Monthly Archives: June 2025

A Mobile App for Early Detection of Heart Attacks and Strokes: A Life-Saving Innovation

A potentially life-saving new smartphone application is showing promise in helping people determine if they are experiencing a heart attack or stroke and, crucially, whether they need to seek immediate medical attention. According to a clinical study, this app could prove invaluable in reducing delays in care, which are often a matter of life and death in such medical emergencies. Developed by a collaborative team of experts from UVA Health, Harvard, Northeastern and other renowned institutions, the app, called ECHAS (Emergency Call for Heart Attack and Stroke), aims to empower people to identify the signs of these emergencies and take action promptly.

The app’s primary goal is to ensure that people can recognise the early symptoms of strokes and heart attacks, which can often be subtle or confusing for those without medical training. ECHAS replicates the key questions that healthcare providers typically ask in emergency rooms, combining these with a simple but effective finger-tapping test to check for weakness on one side of the body — a common sign of a stroke. After the user completes this brief virtual assessment, the app calculates a risk score and advises whether to call emergency services, contact a medical hotline or speak to their doctor.

In the initial clinical trial, which involved over 200 real-life emergency room patients, the ECHAS app showed remarkable accuracy. Researchers reported that it was “susceptible” in identifying those needing emergency care. Moreover, the app was rated “highly usable,” indicating it is accessible to people without medical backgrounds. Amongst the 202 patients, 57 exhibited stroke symptoms, while 145 presented with signs of a heart attack, with an average age of 62. Most of the participants were white, and 126 were men. Despite this diversity, the app consistently identified those who needed hospital admission following emergency evaluation.

Dr Jonathan R. Crowe, a UVA Health neurologist and one of the study’s authors, emphasised the critical importance of rapid care in these situations. “Heart attack and stroke are two leading causes of death in Virginia and the U.S. Our study found that the ECHAS app could accurately identify patients with heart attack, stroke and other emergency brain or heart problems who needed evaluation in the emergency room or admission to the hospital,” he explained. “We hope ECHAS could help save lives by reducing delay and helping patients get the heart attack and stroke care they need.” Dr Crowe’s words highlight the app’s potential to fill an urgent gap in early recognition and response to these life-threatening events.

Speed is of the essence when dealing with strokes and heart attacks. Medical professionals often refer to the first 60 minutes after the onset of symptoms as the “golden hour” — the window during which treatments are most effective and outcomes are vastly improved. Tragically, more than half of all stroke-related deaths occur before the patient even reaches the hospital. Those who survive such an ordeal often face long-lasting, life-altering disabilities. Sadly, many people delay seeking medical help because they are unsure if their symptoms constitute an actual emergency. ECHAS aims to change this hesitation by providing real-time clear, evidence-based guidance.

Although the ECHAS app is not publicly available, the researchers remain optimistic about its future. Dr Crowe noted that they seek additional funding through grants to conduct larger studies and refine the app’s capabilities. “At UVA, we have partnered with UVA’s Center for Telehealth to apply for a grant to study ECHAS here in Virginia,” he said. “We want people in Virginia and around the world to be able to use their smartphones and tablets to reduce delay and help them get the care they need, especially in medical emergencies.” As further trials expand and refine its accuracy and usability, ECHAS promises to transform how people respond to sudden and severe health crises — ultimately saving countless lives in the process.

More information: Jonathan R. Crowe et al, Assessment of the Sensitivity of a Smartphone App to Assist Patients in the Identification of Stroke and Myocardial Infarction: Cross-Sectional Study, JMIR Formative Research. DOI: 10.2196/60465

Journal information: JMIR Formative Research Provided by University of Virginia Health System

Recent scientific research reveals possible connection between microplastics in heavily processed foods and brain function

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A groundbreaking collection of four papers published in the May edition of Brain Medicine has brought together growing evidence that microplastics from ultra-processed foods may be accumulating in the human brain, potentially contributing to the global rise in depression, dementia, and other mental health disorders. These papers offer the most comprehensive examination of how these tiny plastic particles could affect brain health through multiple interconnected biological pathways, opening up urgent new questions about the actual impact of modern diets on our minds.

The striking cover of Brain Medicine’s May 2025 issue features an image of a human brain speckled with vibrant microplastic particles beside a plastic spoon — a potent visual representation of the collection’s core finding that human brains may contain approximately “a spoonful” of microplastics. This theme is explored in depth across the four papers, which include a viewpoint article synthesising emerging evidence of microplastic accumulation in the human body and its potential links to mental health, alongside three new documents that expand on this research.

The featured viewpoint article by Dr. Nicholas Fabiano and colleagues proposes a novel hypothesis connecting ultra-processed food consumption, microplastic exposure, and mental health outcomes. Dr Fabiano notes that ultra-processed foods now make up more than half of energy intake in countries like the United States and contain far higher levels of microplastics than whole foods. Recent studies have shown that these tiny particles can cross the blood-brain barrier and accumulate significantly, suggesting a worrying link between modern diets and brain health.

This hypothesis gains weight from existing evidence showing ultra-processed food consumption’s adverse mental health effects. A recent umbrella review in The BMJ found that people who ate ultra-processed foods had a 22% higher risk of depression and a 48% higher risk of anxiety compared to those who ate more whole foods. What makes the current hypothesis particularly intriguing is that microplastics — particles smaller than 5mm — may be a crucial but previously overlooked link in this relationship, with heavily processed foods such as chicken nuggets containing up to 30 times more microplastics per gram than fresh chicken breasts.

Dr Wolfgang Marx highlights that ultra-processed foods and microplastics share biological mechanisms that could harm mental health, including inflammation, oxidative stress, mitochondrial dysfunction, and disruptions to neurotransmitter systems. The viewpoint article suggests the creation of a Dietary Microplastic Index (DMI) to quantify exposure to these particles through diet, setting the stage for a more rigorous investigation into their potential role in the observed adverse mental health outcomes associated with ultra-processed food consumption.

Alongside this, a Brevia research paper by Dr Stefan Bornstein explores the possibility that therapeutic apheresis — a blood-filtering technique — could remove microplastics from human circulation. While much more research is needed to confirm its viability, it points to a possible pathway for mitigating microplastic accumulation. The issue concludes with a passionate guest editorial by Dr. Ma-Li Wong, who warns that if microplastics can cross the blood-brain barrier, the traditional boundary between the human body and environmental contaminants has already eroded. The authors call for urgent further investigation and underscore the need to reduce ultra-processed food intake and identify ways to detect and remove microplastics from the body, emphasising that these environmental threats may have more profound implications for our mental well-being than previously understood.

More information: Ma-Li Wong et al, Una cuchara de plástico en tu cerebro: The calamity of a plastic spoon in your brain, Brain Medicine. DOI: 10.61373/bm025g.0062

Journal information: Brain Medicine Provided by Genomic Press

Determinants of Healthy Ageing in Humans: Perspectives from Long-Lived Individuals

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Healthy ageing and longevity are intricate, multifactorial phenomena shaped by the dynamic interplay of genetic, epigenetic, metabolic, immune, and environmental determinants. Long-lived individuals (LLIs), particularly centenarians, serve as exceptional models for understanding these mechanisms because of their remarkable ability to avoid or significantly delay the onset of age-related diseases. This review synthesises the current knowledge landscape regarding the myriad factors underpinning exceptional longevity, drawing upon insights from diverse population studies of LLIs.

LLIs, generally defined as those who survive beyond 90 years, exhibit strikingly distinctive health profiles. These individuals tend to experience lower rates of morbidity, a delayed onset of chronic conditions, and a preservation of physiological functions well into advanced age. Notably, many LLIs are found in “longevity blue zones”, such as Okinawa in Japan and Sardinia in Italy, regions where favourable environmental conditions and lifestyle practices intersect with genetic predispositions. Gender differences also play a significant role, with women forming the majority of centenarian populations, though male centenarians often display a reduced burden of age-related diseases. Within this heterogeneous group, LLIs can be further classified as “escapers,” who avoid major diseases entirely; “delayers,” who postpone them until later in life; and “survivors,” who manage to live with chronic illnesses while maintaining resilience.

Genetics contributes substantially to longevity, as evidenced by the familial clustering of LLIs, which suggests a heritable component. Several nuclear genomic variants have been identified as significant contributors to healthy ageing. Among these, APOE ε2 is notable for its protective effect against cardiovascular disease and Alzheimer’s. At the same time, FOXO3A plays a role in oxidative stress resistance and DNA repair, which is crucial for maintaining cellular integrity. SIRT6, another prominent gene, is involved in genome stability and maintenance. Mitochondrial haplogroups J and D have been associated with reduced oxidative stress levels, contributing to healthier cellular environments. Telomere maintenance genes, such as hTERT and TERC, are vital for chromosomal stability and cellular longevity. However, genome-wide association studies (GWAS) consistently highlight APOE and FOXO3A as the most robust genetic factors associated with longevity across diverse populations, underscoring their pivotal influence.

Beyond genetic predispositions, epigenetic mechanisms serve as a bridge between inherited factors and environmental influences. Studies of DNA methylation in LLIs have shown that these individuals exhibit a slower rate of age-related methylation loss, particularly within heterochromatic regions of the genome. This epigenetic stability may act as a safeguard for genomic integrity, forestalling the onset of age-related dysfunctions. Additionally, noncoding RNAs, such as microRNA miR-363* and long noncoding RNAs, like THBS1-IT1/AS1, modulate cellular senescence and gene expression, thereby contributing to maintaining health and vitality. Such epigenetic markers are increasingly recognised as signatures of biological youthfulness and a diminished risk of disease in LLIs and, interestingly, in their offspring.

Metabolic adaptations also feature prominently in the health profiles of LLIs. They generally exhibit favourable lipid metabolism, with lower low-density lipoprotein (LDL) cholesterol and higher high-density lipoprotein (HDL) cholesterol levels. These metabolic profiles are coupled with reduced insulin resistance and heightened antioxidant defences. Hormonal profiles in LLIs often reflect lower thyroid hormone levels and preservation of sex hormones, such as estradiol in females and testosterone in males, which are believed to play protective roles against age-related decline. Caloric restriction (CR), a dietary intervention well-established in model organisms, mimics these metabolic states by improving glucose metabolism and mitigating inflammation. CR mimetics, including metformin and resveratrol, hold promise in replicating these benefits in humans without the challenges of stringent dietary restrictions.

The immune system of LLIs also undergoes significant modulation, which likely contributes to their disease resistance. Unlike the chronic low-grade inflammation typically seen in older adults, known as “inflammaging,” LLIs demonstrate lower levels of pro-inflammatory cytokines such as interleukin-6 (IL-6) and higher levels of anti-inflammatory cytokines like transforming growth factor-beta (TGF-β) and interleukin-10 (IL-10). Their immune systems retain robust T-cell proliferation and natural killer cell activity, reflecting an enduring ability to fend off infections and malignancies. Furthermore, the balance within T-cell populations shifts towards the dominance of regulatory T cells (Tregs) over pro-inflammatory Th17 cells, fostering an anti-inflammatory milieu conducive to longevity.

Environmental and lifestyle factors remain critical to the equation of healthy ageing. Studies of the gut microbiota in LLIs reveal greater microbial diversity and an abundance of health-promoting bacteria, such as Akkermansia muciniphila and Bifidobacterium species, contributing to gut integrity and the production of beneficial metabolites. Diets rich in plant-based foods—vegetables, whole grains, and nuts—are consistently linked to a lower incidence of chronic diseases such as diabetes, cardiovascular ailments, and neurodegenerative disorders. Regular physical activity, especially endurance and strength training, further enhances metabolic health and supports mitochondrial function, mitigating the oxidative stress that accelerates ageing. Additional lifestyle practices, including non-smoking, moderate alcohol consumption, restful sleep, and effective stress management, create a framework that bolsters health and extends lifespan.

Socioeconomic and medical advancements have undoubtedly increased average life expectancy through improved sanitation, vaccinations, and healthcare systems. Yet, the interplay of genetic and epigenetic factors underpins the exceptional longevity observed in LLIs. Future research that harnesses the power of multi-omics approaches—including transcriptomics, proteomics, and metabolomics—promises to unravel the complex networks that govern healthy ageing in larger LLI cohorts. In parallel, functional studies using model organisms and clinical trials of interventions such as probiotics and CR mimetics will be essential for translating these insights into therapeutic strategies.

In conclusion, human longevity emerges from a sophisticated synergy of genetic resilience, epigenetic stability, metabolic flexibility, immune competence, and health-promoting lifestyle choices. Long-lived individuals exemplify the convergence of these factors, offering a living testament to the possibility of delaying ageing and extending health span. As populations around the globe continue to age, deciphering these mechanisms holds the key to developing personalised interventions aimed at enhancing not merely lifespan but also the quality of life in the later years.

More information: Fan-Qian Yin et al, Factors involved in human healthy aging: insights from longevity individuals, Frontiers of Medicine. DOI: 10.1007/s11684-024-1120-4

Journal information: Frontiers of Medicine Provided by Higher Education Press

New Study Reveals Greater Cannabis Retail Density in Low-Income, Predominantly Black and Hispanic Communities

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A new and illuminating study has shed light on the troublingly disproportionate presence of recreational (nonmedical) cannabis retailers in socioeconomically disadvantaged neighbourhoods and areas with higher proportions of Black and Hispanic residents across 18 states in the United States that have legalised adult-use cannabis. The research, published in the American Journal of Preventive Medicine by Elsevier, provides crucial data for policymakers and public health officials, calling for strategies that prioritise equitable distribution of cannabis retailers. This is particularly relevant in an era when cannabis consumption is growing and the legal market continues to expand across the country.

The researchers conducted a detailed analysis using 2023 data from state agencies, which included 5,586 licensed recreational cannabis retailers across the 18 states that legalised recreational cannabis between 2012 and 2022. These states are Alaska, Arizona, California, Colorado, Connecticut, Illinois, Maine, Massachusetts, Michigan, Missouri, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington. To assess the correlation between neighbourhood deprivation and cannabis retailer concentration, the team employed multilevel logistic regression and negative binomial Poisson regression models, using geocoded retailer address data and census tract-level deprivation indices.

Dr Lindsay L. Kephart, the lead author and a researcher in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, emphasised the stark disparity revealed by the findings. She explained that although cannabis retailers were present in just over 10% of census tracts within these legalised states, the most socioeconomically disadvantaged areas were consistently more likely to host them. In particular, neighbourhoods with high concentrations of low-income Black residents had 2.53 times the number of cannabis retailers compared to high-income, predominantly White neighbourhoods. For low-income Hispanic communities, this figure rose to 2.67 times. This pattern persisted across various definitions of neighbourhood disadvantage and was robust across all 18 states studied, regardless of their regional location or the specific timing of cannabis legalisation.

This distribution of cannabis retailers mirrors long-standing patterns observed with other legal substances, such as tobacco and alcohol. Historically, retailers of these products have often been situated in lower-income communities and communities of colour, reflecting systemic and structural factors that shape urban development and commercial zoning. Dr Kephart noted that this clustering may not always result from deliberate targeting but is frequently the outcome of structural inequalities, including zoning and land use policies that have historically placed undesirable commercial enterprises in less privileged neighbourhoods. She pointed to the influence of Not-In-My-Backyard (NIMBY) policies, which often divert cannabis retailers away from more affluent communities.

A particularly intriguing aspect of the study was a sensitivity analysis, which suggested that racial disadvantage alone—absent income considerations—did not significantly predict cannabis retailer density. This implies that socioeconomic factors may exert a more substantial influence than race. However, Dr Kephart cautioned that the intersection of race and income remains vital, as neighbourhoods with high proportions of low-income residents of colour experienced the highest densities of cannabis retailers. This highlights the need for policies that acknowledge the multifaceted nature of disadvantage, incorporating race and income in their analyses and interventions.

The broader implications of these findings are significant. Cannabis is currently one of the most widely consumed substances in the United States, with nearly 19% of those aged 12 or older reporting use in the past year. As of November 2024, 24 states have legalised recreational cannabis sales, raising concerns about how this evolving industry may differentially impact communities. Dr Kephart argued that the high density of cannabis retailers in disadvantaged neighbourhoods could exacerbate substance use disparities by increasing accessibility, lowering perceived health risks, and introducing novel products that may particularly appeal to young people. These factors, in turn, could have long-term implications for public health and community well-being.

Conversely, it is essential to acknowledge that the presence of legal cannabis retailers may also have some potential benefits, particularly in areas where illicit cannabis markets have historically flourished. Dr Kephart observed that a regulated and taxed supply of cannabis may help reduce the demand for illegal products, increase safety by ensuring product quality, and generate tax revenues that can be reinvested in local communities. Indeed, existing research suggests that recreational cannabis legalisation is associated with rising home values, especially in early-adopting states like Colorado and Washington. Although the precise causes are not yet fully understood, they may include economic development linked to the cannabis industry and broader social and policy changes that make neighbourhoods more attractive to homebuyers.

In closing, Dr Kephart stressed the importance of grounding cannabis policy in rigorous, evidence-based research. Such research can provide communities with the tools to make informed decisions about where cannabis retailers should be located, ensuring a balance between consumer access for adults and the minimisation of harm to vulnerable populations, particularly youth. Local policies such as zoning regulations or caps on the number of cannabis retailers in specific neighbourhoods may be instrumental in achieving this balance, helping to mitigate potential harms while supporting safe, legal access for those who choose to use cannabis.

More information: Lindsay L. Kephart et al, The Unequal Geography of Recreational Cannabis Retailers in the U.S., American Journal of Preventive Medicine. DOI: 10.1016/j.amepre.2025.107643

Journal information: American Journal of Preventive Medicine Provided by Elsevier

Fewer new dementia cases in the US, yet growing numbers of people living with it

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A new study published in The BMJ has brought to light a complex and nuanced picture of dementia in the United States. Between 2015 and 2021, the rate of new dementia diagnoses—known as incidence—declined among Americans aged 66 and older. Yet, the number of people living with the condition has steadily risen. This finding reflects a tension between improved disease prevention on the one hand and an ageing population on the other. In 2021 alone, nearly 2.9 million individuals enrolled in traditional Medicare—roughly 12%—were living with a diagnosis of dementia, underscoring the growing impact of this condition on the nation’s healthcare landscape.

Drawing upon an extensive dataset of medical claims for over 5 million fee-for-service Medicare beneficiaries, the researchers noted that incidence fell from 3.5% to 2.8% over the six years. At the same time, prevalence—the proportion of people living with dementia—rose from 10.5% to 11.8%. This paradox reveals an essential aspect of dementia care: even as fewer people are newly diagnosed each year, more people than ever before are living longer lives with the disease. The researchers attribute the decline in new cases partly to improved management of cardiovascular risk factors, which play a significant role in dementia development. However, the ageing of the population means that more people are surviving long enough to experience dementia or are living longer after a diagnosis has been made.

Interestingly, the data reveal subtle yet telling differences between the sexes. In 2015, the incidence of dementia was slightly higher among men (3.5%) than women (3.4%) of the same age, and this gap widened by 2021, with men at 2.9% and women at 2.6%. Yet, paradoxically, the majority of people living with dementia are women—60% of those diagnosed in 2021. The authors explain this by pointing to women’s longer life expectancy, which means that more women live in the age range where dementia risk is highest. As such, while men may face a higher annual risk of developing dementia, the overall burden of the condition weighs more heavily on women in later life.

The study also highlights stark and persistent inequalities in dementia risk among different racial and ethnic groups, as well as across neighbourhoods marked by socioeconomic deprivation. Black beneficiaries had the highest incidence of dementia throughout the period, with 4.2% newly diagnosed in 2015 and 3.1% in 2021. Hispanic beneficiaries followed, with rates of 3.7% and 2.6%, respectively. White beneficiaries had the lowest rates in both years. These disparities underscore how social determinants of health—factors such as income, education, and access to healthcare—play a profound role in shaping the dementia burden across communities.

The authors point out that the reasons behind these racial and socioeconomic disparities are complex and multifaceted. It is possible that structural factors, such as historical discrimination and unequal access to healthcare resources, contribute to higher dementia incidence in marginalised populations. Furthermore, those living in deprived neighbourhoods may face more cumulative risks—poorer nutrition, higher rates of cardiovascular disease, and fewer opportunities for healthy ageing—which in turn elevate dementia risk. Addressing these underlying causes, the researchers argue, is essential to promoting health equity in dementia care.

Notably, the researchers also caution that their robust findings should be interpreted with care. As an observational study, their work does not establish direct cause-and-effect relationships. Moreover, Medicare claims data may not perfectly capture diagnoses or may fail to account for individuals who do not have fee-for-service Medicare coverage. The data also have limitations in accurately classifying race and ethnicity, which means that the true extent of disparities could be even greater than reported. Nevertheless, the sheer size and scope of the dataset provide valuable insights into real-world diagnostic patterns and help fill an essential gap in the medical literature.

An accompanying editorial by UK researchers echoes these concerns, noting that marginalised minorities are often under-represented in fee-for-service Medicare plans. This under-representation suggests that the actual burden of dementia in disadvantaged groups could be even more significant than the current data show. Furthermore, greater health awareness and earlier diagnoses in wealthier communities might mask the true magnitude of the socioeconomic divide. Taken together, these findings highlight the pressing need for improved services for those living with dementia, particularly in areas where higher incidence and prevalence are observed, and for policy initiatives aimed at addressing risk factors and inequalities from early life onwards.

More information: Jay B Lusk et al, Incidence and prevalence of dementia among US Medicare beneficiaries, 2015-21: population based study, The BMJ. DOI: 10.1136/bmj-2024-083034

Journal information: The BMJ Provided by BMJ Group

The Role of Brain Insulin Resistance in Connecting Alzheimer’s Disease and Epilepsy

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Researchers from the University of São Paulo (USP) in Brazil have demonstrated in animal models that insulin resistance in the brain could be a key link between Alzheimer’s disease and epilepsy. Their study, funded by FAPESP and recently published in the Journal of Neural Transmission, provides fresh insights into how these two complex neurological conditions may be intertwined. Professor Norberto Garcia-Cairasco, director of the Laboratory of Neurophysiology and Experimental Neuroethology, highlighted that this discovery bolsters existing evidence that people with epilepsy are more likely to develop Alzheimer’s disease as they age and that seizures are common in those with Alzheimer’s.

Alzheimer’s disease is a multifactorial neurodegenerative condition with no known cure, long associated with the amyloid cascade hypothesis. This theory suggests that the accumulation of beta-amyloid plaques in the brain triggers neuronal damage and cognitive decline. However, other theories have emerged, focusing on the role of tau protein tangles, decreased acetylcholine (a neurotransmitter essential for memory), and neuroinflammation. These factors all contribute to the complex pathology of Alzheimer’s, suggesting that a broader therapeutic approach is needed beyond just targeting beta-amyloid.

Another area of interest is the so-called “type 3 diabetes” hypothesis, which posits that insulin resistance within the brain damages neurons and disrupts synaptic plasticity, especially in the hippocampus. Garcia-Cairasco and his team believe this cerebral insulin resistance can impair cholinergic function, leading to neuroinflammation and increasing the accumulation of beta-amyloid and tau proteins accumulation. Importantly, central insulin resistance can occur even without systemic diabetes, hinting at a unique pathway of neurodegeneration.

The researchers conducted experiments in rats, injecting them with streptozotocin to induce insulin resistance in the brain. They found that these rats not only developed Alzheimer ’s-like symptoms but also showed an increased susceptibility to seizures after exposure to high-intensity sounds. Conversely, genetically engineered rats predisposed to epilepsy (Wistar Audiogenic Rat strain) exhibited molecular markers typical of Alzheimer’s disease, such as tau hyperphosphorylation and reduced insulin receptor activity in the hippocampus.

A single dose of streptozotocin in these rats resulted in both memory deficits and a heightened tendency for seizures. This suggests that insulin resistance in the brain does not just affect memory and cognitive function but increases neuronal excitability, making seizures more likely. The team also noted that genetic differences influence how the brain responds to insulin disruption, hinting at a potential for personalised approaches to treatment in the future.

This critical work has already garnered recognition, winning the Aristides Leão Award at the Brazilian Epilepsy League Congress and the Best Poster Award in Geriatrics at the Brazilian Alzheimer’s Congress. The unique strain of rats developed in this study has been shared with researchers worldwide, offering a new model for studying the complex link between Alzheimer’s disease and epilepsy. Such collaborations may pave the way for more targeted therapies that address insulin resistance in the brain, bringing fresh hope for treating these debilitating conditions.

More information: Norberto Garcia-Cairasco et al, Insulin signaling disruption exacerbates memory impairment and seizure susceptibility in an epilepsy model with Alzheimer’s disease-like pathology, Journal of Neural Transmission. DOI: 10.1007/s00702-025-02896-1

Journal information: Journal of Neural Transmission Provided by Fundação de Amparo à Pesquisa do Estado de São Paulo