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BACKGROUND: Statins are the main strategy to reduce dyslipidemia-related cardiovascular risk. Nevertheless, there is scarce evidence on the real-world statins use in primary care settings in low-middle-income countries. OBJECTIVE: We conducted a cross-sectional retrospective study using anonymized data routinely collected by community health workers in Brazil aimed to evaluate statin use and associated factors in a primary prevention population with cardiovascular risk enhancers. METHODS: Study population consisted of adults with hypertension, diabetes, and/or dyslipidemia. The primary and secondary outcomes were the proportion of individuals self-reporting statins use on any dose and high-dose statins/high-intensity lipid-lowering therapy (LLT), respectively. RESULTS: Of the 2,133,900 adult individuals in the database, 415,766 (19.5%) were included in the study cohort. From this cohort, 89.1% had hypertension, 28.9% diabetes, and 5.5% dyslipidemia. The mean age was 61.5 (standard deviation 14.5) years, 63.4% were female, and 61.0% were of mixed-race. Only 2.6% and 0.1% of individuals self-reported the use of statins and high-dose statins/high-intensity LLT, respectively. Older age (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.88, 2.05, p < 0.001), living in the South region of Brazil (OR 4.39; 95% CI 3.97, 4.85, p < 0.001), heart failure (OR 2.60; 95% CI 2.33, 2.89, p < 0.001), chronic kidney disease (OR 1.49; 95% CI 1.35, 1.64, p < 0.001), and anti-hypertensive medications use (OR 4.38; 95% CI 4.07, 4.71, p < 0.001) were independently associated with statin use. CONCLUSION: In a real-world evidence study analyzing data routinely collected in a digitized primary care setting, we observed a very low use of statins in a primary prevention population with cardiovascular risk enhancers in Brazil. Socio-demographic factors and co-morbidities were associated with higher statins use rates.

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Environmental wealth is the main basis of the social, cultural and economic development of a country, but if there is an absence of the valuation of these natural resources, it can lead to a disproportionate usufruct that causes the deterioration of the ecosystem and even collateral effects of human health. This research aimed to know the total economic value of the ecosystem of the high Andean water basin tributary of the Chumbao River, located between 2000 to 4800 meters above sea level belonging to the province of Andahuaylas, Apurimac region in Perú. The valuation procedure consisted of using the analytical method of multicriteria valuation applying the concept of Total Economic Value, which involved direct and indirect uses related to environmental assets, in which a collective panel of people from different training disciplines (experts) participated, which were made up of researchers, engineers, public officials, farmers and ecologists who had extensive knowledge about the environmental asset. of the geographical area in reference; and once the paired comparison survey was done, the total economic value was quantified up to three amounts, so the respondents were formed into three statistically significant segments (SIG<0.05). The cluster (1): assigned a weighting that quantifies to an economic value of USS 4,359,179,489.46; followed by cluster (2): an intermediate value of USS 4,029,902,444.41 and cluster (3): assigned a lower value to USS 774,163,167.16. Thus, it follows that, on average, 51.78% equals value in use and 48.21% equals value in non-use, respectively. This value expressed as an interval reflects the environmental ethical positions of the groups and makes available as an indicator to government authorities and society in order to exercise actions of environmental sustainability high andean.

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Background: The digitization of the primary care system provides an opportunity to evaluate the current use of statins in secondary prevention populations (myocardial infarction or stroke). Methods: We conducted a cross-sectional study (ClinicalTrials.gov, NCT05285085), analysing anonymised data routinely collected by community health workers (CHW) in Brazil between May 2016 and September 2021 to assess the proportion of self-reported statins use and associated factors. Findings: From the 2,133,900 individuals on the database, 35,103 (1.6%), mean age 66.2 years (SD14.6), 49.5% (17,382/35,103) male sex, 50.5% (17,721/35,103) female sex, and 29.6% (10,381/34,975) Caucasians, had a previous myocardial infarction (MI) (n = 11,628; 33.1%) or stroke (n = 25,925; 73.9%). Approximately 50% (17,020/35,103) were from the Northeast region, 78.7% (27,605) from urban zones, and 39.4% (13,845) with social development index (SDI) >0.7. Overall, 6.7% (2346) and 0.6% (212) reported statins and high dose statins use, respectively. Age over 60 years old (OR 1.32 [95% CI 1.19-1.47), living in the Southern region (OR 4.53 [95% CI 3.66-5.60]), having a previous diagnosis of MI (OR 4.53 [95% CI 3.66-5.60]), heart failure (OR 2.29 [95% CI 1.13-1.47]), diabetes (OR 1.50 [95% CI 1.37-1.64]), dyslipidaemia (OR 2.90 [95% CI 2.55-3.29]), chronic kidney disease (OR 1.27 [95% CI 1.08-1.48]) and use of anti-hypertensives (OR 5.47 [95% CI 4.60-6.47]) were associated with statin use. Interpretation: The analysis of a real-world database from a digitized primary care system, allowed us to identify a very low use of statins in secondary prevention Brazilian patients, mostly influenced by socio-demographic factors and co-morbidities. Funding: Novartis Biociências, Brazil.

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Sacha Inchi seed oil (SIO) is rich in omega 3, 6, and 9 fatty acids with important health benefits, but is temperature sensitive. Spray drying is a technology that improves the long-term stability of bioactive compounds. This work aimed to study the effect of three different homogenization techniques on some physical properties and bioavailability of microcapsules of Sacha Inchi seed oil (SIO) emulsions obtained by spray drying. Emulsions were formulated with SIO (5%, w/w), maltodextrin:sodium caseinate as wall material (10%, w/w; 85:15), Tween 20 (1%, w/w) and Span 80 (0.5%, w/w) as surfactants and water up to 100% (w/w). Emulsions were prepared using high-speed (Dispermat D-51580, 18,000 rpm, 10 min), conventional (Mixer K-MLIM50N01, Turbo speed, 5 min), and ultrasound probe (Sonics Materials VCX 750, 35% amplitude, 750 W, 30 min) homogenization. SIO microcapsules were obtained in a Mini Spray B-290 (Büchi) using two inlet temperatures of the drying air (150 and 170 °C). Moisture, density, dissolution rate, hygroscopicity, drying efficiency (EY), encapsulation efficiency (EE), loading capacity, and oil release in digestive fluids in vitro were studied. Results showed that the microcapsules obtained by spray-drying had low moisture values and high encapsulation yield and efficiency values (greater than 50% and 70%, respectively). The thermogravimetric analysis indicates that heat protection was assured, enhancing the shelf life and the ability to withstand thermal food processing. Results suggest that spray-drying encapsulation could be a suitable technology to successfully microencapsulate SIO and enhance the absorption of bioactive compounds in the intestine. This work highlights the use of Latin American biodiversity and spray drying technology to ensure the encapsulation of bioactive compounds. This technology represents an opportunity for the development of new functional foods, improving the safety and quality of conventional foods.

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Refractance window (RW) drying is considered an emerging technique in the food field due to its scalability, energy efficiency, cost and end-product quality. It can be used for obtaining flakes from high-oleic palm oil (HOPO) nanoemulsions containing a high concentration of temperature-sensitive active compounds. This work was thus aimed at studying the effect of temperature, thickness of the film drying, nanoemulsion process conditions, and emulsion formulation on the flakes' physical properties and microstructure. The results showed that HOPO flakes had good physical characteristics: 1.4% to 5.6% moisture content and 0.26 to 0.58 aw. Regarding microstructure, lower fractal dimension (FDt) was obtained when RW drying temperature increased, which is related to more regular surfaces. The results indicated that flakes with optimal physical properties can be obtained by RW drying of HOPO nanoemulsions.

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IMPORTANCE: Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low- and middle-income countries. OBJECTIVE: To assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA. DESIGN, SETTING AND PARTICIPANTS: This 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle. INTERVENTIONS: The multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale). RESULTS: A total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, -3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P = .01). CONCLUSIONS AND RELEVANCE: A multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02223273.

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RESULTS Of the 1619 included patients,1029 (63.6%) weremale,1327(82.0%) had coronary artery disease (843[52.1%] with prioracutemyo cardial infarction),355(21.9%)had priorischemicstroke ortransientischemicattack,and197 (12.2%) had peripheral vascular disease,andthemean( SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary careunits,and 26 (65%) were teaching institutions.Amonge ligible patients,thosein intervention clusters were more like ly to receive aprescription of evidence-based therapies thant hose in control clusters (73.5%[515of701] vs58.7% [493of840];oddsratio,2.30;95%CI,1.14-4.65). There were no differences between the intervention and control group swithregard storisk factor control(ie,hyperlipidemia,hypertension,ordiabetes).Ratesofeducationforsmokingcessationwere higher among current smokers in the intervention group thanin the control group (51.9%[364of701] vs18.2%[153of840];oddsratio,11.24;95%CI,2.20-57.43).Therateofcardiovascularmortality,acute myocardial infarction,andstrokewas2.6%for patients from intervention cluster sand 3.4%forthose in the control group (hazardratio, 0.76;95%CI,0.43-1.34). (AU)

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Importance: Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. Objective: To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. Design, Setting, and Participants: In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. Interventions: Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. Main Outcomes and Measures: The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. Results: Of the 1619 included patients, 1029 (63.6%) were male, 1327 (82.0%) had coronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197 (12.2%) had peripheral vascular disease, and the mean (SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26 (65%) were teaching institutions. Among eligible patients, those in intervention clusters were more likely to receive a prescription of evidence-based therapies than those in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control (ie, hyperlipidemia, hypertension, or diabetes). Rates of education for smoking cessation were higher among current smokers in the intervention group than in the control group (51.9% [364 of 701] vs 18.2% [153 of 840]; odds ratio, 11.24; 95% CI, 2.20-57.43). The rate of cardiovascular mortality, acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). Conclusions and Relevance: Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies. Trial Registration: ClinicalTrials.gov identifier: NCT02851732.

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Human consumption of flaxseed is increasing due to its health benefit properties and extrusion processes can enhance its nutritional quality. Extruded flaxseed meal (EFM) obtained in a pilot plant was characterized and incorporated in flour mixes and cereal-based bars to demonstrate its nutritious usefulness. Amino acid content was not affected by extrusion and, despite lysine was the limitating amino acid, the chemical score (CS) was 83 %. Thiamin and riboflavin decreased slightly as consequence of extrusion, phytic acid did not change and trypsin inhibitor activity was undetectable. Proximate composition and nutritional quality determined by biological and chemical indexes were compared among EFM, flour mixes (FM) and cereal bars (CB). They presented high protein levels (26, 20 and 17 %, respectively), good biological value (BV) (80, 79 and 65, respectively), acceptable true protein digestibility (TD) (73, 79 and 78, respectively), and high dietary fiber (33, 20.5 and 18 %, respectively). The ratio of ω6:ω3 for CB was within the WHO/FAO recommendations. These results open a new venue for the usefulsess of nutritious/healthy extruded flaxseed flours into ready-to-eat cereal-based products with improved nutritional quality.

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Respirometry consists in the measurement of the biological oxygen consumption rate under well-defined conditions and has been used for the characterization of countless biological processes. In the field of biotechnology and applied microbiology, several respirometry methods are commonly used for the determination of process parameters. Dynamic and static respirometry, which are based on oxygen measurements with or without continuous aeration, respectively, are the methods most commonly used. Additionally to several respirometry methods, different methods have also been developed to retrieve process parameters from respirometric data. Among them, methods based on model fitting and methods based on the injection of substrate pulse at increasing concentration are commonly used. An important question is then; what respirometry and data interpretation methods should be preferably used? So far, and despite a growing interest for respirometry, relatively little attention has been paid on the comparison between the different methods available. In this work, both static and dynamic respirometry methods and both interpretation methods; model fitting and pulses of increasing concentration, were compared to characterize an autotrophic nitrification process. A total of 60 respirometry experiments were done and exhaustively analysed, including sensitivity and error analyses. According to the results obtained, the substrate affinity constant (K S ) was better determined by static respirometry with pulses of increasing concentration and the maximum oxygen uptake rate (OUR ex.max ) was better determined by dynamic respirometry coupled to fitting procedure. The best method for combined K S and OUR ex.max determination was static respirometry with pulses of increasing concentration.

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