Fatores de risco para infecções relacionadas à assistência à saúde em unidades de terapia intensiva / Risk factors for healthcare-associated infections in intensive care units

Objetivo: Investigar os fatores de risco para infecções relacionadas à assistência entre pacientes internados em uma Unidade de Terapia Intensiva de uma capital do Norte do Brasil. Métodos: Estudo de coorte prospectiva, com 267 pacientes internados no período de 01 de outubro de 2017 a 30 de janeiro 2019. As informações foram coletadas de prontuário eletrônico, físico e padrão de acompanhamento dos pacientes. Investigaram-se informações demográficas sobre a internação e tratamento. Realizada regressão de Poisson para avaliação das variáveis com o desfecho. Resultados: A incidência de infecções foi de 10,49 casos por 100 pacientes, com a maior frequência para infecção de sítio cirúrgico. Na análise ajustada, internação por mais de cinco dias (RR: 6,98; IC95%: 1,42; 34,15), parada cardiorrespiratória (RR: 2,89; IC95%:1,05;7,96), ter ostomia (RR: 9,22; IC95%:1,47; 57,65) ou traqueostomia (RR: 10,23; IC95%: 1,56;67,22) foram associados às infecções relacionadas à assistência. Conclusão: A incidência de infecções encontrada foi superior às outras regiões brasileiras. Recomenda-se vigilância ativa, principalmente em pacientes com internação prolongada e ostomias, avaliação criteriosa da necessidade de dispositivos e uso de protocolos para adoção de boas práticas. Descritores: Infecção Hospitalar; Unidades de Terapia Intensiva; Segurança do Paciente.

Objective: To investigate the risk factors for infections related to care among patients hospitalized in an Intensive Care Unit in a capital in northern Brazil. Methods: A prospective cohort study, with 267 patients hospitalized from October 1, 2017 to January 30, 2019. Information was collected from electronic and physical medical records and patients' follow-up pattern. Information was collected from electronic and physical medical records and patients' follow-up pattern. Demographic information about hospitalization and treatment was investigated. Poisson regression was performed to assess the variables with the outcome. Results: Infection incidence was 10.49 cases per 100 patients, with the highest frequency for surgical site infection. In the adjusted analysis, hospitalization for more than five days (RR: 6.98; 95%CI: 1.42; 34.15), cardiopulmonary arrest (RR: 2.89; 95%CI:1.05;7.96), having an ostomy (RR: 9.22; 95%CI:1.47; 57.65) or tracheostomy (RR: 10.23; 95%CI: 1.56;67.22) were associated with healthcare-associated infections. Conclusion: The incidence of infections found was higher than in other Brazilian regions. Active surveillance is recommended, especially in patients with prolonged hospitalization and ostomy, careful assessment of the need for devices and use of protocols for the adoption of good practices. Descriptors: Cross Infection; Intensive Care Units; Patient Safety.

Autoavaliação dos Núcleos de Segurança do Paciente em um estado do norte do Brasil / Self-assessment of Patient Safety Centers in a state in Northern Brazil

Avaliar a estrutura organizacional dos Núcleos de Segurança do Paciente dos hospitais de Rondônia. Estudo transversal, realizado entre novembro e dezembro de 2020, com 25 dos 40 núcleos de segurança do paciente cadastrados na Agência Nacional de Vigilância Sanitária. Os dados foram coletados mediante instrumento com indicadores de estrutura, processo e resultados.Houve maior adesão aos indicadores de estrutura e quase todas as instituições possuíam núcleo de segurança totalmente implantado. Contudo, evidencia-se fragilidade na execução de algumas ações, principalmente no gerenciamento de riscos. Apenas seis organizações realizaram notificações de eventos adversos, demonstrando relação direta com a alta adesão às boas práticas de segurança (p = 0,04) juntamente com o tipo de instituição (p = 0,02).Embora os núcleos estejam totalmente implantados, os indicadores de processo e resultados indicam a necessidade de qualificação de seus membros e um acompanhamento mais próximo pela coordenação estadual de segurança do paciente.

To evaluate the organizational structure of Patient Safety Centers in hospitals in the state of Rondônia. Cross-sectional study, carried out between November and December 2020. The study population consisted of 25 out of the 40 patient safety centers registered with the National Health Surveillance Agency. Data were collected using an instrument with structure, process, and outcome indicators. There was greater adherence to structure indicators and almost all institutions had a fully implemented Safety Center, however, there was evidence of weakness in the execution of some actions, mainly in risk management. Only six institutions reported adverse events, which showed a direct relationship with high adherence to good safety practices (p=0.04) along with the type of institution (p=0.02).Although the centers are fully implemented, the process and outcome indicators indicate the need for the qualification of their members and closer monitoring by the state coordination of patient safety.

Cytogenetic and Molecular Characterization of Eigenmannia aff. desantanai (Gymnotiformes: Sternopygidae): A First Report of System of Sex Chromosomes ZW1W2/ZZ in Gymnotiformes.

Gymnotiformes a monophyletic group of fish endemic to the Neotropics, represent an important component of the freshwater ichthyofauna that presents relevant taxonomic problems. Thus, in view of the morphological complexity involving Eigenmannia (Gymnotiformes) fish species, this study aimed to characterize Eigenmannia aff. desantanai of the upper Paraguay River basin through cytogenetic and molecular analyses, to help in the correct identification and delimitation of species. This study reports a multiple sex system of the type ZW1W2/ZZ, with 2n = 31 for females and 2n = 30 for males. A single pair of chromosomes carrying the nucleolar organizing regions (NORs) was detected. The heterochromatin was colocated in NOR sites and mainly located in the centromeric regions of chromosomes. Besides that, individual sequences COI from the specimens of E. aff. desantanai were obtained, totalizing three haplotypes. The distance p between the haplotypes in E. aff. desantanai, ranged from 0.2% to 7.1%. Species delimitation tests indicated the existence of two possible operational taxonomic units of E. aff. desantanai. Thus, this study reports a new multiple sex system in Gymnotiformes and these specimens previously identified as E. aff. desantanai may belong to two distinct species.

Reinternações não planejadas após cirurgias em um hospital do norte do Brasil: coorte prospectiva / Reingresos no planificados después de la cirugía en un hospital del norte de Brasil: cohorte prospectiva / Unplanned readmissions after surgery in a hospital in northern Brazil: prospective cohort

Objetivo:analisar as reinternaçõesnão planejadas após procedimentos cirúrgicos e seus fatores de risco em um hospital de grande porte no Norte do Brasil. Método:coorte prospectiva, com dados coletados de prontuários e à cabeceira do leito. Foram realizadas análises descritivas, análise bivariada e múltipla por meio da regressão de Poisson no Stata® v.16.0. Resultados:do total de 486 pacientes, 1,47% reinternaram. A incidência de reinternação foi 68 a cada 1.000 procedimentos (IC95%: 47,10; 93,85). Na análise ajustada apresentaram-se comofatores de risco não ser branco (RR: 2,06; IC95% 1,13; 3,75), usar implante na cirurgia (RR: 2,00; IC95%: 1,05; 3,81) e procedimentos das especialidades urologia/renal (RR: 3,17; IC95%:1,59-6,31) e ginecologia (RR: 2,18; IC95%:1,06-4,49). Conclusão:a incidência de reinternação nesta região é maior do que outras regiões. Características demográficas e tipo de procedimento cirúrgico foram fatores de risco para o desfecho

Objective:to analyze unplanned readmissions after surgical procedures and their risk factors in a large hospital in Northern Brazil. Method:prospective cohort, with data collected from medical records and at the bedside. Descriptive, bivariate and multiple analysis were performed using Poisson regression in Stata® v.16.0. Results: of the total of 486 patients, 1.47% were readmitted. The incidence of readmissions was 68 per 1,000 procedures (95%CI: 47.10; 93.85). In the adjusted analysis, the risk factors were not being white (RR: 2.06; 95%CI 1.13; 3.75), using implants in surgery (RR: 2.00; 95%CI: 1.05; 3.81) and procedures of the urology/renal specialties (RR: 3.17; 95%CI: 1.59-6.31) and gynecology (RR: 2.18; 95%CI: 1.06-4.49). Conclusion:the incidence of readmissions in this region is higher than in other regions. Demographic characteristics and type of surgical procedure were risk factors for the outcome

Objetivo:analizar los reingresos no planificados después de procedimientos quirúrgicos y sus factores de riesgo en un gran hospital del norte de Brasil. Método:cohorte prospectiva, con datos recolectados de historias clínicas y al lado de la cama. Se realizaron análisis descriptivos, bivariados y múltiples mediante regresión de Poisson en Stata® v.16.0. Resultados:del total de 486 pacientes, el 1,47% reingresó. La incidencia de reingresos fue de 68 por 1.000 procedimientos (IC del 95%: 47,10; 93,85). En el análisis ajustado, los factores de riesgo fueron no ser blanco (RR: 2,06; IC 95% 1,13; 3,75), uso de implantes en cirugía (RR: 2,00; IC 95%: 1,05; 3,81) y procedimientos de la urología/especialidades renales (RR: 3,17; IC 95%: 1,59-6,31) y ginecología (RR: 2,18; IC 95%: 1,06-4,49). Conclusión: la incidencia de reingresos en esta región es mayor que en otras regiones. Las características demográficas y el tipo de procedimiento quirúrgico fueron factores de riesgo para el resultado

Fatores de risco nas neurocirurgias: um estudo de coorte no norte do Brasil / Risk factors in neurosurgery: a cohort study in northern Brazil

Introdução: Pacientes neurocirúrgicos apresentam elevado risco de complicações locais e sistêmicas que podem aumentar o tempo de internação e o risco de morte. Este estudo tem como objetivo avaliar a incidência de infecções relacionadas à assistência à saúde e os fatores de risco associados em pacientes submetidos às neurocirurgias. Materiais e métodos: Estudo de coorte prospectiva, realizado em um Hospital de grande porte do estado de Rondônia, no período de 2018 a 2019, incluindo 36 pacientes. Resultados: A incidência de infecções relacionada à assistência à saúde foi 19,4 a cada 100 pacientes (IC95%: 8,19 ­ 36,02). Ter utilizado sonda nasoenteral aumentou em 6,5 vezes o risco de IRAS (IC 95%: 1,26 ­ 33,5), a ventilação mecânica aumentou 5,52 vezes o risco (IC95%: 1,23 ­ 24,6), a presença de traqueostomia aumentou seis vezes (IC95%: 1,34 ­ 26,8) e realização de exame invasivo aumentou o risco em 6,79 para ter infecção (IC95%: 1,31 ­ 35,05). Na análise ajustada as variáveis não apresentaram significância estatística. Discussão: A incidência de infecções foi maior do que em regiões com melhores condições socioeconômicas o que pode estar relacionado à menor adesão de boas práticas na assistência. Conclusão: Nas neurocirurgias além das infecções de sítio cirúrgico outras topografias também devem ser consideradas para investigação de infecção. O uso de dispositivos invasivos foi associado à ocorrência de infecções relacionadas à assistência à saúde, portanto as boas práticas no seu uso são essenciais no momento da indicação e uso destes dispositivos.

Introduction: Neurosurgical patients are at high risk of local and systemic complications that can increase the length of hospital stay and the risk of death. This study aims to assess the incidence of healthcare-associated infections and associated risk factors in patients undergoing neurosurgery. y. Materials and Methods:: Prospective cohort study, carried out in a large hospital in the state of Rondônia, from 2018 to 2019, including 36 patients. Results:The incidence of healthcare-associated infections was 19.4 per 100 patients (95%CI: 8.19 ­ 36.02). Having used a nasoenteral tube increased the risk of HAI by 6.5 times (95% CI: 1.26 ­ 33.5), mechanical ventilation increased the risk by 5.52 times (95% CI: 1.23 ­ 24.6) , the presence of tracheostomy increased six-fold (95%CI: 1.34 ­ 26.8) and performing an invasive examination increased the risk of infection by 6.79 (95%CI: 1.31 ­ 35.05). In the adjusted analysis, the variables did not show statistical significance. Discussion:The incidence of infections was higher than in regions with better socioeconomic conditions, which may be related to lower adherence to good care practices. Conclusions: : In neurosurgery, in addition to surgical site infections, other topographies should also be considered for the investigation of infection. The use of invasive devices was associated with the occurrence of infections related to health care, so good practices in their use are essential when indicating and using these devices.

Introducción:Los pacientes neuroquirúrgicos tienen un alto riesgo de complicaciones locales y sistémicas que pueden aumentar la estancia hospitalaria y el riesgo de muerte. Este estudio tiene como objetivo evaluar la incidencia de infecciones asociadas a la atención médica y los factores de riesgo asociados en pacientes sometidos a neurocirugía. Materiales y métodos: : Estudio de cohorte prospectivo, realizado en un gran hospital del estado de Rondônia, de 2018 a 2019, con 36 pacientes. Resultados: La incidencia de infecciones asociadas a la asistencia sanitaria fue de 19,4 por 100 pacientes (IC95%: 8,19 ­ 36,02). Haber utilizado una sonda nasoenteral aumentó el riesgo de IRAS en 6,5 veces (IC 95%: 1,26 ­ 33,5), la ventilación mecánica aumentó el riesgo en 5,52 veces (IC 95%: 1,23 ­ 24,6), la presencia de traqueotomía aumentó seis veces (IC95%: 1,34 ­ 26,8) y realizar un examen invasivo aumentó el riesgo de infección en 6,79 (IC95%: 1,31 ­ 35,05). En el análisis ajustado, las variables no presentaron significación estadística. Discusión: La incidencia de infecciones fue mayor que en las regiones con mejores condiciones socioeconómicas, lo que puede estar relacionado con una menor adherencia a las buenas prácticas de cuidado. Conclusión: En neurocirugía, además de las infecciones del sitio quirúrgico, también se deben considerar otras topografías para la investigación de la infección. El uso de dispositivos invasivos se asoció con la ocurrencia de infecciones relacionadas con el cuidado de la salud, por lo que las buenas prácticas en su uso son fundamentales a la hora de indicar y utilizar estos dispositivos

Cultura de segurança do paciente em maternidade da Amazônia Ocidental / Culture of patient safety in maternity in the western amazon / Cultura de seguridad del paciente en maternidad en la amazonia occidental

Objetivo: analisar a cultura de segurança do paciente entre os profissionais de saúde de maternidade pública da Região Norte do Brasil. Método: estudo transversal, realizado em 2019, com 70 profissionais atuantes na gestão ou assistência à saúde. Analisaram-se 12 dimensões da cultura de segurança do paciente, por meio do questionário Hospital Survey on Patient Safety Culture. Procedeu-se à análise descritiva e aplicou-se o teste Qui-quadrado de Pearson para verificar associação estatística entre as variáveis do estudo. Resultados: a maioria dos participantes era do sexo feminino, média de idade 39 anos e com cursos de pós-graduação. Na avaliação das 12 dimensões da cultura de segurança do paciente, verificou-se uma área de fortaleza com mais de 75% de respostas positivas ­ "Expectativas e ações do supervisor/chefe para a promoção da segurança do paciente". Houve diferença estatisticamente significativa entre o tempo de trabalho na instituição e o modo com que o participante qualificou a segurança do paciente. Conclusão: substituir a cultura punitiva pelo aprendizado com os erros e estimular a comunicação interprofissional são ações que podem ser trabalhadas pelo serviço na busca de uma cultura positiva. Descritores: Estudos transversais; Segurança do Paciente; Cultura organizacional; Saúde materno-infantil; Maternidades; Profissionais de saúde.(AU)

Objective: to analyze the patient safety culture among health professionals in a public maternity hospital in the North region of Brazil. Method: cross-sectional study, conducted in 2019 with 70 professionals working in management or health care. The 12 dimensions of patient safety culture were analyzed using the Hospital Survey on Patient Safety Culture questionnaire. Descriptive analysis and Pearson's chi-square test were performed to verify statistical association among the study variables. Results: most participants were female, mean age of 39 years and had postgraduate degrees. In the evaluation of the 12 dimensions of Patient Safety Culture there was only one area of strength with more than 75% of positive answers - "Expectations and actions of the supervisor/chief for the promotion of patient safety". There was a statistically significant difference between the length of time working at the institution and the way this participant rated patient safety. Conclusion: replacing the punitive culture by learning from mistakes and stimulating interprofessional communication are actions that can be worked on by the service in the search for a positive culture.(AU)

Objetivo: analizar la cultura de seguridad del paciente entre los profesionales de la salud en una maternidad pública de la región Norte de Brasil. Método: estudio transversal realizado en 2019 con 70 profesionales que trabajan en la gestión de la salud o en la atención sanitaria. Las 12 dimensiones de la cultura de seguridad del paciente se analizaron mediante el cuestionario Hospital Survey on Patient Safety Culture. Se realizó un análisis descriptivo y la prueba de Chi-cuadrado de Pearson para verificar la asociación estadística entre las variables del estudio. Resultados: la mayoría de los participantes eran mujeres, tenían una edad media de 39 años y contaban con títulos de postgrado. En la evaluación de las 12 dimensiones de la Cultura de Seguridad del Paciente se verificó sólo un área de fortaleza con más del 75% de respuestas positivas - "Expectativas y acciones del supervisor/jefe para la promoción de la seguridad del paciente". Hubo una diferencia estadísticamente significativa entre el tiempo de trabajo en la institución y la forma en que este participante calificó la seguridad del paciente. Conclusión: reemplazar la cultura punitiva por el aprendizaje de los errores y estimular la comunicación interprofesional son acciones que pueden ser trabajadas por el servicio en la búsqueda de una cultura positiva.(AU)

Palliative sedation in patients with advanced cancer in a specialized unit in a middle-income country: A retrospective cohort study.

OBJECTIVE: To describe the 5-year practice on palliative sedation in a specialized palliative care unit in a deprived region in Brazil, and to compare survival of patients with advanced cancer who were and were not sedated during their end-of-life care. METHOD: Retrospective cohort study in a tertiary teaching hospital. We described the practice of palliative sedation and compared the survival time between patients who were and were not sedated in their last days of life. RESULTS: We included 906 patients who were admitted to the palliative care unit during the study period, of whom, 92 (10.2%) received palliative sedation. Patients who were sedated were younger, presented with higher rates of delirium, and reported more pain, suffering, and dyspnea than those who were not sedated. Median hospital survival of patients who received palliative sedation was 9.30 (CI 95%, 7.51-11.81) days and of patients who were not sedated was 8.2 (CI 95%, 7.3-9.0) days (P = 0.31). Adjusted for age and sex, palliative sedation was not significantly associated with hospital survival (hazard ratio = 0.93; CI 95%, 0.74-1.15). SIGNIFICANCE OF RESULTS: Palliative sedation can be accomplished even in a deprived area. Delirium, dyspnea, and pain were more common in patients who were sedated. Median survival was not reduced in patients who were sedated.

Evaluation of the Effects of Maytenus ilicifolia on the Activities of Cytochrome P450 3A and P-glycoprotein.

BACKGROUND: Maytenus ilicifolia is a Brazilian popular medicine commonly used to treat ulcer and gastritis. Despite the absence of toxicity regarding its consumption, possible interactions when co-administrated with conventional drugs, are unknown. OBJECTIVE: This study aimed to evaluate the effects of M. ilicifolia extracts on Cytochrome P450 3A (CYP3A) and P-glycoprotein (P-gp) activities. METHODS: The extracts were obtained by infusion (MI) or turbo-extraction using hydro-acetonic solvent (MT70). The content of polyphenols in each extract was determined. To assess the modulation of M. ilicifolia on P-gp activity, the uptake of fexofenadine (FEX) by Caco-2 cells was investigated in the absence or presence of MI or MT70. The effect on CYP3A activity was evaluated by the co-administration of midazolam (MDZ) with each extract in male Wistar rats. The pharmacokinetic parameters of the drug were determined and compared with those from the control group. The content of total phenolic compounds, tannins, and flavonoids on MT70 extract was about double of that found in MI. RESULTS: In the presence of the extracts, the uptake of the P-gp marker (FEX) by Caco-2 cells increased from 1.7 ± 0.4 ng.mg-1 protein (control) to 3.5 ± 0.2 ng.mg-1 protein (MI) and 4.4 ± 0.5 ng.mg-1 protein (MT70), respectively. When orally co-administrated with MDZ (substrate of CYP3A), the extracts augmented the AUC(0-∞) (Control: 911.7 ± 215.7 ng.h.mL-1; MI: 1947 ± 554.3 ng.h.mL-1; MT70: 2219.0 ± 506.3 ng.h.mL-1) and the Cmax (Control: 407.7 ± 90.4 ng.mL-1; MI: 1770.5 ± 764.5 ng.mL-1; MT70: 1987.2 ± 544.9 ng.mL-1) of the drug in rats indicating a 50% reduction of the oral Cl. No effect was observed when midazolam was given intravenously. CONCLUSION: The results suggest that M. ilicifolia can inhibit the intestinal metabolism and transport of drugs mediated by CYP3A and P-gp, respectively, however, the involvement of other transporters and the clinical relevance of such interaction still need to be clarified.

Relationship between the type of delivery and the epidemiological profile of prenatal and perinatal assistance in a municipality of Minas Gerais / Relação do tipo de parto com o perfil epidemiológico da assistência pré-natal e perinatal em um município de Minas Gerais

Abstract Objectives: to describe the profile of prenatal and perinatal health by correlating it with sociodemographic and clinical conditions, verifying the effectiveness of health actions. Methods: quantitative, descriptive and retrospective research using data from the Live Birth Information System (Sinasc) of the municipality of Patos de Minas in the period of 2011 to 2015. Results: between 2011 and 2014 there was a reduction in the rate of vaginal births and a slight increase in 2015, however, the rates of cesarean delivery were higher than recommended by the Ministry of Health. In both types of delivery, most pregnant women attended seven or more prenatal consultations, however, this rate was significantly higher for pregnant women who underwent cesarean section. Maternal age > 35 years was also related to cesarean delivery, however, there was no significant relationship between type of delivery, the gestation time, birth weight and occurrence of maternal death. Conclusions: during the analyzed period there were more cesarean sections in relation to vaginal deliveries, with no significant change in the number of maternal deaths. A significant association was found between the highest number of prenatal consultations and maternal age > 35 years in pregnant women who underwent caesarean section. Verification of these associations can help in reorienting health practices in the region.

Resumo Objetivos: traçar o perfil da saúde pré-natal e perinatal relacionando-o com as condições sociodemográficas e clínicas, verificando a efetividade das ações de saúde. Métodos: pesquisa quantitativa, descritiva e retrospectiva com dados do Sistema de Informações sobre Nascidos Vivos (Sinasc) do município de Patos de Minas no período de 2011-2015. Resultados: entre 2011-2014 houve redução na taxa de partos vaginais, com leve aumento em 2015, todavia, as taxas de parto cesáreo foram maiores que o preconizado pelo Ministério da Saúde. Em ambos os tipos de parto, a maioria das gestantes compareceram em sete ou mais consultas pré-natais, entretanto, essa taxa foi significativamente maior para as gestantes que se submeteram à operação cesariana. A idade materna >35 anos também esteve relacionada ao parto cesáreo, entretanto, não houve relação significativa entre o tipo de parto, a duração da gestação, o peso ao nascer e a ocorrência de óbito materno. Conclusões: no período analisado ocorreram mais operações cesarianas em relação aos partos vaginais, sem alteração significativa no número de óbitos maternos. Constatou-se associação significativa entre o maior número de consultas pré-natais e idade materna >35 anos em gestantes que fizeram cesarianas. A verificação dessas associações pode auxiliar na reorientação das práticas de saúde da região.

Mortalidade por causas externas no estado de Rondônia: análise de série temporal de 1999 a 2015 / Mortality due to external causes in the state of Rondônia: time series analysis from 1999 to 2015 / Mortalidad por causas externas en el Estado de Rondônia: análisis de serie temporal de 1999 a 2015

Objetivo: descrever a mortalidade por causas externas no Estado de Rondônia no período de 1999 e 2015. Método: estudo de série temporal utilizando dados da Declaração de Óbito disponibilizados pela Agência de Vigilância em Saúde do Estado de Rondônia. Para a análise de tendência realizou-se regressão linear utilizando o pacote estatístico Stata®11. Resultados: foram registrados no Estado de Rondônia 111.651 óbitos sendo 22,2% classificados como causas externas. O coeficiente médio de óbitos por esta causa no período foi 89,7 por 100.000 habitantes e desvio padrão de 6,5. A regressão linear apresentou um aumento anual nos óbitos por acidentes de trânsito de 2,1%, os óbitos por agressões tiveram um decréscimo anual de 1,98%, suicídios e outras causas externas permaneceram estacionárias. Conclusão: os resultados evidenciaram a necessidade de fortalecimento das ações preventivas entre homens jovens e políticas públicas para redução de acidentes de trânsito no estado de Rondônia

Objective: the objective was to describe the mortality from external causes in the State of Rondônia in the period of 1999 and 2015. Method: a time series study using data from the Death Certificates provided by the Health Surveillance Agency of the State of Rondônia. Linear regression was used for the trend analysis using the statistical package Stata®11. Results: 111,651 deaths were recorded in the State of Rondônia, 22.2% of which were classified as external causes. The mean number of deaths due to this cause in the period was 89.7 per 100,000 inhabitants and the standard deviation was 6.5. The linear regression showed an annual increase in deaths due to traffic accidents of 2.1%, deaths due to aggressions had an annual decrease of 1.98%, suicides and other external causes remained stationary. Conclusion: the results evidenced the need to strengthen preventive actions among young men and public policies to reduce accidents in the state of Rondônia

Objetivo: el objetive fue describir la mortalidad por causas externas en el Estado de Rondônia en el período de 1999 y 2015. Método: estudio de serie temporal utilizando datos de la Declaración de Óbito disponibilizados por la Agencia de Vigilancia en Salud del Estado de Rondônia. Para el análisis de tendencia se realizó regresión lineal utilizando el paquete estadístico Stata®11. Resultados: se registraron en el Estado de Rondônia 111.651 óbitos siendo 22,2% clasificados como causas externas. El coeficiente medio de muertes por esta causa en el período fue 89,7 por 100.000 habitantes y desviación estándar de 6,5. La regresión lineal presentó un aumento anual en las muertes por accidentes de tránsito del 2,1%, las muertes por agresiones tuvieron un descenso anual del 1,98% y los suicídios y otras causas externas permanecieron estacionarias. Conslusión: los resultados evidenciaron la necesidad de fortalecimiento de las acciones preventivas entre hombres jóvenes y políticas públicas para reducción de accidentes en el estado de Rondônia

Trunk muscular endurance, lumbar spine mobility and hip flexibility in sailors with and without low back pain / Análise da resistência muscular do tronco, mobilidade da coluna lombar e flexibilidade do quadril em velejadores com e sem dor lombar

Abstract Introduction: Low back pain is one of the most common injuries in sailors. Findings in the literature indicate that poor trunk endurance, flexibility and muscle strength are common in individuals with low back pain (LBP). Objective: Analyze trunk muscle endurance, lumbar spine mobility and hip flexibility in windsurfers with and without low back pain. Method: Sailors of both sexes with at least three years' experience in the sport answered the Nordic Musculoskeletal Questionnaire and were submitted to Schober's test, the passive straight leg raise (PSLR), the modified Thomas test, and isometric endurance assessment of the flexor, extensor and lateral flexor muscles of the torso. The sailors were divided into two groups (with and without LBP) and compared using the Student's t-test or Mann Whitney U test. Results: Participants were 22 national-level sailors, 11 with low back pain (LBP) and 11 without (NLBP). The LBP group obtained longer holding times for the trunk extensors (p=0.028) and a greater difference in endurance between the right and left sides for lateral trunk muscles (p=0.030). Both groups obtained results below normative values in most of the tests performed. Conclusion: Sailors with low back pain exhibited greater trunk extensor endurance and a larger imbalance between lateral trunk muscles when compared to those with no LBP. Spinal mobility and hip flexibility were similar between groups.

Resumo Introdução: A dor lombar é uma das lesões que mais afeta os velejadores. Achados na literatura mostram que a deficiência de força do tronco, flexibilidade e resistência muscular é comum em indivíduos com dor lombar. Objetivo: Analisar a resistência muscular do tronco, a mobilidade da coluna lombar e a flexibilidade do quadril em velejadores com e sem dor lombar. Método: Velejadores de ambos os sexos e com no mínimo três anos de prática responderam ao questionário nórdico de lesões osteomusculares e realizaram os testes de Schöber, de Elevação Passiva da Perna Estendida, de Thomas Modificado e de resistência isométrica dos músculos flexores, extensores e laterais do tronco. Os velejadores foram divididos em dois grupos (com e sem dor lombar), comparados por meio do teste t de Student para amostras independentes ou U de Mann Whitney. Resultados: 22 velejadores de nível nacional, 11 com dor lombar (CDL) e 11 sem dor lombar (SDL), participaram do estudo. O grupo CDL apresentou maior tempo de permanência no teste de resistência dos extensores do tronco (p=0,028) e maior diferença entre os lados direito e esquerdo no teste de resistência dos músculos laterais do tronco (p=0,030). Na maioria dos testes realizados, os dois grupos apresentaram resultados abaixo dos valores normativos. Conclusão: Velejadores com dor lombar apresentaram maior resistência dos extensores do tronco, porém maior desequilíbrio entre as cadeias laterais do tronco, em comparação a velejadores sem dor lombar. A mobilidade da coluna e a flexibilidade do quadril foram semelhantes entre os grupos.

A Influência da Espiritualidade e da Religiosidade na Aceitação da Doença e no Tratamento de Pacientes Oncológicos: Revisão Integrativa da Literatura / The Influence of Spirituality and Religiosity in Acceptance of the Disease and Treatment of Oncologic Patients: an Integrative Literature Review / La Influencia de la Espiritualidad y la Religiosidad en la Aceptación de Enfermedad y Tratamiento de Pacientes con Cáncer: una Revisión Integradora de Literatura

Introdução: A religiosidade e a espiritualidade são fatores ímpares na saúde do ser humano. Elas servem de auxílio para lidar com o câncer em seu processo de história natural. Objetivo: Analisar a produção científica nacional e internacional, acerca dos temas espiritualidade, religiosidade e pacientes oncológicos. Método: Revisão integrativa de literatura sobre a influência da espiritualidade e da religiosidade em pacientes oncológicos, nas bases de dados SciELO, MEDLINE e EBSCO e nos idiomas português e inglês, que buscou artigos publicados entre janeiro de 2009 a janeiro de 2019. Resultados: Oito artigos relataram a influência da religiosidade e da espiritualidade desde o momento do diagnóstico do câncer até a aceitação do tratamento. Dez artigos relataram que ambas servem como apoio, chance de encarar a vida e a morte de forma diferentes e de melhorar a qualidade de vida e bem-estar do paciente. A religiosidade e a espiritualidade ajudam os pacientes com as consequências do câncer e influenciarão a sua vida e o seu modo de viver durante o tratamento. Além disso, constituem uma estratégia que legitima e ameniza a incerteza diante das questões de caráter moral, pessoal e social, relativas à condição oncológica crônica. Conclusão: O apego à espiritualidade e à religiosidade influencia positivamente na saúde biopsicossocial do paciente com câncer. Ademais, pacientes dotados de espiritualidade e religiosidade podem apresentar melhor maior aceitação do câncer do tratamento, além de maior esperança e positividade no decorrer da doença.

Introduction: Religiosity and spirituality are unique factors in human health. They are helpful in dealing with cancer in its natural course. Objective: Analyze the national and international scientific publications involving the themes of Spirituality and Religiosity in Cancer Patients. Method: Integrative literature review that searched SciELO, MEDLINE and EBSCO databases for articles published between January 2009 and January 2019, in Portuguese and in English, about the influence of spirituality and religiosity in cancer patients from. Results: Eight articles reported the influence of religiosity and spirituality from the moment of cancer diagnosis through acceptance of the treatment. 10 articles reported that both serve as support, chance of facing life and death differently and to improve the patient's quality of life and well-being. Religiosity and spirituality help patients with the consequences of cancer and will influence their life and lifestyle during and after treatment. Moreover, they constitute a strategy that legitimizes and mitigates uncertainty about moral, personal and social issues related to the chronic oncological condition. Conclusion: Attachment to spirituality and religiosity positively influences the biopsychosocial health of cancer patients. Moreover, patients endowed with spirituality and religiosity may have better acceptance of cancer treatment, in addition of greater hope and positiveness during the course of the disease.

Introducción: La religiosidad y la espiritualidad son factores únicos en la salud humana. Son útiles para tratar el cáncer en su proceso de historia natural. Objetivo: Analizar la producción científica nacional e internacional, sobre los temas Espiritualidad, Religiosidad y Pacientes con cáncer. Método: Revisión bibliográfica integradora sobre la influencia de la espiritualidad y la religión en pacientes con cáncer en las bases de datos SciELO, MEDLINE y EBSCO, en idiomas portugués e inglés, quienes buscaron artículos publicados entre enero de 2009 y enero de 2019. Resultados: Ocho de los artículos informaron la influencia de la religiosidad y la espiritualidad desde el momento del diagnóstico del cáncer hasta la aceptación del tratamiento. Diez artigos informaron que ambos sirven como apoyo, una oportunidad para enfrentar la vida y la muerte de manera diferente y para mejorar la calidad de vida y el bienestar del paciente.La religiosidad y la espiritualidad ayudan a los pacientes con las consecuencias del cáncer e influirán en su vida y estilo de vida durante el tratamiento. Además, constituyen una estrategia que legitima y mitiga la incertidumbre frente a cuestiones morales, personales y sociales relacionadas con la condición oncológica crónica. Conclusion: Attachment to spirituality and religiosity positively influences the biopsychosocial health of cancer patients. Moreover, patients with spirituality and religiosity may have better acceptance of cancer treatment, and greater hope and positivity during the course of the disease.

Stability Analysis of Bitemarks in Different Conditions of Time and Temperature and Its Reliability as Evidence in Criminal Investigations.

The objective of this study was to evaluate the stability of bite marks in foods in different conditions of time and temperature and their reliability as evidenced in criminal investigations. Sampling came from 20 subjects, who were instructed to bite five pieces of cheese and five pieces of chocolate. Bites were produced by the anterior teeth, from canine to canine, and the volunteers had their dental arches molded to obtain plaster models that were used for later comparison. The samples produced by each participant were stored and analyzed according to the temperature (room and refrigerator) and time period (immediately after, three days, seven days). The linear model with mixed effects using R Core Team and SAS Statistical Software were used for the statistical analysis. The results of this study reveal that the storage temperature of these materials does not exert a significant influence. Both chocolate and cheese showed better results when measurements were made shortly after, however the chocolate showed to be more stable in longer periods of time. By means of this study, it was possible to demonstrate that the storage temperature does not exert a significant influence. However, the bite marks found in foods with greater dimensional stability and short time intervals, are more reliable and allow their use as evidence in criminal investigations. Still, due to the limitations presented, we recommend its use for the exclusion of possible suspects and not for the suspects identification.

Stability analysis of bitemarks in different conditions of time and temperature and its reliability as evidence in criminal investigations

Abstract The objective of this study was to evaluate the stability of bite marks in foods in different conditions of time and temperature and their reliability as evidenced in criminal investigations. Sampling came from 20 subjects, who were instructed to bite five pieces of cheese and five pieces of chocolate. Bites were produced by the anterior teeth, from canine to canine, and the volunteers had their dental arches molded to obtain plaster models that were used for later comparison. The samples produced by each participant were stored and analyzed according to the temperature (room and refrigerator) and time period (immediately after, three days, seven days). The linear model with mixed effects using R Core Team and SAS Statistical Software were used for the statistical analysis. The results of this study reveal that the storage temperature of these materials does not exert a significant influence. Both chocolate and cheese showed better results when measurements were made shortly after, however the chocolate showed to be more stable in longer periods of time. By means of this study, it was possible to demonstrate that the storage temperature does not exert a significant influence. However, the bite marks found in foods with greater dimensional stability and short time intervals, are more reliable and allow their use as evidence in criminal investigations. Still, due to the limitations presented, we recommend its use for the exclusion of possible suspects and not for the suspects identification.

Resumo O objetivo deste estudo foi avaliar a estabilidade das marcas de mordida em alimentos em diferentes condições de tempo e temperatura e sua confiabilidade como evidência em investigações criminais. A amostragem foi composta por 20 indivíduos, que foram instruídos a morder cinco pedaços de queijo e cinco pedaços de chocolate. As mordidas foram produzidas pelos dentes anteriores, de canino a canino, e os sujeitos da pesquisa tiveram seus arcos dentais moldados para obter modelos que foram usados para posterior comparação. As amostras produzidas por cada participante foram armazenadas e analisadas de acordo com a temperatura (ambiente e geladeira) e período de tempo (imediatamente, após três dias e sete dias). Para a análise estatística, utilizou-se o modelo linear com efeitos mistos, utilizando R Core Team e SAS Statistical Software. Os resultados deste estudo revelam que a temperatura de armazenamento desses materiais não exerce influência significativa. Tanto o chocolate quanto o queijo apresentaram melhores resultados quando as mensurações foram feitas logo após, porém o chocolate mostrou-se mais estável em períodos mais longos. Por meio deste estudo, foi possível demonstrar que a temperatura de armazenamento não exerce influência significativa. Entretanto, as marcas de mordida encontradas em alimentos com maior estabilidade dimensional e intervalos de tempo curtos são mais confiáveis e permitem seu uso como evidência em investigações criminais. Ainda assim, devido às limitações apresentadas, recomendamos seu uso para a exclusão de possíveis suspeitos e não para a individualização dos mesmos.

Skin temperature changes during muscular static stretching exercise.

This study aimed to investigate the acute effects of stretching exercise on skin temperature, flexibility, passive muscle stiffness, and pain during hamstring stretching in healthy young subjects. Thirty-one participants (n=31) were randomly divided into 2 groups: an experimental group (EG, n=15), which was submitted to hamstring stretching exercise for 180 sec, and the control group (n=16), which was not exercised. Skin temperature (TsK) was collected in subjects' posterior thigh using a thermographic camera at 7 time points with intervals of 30 sec each: T0 (rest), T30, T60, T90, T120, T150, and T180. In addition, the knee range of motion, passive stiffness and muscle soreness (visual analogue scale) were recorded during the stretching procedure at the same times. The EG presented a small but progressive increase in TsK (30.8°C±0.6°C to 31.1°C±0.6°C, P<0.01), with an increased range of motion (P<0.01) and muscle soreness levels (P<0.01) during the gradual hamstring stretching protocol. Additionally, there was an increment of passive stiffness (P<0.01) that was partially reversed toward the end of the stretching period. This research presents evidence that constant, passive and progressive stretching of the hamstrings progressively increased the local TsK by about 0.3°C after 180 sec of stretching. These findings may help to understand the effects of repeated stress on the muscle-tendon unit and the role of muscle stretching in warm-up protocols and rehabilitation.

Correlação entre reclamações de consumidores e ações judiciais por falhas na prestação de serviços odontológicos no estado de São Paulo, Brasil / Correlation between consumer complaints and lawsuits for failures in dental services, São Paulo state, Brazil

A responsabilidade dos cirurgiões-dentistas tem como principais enfoques os direitos e as obrigações destes profissionais. O objetivo do trabalho foi realizar a associação entre os cirurgiões-dentistas e/ou as empresas que prestam serviços odontológicos que tiveram seus nomes apontados em sites especializados em reclamações e, a partir desses nomes reclamados, buscar as demandas judiciais no Estado de São Paulo. A amostra foi composta por processos disponíveis no site do Tribunal de Justiça de São Paulo. Os nomes de 175 cirurgiões-dentistas e/ou empresas odontológicas foram coletados a partir de sites especializados em reclamações utilizando termos relacionados à Odontologia. Os resultados mostraram que, a partir dos 175 nomes encontrados, havia 313 processos constando esses nomes como parte requerida em processos judiciais. O ano com maior ocorrência dos casos foram 2011 e 2012. A maioria das ações foi promovida por pessoas do sexo feminino (62%) e os planos odontológicos constituem o principal alvo dos processos. Com relação ao "tipo de ação" referente ao fator motivador dos processos analisados, os "danos morais", "danos materiais e morais", "danos materiais", seguido de "contrato" e "obrigação" foram os termos mais encontrados. Os valores pleiteados, quando divulgados, foram bastante variados, com uma média correspondendo a um montante de R$ 27.349,54. Pode-se concluir que houve associação entre os nomes que estavam sendo reclamados nos sites brasileiros especializados em reclamação de consumidores e as demandas judiciais no Estado de São Paulo.

The main topic of Dentistry responsibility is the professional´s rights and obligations. This study aimed to verify the association between dentists and/or dental companies´ names presents in specific complaints websites, and with these names look for lawsuits using the online database of the São Paulo State Court. The sample was com posed by lawsuits from these websites. The 175 dentists and/or dental companies´ names were collected using keywords about Dentistry. The results showed that 175 names were found in complaints websites and after the search using these names in database of the São Paulo State Court were found 313 lawsuits against the professional and companies found. The majority of cases occurred in the years 2011 and 2012. The most lawsuits were filed by women (62%) and the dental companies were the lawsuits´main target. About the lawsuit "nature" an "topic" concerning the reason to start the lawsuit the studied shows that "moral damage", "moral and material damage", "material damage", and "contract" and "obligation" were the principal terms found. The requested compensation values were varied, and the mean value was R$ 27,349.54 (in Brazilian reais). It was concluded that there is association between the names found in specific complaints websites and the lawsuits database of the São Paulo State Court.

Sex Determination of Adult Human Maxillary Sinuses on Panoramic Radiographs.

The purpose of this study was to evaluate dimensions of adult human maxillary sinuses on panoramic radiographs and their possible application on the sex determination for forensic purposes. The sample comprised 64 database panoramic radiographs from individuals aged 20 years or older (32 male and 32 female subjects), with complete permanent dentition (or absence of third molars). One examiner measured the width and height of the right and left maxillary sinuses using the software Image J 1.47v (National Institutes of Health, Bethesda, USA). Measurements were repeated to calculate intra-observer agreement. Chi-Square test, Kappa, ANOVA and T-Student were used for results analysis for p≤ 0.05. Intra-observer agreement with correlation Kappa ranged between 0.38 and 0.96. For female subjects, the mean height and width of the left maxillary sinus were 28.7856mm and 44.6178mm, respectively. And right maxillary sinus was 27.7163mm for height and 45.1850mm for width. Male subjects were found to have the mean height and width of the left maxillary sinus 30.9981mm and 48.7753mm, respectively. And right maxillary sinus was 30.7403mm for height and 48.5753mm for width. There was a statistically significant difference in the height and width of maxillary sinuses between males and females. It can be concluded that maxillary sinuses height and width on panoramic radiographs can be used to determine the gender of adult human subjects.

An extensive reef system at the Amazon River mouth.

Large rivers create major gaps in reef distribution along tropical shelves. The Amazon River represents 20% of the global riverine discharge to the ocean, generating up to a 1.3 × 10(6)-km(2) plume, and extensive muddy bottoms in the equatorial margin of South America. As a result, a wide area of the tropical North Atlantic is heavily affected in terms of salinity, pH, light penetration, and sedimentation. Such unfavorable conditions were thought to imprint a major gap in Western Atlantic reefs. We present an extensive carbonate system off the Amazon mouth, underneath the river plume. Significant carbonate sedimentation occurred during lowstand sea level, and still occurs in the outer shelf, resulting in complex hard-bottom topography. A permanent near-bottom wedge of ocean water, together with the seasonal nature of the plume's eastward retroflection, conditions the existence of this extensive (~9500 km(2)) hard-bottom mosaic. The Amazon reefs transition from accretive to erosional structures and encompass extensive rhodolith beds. Carbonate structures function as a connectivity corridor for wide depth-ranging reef-associated species, being heavily colonized by large sponges and other structure-forming filter feeders that dwell under low light and high levels of particulates. The oxycline between the plume and subplume is associated with chemoautotrophic and anaerobic microbial metabolisms. The system described here provides several insights about the responses of tropical reefs to suboptimal and marginal reef-building conditions, which are accelerating worldwide due to global changes.