Identify gender gaps in the employment conditions, work and quality of life of informal sellers in Vega Central of Chile.Encuesta Nacional de Condiciones de Empleo, Trabajo y Salud  and the SF-36 Health Questionnaire for data collection. We performed a descriptive analysis to determine the characteristics of the population and the Chi-square test to study correlations between each of the variables with gender. We conducted a cross-sectional study with eighty workers, who answered modules of the  Of the sample, fifty (62.5%) are male and thirty (37.5%) are female. Both groups have similar conditions of employment, work and quality of life. However, women express greater fear than men do with respect to demanding better working conditions, as well as more discouragement and sadness during the workday and a worse perception of their state of health. Strategies for the promotion and prevention of occupational health and social security should consider a gender perspective on working conditions and health indicators, allowing women to develop tools to demand fair conditions and promote employer obligations to care for the well-being of male and female workers. Vega Central is an urban market with high concentration of commercial activity in the Metropolitan Region of Chile. There are two main jobs: goods carriers, who transport and deposit goods in warehouses; and kiosk and market stall sellers, who buy and sell food products1. In total, Vega Central includes around 1,200 storesa.2. In Latin America and the Caribbean, at least 50% of workers work informally3 and, of all women who work, 59% are in informal jobs4.These labor activities are mostly carried out in informal conditions, understood as those jobs that have little or no social protection, are not subject to labor legislation, have no right to benefits and are not subject to taxation5 such as occupation and working conditions. Worldwide, women are more likely to have poorer working conditions than men, such as greater difficulty in covering their expenses with wages, longer working hours, more hours of involuntary part-time work, less training and health and safety information about their workplace, fewer non-wage benefits, and less communication with their superiors6.In this context, gender is a social construct that produces health inequities on its own, which can be accentuated if it interacts with other social determinants of health2. There is a relationship between informal work and poorer health8, with the self-perceived health of informal workers being worse than that of formal workers9. At the same time, informal workers are exposed to greater occupational accidents; they do not have coverage for health care, unemployment insurance or retirement10. In contrast, there is literature that found no evidence on the relationship between informal work and poorer health6.Informal employment presents conditions of high vulnerability, especially in the face of risk situations11one study reported worse effects of informality in men with respect to self-perceived and mental health7. In the Chilean context, the Encuesta Nacional de Condiciones de Empleo, Trabajo y Salud , published in 201114, shows that labor informality has a negative impact on the perception of mental or emotional health, affecting mostly women. However, the information on informal employment in Chile and its impact on workers’ health are scarce, does not specify the categories analyzed and the differences by gender are still unclear.While most studies suggest that the results are more unfavorable for the female populationWith this in mind, this study aims to identify gender gaps in the employment conditions, work and quality of life of informal sellers in Vega Central, in Chile. Thus, the expectation is that, under the same conditions of employment and work in this area, women with informal labor have worse health and quality of life outcomes than men have. This study provides background information for the development of prevention and promotion of occupational health from a gender perspective.15 based on the proportion of informal work at the national level14, given the lack of knowledge of the total number of informal workers in Vega Central. We obtained an estimated sample size of 148 subjects, with a confidence interval of 95% and a precision of 3%. We reached a final sample of 80 workers without a current employment contract, who had been involved in sales activity for at least 3 months and who communicated in Spanish , employment conditions, working conditions and quality of life. We considered the gender category in a binary dimension for statistical power criteria of each group. We used this variable for gender analysis by comparing roles and working conditions.14 to measure employment and work conditions, while the quality of life was measured using the SF-3617 questionnaire. For the application of the instruments, we previously read the complete set of questions and answer options. We obtained weight and height numbers of each worker by self-reporting.On the other hand, we used modules A and B of the ENETS18 adjusted standardized residuals as ≤ -1.96 and ≥ 1.96 to identify significant associations. We used the statistical program IBM SPSS Statistics for Macintosh, version 22.0 .We described frequencies and percentages for the analysis of qualitative variables. Subsequently, we used the chi-square test to analyze the associations between the variables: gender – employment conditions; gender – working conditions; and gender – quality of life. We considered p value ≤ 0.05 and HabermanFacultad de Medicina de la Universidad de Chile approved this study, assigned no. 80, dated September 12, 2017.The Human Research Ethics Committee of the Of 80 people surveyed, 62.5% were male and 37.5% were female, corresponding to 50 and 30 people, respectively. The median age of the women surveyed was 44 years, while the median age of the men was 50 years. With respect to employment conditions, only three variables showed significant differences in relation to gender . Men werWomen and men work under the same conditions in most cases . Two varWe observed some differences by gender with respect to quality of life , the varRegarding the identification of such self-perception, we developed correlations with respect to quality of life variables, recognizing common associations in both genders between self-perception of health and limitation in walking more than 10 blocks (-0.417); limitation when climbing only one floor (-0.477); limitation of activities due to intense efforts (-0.412); limitation when walking several blocks (-0.390); limitation when climbing several floors (-0.567). On the other hand, we identified correlations only for women, such as limitation to moderate and minimal effort , while in men, significant negative correlations were obtained in the variables “I feel that I get sick more easily” (-0.288); limitations in work/activity (-0.296); comparison of health status with the previous year (-0.299); reduction of work time due to emotional problems (-0.344); limitation when walking only one block (-0.334); limitation when bathing or dressing (-0.354); felt discouraged and sad (-0.354); limitation when squatting (-0.366) and limitation when lifting something light (-0.369).This study sought to identify gender differences in the employment conditions, work and quality of life of informal workers in Vega Central. It did not identify major gender differences in employment and working conditions, however women express a greater fear than men do with demanding better conditions, as well as feeling more discouraged and sad during the workday.Compared with national data from the same survey used as a basis , it is evident that at the national level 10.7% of men and 3.7% of women who are informal workers do not have a social security system, while in Vega Central over 60% of both genders report not being affiliated to a social security system, even when the public health system has affiliation for people with no formal income. On the other hand, 20% of women workers in this market do not know if they have health insurance, demonstrating greater vulnerability in this group.19, it is important in this context to implement social security strategies with a gender perspective allowing women to develop tools and spaces to demand fair conditions.Although the female and male population in the workplaces studied do not feel defenseless before their superiors, do not fear being dismissed, and do not perceive unfair or violent treatment, women are more fearful than men of demanding better working conditions. Considering that the global trend of informal employment describes that women receive lower remuneration for their work and at the same time are exposed to greater decent work deficits12, in which the lack of social security is higher among women than among men (4% versus 1.5%). It is possible to attribute this lack of significant difference to the fact that the population analyzed is working in a not feminized or masculinized job, as other jobs in the informal sector might be. Because of the health impact this entails, it is a factor to consider knowing that, in developing countries, the informal sector is the main source of employment for women4.Most of the participants do not have a formal social security system, not presenting gender gaps, which is contrary to what has been reported in other studies on informal work19.While, in men’s and women’s perception, there is heterogeneity of the employer’s concern about their health and safety, we identify a trend towards greater perception of neglect by women (p = 0.034). We could link this difference to cultural aspects regarding the greater relevance given to health and safety in the female role. However, such negligence is present in similar reports of low access to training, information and personal protection elements in their work. This also shows that in this workplaces no clear practices exist with respect to the employer’s obligations to care for the welfare of workers, which is consistent with other studies on informal labor12, under high physical demands and suffer more injuries from work-related accidents20, along with higher levels of work standing up, repetitive movements, lifting or carrying heavy objects, among others14. Despite the way in which female and male identities are configured21 to determine the distribution of women and men in the labor market, in general, the above results reflect an unclear division of tasks or working conditions by gender, being both equally demanded.In general, we identified only physical factors  that presented exposure in more than half of the sample, while overall exposure levels of under 30% to noise, high and low temperatures or light during the working day. The only difference between genders in working conditions was identified in the high level of exposure of women to low temperatures (p = 0.012), which could be attributed to the fact that most of the day women report that they are seated and engaged in selling in an open space with a high ceiling that allows air circulation, such as the shed where Vega Central stalls are located. In contrast, similar international and national studies identified that men are more exposed to work in awkward postures22. In addition, the literature on social determinants of health and its impact on the social gradient of health places mental health problems and disorders with a higher prevalence in population groups with lower educational levels and younger age24, an element to consider given the low educational level presented in the sample in general and in women compared to men. However, another study on the context of informality in Central America11 reports that both men and women have a poor perception of mental health. These results are similar to those reported in Chile, where unstable and informal workers have significantly lower levels of mental wellbeing than stable and formal workers14, so that discouragement and sadness could be equally associated with or enhanced by informal work and low educational level, which is also one of the reasons for accessing this type of employment.In relation to quality of life, although most of the workers felt exhausted most of the time, they did not report difficulties in performing their work activities or doing less than desired due to emotional problems. However, women perceive themselves to be discouraged and sad during the workday more than 2.01 (95%CI: 1.16–3.50) times than men, which can be attributed to several factors, among them, the different openness to recognize the mood of men and women, since according to the hegemonic mandate of masculinity a man should not be weak or recognize sadness. On the other hand, this finding is consistent with statistics on mental health in the general population, since women have a higher prevalence of depressive symptoms than men11may be explained by the similarity of the demanding working and employment conditions in which both genders perform their jobs. In turn, when describing the categories “almost always false/definitely false”, a gap of more than double was identified between women (33.3%) and men (12.2%), with a relative risk of 2.07 (95%CI: 1.18-3.62). This association shows a greater correlation in the case of men to factors of physical and psychological origin (correlation levels close to -0.4), while in women it is mainly associated with physical factors in the tasks they perform (with significant correlations close to 0.4). Other studies explain this gap by physical and sensory risk factors, dual presence, low quality of leadership, low social support and little opportunity for skills development at work26 and time conflicts to conform work and family demands in women27.Regarding self-perceived health in general, more than 60% say that is “definitely true/almost always true” that their health is excellent, 53.3% of women and 74% of men respectively. This overall similarity in self-perceived health, although not consistent with that reported in other studies28. Furthermore, Alfers et al.8 showed that in the context of labor informality in South Africa exists a strong association between low income and poorer health status, even greater than with labor formality. In other associations with health, it has been shown that exposure to psychosocial risks is also mediated by the social class to which the person belongs28.Based on the literature, another factor that influences the self-perception of health of informal workers is the characteristics and experiences of the health systems in which the people working in Vega Central participate, such as problems in the administration of health services, bad treatment of users, and the lack of resources for the health sector29 , considering that migration in Chile has been increasing steadily and that health and social security policies continue to leave out of their reforms the situation of informality and the effects on the welfare of workers30.The growth of the informal labor market in Latin America is recognized as a consequence of the development of the economic model, to which important attention should be paid given the trend towards informality as a result of the migratory processes of the population towards large citiesAmong the limitations of this study are the barriers presented in the process of recruiting participants and collecting data in the context of informal employment, both due to the time burden of the work and the extent of the instruments. Although this affects the statistical power of the data, we performed a post hoc analysis, finding values higher than 0.8 in the following variables that present gender differences: “self-perception of health”, “perception of encouragement and fear to demand better conditions”, and “concern of the companies about your health and safety at work”.Another limitation of this study is that, given its descriptive scope, it does not identify the underlying causes of gender differences in the perception of health, so it is important to do new prospective or qualitative studies to deepen the understanding of informal work in markets or street markets.The results of this study and its analysis allow us to conclude that, despite the fact that women and men have similar working and labor conditions in the area studied, women have a worse perception of their mental health and general health. We only identified gender differences in the perception of the employer’s concern for health and safety at work. Therefore, occupational health promotion and prevention strategies in the different areas of informal work, as well as future studies in this field, should be designed from a gender perspective, incorporating both working conditions and health and quality of life indicators. On the other hand, as employment formalization and social security policies advance, alternative strategies can be implemented to support mothers and fathers with the care of young children, such as the development of agreements with local public services to have benefits such as access to kindergartens, extended school hours programs, or daycare facilities on the same place they work. Therefore, all measurement and research on informal work requires consideration of the particularities of women that influence their performance and overall health at work. 1. En total, la Vega Central reúne cerca de 1.200 localesa.La Vega Central es un mercado urbano que concentra una alta actividad comercial en la Región Metropolitana de Chile. Se desempeñan principalmente dos puestos de trabajos: peón de carga, quienes transportan y depositan mercancías en almacenes, y los/as vendedores/as de quioscos y puestos de mercado, quienes realizan las tareas de comprar y vender productos alimenticios2. Cabe destacar que en América Latina y el Caribe, al menos el 50% de los/as trabajadores/as lo hace en condiciones de informalidad3 y, del total de mujeres que trabaja, el 59% lo hace en un empleo informal4.Estas actividades laborales se realizan mayormente en condiciones de informalidad, entendida como aquellos empleos que tienen escasa o nula protección social, no están sujetos a legislación laboral, no poseen derecho a prestaciones y están al margen de pago de impuestos5, como la ocupación y las condiciones laborales. Mundialmente, se ha observado que existe una mayor probabilidad de precarización de las condiciones de trabajo de mujeres respecto a la de los hombres, tales como mayor dificultad para cubrir sus gastos con el salario, jornadas de trabajo más extensas, más horas de trabajo a tiempo parcial involuntario, menos capacitación e información de salud y seguridad de su lugar de trabajo, menos prestaciones no salariales y menor comunicación con sus superiores6.En este contexto, cabe destacar que el género es una construcción social que produce inequidades sanitarias por sí sólo, las cuales pueden acentuarse si interactúa con otros determinantes sociales de la salud2. Existe una relación entre trabajo informal y peor salud8, siendo la salud autopercibida de los/as trabajadores/as informales peor que la de los/as trabajadores/as formales9. A su vez, están expuestos a mayores accidentes laborales, no tienen cobertura para tratamientos de salud, seguro de desempleo ni jubilación10. En contraste, existe literatura que no encontró evidencia sobre la relación entre trabajo informal y peor salud6.Se ha evidenciado que el empleo informal presenta condiciones de alta vulnerabilidad, especialmente frente a situaciones de riesgo11, un estudio ha reportado peores efectos de la informalidad en hombres respecto a la salud autopercibida y mental7. En el contexto chileno, la Encuesta Nacional de Condiciones de Empleo, Trabajo y Salud (ENETS), publicada el año 201114, demuestra que la informalidad laboral tiene un impacto negativo en la percepción de salud mental o emocional, afectando en mayor medida a las mujeres. No obstante, la información sobre el empleo informal en Chile y sus repercusiones en la salud de los trabajadores es escasa, no precisa los rubros analizados y las diferencias por género aún no están claras.Si bien la mayor parte de estudios sugieren que los resultados son más desfavorables para la población femeninaTeniendo en cuenta esto, el presente estudio tiene por objetivo identificar brechas de género en las condiciones de empleo, trabajo y calidad de vida de vendedores informales de la Vega Central de Chile. De este modo, se espera que, bajo las mismas condiciones de empleo y trabajo en este rubro, las mujeres con informalidad laboral tengan peores resultados en salud y calidad de vida que los hombres. Este estudio permite contribuir con antecedentes al desarrollo de prevención y promoción de salud laboral desde una perspectiva de género.15 según la proporción de trabajo informal a nivel nacional14, dado el desconocimiento de la cantidad total de trabajadores informales presentes en La Vega Central. Se obtuvo un tamaño muestral estimado de 148 sujetos, con un nivel de confianza del 95% y precisión del 3%. Se alcanzó una muestra final de 80 trabajadores/as sin contrato laboral vigente, que mantenían una actividad de ventas en un periodo de al menos 3 meses y se comunicaban en idioma español , condiciones de empleo, condiciones de trabajo y calidad de vida. La categoría de género se consideró en una dimensión binaria por criterio de potencia estadística de cada grupo. Esta variable fue utilizada para el análisis de género, mediante la comparación de roles y condiciones de trabajo.14, mientras que la medición de calidad de vida se realizó mediante el Cuestionario SF-3617. Para la aplicación de los instrumentos, se realizó previamente la lectura completa de preguntas y opciones de respuesta. Los valores de peso y talla de cada trabajador se obtuvieron mediante autorreporte.Por otro lado, para la medición de las condiciones de empleo y trabajo se utilizaron los módulos A y B de la ENETS18 como ≤ -1,96 y ≥ 1,96 para identificar asociaciones significativas. Se utilizó el programa estadístico IBM SPSS Statistics para Macintosh, versión 22.0 .Para el análisis de las variables cualitativas, se describieron frecuencias y porcentajes. Posteriormente, se utilizó la prueba de chi-cuadrado para analizar las asociaciones entre las variables: género – condiciones de empleo; género – condiciones de trabajo; y género – calidad de vida. Se consideró el valor de p ≤ 0,05 y los residuos tipificados corregidos de HabermanEste estudio fue aprobado por el Comité de Ética de Investigación en Seres Humanos de la Facultad de Medicina de la Universidad de Chile, asignado al n.° 80 con fecha 12 de septiembre de 2017.Del total de 80 personas encuestadas, el 62,5% pertenecía al género masculino y un 37,5% al género femenino, lo que corresponde a 50 y 30 personas, respectivamente. La mediana de edad de las mujeres encuestadas fue de 44 años, mientras que la de los hombres fue de 50 años. La caracterización sociodemográfica de las personas participantes se encuentra en la Respecto a las condiciones de empleo, solo tres variables presentaron diferencias significativas en relación al género . Los homSe observó que mujeres y hombres trabajan bajo las mismas condiciones en la mayor parte de los casos . Dos varSe observaron algunas diferencias por género respecto a la calidad de vida , la variRespecto a la identificación de dicha autopercepción, se desarrollaron correlaciones respecto a las variables de calidad de vida, reconociendo asociaciones comunes en ambos géneros entre la autopercepción de salud y la limitación al caminar más de 10 cuadras ; limitación al subir solo un piso ; limitación de actividades por esfuerzos intensos ; limitación al caminar varias cuadras ; limitación al subir varios pisos . Por otro lado, se identificaron correlaciones que solo eran de género femenino, tales como limitación a esfuerzos moderados y mínimos , mientras que en hombres se obtuvieron niveles de correlación negativa significativas en las variables “siento que me enfermo con mayor facilidad” ; limitaciones en trabajo/actividad ; comparación de estado de salud con el año anterior ; reducción de tiempo de trabajo por problemas emocionales ; limitación al caminar solo una cuadra ; limitación al bañarse o vestirse ; se sintió desanimado y triste ; limitación al agacharse  y limitación al levantar algo liviano .En este estudio, se buscaba identificar diferencias de género en las condiciones de empleo, trabajo y calidad de vida de los/as trabajadores/as informales de la Vega Central. No se han identificado mayores diferencias de género en las condiciones de empleo y trabajo, pero las mujeres manifiestan un mayor temor que los hombres a reclamar mejores condiciones, así como se sienten más desanimadas y tristes durante la jornada.Comparando con los datos nacionales de la misma encuesta utilizada como base , llama la atención que a nivel nacional un 10,7% de los hombres y un 3,7% de las mujeres que son trabajadores/as informales no cuentan con sistema de previsión, mientras que en la Vega Central sobre un 60% de ambos géneros refiere no estar afiliado a un sistema previsional, aun cuando en el sistema público de salud exista la afiliación de personas sin ingresos formales. Por otro lado, un 20% de las mujeres trabajadoras de este mercado desconoce si tiene previsión de salud, demostrando mayor vulnerabilidad en este grupo.19, es importante para este contexto implementar estrategias de seguridad social con perspectiva de género, que permitan a mujeres desarrollar herramientas y espacios para demandar justas condiciones.Si bien la población femenina y masculina en el rubro estudiado no se sienten indefensos ante sus superiores, no presentan temor a ser despedidos/as, ni perciben tratos injustos o violentos, las mujeres manifiestan un mayor temor que los hombres a reclamar mejores condiciones laborales. Considerando que en la tendencia mundial del empleo informal se describe que las mujeres reciben una remuneración inferior por su trabajo y al mismo tiempo están expuestas a mayores déficits de trabajo decente12, en que la falta de seguridad social es mayor en mujeres que en hombres . Esta falta de diferencia significativa puede atribuirse a que la población analizada se desempeña en un puesto de trabajo que no está feminizado o masculinizado, como sí podrían estar otros puestos de trabajo del ámbito informal. Debido al impacto en salud que esto conlleva, es un factor que se debe tomar en cuenta si se sabe que, en los países en desarrollo, el sector informal es la principal fuente de empleo para las mujeres4.La mayor parte de los/as participantes no cuenta con sistema previsional formal, no presentando brechas de género, lo que es contrario a lo reportado en otros estudios sobre trabajo informal19.Si bien existe una heterogeneidad en la percepción, tanto de hombres como mujeres, de la preocupación del empleador sobre su salud y seguridad, se identifica una tendencia hacia la mayor percepción de negligencia por parte de las mujeres . Podríamos vincular esta diferencia a aspectos culturales sobre la mayor relevancia que se da a la salud y la seguridad en el rol femenino. No obstante, dicha negligencia se expresa en los relatos similares de bajo acceso a capacitación, información y elementos de protección personal en su trabajo. A su vez, esto evidencia que en este rubro no existen prácticas claras respecto a las obligaciones del empleador a preocuparse del bienestar de trabajadores y trabajadoras, lo que es coincidente con otros estudios sobre trabajo informal12, bajo altas exigencias físicas y sufren más lesiones por accidentes de trabajo20, junto a mayores niveles de trabajo de pie, movimientos repetitivos, con levantamiento o traslado de objetos pesados, entre otros14. Pese a que la distribución de mujeres y hombres en el mercado laboral, en general, está dada por cómo se configuran las identidades femeninas y masculinas21, los resultados anteriores reflejan que en estos puestos de trabajo no existe una clara división de tareas ni de sus condiciones de trabajo por género, siendo ambos igualmente exigidos.En general, solo factores físicos  presentan una exposición en más de la mitad de la muestra, mientras que se identificaron niveles de exposición global bajo un 30% a ruido, altas y bajas temperaturas o luz durante la jornada laboral. La única diferencia entre géneros en las condiciones de trabajo se identificó en el alto nivel de exposición a bajas temperaturas por parte de las mujeres , lo cual podría atribuirse a que la mayor parte del día las mujeres refieren estar sentadas dedicadas a la venta en un espacio abierto y con techo alto que permite la circulación de aire como es el galpón donde se ubican los puestos de la Vega Central. En contraste, estudios similares tanto internacionales como nacionales han identificado que los hombres se exponen más a realizar trabajos en posturas incómodas22. Adicionalmente, la literatura sobre determinantes sociales de la salud y su impacto en la gradiente social de salud sitúa a los problemas y trastornos de salud mental con mayor prevalencia en grupos poblacionales con menor nivel educativo y menor edad24, elemento que considerar dado el bajo nivel educativo presentado en la muestra en general y en las mujeres en comparación a los hombres. Sin embargo, otro estudio sobre contexto de informalidad en América Central11 refiere que tanto hombres como mujeres presentan una mala percepción de salud mental, resultados similares a lo reportado en Chile, en que los trabajadores inestables e informales presentan significativamente menores niveles de bienestar mental respecto de los estables y formales14, por lo que el desánimo y la tristeza podrían estar igualmente asociados o bien potenciados por el trabajo informal y el bajo nivel educativo, que es a la vez una de las razones por las cuales se accede a este tipo de empleos.En relación a la calidad de vida, si bien la mayoría de los trabajadores se han sentido agotados la mayor parte del tiempo, no manifiestan dificultades para realizar su actividad laboral ni hacen menos de lo deseado por problemas emocionales. No obstante, las mujeres se perciben desanimadas y tristes durante la jornada en más de 2,01  veces que los hombres, lo cual puede atribuirse a diversos factores, entre ellos, la diferente apertura a reconocer el estado anímico de hombres y mujeres, ya que de acuerdo al mandato hegemónico de la masculinidad un hombre no debe ser débil o reconocer tristeza. Por otro lado, este hallazgo es concordante con la estadística en la población general sobre salud mental, ya que mujeres presentan mayor prevalencia de síntomas depresivos que hombres11, puede ser explicada por la semejanza de las exigentes condiciones de trabajo y empleo en que ambos géneros desempeñan sus labores. A su vez, al describir las categorías “casi siempre falso/definitivamente falso”, se identificó una brecha de más del doble entre mujeres  y hombres , con un riesgo relativo de 2,07 . Dicha asociación muestra mayor correlación en el caso de hombres a factores de origen físico y psicológico , mientras que en mujeres muestra principal asociación con factores físicos en las tareas que realizan . Otros estudios explican esta brecha por factores de riesgo físicos y sensoriales, doble presencia, baja calidad de liderazgo, bajo apoyo social y poca oportunidad de desarrollo de habilidades en el trabajo26 y conflictos de tiempo para conciliar demandas laborales y familiares en las mujeres27.Respecto a la autopercepción de salud en general, más del 60% señala como “definitivamente cierto/casi siempre cierto” que su salud es excelente, presentándose en un 53,3% de mujeres y un 74% de hombres. Esta similitud global en la salud autopercibida, si bien no es consistente con lo reportado en otros estudios28. Además, Alfers et al.8 mostraron que en el contexto de informalidad laboral en Sudáfrica existe una fuerte asociación entre bajos ingresos y peor estado de salud, incluso mayor que con la formalidad laboral. En otras asociaciones con la salud, se ha visto que la exposición a riesgos psicosociales está mediada también por la clase social a la que la persona pertenece28.Con base en la literatura, otro de los factores que influyen en la autopercepción de salud de trabajadores informales corresponde a las características y experiencias de los sistemas de salud en los que participan las personas que trabajan en la Vega Central, tales como los problemas de administración de los servicios de salud, los malos tratos hacia los usuarios y la falta de recursos para el sector salud29, considerando que la migración en Chile viene en aumento sostenido y que las políticas de salud y seguridad social siguen dejando fuera de sus reformas la situación de informalidad y los efectos en el bienestar de las trabajadoras y los trabajadores30.El crecimiento del mercado de trabajo informal en América Latina se reconoce como una consecuencia del desarrollo del modelo económico, al cual se debe poner importante atención dada la tendencia a la informalidad como resultante de los procesos migratorios de la población hacia grandes ciudadesDentro de las limitaciones de este estudio, se encuentran las barreras presentadas en el proceso de reclutamiento de participantes y recolección de datos en el contexto del empleo informal, tanto por la carga temporal en el trabajo como por la extensión de los instrumentos. Si bien esto afecta la potencia estadística de los datos, se realizó un análisis post-hoc, encontrando valores superiores a 0,8 en las siguientes variables que presentan diferencias de género: “autopercepción de la salud”, “percepción de ánimo y temor a reclamar mejores condiciones”, y “preocupación de las empresas sobre su salud y seguridad en el trabajo”.Otra limitación de este estudio es que dado su alcance descriptivo no profundiza en identificar las causas subyacentes a las diferencias de género en la percepción de salud, por lo que se requieren nuevos estudios que sean prospectivos o cualitativos, que puedan profundizar la comprensión del trabajo informal en mercados o ferias libres.Los resultados de este estudio y su análisis permiten concluir que, a pesar de que en el rubro estudiado mujeres y hombres presentan similares condiciones de trabajo y laborales, las mujeres tienen peor percepción de su salud mental y salud general. Solo se identifican diferencias de género en la percepción sobre la preocupación del empleador por la salud y seguridad en el trabajo. Por lo tanto, las estrategias de promoción y prevención en salud laboral en los distintos rubros del trabajo informal, así como futuros estudios en este ámbito, deben diseñarse desde una perspectiva de género, incorporando tanto las condiciones laborales como los indicadores de salud y calidad de vida. Por otro lado, en cuanto avanzan las políticas de formalización del empleo y seguridad social, se pueden implementar estrategias alternativas para apoyar a madres y padres con el cuidado de hijos pequeños, tales como el desarrollo de convenios con servicios públicos locales para acceder a beneficios como el acceso a jardines infantiles, a los programas de extensión horaria de las escuelas, o bien contar con guarderías en el mismo recinto. Por lo anterior, toda medida e investigación en trabajo informal requieren considerar las particularidades de las mujeres que influyen en su desempeño y salud general en el trabajo.


A cardiomiopatia hipertrófica (CMH) é um distúrbio genético caracterizada pela hipertrofia inexplicada do ventrículo esquerdo, comumente assimétrico com maiores espessamentos do septo interventricular basal. A obstrução da via de saída do ventrículo esquerdo está presente em repouso em cerca de um terço dos pacientes e pode ser provocada em outro terço. As características histológicas da CMH incluem hipertrofia e desordem dos miócitos, além de fibrose intersticial. A hipertrofia também é frequentemente associada à disfunção diastólica do ventrículo esquerdo.5O primeiro caso de CMH foi descrito por Henri Liouville em 1869 no Gazette Medecine Paris. Em 1907, o Dr. A. Schmincke, patologista alemão, descreveu dois corações com hipertrofia ventricular esquerda; ambos vieram de mulheres na casa dos cinquenta anos. Levy e von Glahn, em 1944, da Universidade da Colômbia, em Nova York, publicaram uma série de casos que se assemelham a CMH. Em 1949, William Evans, um cardiologista de Londres, descreveu a ocorrência familiar de hipertrofia cardíaca em uma série de pacientes semelhantes aos descritos no artigo de Levy e von Glahn. Dr. Eugene Braunwald e Dr. Andrew Glenn Morrow publicaram uma série de trabalhos onde detalharam aspectos clínicos e hemodinâmicos desta doença permitindo estabelecer objetivos terapêuticos.7 A prevenção de eventos de MS através de implante de um dispositivo de implantado parece óbvia, uma vez que as opções de tratamento clínico para prevenção de arritmia grave fatal não podem ser oferecida pelo tratamento farmacológico de forma confiável. Como uma terapia de elevado custo e não isenta de eventos adversos (infecção e choque inapropriado) tornou-se mandatório estabelecer quais grupos teriam benefício com a indicação de terapia com desfibrilador implantado.Na maioria dos pacientes a CMH tem um curso relativamente benigno. Porém a CMH também é uma causa importante de morte súbita (MS), particularmente em adolescentes e adultos jovens, com risco de 0,5 a 2% ao ano, sendo a causa mais frequente de MS em adolescentes.8 e a calculadora de risco para avaliação de MS pela Sociedade Europeia de Cardiologia em 2015.9 Com metodologias diferentes ambas se propunham auxiliar o clínico a identificar um grupo de pacientes de maior benefício.Entre os escores de avaliação de risco de MS para definir os pacientes de maior benefício, ganharam destaques a calculadora de risco da AHA publicada em 201110Um classificador ideal deveria ser simples, com poucos critérios, cada critério sendo de fácil interpretação, reproduzível com base na prática existente, altamente sensível, de alto valor preditivo negativo, capaz de reduzir riscos com menor custo possível. Ainda que atenda a todos os quesitos acima, temos que levar em consideração que os modelos prognósticos são desenvolvidos para serem aplicados em novos pacientes, que podem vir de diferentes centros, de diferentes raças, hábitos, morbidades distintas e com os mais diferentes microbiomas. Portanto, novos pacientes são comumente referidos como diferentes, mas semelhantes aos pacientes usados para desenvolver os modelos. Quando uma nova população de pacientes pode ser considerada semelhante (suficiente) à população em desenvolvimento para justificar a validação e, eventualmente, a aplicação de um modelo? A resposta a esta pergunta é totalmente dependente de registros médicos que possam revalidar ferramentas que usamos em nossa prática.11 vai além e avalia de forma prospectiva uma coorte de pacientes aplicando as ferramentas mais usadas na atualidade para validar qual delas seria de maior acurácia em nossa população, assim como identifica pontos fortes e fragilidades de nossa capacidade de avaliar e predizer eventos futuros. A importância do trabalho vai além do tema, uma vez que demonstra a necessidade de obtermos registros, permitindo que a comunidade cientifica seja capaz de revalidar os mais distintos escores clínicos em nossa prática. Com enorme impacto em eficácia (ao reduzir ocorrência de mortes súbitas) assim como de eficiência .O trabalho em questão Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by commonly asymmetric unexplained left ventricular hypertrophy, with greater thickening of the basal interventricular septum. Left ventricular outflow tract obstruction is present at rest in around one third of patients and can be caused in another third. The histological features of HCM include hypertrophy and myocyte disorder, in addition to interstitial fibrosis. Hypertrophy is also often associated with left ventricular diastolic dysfunction.5The first case of HCM was described by Henri Liouville in 1869 in the Gazette Medecine Paris. In 1907, Dr. A. Schmincke, a German pathologist, described two hearts with left ventricular hypertrophy; both were seen in women in their fifth decade of life. Levy and von Glahn, in 1944, from the University of Colombia, in New York, published a series of cases that resembled HCM. In 1949, William Evans, a cardiologist from London, described the familial occurrence of cardiac hypertrophy in a series of patients similar to those described in the article by Levy and von Glahn. Dr. Eugene Braunwald and Dr. Andrew Glenn Morrow published a series of studies where they detailed the clinical and hemodynamic aspects of this disease, allowing the establishment of therapeutic objectives.7 The prevention of SD events through a device implantation seem obvious, since the clinical treatment options for the prevention of severe fatal arrhythmia cannot be reliably offered by pharmacological treatment. As a high-cost therapy and one that is not exempt from adverse events (infection and inappropriate shock), it became mandatory to establish which groups would benefit from the indication of therapy with an implanted defibrillator.HCM has a relatively benign course in the majority of patients. However, HCM is also an important cause of sudden death (SD), particularly in adolescents and young adults, with a risk of 0.5 to 2% per year, being the most frequent cause of SD in adolescents.8 and the risk calculator for assessing SD by the European Society of Cardiology in 2015 were highlighted.9 With different methodologies, both proposed to assist the clinician in identifying a group of patients that would have the greatest benefit.Among the SD risk assessment scores to define which patients would have the greatest benefit, the AHA risk calculator published in 201110An ideal classification system should be simple, have few criteria, with each criterion being easy to interpret, be reproducible based on existing practice, highly sensitive, with high negative predictive value, capable of reducing risks at the lowest possible cost. Although it meets all the above requirements, we have to consider that the prognostic models are developed to be applied to new patients, who may come from different centers, have different ethnicities, habits, different morbidities and with the most different microbiomes. Therefore, new patients are commonly referred to as different, but similar to the patients who were used to develop the models. When can a new population of patients be considered (sufficiently) similar to the developing population to justify the validation and, possibly, the application of a model? The answer to this question is totally dependent on medical records that can revalidate tools used in our practice.11 goes further and prospectively evaluates a cohort of patients using the tools most frequently used at present to validate which of them would be the most accurate in our population, and also identifies the strengths and weaknesses of our capacity to assess and predict future events. The importance of the study goes beyond the topic, since it demonstrates the need to obtain records, allowing the scientific community to be able to revalidate the most distinct clinical scores in our practice, with a huge impact on efficacy (by reducing the occurrence of sudden deaths) as well as efficiency .The present study


Esse número diminuiu para 1380 nos mesmos meses em 2020 (durante a COVID-19), o que representou uma redução de 57% no número total de pacientes atendidos. AAs características sociodemográficas dos pacientes atendidos no setor de emergência antes e durante a crise da COVID-19 estão detalhadas na tabela S1 . A idade média dos pacientes diminuiu, assim como o percentual de pacientes ≥ 60 anos e de pacientes atendidos no setor de emergência provenientes de outras cidades que não Goiânia. O percentual de funcionários do hospital e de pacientes sem plano de saúde aumentou durante o surto de COVID-19.Ao se avaliar as diferenças clínicas entre os pacientes e tratamentos antes e durante o surto de COVID-19, houve alterações significativas em quase todas as variáveis. O número de pacientes classificados como urgentes na triagem aumentou, assim como o tempo gasto no setor de emergência. Houve também um aumento do número de todos os procedimentos diagnósticos realizados no setor de emergência , enquanto o uso de medicamentos diminuiu. A quantidade de pacientes que necessitaram de interação hospitalar aumentou, especialmente daqueles que necessitaram de internação na UTI. Ao se comparar os diagnósticos mais comuns, houve uma diminuição nos casos de gastroenterite infecciosa e de dengue. Por outro lado, os casos de transtorno de ansiedade aumentaram, assim como os de síndrome respiratória viral. Não houve alteração no percentual de casos de doença cardiovascular, embora tenha havido uma redução de 49,6% no número absoluto de casos. AAlém disso, a tabela S2  detalha as diferenças sociodemográficas e clínicas entre os pacientes com e sem síndrome respiratória viral. As diferenças mais significativas em favor daqueles que não apresentaram síndrome respiratória viral foram observadas no percentual de pacientes ≥ 60 anos, que foram classificados como urgentes na triagem, que necessitaram de medicamento e que realizaram ECG no setor de emergência. Por outro lado, as diferenças mais significativas em favor dos pacientes com síndrome respiratória viral foram observadas no percentual de paciente que eram funcionários do hospital, que realizaram exames de imagem e que solicitaram afastamento por doença.Alterações significativas no número de pacientes atendidos nas emergências de todo o mundo durante o surto de COVID-19 foram relada em cartas ao editor, pontos de vista e documentos não cientificos. Entretanto, segundo nosso conhecimento, este é o primeiro estudo científico o apresentar os resultados dessas alterações com dados da vida real. De fato, nosso estudo observou uma redução significativa do número de pacientes no setor de emergência, a qual alcançou 57%. Ocorreram alterações na frequência de diagnósticos, além de diferenças no atendimento prestado a esses pacientes.9 Diante disso, acreditamos que nossa comparação é a mais confiável e eficaz na prevenção de vieses.A comparação dos 2 meses após a implementação das medidas oficiais de distanciamento social motivadas pela COVID-19 com o período equivalente do ano anterior baseou-se nas diferenças sazonais dos pacientes atendidos nas emergências. Na região onde o estudo foi realizado, arboviroses, especialmente a dengue, são condições altamente prevalentes no período analisado.10 Outro estudo, realizado nos EUA, observou um redução de até 48% nas taxas semanal de hospitalização por infarto agudo do miocárdio durante o período da pandemia de COVID-19.11 Embora a redução do número absoluto observada em nosso estudo seja semelhante à de outros dados internationais, não houve alteração no percentual de pacientes com doenças cardiovasculares atendidos no setor de emergência durante o surto de COVID-19.Houve uma redução de 49,6% no número absoluto de pacientes com doenças cardiovasculares atendidos no setor de emergência. Um estudo italiano obteve resultados semelhantes ao avaliar apenas as internações hospitalares por infarto agudo do miocárdio durante uma semana em comparação a uma semana equivalente em 2019.12 Esse achado é corroborado por várias publicações que avaliaram a COVID-19 e também as medidas de distanciamento social e o seu impacto na saúde mental da população.15Um aspecto interessante dos resultados aqui apresentados é o aumento do percentual de pacientes com transtornos de ansiedade atendidos no setor de emergência durante a pandemia de COVID-19.16 Por fim, o aumento do número de pacientes que necessitaram de internação na UTI demonstra a gravidade da doença.17As características clínicas dos casos suspeitos/confirmados de COVID-19 podem ser observadas nos nossos resultados ao se comparar os pacientes com e sem síndrome respiratória viral. Primeiramente, o atendimento a esses pacientes demanda mais tempo, conforme demonstrado pelo aumento significativo do tempo gasto no setor de emergência. Visto que se trata de uma doença altamente contagiosa, são solicitados mais afastamentos por doença. O número de pacientes atendidos que trabalhavam no hospital também aumentou, sugerindo uma alta prevalência da doença em profissionais da saúde, conforme já relatado anteriormente.As potenciais limitações deste estudo devem ser mencionadas. Em primeiro lugar, trata-se de um estudo unicêntrico realizado na capital de um estado no qual o número de casos de COVID-19 era baixo se comparado ao de outras capitais do Brasil. Em segundo lugar, selecionamos os diangósticos mais comuns, de acordo com a definição do médico assistente do setor de emergência, deixando assim de investigar algumas doenças. Por último, as comorbidades dos pacientes não foram relatadas, porque essa informação não estava disponível no banco de dados utilizado no estudo.É importante ressaltar que a coleta de dados durante uma emergência de saúde pública é extremamente desafiadora. Todos os esforços estão voltados para a pandemia, tanto no cuidado aos pacientes quanto na preocupação dos prestadores de cuidados de saúde em se contaminarem. Ainda assim, quanto mais dados científicos forem disponibizados, melhores serão os cuidados para tratar a COVID-19 e todas as outras doenças que estão afetando os pacientes nesses tempos tão difíceis. Outro aspecto importante é o fato de que este é um estudo observacional em que foram descritas as alterações nas características dos pacientes. Sendo assim, não é possível estabelecer uma relação causa-efeito precisa.*Material suplementarclique aquiPara informação adicional, por favor, 1On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization, and the first case was reported in Brazil by the end of February.2The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1Considering public health, the traditional outbreak response strategy of isolation, quarantine, social distancing, and community containment has been implemented in multiple countries and has played an important role in preventing disease spread.3Given the absence of specific treatment and the high morbidity and mortality of COVID-19, particularly in high-risk groups, extraordinary public health measures have been implemented worldwide.5These actions were justified by the worrisome COVID-19 spread in ERs and the habit of the Brazilian population of seeking ER care as an alternative to regular care with primary care physicians.6Since the first COVID-19 case was reported in Brazil, in addition to social distancing measures, a massive campaign has been implemented to prevent patients from seeking medical care at emergency rooms (ER) unless extremely necessary. Most campaign actions took place on social media, traditional media, and government reports.8Despite these changes, there is a lack of scientific data on the real impact of the COVID-19 outbreak on ERs in Brazil. Aiming to address this knowledge gap, we compared the sociodemographic and clinical characteristics of patients seeking ERs before and after the onset of the COVID-19 outbreak in Brazil.The number of patients around the country seeking medical assistance in ERs for reasons other than acute respiratory syndromes has decreased significantly, particularly after the implementation of social distancing measures.We conducted a retrospective single-center study assessing the medical records of all consecutive patients who sought medical care in an ER of a private general hospital specialized in cardiovascular care. This facility is located in a state capital of Brazil’s Central-West region. We compared data of patients treated before the implementation of quarantine measures in the city and those treated afterwards. The study was approved by the institution’s Ethics Committee and as no patient identification data were to be used, a consent form was not required.The mean number of patients treated monthly in the institution’s ER in 2019 was 1500. Since social distancing measures were officially implemented on March 16, 2020 by a state resolution, we decided to compare data referring to the 2 months after quarantine implementation  with the same period of the previous year .The assessed variables were: number of patients, age, sex, city of residency, health insurance, reason for seeking medical assistance, and time spent in the ER; we also evaluated whether the patient was a hospital employee, required sick leave, received medication, underwent any laboratory or imaging tests, underwent an electrocardiogram (EKG), was discharged from the ER, required hospital admission, or required admission to an intensive care unit (ICU).Detailed descriptions of the methods are provided on the Supplemental Material.During the 2 assessed months of 2019 (pre-COVID-19), the total number of patients treated at the ER was 2934. This number decreased to 1380 in the same months of 2020 (during COVID-19), which translates into a 57% reduction in the total number of treated patients. The number of patients treated per month during the studied time frame is shown onThe sociodemographic characteristics of patients treated at the ER pre- and during the COVID-19 crisis are shown on Table S1 . Their mean age was decreased, as well as the percentage of patients aged ≥ 60 years and coming from cities other than Goiânia. The proportion of hospital employees and of patients with no health insurance increased during the COVID-19 outbreak.When comparing the clinical characteristics of patients and treatments pre- and during the COVID-19 outbreak, we observed that almost all variables changed significantly. The number of urgent triage classifications increased, and so did the time spent by patients at the ER. The number of diagnostic procedures performed at the ER  increased, while medication use decreased. Patients requiring hospital admission increased, particularly those requiring ICU admission. When comparing the most common diagnoses, there was a decrease in infectious gastroenteritis and dengue fever cases. Conversely, the number of patients with anxiety disorders and respiratory viral syndromes increased. No changes were seen on the proportion of cardiovascular diseases in relation to other diagnoses, although a 49.6% absolute reduction in their cases was observed. A summary of these findings is presented onAdditionally, on Table S2 , the sociodemographic and clinical differences between patients with or without respiratory viral syndromes were compared. The most significant differences towards patients without respiratory viral syndromes were in the proportion of patients aged ≥ 60 years, triaged as urgent, who required medication, or underwent electrocardiography at the ER. On the other hand, the percentages of patients who were hospital employees, underwent imaging tests, or required sick leaves were the most significantly different and higher in those with respiratory viral syndromes.A significant change in the number of patients treated at ERs worldwide during the COVID-19 outbreak has been reported by letters to editors, points of view, and non-scientific documents. Nevertheless, to our knowledge, this is the first scientific study presenting real-life results of these changes. In our study, we observed a significant reduction in the number of patients cared for at the ER, reaching a 57% decrease. Changes in frequencies of different diagnoses also happened, as well as in the care given to the patients.9Therefore, we believe that our method of comparison is the most reliable and effective for avoiding bias.The comparison between the 2 months following official COVID-19 social distancing measures and the same period of the previous year was based on seasonal differences observed in patients treated at ERs. In the Brazilian region where the study was conducted, arboviruses, particularly dengue fever, have a high prevalence during the assessed months.10Another study, conducted in the USA, found that weekly hospitalization rates for acute myocardial infarction decreased by up to 48% during the COVID-19 period.11Although the absolute reduction found in our study was similar to other international data, we found no changes in the relative percentage of patients with cardiovascular diseases treated at the ER during the COVID-19 outbreak.We observed a 49.6% absolute reduction in the number of patients with cardiovascular diseases treated at the ER. An Italian study found similar results when assessing only hospital admissions for acute myocardial infarction over a period of one week in comparison with the same week of 2019.12This finding is supported by various publications that assessed COVID-19, social distancing measures, and the impact on the population’s mental health.15An interesting aspect of the results presented here is the increase in the percentage of patients with anxiety disorders being treated at the ER during the COVID-19 pandemic.16Finally, the higher number of patients requiring ICU admission indicated disease severity.17Clinical features of suspected/confirmed COVID-19 cases can be seen in our results when comparing patients with and without respiratory viral syndromes. Firstly, the treatment of these patients is time-consuming, which was indicated by a significant increase in time spent at the ER. Since this is a highly contagious disease, patients required more sick leaves. The number of treated patients who were hospital workers also increased, suggesting a high prevalence of COVID-19 in health care professionals, as previously reported.Potential limitations of this study need to be acknowledged. This was a single-center study conducted in the capital of a state in which the number of COVID-19 cases was low when compared to other state capitals in Brazil. Secondly, we selected only the most common diagnoses defined by the attending ER physician, which left some diseases uninvestigated. Finally, the patients’ comorbidities were not reported, since this information was not available on the database used in this study.It is important to highlight that data collection during a public health emergency is extremely challenging. All efforts were targeted at the pandemic; not only on patient care, but also on the worrisome possibility of health care providers being infected. As more scientific data becomes available, health care teams will be able to provide better care for patients with COVID-19 and other diseases in these difficult times. Another important aspect is the fact that this is an observational study that described changes on patients’ features, thus not being accurate for establishing cause-effect relationships.*Supplemental Materialsplease click here.For additional information,


Os polifénois são um grupo de moléculas encontradas em alimentos vegetais e tem sido associados a efeitos benéficos no tratamento de várias condições clínicas.7 O pterostilbeno (PS) é um derivado do resveratrol encontrado em frutas vermelhas e uvas e com efeito antioxidante em diferentes modelos.12Nos cardiomiócitos, as espécies reativas podem ter origem nas enzimas nicotinamida adenina dinucleotíde (NADPH) oxidases, xantina oxidase e óxido nítrico sintase (NOS) desacoplada.13Nesta edição dos Arquivos Brasileiros de Cardiologia, Tasca et al. mostram o efeito protetor deste composto nos tecidos cardíacos e pulmonares em modelo experimental de infarto agudo do miocárdio (IAM) em ratos Wistar. O IAM promoveu alterações funcionais cardíacas, acompanhadas de aumento das enzimas oxidantes  e menor concentração de antioxidantes (sulfidrilas e NOS). Nos pulmões, houve redução da concentração de SOD 14 dias após o evento isquêmico nos animais que não receberam o composto antioxidante. Em relação aos efeitos do PS, este reverteu as alterações encontradas nas enzimas antioxidantes do VD pós-infarto e aumentou a concentração de glutationa, SOD e CAT no tecido pulmonar, confirmando o efeito antioxidante. É interessante observar ainda que houve aumento da expressão do fator nuclear 2 relacionado ao eritroide 2 (Nrf2), um regulador chave da resposta antioxidante, indicando um potencial mecanismo de ação do PS.Desta forma, nota-se que a avaliação do tecido pulmonar e do VD após o IAM é um diferencial do trabalho, bem como a caracterização do efeito antioxidante do PS nesses tecidos, abrindo caminhos para melhor entendimento das ações de compostos antioxidantes nas alterações pós infarto e o uso do PS em diferentes tempos de intervenção e em outros modelos. 2 In Brazil, ischemic heart diseases are the leading cause of cardiovascular death,3 and acute myocardial infarction presented a mortality rate of 9.06% until October 2021.4Cardiovascular diseases are the main cause of death worldwide.7 However, when there is prolonged production of reactive species, incapacity of the antioxidant system and amplification of inflammatory and metabolic changes in the heart, non-infarcted region is impaired, leading to progressive changes in ventricular geometry.8 Progressively, changes can occur in the left and right ventricles associated with hemodynamic changes in the pulmonary vessels and consequent pulmonary hypertension.9 In this context, the search for treatments that might attenuate cardiac and pulmonary changes focusing on redox balance stand out.Myocardial ischemia generates reactive oxygen species (ROS) and reactive nitrogen species (RNS), which, in turn, increases pro-inflammatory mediators that might activate different pathways to promote repairing of the infarcted region, a process known as cardiac remodeling.10 Reactive species production generated in tissues can be blocked through enzymatic antioxidant system, including glutathione peroxidase (GPx), superoxide dismutase (SOD) and catalase (CAT), or through non-enzymatic systems, which include glutathione, vitamin C and E.6 Recently, the use of antioxidant components derived from foods has been highlighted in different models. Polyphenols are a group of molecules found in plant foods and have been associated with beneficial effects in prevention and treatment of various clinical conditions.7 Pterostilbene (PS) is a resveratrol derivative found in red fruits and grapes and it has been exhibited antioxidant effect in different disease models.12Regarding cardiomyocytes, reactive species can be originated from nicotinamide adenine dinucleotide (NADPH) oxidases, xanthine oxidase and uncoupled nitric oxide synthase (NOS) enzymes.13In the present issue of Arquivos Brasileiros de Cardiologia, Tasca et al. show the protective effect of this compound on cardiac and pulmonary tissues in an experimental model of acute myocardial infarction (AMI) in Wistar rats. AMI promoted cardiac functional alterations, accompanied by an increase in oxidizing enzymes  and lower concentration of antioxidants (sulfhydryls and NOS) in the right ventricle (RV). In lung tissue, reduction in the concentration of SOD 14 days after the ischemic event in animals that did not receive the antioxidant compound was observed. Regarding PS effects, it reversed the changes found in antioxidant enzymes of the post-infarction RV and increased the concentration of glutathione, SOD and CAT in the lung tissue, confirming the antioxidant effect. Interestingly, there was an increase in the expression of nuclear factor 2 related to erythroid 2 (Nrf2), a key regulator of the antioxidant response, indicating a potential mechanism of action for PS.Thus, it is noted that the assessment of lung tissue and the RV after AMI is a differential of the present research, as well as the characterization of the antioxidant effect of PS in these tissues, opening paths for a better understanding of antioxidant compounds action in post-infarction changes and the use of PS in different times of intervention and other models.


Caro Editor,Gostaríamos de compartilhar ideias sobre a publicação “Valor Prognóstico da Troponina T e do Peptídeo Natriurético Tipo B em Pacientes Internados por COVID-19. Dear Editor,In the first 24h of admission, TnT, but not BNP, was an independent marker of mortality or need for invasive mechanical ventilation.”We would like to share ideas on the publication “Prognostic Value of Troponin-T and B-Type Natriuretic Peptide in Patients Hospitalized for COVID-19 [1].” Almeida Jr. et al.


Últimos dados divulgados pelo DATASUS (2020) mostram que ocorrem 26.482 mortes por IC.3A insuficiência cardíaca (IC) constitui problema clínico de extrema importância devido à sua alta prevalência e à gravidade das manifestações clínicas.6A característica multifatorial da síndrome exige que a escolha do tratamento seja realizada por equipe multiprofissional e atenta para as recomendações propostas nas diretrizes de tratamento da IC. O acompanhamento e monitorização dos pacientes são essenciais para a melhora dos desfechos clínicos.4 Diversos estudos evidenciaram a importância do controle da FC para melhorar os desfechos como risco de morte e admissão hospitalar por IC.8O controle da frequência cardíaca (FC) é considerado alvo terapêutico no tratamento da IC, visto que FC elevada é marcador de eventos em IC.9 teve o objetivo de avaliar se os pacientes acompanhados em ambulatório de cardiologia tem sua FC controlada e recebem prescrição de medicação para IC adequada segundo as diretrizes.9Portanto, estudos observacionais que monitoram pacientes com IC são fundamentais para apresentar um panorama da efetividade dos tratamentos na IC. Nesse sentido, estudo realizado por Cardoso et al.10Em um recente estudo global foi observado que, apesar de satisfatória aderência às recomendações das diretrizes de tratamento da IC, é observada subdosagem dos medicamentos recomendados. São necessárias ações para melhorar essa situação, pois altas doses das terapias recomendadas são associadas à redução da mortalidade em estudos observacionais de IC.9 ressaltam que a redução da FC com os betabloqueadores não é igual para todos os pacientes. Levantando, dessa forma, o importante questionamento do que seria mais importante para determinar uma boa evolução dos pacientes com IC, a dose alvo do betabloqueador ou a redução da FC?Em seu estudo, Cardoso et al.9O estudo avaliou 171 pacientes e mostraram dados muito relevantes sobre a eficácia do tratamento da IC sobre o controle da FC. Apesar de o betabloqueador ter sido prescrito em doses elevadas para 98,8% dos pacientes, uma grande parcela  apresentou FC maior que 70 batimentos por minuto. Os autores observaram também que outras classes de medicamentos recomendados para tratamento da IC, como inibidores da enzima conversora de angiotensina, bloqueadores do receptor da angiotensina e diuréticos, estavam sendo prescritos adequadamente.9 sugere que outras medidas precisam ser adotadas, além da prescrição das doses alvo dos medicamentos indicados pelas diretrizes, para manter o controle da FC em pacientes com IC.Dessa forma, considerando o impacto da FC no prognóstico de pacientes com IC, o estudo conduzido por Cardoso et al. 2 The increment in population longevity has increased the number of hospitalizations and deaths due to HF. Recent data by DATASUS (2020) show the occurrence of 26,482 deaths from HF.3Heart failure (HF) is an important public health issue due to its high prevalence and the severity of clinical manifestations.6This syndrome has a multifactorial characteristic and its treatment requires a multidisciplinary team to meet the recommendations proposed in the guidelines for the treatment of HF. Follow-up and monitoring of patients are essential for improving the clinical outcomes.4 Several studies have shown the importance of HR control to improve outcomes such as risk of death and hospital admission by HF.8Heart rate (HR) is considered a therapeutic target in the treatment of HF, since elevated HR is a marker of events in HF.9 aimed to assess whether patients monitored in outpatient settings have their HR controlled and receive drug prescriptions according to the guidelines for the treatment of HF.9Therefore, observational studies are essential to investigate the impact of the treatment of patients with HF. In this sense, a study carried out by Cardoso et al.10A recent global study showed that despite satisfactory adherence to the recommendations of guidelines for the treatment of HF, an under-dosage of the recommended drugs is observed. Actions are needed to improve this situation, since high doses of recommended therapies are associated with reduced mortality in observational studies of patients with HF.9 mentioned that beta-blockers do not have the same effect reducing HR for all patients. Thus, the authors raised an important question of what would be more important to determine a good outcome for patients with HF, the target dose of the beta-blocker or the reduction in HR?In their study, Cardoso et al.9The study evaluated 171 patients in outpatient settings and showed very relevant data on the effectiveness of the treatment of HF on HR control. Although beta-blockers were prescribed in high doses for 98.8% of patients, a large portion (40.9%) had HR greater than 70 beats per minute. The authors also observed that other classes of drugs recommended for the treatment of HF, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and diuretics, were properly prescribed.9 suggests that other actions in addition to the prescription of the recommended drug therapy need to be adopted to ensure the control of HR in patients with HF.Thus, considering the impact of HR on the prognosis of patients with HF, the study conducted by Cardoso et al.


O Arquivos Brasileiros de Cardiologia (ABC Cardiol) é o periódico científico de maior impacto em Cardiologia no Brasil e na América Latina. Em sua história tem tido o papel fundamental de divulgar a produção cientifica nacional em periódico indexado em todas as bases de dados internacionais mais significantes e em língua inglesa. No momento atual constitui-se, portanto, na verdadeira janela da nossa produção científica para o mundo.1 na Journal of Citation Report. A palavra aqui é gratidão a todos os que direta ou indiretamente contribuíram ee torcem para o sucesso do ABC Cardiol e, principalmente, a nossa comunidade científica.2As evoluções e resultados positivos que obtivemos nesta gestão atual se apoiam em ações contínuas de gestões anteriores do ABC Cardiol. Aqui aproveito para textualizar meus agradecimentos a todos os Editores-Chefes anteriores, fundamentais na evolução do ABC Cardiol e que permitiu que a gestão atual atingisse resultados positivos, como o do fator de impacto de 2,0No entanto, os desafios continuam na busca de atingir novos patamares nas missões dos Arquivos Brasileiros de Cardiologia. Nessa jornada de avanços, as melhores ideias vêm da discussão com grupos envolvidos na gestão e da “inteligência coletiva” que Editores-Associados, Assistentes Editoriais, Revisores, membros dos conselhos de publicação da SBC, Editores Anteriores, Diretores da SBC e membros da SBC. Aqui convoco a todos a participarem ativamente do ABC Cardiol e a submeterem seus melhores trabalhos na mais importante revista de Cardiologia do nosso meio.O que estamos planejando hoje para os próximos 4 anos de gestão, até 2025, estão no texto deste Editorial. Porém novas ideias e ações podem surgir e tudo depende da participação ativa de todos. Este Editor-Chefe tem os ouvidos, mente e coração abertos a sugestão de todos. Contribuam!Na linha editorial e formato do ABC Cardiol, continuaremos com os minieditoriais convidando os Revisores de artigos a escreverem sua visão sobre o dado original publicado no ABC Cardiol. No ABC Cardiol, quem revisa, escreve minieditoriais!9 O foco está e continuará nas doenças cardiovasculares sob todos os seus aspectos, incluindo a interdisciplinaridade.Estamos estimulando publicações de revisões sistemáticas e metanálises de alta qualidade, o que tem ajudado muito a responder perguntas para as quais estudos clínicos randomizados ainda não estão disponíveis. Temos ainda uma grande missão de divulgar nossos dados populacionais para ajudar nossos gestores públicos a realizarem as melhores decisões em prol da população brasileira.o novo portal do ABC Cardiol, que inclui modernas técnicas de procura e permite que web crawlers do Google e de outras ferramentas de procura identifiquem nossos artigos publicados e disponibilizem nas buscas efetivadas por usuários nestas ferramentas. Os resultados já são perceptíveis com até 80 mil acessos por mês nas nossas páginas.Estudos com dados originais dos programas de pós-graduação de todo o nosso país são a fonte dos artigos de melhor qualidade do ABC Cardiol e sempre avaliamos estes artigos com olhar especial. Programas de pós-graduação das universidades públicas e privadas na área de Cardiologia e das Ciências Cardiovasculares submetam artigos ao ABC Cardiol! Destaque, vídeos, podcasts, repercussão e comentários em nossas páginas totalmente integradas as redes sociais e redes científicas darão a repercussão desejada e muitas vezes superiores a publicações em periódicos internacionais que não darão a devida importância que damos a nossa produção local. A divulgação dos nossos artigos terá prioridade máxima nestes próximos 4 anos e o benefício é de todos, autores, instituições e periódico. Apenas como exemplo, Uma nova ação será a indicação de embaixadores do ABC Cardiol nas várias partes do mundo que ajudará a divulgar nossa revista e nossa produção, assim como atrair artigos de alta qualidade destas regiões. Embaixadores da Ásia, Europa, América Latina, Austrália, África e países de língua portuguesa estão programados.Uma das grandes novidades será a introdução da Figura Central, ou ainda chamada de Resumo Visual ou Resumo Gráfico/Ilustrativo. Esta figura que resume toda a mensagem do artigo científico em uma única figura ou arte gráfica, será distribuída em formatos simples que permitem a rápida difusão pelas mídias sociais e científicas de forma clara e precisa e sempre carregando a referência do nosso artigo. O nome desta arte gráfica em português e inglês para nossa revista ainda não está definido. Mande sua mensagem nos comentários desta página dizendo qual a nomenclatura para esta ilustração você prefere. Participe desta decisão! Ainda no podcast mensal faremos os resumos do número e das novas publicações para os nossos leitores.A segunda grande novidade planejada para 2023, com transição em 2022, será a publicação continuada, na qual os artigos são publicados de forma imediata após aprovação e diagramação. Isto resultará numa diminuição drástica do tempo entre aprovação e ter o artigo citável com DOI e toda a sua referência para a divulgação dos autores. A meta é reduzir dos atuais aproximados 120 dias para 60 dias ou menos. Os fascículos mensais continuarão a existir, mas serão construídos retrospectivamente. Isto poderá afetar um pouco a paginação do artigo, mas no mundo moderno digital este detalhe perdeu sua importância e vamos nos adaptar aos novos formatos das referencias.10 Esteja próximo para participar da escrita da história da nossa ciência cardiovascular junto com o ABC Cardiol com 73 anos de história e muito mais pela frente. Venha, faça parte desta história! Estamos de braços abertos a todos da nossa comunidade científica. Planejamos também a ampliação das premiações a revisores e colaboradores assim como tornar a revisão visível através do Publons, ajudando assim a carreira acadêmica de nossos revisores, editores e colaboradores. Ainda em discussão, mas poderemos ainda nesta gestão adotar a publicação dos nomes dos revisores de artigos aprovados, sempre com a aprovação dos revisores e autores.Estamos planejando uma ampliação no nosso corpo de revisores, editores-associados, embaixadores e colaboradores nacionais e internacionais.13 como: International Journal of Cardiovascular Sciences, ABC Cardiovasular Imaging (revista do DIC), ABC Heart Failure & Cardiomyopahty (revista do DEIC), Revista do DERC, Journal of Transcatheter Interventions (JOTCI da SBHCI), Brazilian Jounal of Cardiovascular Surgery (da Sociedade Brasileira de Cirurgia Cardiovascular). Toda essa oportunidade em uma única submissão! Os editores querem que seu artigo encontre sua casa e morada final o mais rápido possível. E essa integração com a Família ABC aumenta em muita sua chance de atingir este objetivo essencial na carreira acadêmica dos dias de hoje: Publicar! O ABC Cardiol ainda aceita submissões de artigos que já foram publicados em servidores de pre-print reconhecidos pela Scielo e pelo ABC Cardiol como: Scielo pre-prints, MedRxiv, OSFPreprints e Preprints.Nossa internacionalização como periódico continua, com mais um terço das publicações oriundas de centros internacionais. Nossa taxa de aceitação no último ano de aproximadamente 10% apenas dos artigos originais submetidos é um dado que demonstra a qualidade das publicações aprovadas no ABC Cardiol atualmente. Embora isso possa ser um desafio para os autores, a submissão no ABC Cardiol garante uma análise de peer-review  e um encaminhamento direto, se apropriado, para as outras revistas da Família ABC e parceirosO caminho à frente é desafiador, mas estamos prontos para o desafio e vamos crescer muito junto com a nossa comunidade científica que tem um talento fenomenal e que precisa ser mostrado ao mundo. The Brazilian Archives of Cardiology (ABC Cardiol) is the scientific journal with the greatest impact on Cardiology in Brazil and Latin America. In its history, it has had the fundamental role of disclosing the national scientific production in a journal indexed in all the most significant international databases and in the English language. At present, it is, therefore, the true window of our scientific production to the World.1 in the Journal of Citation Report. The word here is gratitude to all those who directly or indirectly contributed and support the success of ABC Cardiol and, especially, our scientific community.2The positive evolutions and results we have achieved in this current administration are supported by continuous actions from previous ABC Cardiol administrations. Here I take this opportunity to text my thanks to all the previous Editors-in-Chief, who were fundamental in the growth of ABC Cardiol and who allowed the current leadership to achieve positive results, such as the impact factor of 2.0However, challenges continue in the quest to reach new heights in the missions of the Arquivos Brasileiros de Cardiologia. In this journey of advancement, the best ideas come from discussions with groups involved in management and “collective intelligence” that Associate Editors, Editorial Assistants, Reviewers, members of SBC's publishing boards, Previous Editors, SBC Directors and SBC members. Here, I invite everyone to actively participate in ABC Cardiol and submit their best work to the most important Cardiology journal in our country.What we are planning today for the next 4 years of management, until 2025, are in the text of this Editorial. But new ideas and actions can emerge, and everything depends on the active participation of everyone. This Editor-in-Chief has an open ear, mind, and heart to everyone's suggestion. Contribute!In the editorial line and format of ABC Cardiol, we will continue with the mini-editorials inviting the Reviewers of articles to write their vision about the original data published on ABC Cardiol. At ABC Cardiol, whoever reviews, writes mini-editorials!9 The focus is and will continue to be on cardiovascular disease in all its aspects, including interdisciplinarity.We are encouraging publications of high-quality systematic reviews and meta-analyses, which have greatly helped to answer questions for which randomized controlled trials are not yet available. We also have a great mission to disseminate our populational data to help our public managers to make the best decisions for the benefit of the Brazilian population.Studies with original data from postgraduate programs throughout our country are the source of the best quality articles on ABC Cardiol and we always evaluate these articles with a special eye. Postgraduate programs from public and private universities in the field of Cardiology and Cardiovascular Sciences submit articles to ABC Cardiol! Highlights, videos, podcasts, reverberations, and comments on our pages, fully integrated with social networks and scientific networks, will give the desired aftermath and often superior to publications in international journals that will not give the due importance that we give to our local production. The dissemination of our articles will have top priority over the next 4 years and the benefit belongs to all, authors, institutions, and journals. Just as an example, the new ABC Cardiol portal, which includes modern search techniques and allows web crawlers from Google and other search tools to identify our published articles and make them available in searches carried out by users in these tools. The results are already noticeable with up to 80 thousand hits per month on our pages.A new action will be the appointment of ambassadors of ABC Cardiol in various parts of the World that will help to publicize our magazine and our production, as well as attract high-quality articles from these regions. Ambassadors from Asia, Europe, Latin America, Australia, Africa, and Portuguese-speaking countries are scheduled.One of the big news will be the introduction of the Central Figure, also called Visual Abstract or Graphical/Illustrative Summary. This figure, which summarizes the entire message of the scientific article in a single figure or graphic art, will be distributed in simple formats that allow rapid dissemination through social and scientific media in a clear and precise manner and always carrying the reference of our article. The name of this graphic art in Portuguese and English for our Journal has not yet been defined. Send your message in the comments on this page saying which name for this illustration you prefer. Participate in this decision! Also in the monthly podcast, we will make summaries of the issue and new publications for our readers.The second big news planned for 2023, with transition in 2022, will be continued publication, in which articles are published immediately after approval and layout. This will result in a drastic reduction in the time between approval and having the article citable with DOI and all its references for publication by the authors. The goal is to reduce the current approximate 120 days to 60 days or less. The monthly issues will continue to exist, but they will be built retrospectively. This may affect the pagination of the article a little, but in the modern digital world this detail has lost its importance and we are going to adapt to the new formats of references.10 Be close by to participate in writing the history of our cardiovascular science alongside ABC Cardiol with 73 years of history and much more to come. Come to be part of this story! We welcome everyone in our scientific community with open arms. We also plan to expand the awards to reviewers and collaborators, as well as make the review visible through Publons, thus helping the academic career of our reviewers, editors, and collaborators. Still under discussion, but we may adopt in this new administration the publication of the names of the reviewers of approved articles, only if the reviewers and authors approve.We are planning to expand our body of reviewers, associate editors, ambassadors and national and international contributors.13 as International Journal of Cardiovascular Sciences, ABC Cardiovascular Imaging , ABC Heart Failure & Cardiomyopahty , DERC Magazine, Journal of Transcatheter Interventions (SBHCI JOTCI), Brazilian Journal of Cardiovascular Surgery (from the Brazilian Society of Cardiovascular Surgery). All these opportunities in a single submission! The Editors want the submitted articles to find their home Journal as quickly as possible. And this integration with the ABC Family greatly increases your chance of achieving this essential objective in today's academic career: To publish! ABC Cardiol even accepts submission of articles that have already been published on pre-print servers recognized by Scielo and ABC Cardiol as Scielo pre-prints, MedRxiv, OSFPreprints, and Preprints.The internationalization of our Journal continues, with over a third of publications coming from international centers. Our acceptance rate in the last year of approximately only 10% of the original articles submitted is a fact that demonstrates the quality of publications currently approved by ABC Cardiol. Although this can be a challenge for authors, submission to ABC Cardiol guarantees a peer-review review (at least between two editors in the case of immediate rejection) and direct referral, if appropriate, to the other ABC Family and partnersThe way-ahead is challenging, but we are ready for the challenge, and we are going to grow a lot together with our scientific community, which has phenomenal talent, and which needs to be shown to the World.


Following the publication of the original article , we wereOriginally published names: Mausbach Jelena, Laurila Anssi and Räsänen Katja.Corrected names: Jelena Mausbach, Anssi Laurila and Katja Räsänen.The original article has been corrected.


Scientific Reports, 10.1038/s41598-021-91266-4, published on 09 June 2021Correction to: The Funding section in the original version of this Article was omitted. The Funding section now reads:“Brais Álvarez Pereira's work on this study was funded by Fundação para a Ciência e a Tecnologia , POR Lisboa and POR Norte .”The original Article has been corrected.