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Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P<0.001), delays related to quality of medical care (P=0.012), absence of blood derivatives (P=0.013), difficulties of communication between health services (P=0.004), and any delay during the whole process (P=0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

Maternal educational attainment has been identified as relevant to several child health and development outcomes. This study aimed to evaluate the association of sociodemographic and maternal education factors with child development in families living below the poverty line. A cross-sectional study was conducted through telephone contact from May to July 2021 in Ceará, a state in Northeastern Brazil. The study population comprised families with children up to six years of age participating in the cash transfer program “Mais infância”. The families selected to participate in this program must have a monthly per capita income of less than US$16.50. The Ages and Stages Questionnaire version 3 was applied to assess the children’s development status. The mothers reported maternal educational attainment as the highest grade and or degree obtained. The final weighted and adjusted model showed that maternal schooling was associated with the risk of delay in all domains except for the fine motor domain. The risk of delay in at least one domain was 2.5-fold higher in mothers with a lower level of schooling (95% CI: 1.6–3.9). The findings of this study suggest that mothers with higher educational attainment have children with better child development outcomes.

Background Intimate partner violence (IPV) is a pervasive public health issue that affects millions of women worldwide. Women living below the poverty line experience higher rates of violence and fewer resources to escape or cope with the abuse, and the COVID-19 pandemic has significantly impacted women’s economic well-being worldwide. We conducted a cross-sectional study in Ceará, Brazil, on women in families with children living below the poverty line at the peak of the second wave of COVID to assess the prevalence of IPV and its association with common mental disorders(CMD). Methods The study population comprised families with children up to six years of age who participated in the cash transfer program “ Mais Infância ”. The families selected to participate in this program must meet a poverty criterion: families must live in rural areas, in addition to a monthly per capita income of less than US$16.50 per month. We applied specific instruments to evaluate IPV and CMD. To access IPV, we used the Partner Violence Screen (PVS). The Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. To verify the association between IPV and the other evaluated factors with CMD, simple and hierarchical multiple logistic models were used. Results Of the 479 participant women, 22% were positively screened for IPV (95% CI 18.2–26.2). After multivariate adjustment, the chances of CMD are 2.32 higher in women exposed to IPV than in those not exposed to IPV ((95%CI 1.30–4.13), p value = 0.004). CMD was also associated with job loss during the COVID-19 pandemic (ORa 2.13 (95% CI 1.09–4.35), p-value 0.029). In addition to these, separate or single marital status, as well as non-presence of the father at home and food insecurity were associated with CMD. Conclusion We conclude that the prevalence of intimate partner violence in families with children up to six years of age living below the poverty line in Ceará is high and is associated with greater chances of common mental disorders in mothers. Also, job loss and reduced access to food caused by the Covid 19 pandemic exacerbated both phenomena, constituting a double burden generator factor on mothers.

We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p  = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p  = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) ( p  = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p  = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p  = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p  = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p  = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p  = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p  = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.

Introduction: Giardia lamblia is a global parasite that infects both humans and animals. However, its pathogenic mechanisms remain poorly understood. Infected children, in particular, may exhibit deficits in physical and cognitive development. To better comprehend the metabolic changes associated with the disease, this study investigated the biochemical profile of gerbils experimentally infected with the Portland strain of G. lamblia Methodology: Sixteen gerbils, equally divided by sex, were included in the experiment for 35 days, with blood samples collected every 7 days. Results: blood glucose and insulin levels increased on the 21st day post-infection (DPI), suggesting persistent inflammation and increased insulin resistance. Additionally, there was a progressive decrease in total protein with a paradoxical increase in albumin, indicating a state of anabolism in response to infection. Alkaline phosphatase, AST, and ALT levels remained unchanged, suggesting that liver function was not affected by the infection. Cortisol levels increased from the 7th DPI onwards, while calcium, cholesterol, and triglyceride levels began to increase from the 21st DPI onwards. Conclusions: These findings confirm the systemic inflammatory state induced by giardiasis and highlight significant metabolic alterations in experimentally infected animals. Further research is warranted to elucidate the pathophysiological mechanisms underlying these metabolic disturbances.

Background Government-led, population-wide initiatives are crucial for advancing the management of hypertension − a leading cause of cardiovascular disease (CVD) morbidity and mortality. An urban population health initiative was conducted against this backdrop, focussing on hypertension in the primary health system in São Paulo, Brazil. Within the frame of the initiative and under the supervision and leadership of the municipal health authorities, a situational analysis was conducted on the needs in hypertension management, marking the first phase of a Design Thinking process. This article describes the situational analysis process and presents the identified elements to be strengthened considering hypertension diagnosis, treatment and control. Methods First, a mixed-methods approach was used, starting with a literature review of municipal hypertension data followed by meetings ( N  = 20) with the local public health administration to assess health system level components. To investigate activities on hypertension diagnosis, treatment and control, nine primary healthcare units were selected from two districts of São Paulo city– Itaquera and Penha– which received an online form addressed to managers, participated in conversation circles of staff and patients, and underwent shadowing of community health agents. Results Data gave rise to two main outputs: (i) a patient care journey map; and (ii) a matrix summarizing the identified needs at patient, healthcare professional and health system level for diagnosis, treatment and control of hypertension. Patient awareness and knowledge of hypertension was found to be insufficient and its management needs to be improved. For health professionals, disease awareness, technical training, more time dedicated to patients, and simplified guidelines and clinical decision-making tools for hypertension management were identified as principal needs. The situational analysis found that the healthcare systems efficiency might be improved by establishing defined treatment and care delivery goals with a focus on outcomes and implemented through action plans. Conclusions This situational analysis identified several needs related to hypertension control in São Paulo that are in line with global challenges to improve the control of CVD risk factors. Findings were also confirmed locally in an expansion phase of this situational analysis to additional primary care facilities. As a consequence, solutions were designed, promptly taken up and implemented by the municipal health secretariat.

Introduction and hypothesisIn the literature, it is suggested that supervised pelvic floor muscle training (PFMT) might be the first option treatment for female stress urinary incontinence (SUI). However, inadequate accessibility to health care and scarce individual resources may prevent adherence to the treatment. Our study is aimed at comparing the efficacy of performing PFMT in an outpatient clinic and at home in Brazilian incontinent women, and to verify if home PFMT may be an alternative to those not able to attend the outpatient sessions.MethodsA total of 69 women with predominant SUI were randomised into two groups: outpatient PFMT and home PFMT. The primary outcome was the cure of SUI defined as <2 g of leakage in a 20-min pad test. Secondary outcomes were: pelvic floor muscle function; urinary symptoms; quality of life; patient satisfaction; and adherence to home exercise sets. The assessments were conducted at baseline and after 3 months of treatment. Statistical analyses consisted of Student’s t, Mann–Whitney U, Chi-squared, and Wilcoxon tests, with a 5% cut-off for significance.ResultsA superior objective cure of SUI was observed in the outpatient clinic (62%) compared with the home (28%) PFMT groups (OR: 4.0 [95% CI: 1.4–11.0]; p = 0.011). Secondarily, there was no difference between groups regarding the following: satisfaction with the treatment; quality of life; function of the PFMs; and number of episodes of urine leakage per week. The home adherence to the exercises was superior in the outpatient PFMT group only during the first-month training.ConclusionsOutpatient PFMT was associated with a higher objective cure of SUI than home PFMT. However, subjective findings show equal benefit of home PFMT providing evidence that this may be an alternative treatment to our population.

This paper explores the association between job strain and adiposity, using two statistical analysis approaches and considering the role of gender. The research evaluated 11,960 active baseline participants (2008–2010) in the ELSA-Brasil study. Job strain was evaluated through a demand–control questionnaire, while body mass index (BMI) and waist circumference (WC) were evaluated in continuous form. The associations were estimated using gamma regression models with an identity link function. Quantile regression models were also estimated from the final set of co-variables established by gamma regression. The relationship that was found varied by analytical approach and gender. Among the women, no association was observed between job strain and adiposity in the fitted gamma models. In the quantile models, a pattern of increasing effects of high strain was observed at higher BMI and WC distribution quantiles. Among the men, high strain was associated with adiposity in the gamma regression models. However, when quantile regression was used, that association was found not to be homogeneous across outcome distributions. In addition, in the quantile models an association was observed between active jobs and BMI. Our results point to an association between job strain and adiposity, which follows a heterogeneous pattern. Modelling strategies can produce different results and should, accordingly, be used to complement one another.

Background Stress urinary incontinence (SUI) is a subtype of urinary incontinence that occurs more commonly amongst women. The pelvic floor muscle training (PFMT) is considered the gold standard for treating SUI. Another technique called the Knack postulated that pre-contraction of the pelvic floor muscles (PFM) during activities of increasing intra-abdominal pressure prevents urinary loss. Currently, there are no studies supporting the Knack for the treatment of SUI. Thus, the aim of this study is to test the hypothesis that voluntary pre-contraction of PFM can treat SUI. For this purpose, the following parameters will be analysed and compared amongst (1) the Knack, (2) PFMT and (3) the Knack + PFMT groups: urine leakage as assessed by the pad test, urinary symptoms, muscle function, quality of life, subjective cure, adherence to exercises in the outpatient setting and at home and perceived self-efficacy of PFM exercises. Methods A single-centre, double-blind (investigator and outcome assessor) randomised controlled trial with a 3-month follow-up of supervised treatment and an additional 3 months of follow-up (unsupervised) for a total of 6 months of follow-up. Two hundred ten women with mild to moderate SUI will be included, aged between 18 and 70 years. To compare the primary and secondary outcome measures within and between the groups studied (before and after intervention), the ANOVA statistical test will be used. Primary and secondary outcome measures will be presented as mean, standard deviation, 95% confidence interval and median and minimum and maximum values. Discussion/significance This study closes a gap, as voluntary PFM pre-contraction (the Knack) has not yet been included in the physiotherapeutic treatment of SUI, and if shown successful could be implemented in clinical practice. Trial registration ClinicalTrials.gov NCT03722719 . Registered on October 29, 2018. Study protocol version 1. Was this trial prospectively registered? Yes Funded by : The present study did not receive funding. Anticipated completion date: The anticipated trial commencement and completion dates are October 2018 and October 2021, respectively. Provenance: Not invited. Peer reviewed. Human research ethics approval committee: Research Ethical Board of the Universidade Federal de São Paulo (UNIFESP), Brazil. Human research ethics approval number: 2.517.312.

Salmonella is a major causative agent of foodborne illness and rapid identification of this pathogen is essential to prevent disease. Currently most assays require high bacterial burdens or prolonged enrichment to achieve acceptable performance. A reduction in testing time without loss of sensitivity is critical to allow food processors to safely decrease product holding time. To meet this need, a method was developed to detect Salmonella using luciferase reporter bacteriophages. Bacteriophages were engineered to express NanoLuc, a novel optimized luciferase originating from the deep-sea shrimp Oplophorus gracilirostris . NanoLuc-expressing bacteriophages had a limit of detection of 10–100 CFU per mL in culture without enrichment. Luciferase reporters demonstrated a broad host range covering all Salmonella species with one reporter detecting 99.3% of 269 inclusivity strains. Cross-reactivity was limited and only observed with other members of the Enterobacteriaceae family. In food matrix studies, a cocktail of engineered bacteriophages accurately detected 1 CFU in either 25 g of ground turkey with a 7 h enrichment or 100 g of powdered infant formula with a 16 h enrichment. Use of the NanoLuc reporter assay described herein resulted in a considerable reduction in enrichment time without a loss of sensitivity.