actions disrespect the existing prerogatives focused on the promotion of an education for human rights and for the valorization of the interculturality. A bibliographical review indicated the need to develop material and strategies for the discussion of relations between science and religion in the classroom. From this, we elaborate a historical narrative that can offer subsidies to guide this subject in teachers training. Besides, a proposal in which we collected different episodes of the history of the sciences for a diverse and plural debate. In this mostly theoretical project, we apply the methodologies of bibliographic analysis and document analysis, in addition to the content analysis for the optimization and evaluation of the review of selected articles. Different results have been obtained in this study. The bibliographical review was able to map the types of publications developed in recent years, pointing out ways to develop the theme in science teaching. Following one of these paths, based on a research focused on science teaching, we proposed a course involving different moments and historical characters that bring together several aspects about the origin and development of the Universe. We present a narrative about aspects of the Isaac Newton's work, which can be applied in one of these proposed moments. We seek to offer some subsidies for teachers' awareness of the students' right to belief, guiding contexts of different scopes and social nuances that influence the development of scientific thinking. We intended to have this action reverberated and that different aspects of the nature of science can be discussed into teacher's education.

Pretendeu-se analisar o significado das vivências dos estudantes de cursos de graduação da área da saúde que participaram de novos espaços de formação, resultantes de estratégias de reorientação da formação em saúde na perspectiva do Sistema Único de Saúde (SUS). Na produção dos dados da pesquisa exploratória de tipo qualitativo, utilizou-se a entrevista semiestruturada com 12 estudantes de diferentes cursos. Para análise dos dados, adotou-se análise de conteúdo temática. Para os estudantes, participar do PET-Saúde e do Estágio de Vivências do SUS é importante, pois aprendem conteúdos significativos que não são abordados na universidade; desenvolvem atividades conjuntas com estudantes de diferentes cursos, e o aprendizado resultante desta articulação motiva-os para o desenvolvimento do trabalho profissional no sistema público, pois permite vivenciar o cotidiano do trabalho; gera sentimentos de angústia, inquietação e luta; e representa um incentivo para a busca de conhecimentos.

The functional determinants of the insulinotropic action of alpha-D-glucose pentaacetate were investigated in rat pancreatic islets. The ester mimicked the effect of nutrient secretagogues by recruiting individual B cells into an active secretory state, stimulating proinsulin biosynthesis, inhibiting 86Rb outflow, and augmenting 45Ca efflux from prelabeled islets. The secretory response to the ester was suppressed in the absence of Ca2+ and potentiated by theophylline or cytochalasin B. The generation of acetate from the ester apparently played a small role in its insulinotropic action. Thus acetate, methyl acetate, ethyl acetate, alpha-D-galactose pentaacetate, and beta-D-galactose pentaacetate all failed to stimulate insulin release. The secretory response to alpha-D-glucose pentaacetate was reproduced by beta-D-glucose pentaacetate and, to a lesser extent, by beta-L-glucose pentaacetate. It differed from that evoked by unesterified D-glucose by its resistance to 3-O-methyl-D-glucose, D-mannoheptulose, and 2-deoxy-D-glucose. It is concluded that the insulinotropic action of alpha-D-glucose pentaacetate, although linked to the generation of the hexose from its ester, entails a coupling mechanism that is not identical to that currently implied in the process of glucose-induced insulin release.

Pesquisa qualitativa, cujo objetivo foi descrever as situações vivenciadas e os dilemas éticos dos enfermeiros no percurso de encaminhamento e recebimento, por ordem judicial, de pacientes com indicação de internação em Unidade de Terapia Intensiva (UTI). Foi efetivada entrevista parcialmente estruturada com 10 enfermeiros, que atuam em UTI e 10 que atuam em emergência de hospitais públicos e privados da região metropolitana de Porto Alegre, Brasil. Os dados foram submetidos à análise temática. Os resultados indicam que os enfermeiros vivenciam dilemas éticos consequentes aos problemas de superlotação das UTI e das emergências, da precária tecnologia especializada, da orientação quanto ao benefício concedido pela lei. Concluiu-se que é fundamental a participação dos enfermeiros em debates que possibilitem mapear as diferentes instâncias que têm promovido esta situação, muitas vezes caótica.

Abstract Objective: an integrative review of the treatment of oral candidiasis, root caries and xerostomia among the elderly population, focusing on Primary Health Care, was carried out. Method: scientific articles were collected from the MEDLINE/PUBMED database using the keywords "Geriatric dentistry" and "Oral health", crossed with corresponding descriptors, together with specific terms for the pathologies studied, and with “the clinical trial” filter activated. The abstracts of the articles were read by three researchers. Result: oral candidiasis: six randomized clinical trials and one quasi-experimental design study, on the treatment of prosthetic stomatitis by medication and/or the disinfection of dentures by different techniques, were identified; root caries: three randomized clinical trials were included, which tested the use of mouthwash with chlorhexidine solution and oral hygiene instruction associated or otherwise with other drugs; and xerostomia: two articles were analyzed using various medications, and the functional massage of the salivary glands and associated muscles. Conclusion: The results demonstrate a variety of treatment options for the studied clinical situations, although these should be adapted to the characteristics of the services and the population, as standard treatment in Primary Health Care has not been established. Strategies based on soft technologies, such as health education, seem to provide good results. The present study provides additional knowledge for health professionals in search of more resolutive and qualified dental care for the elderly in primary health care.

El acuerdo de paz entre el gobierno colombiano y las Fuerzas Armadas Revolucionarias de Colombia (FARC) dejó de nuevo aplazada, por tercera vez en ochenta años (1936, 1960-1968, 2016), la reforma agraria. En el acuerdo del 2016, las partes acordaron un lacónico proceso de formalización de la propiedad privada mediante la asignación de títulos para quienes ya tienen posesión sobre la tierra. También se aceptó restituir y reparar a quienes perdieron la tierra en la guerra de 25 años y se volvió a dejar para después la redistribución de la propiedad. Este asunto es de especial importancia, pues el coeficiente Gini de tierras en Colombia llega al 0,8 %, uno de los más desiguales del mundo. Teniendo en cuenta lo anterior, en este artículo se revisa cómo el tema agrario en Colombia continúa siendo un proceso de acumulación originaria permanente —con el latifundio como su forma dominante—, y se sostiene que la paz acordada es solo una manera de preparar el mundo agrario colombiano para el gran capitalismo, creando derechos de propiedad necesarios en la agroindustria y haciendo de los campesinos una fuerza de trabajo disponible para la producción, ahora que estos han quedado liberados de la guerra.

The aim of this study was to examine the effect of polymorphisms in the cytochrome P450 (CYP) 2C19 gene (CYP2C19) on the Helicobacter pylori eradication rate in Brazilian patients with functional dyspepsia. Adults diagnosed with functional dyspepsia based on the ROME III criteria and infected with H. pylori were recruited to this study. The patients were subjected to gastrointestinal endoscopy and the H. pylori status was defined when both urease test and histopathology results were negative or positive. The patients were treated with proton pump inhibitor-based triple therapy (omeprazole, amoxicillin, and clarithromycin). CYP2C19*2 and CYP2C19*3 were genotyped by polymerase chain reaction-restriction fragment length polymorphism. One hundred and forty-eight patients (81.8% women) with a mean (± SD) age of 46.1 (12.2) years were included in this study. Based on the CYP2C19 genotypes, the patients were classified as homozygous extensive metabolizer (HomEM; 67.6%), heterozygous extensive metabolizer (HetEM; 26.3%), or poor metabolizer (PM; 6.1%). The H. pylori eradication rates in patients with HomEM, HetEM, and PM were 85.0, 89.7, and 100.0% (P = 0.376), respectively. The included study population comprised a high frequency of patients carrying the HomEM genotype. Although the genotypes of CYP2C19 variants were not statistically significant, the results of this study suggest a possible effect of the PM genotype on the efficacy of H. pylori eradication.

Recent evidence indicates that Type 2 Diabetes Mellitus (T2DM) is a complex and highly heterogeneous disease involving various pathophysiological and genetic pathways, which presents clinicians with challenges in disease management. While deep learning models have made significant progress in helping practitioners manage T2DM treatments, several important limitations persist. In this paper we propose DARE, a model based on the transformer encoder, designed for analyzing longitudinal heterogeneous diabetes data. The model can be easily fine-tuned for various clinical prediction tasks, enabling a computational approach to assist clinicians in the management of the disease. We trained DARE using data from over 200,000 diabetic subjects from the primary healthcare SIDIAP database, which includes diagnosis and drug codes, along with various clinical and analytical measurements. After an unsupervised pre-training phase, we fine-tuned the model for predicting three specific clinical outcomes: i) occurrence of comorbidity, ii) achievement of target glycemic control (defined as glycated hemoglobin < 7 % ) and iii) changes in glucose-lowering treatment. In cross-validation, the embedding vectors generated by DARE outperformed those from baseline models (comorbidities prediction task A U C = 0 . 88 , treatment prediction task A U C = 0 . 91 , HbA1c target prediction task A U C = 0 . 82 ). Our findings suggest that attention-based encoders improve results with respect to different deep learning and classical baseline models when used to predict different clinical relevant outcomes from T2DM longitudinal data. • Deep learning shows promise in managing T2DM and predicting its progression • We developed DARE, a transformer model for analyzing T2DM longitudinal records • DARE was trained on data from 200K diabetic patients spanning a 5-year period • DARE forecasts treatment changes, HbA1c targets, and diabetes comorbidities.