Desafios do processo gestacional de mulheres negras: uma revisão narrativa / Challenges in the gestational process of black women: a narrative review

Esta revisão narrativa procura discutir aspectos concernentes ao processo gestacional de mulheres negras, quais sejam: se existem diferenças de tratamento entre mulheres brancas e negras durante a gravidez e nos momentos do parto e pós-parto, como essas diferenças são influenciadas pelos aspectos fisiológicos de cada grupo étnico e como isso afeta as taxas de morbimortalidade. Para esta revisão, quatro bases de dados foram usadas (SciELO, LILACS, PubMed e MEDLINE) e 23 artigos foram lidos na íntegra, depois de selecionados por data de publicação, língua, país da pesquisa e análise dos títulos e resumos. Como principais resultados, os autores encontraram diferenças claras entre mulheres brancas e negras quanto ao acesso à saúde, sendo as negras mais propensas a usar os sistemas públicos e ter menos consultas pré-natal. Também foi observado que as mulheres negras reportaram maus-tratos mais vezes, tinham maiores chances de serem proibidas de ter um acompanhante durante o parto e recebiam menos anestesia para episiotomias. As características fisiológicas também foram apontadas várias vezes. Nesse sentido, altas taxas de anemia ferropriva e hipertensão durante a gravidez foram mais comuns entre as negras. Além disso, em se tratando de taxas de morbimortalidade, mulheres negras tinham uma chance consideravelmente maior de serem readmitidas pós-parto e maiores taxas de mortalidade, quando comparadas com mulheres brancas.(AU)

This review aims to discuss aspects related to the gestational process of black women, namely: if there is a difference in how black and white women are treated throughout pregnancy, partum and postpartum moments, how this difference is influenced by the physiological aspects of each ethnical group and how it affects their morbidity and mortality rates. For this review, four databases were used (SciELO, LILACS, PubMed and MEDLINE) and 23 articles were fully read, after being selected by publishing date, language, country of research, title and abstract analysis. The authors found as the main results clear differences between black women's and white women's access to health care, as black women are more likely to use public health care systems and have fewer prenatal appointments. It was also noticed that black women reported maltreatment more frequently, had a higher chance of being prohibited from keeping a companion during labor and suffering from less local anesthesia for episiotomy. The physiological characteristics were also pointed out several times, with high rates of iron deficiency anemia and hypertension during pregnancy being more common among black women. Moreover, when it comes to morbidity and mortality rates, black women had an extremely higher chance of being readmitted postpartum, and a higher mortality rate, when compared to white women.(AU)

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

Desafios do processo gestacional de mulheres negras: uma revisão narrativa / Challenges in the gestational process of black women: hia narrative review

Esta revisão narrativa procura discutir aspectos concernentes ao processo gestacional de mulheres negras, quais sejam: se existem diferenças de tratamento entre mulheres brancas e negras durante a gravidez e nos momentos do parto e pós-parto, como essas diferenças são influenciadas pelos aspectos fisiológicos de cada grupo étnico e como isso afeta as taxas de morbimortalidade. Para esta revisão, quatro bases de dados foram usadas (SciELO, LILACS, PubMed e MEDLINE) e 23 artigos foram lidos na íntegra, depois de selecionados por data de publicação, língua, país da pesquisa e análise dos títulos e resumos. Como principais resultados, os autores encontraram diferenças claras entre mulheres brancas e negras quanto ao acesso à saúde, sendo as negras mais propensas a usar os sistemas públicos e ter menos consultas pré-natal. Também foi observado que as mulheres negras reportaram maus-tratos mais vezes, tinham maiores chances de serem proibidas de ter um acompanhante durante o parto e recebiam menos anestesia para episiotomias. As características fisiológicas também foram apontadas várias vezes. Nesse sentido, altas taxas de anemia ferropriva e hipertensão durante a gravidez foram mais comuns entre as negras. Além disso, em se tratando de taxas de morbimortalidade, mulheres negras tinham uma chance consideravelmente maior de serem readmitidas pós-parto e maiores taxas de mortalidade, quando comparadas com mulheres brancas.(AU)

This review aims to discuss aspects related to the gestational process of black women, namely: if there is a difference in how black and white women are treated throughout pregnancy, partum and postpartum moments, how this difference is influenced by the physiological aspects of each ethnical group and how it affects their morbidity and mortality rates. For this review, four databases were used (SciELO, LILACS, PubMed and MEDLINE) and 23 articles were fully read, after being selected by publishing date, language, country of research, title and abstract analysis. The authors found as the main results clear differences between black women's and white women's access to health care, as black women are more likely to use public health care systems and have fewer prenatal appointments. It was also noticed that black women reported maltreatment more frequently, had a higher chance of being prohibited from keeping a companion during labor and suffering from less local anesthesia for episiotomy. The physiological characteristics were also pointed out several times, with high rates of iron deficiency anemia and hypertension during pregnancy being more common among black women. Moreover, when it comes to morbidity and mortality rates, black women had an extremely higher chance of being readmitted postpartum, and a higher mortality rate, when compared to white women.(AU)

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

Completude e atraso vacinal das crianças antes e após intervenção educativa com as famílias / Pleno cumplimiento y atraso vacunatorios en niños antes y después de una intervención educativa con las familias / Vaccination completion and delay in children before and after an educational intervention with their families

RESUMO Objetivo: avaliar a completude e o atraso vacinal das crianças de um centro de educação infantil antes e após uma intervenção educativa com as famílias. Método: estudo do tipo antes e depois, realizado em um centro de educação infantil em São Paulo de fevereiro a abril de 2017. A intervenção consistiu no envio de lembretes e folhetos às famílias sobre a importância da vacinação. A situação vacinal foi verificada através da Caderneta de Saúde da Criança. Foram utilizados os testes qui-quadrado e exato de Fisher. Resultados: participaram do estudo 151 crianças e suas famílias antes e 145 depois. A prevalência da completude vacinal passou de 81,5% para 93,1% após a intervenção (p=0,003). O atraso vacinal foi mais frequente entre crianças menores de dois anos e aquelas do sexo mascuilno. Conclusão: a intervenção contribuiu para o aumento da completude vacinal por meio da educação em saúde das famílias das crianças.

RESUMEN: Objetivo: evaluar el pleno cumplimiento y el atraso vacunatorios en niños de un centro de educación infantil antes y después de una intervención educativa con las familias. Método: estudio del tipo antes y después realizado en un centro de educación infantil de San Pablo entre febrero y abril de 2017. La intervención consistió en enviar recordatorios y folletos a las familias sobre la importancia de la vacunación. La situación de vacunas se verificó a través de la Libreta de vacunas infantiles. Se emplearon las pruebas de chi-cuadrado y Exacta de Fisher. Resultados: del estudio participaron 151 niños y sus familias antes de la intervención, y 145 después de ella. La prevalencia del pleno cumplimiento vacunatorio aumentó del 81,5% al 93,1% después de la intervención (p=0,003). El atraso en las vacunas fue más frecuente entre los niños de menos de dos años de edad y entre los del sexo masculino. Conclusión: la intervención contribuyó a mejorar el índice de pleno cumplimiento vacunatorio al ofrecer educación en salud a las familias de los niños.

ABSTRACT Objective: To assess vaccination completion and delay in children at a child education center before and after an educational intervention with their families. Method: A before-and-after study carried out at a child education center in São Paulo from February to April 2017. The intervention consisted of sending reminders and leaflets to the families about the importance of vaccination. The vaccination status was verified through the Child Health Handbook. Fisher's exact and chi-square tests were used. Results: 151 children and their families participated in the before-phase of the study, and 145 in its after-phase. The prevalence of vaccination completion rose from 81.5% to 93.1% after the intervention (p=0.003). Vaccination delay was more frequent among children under two years of age and those who were male. Conclusion: The intervention contributed to the increase of vaccination completion through health education of the children's families.

Desenvolvimento do mapa estratégico como diretriz de gestão em serviço de fisioterapia hospitalar / Development of a strategic map as a management guideline in hospital-based physiotherapy

Trata-se de um relato de caso abordando a experiência de um projeto de gestão desenvolvido na Divisão de Fisioterapia do Instituto Central do Hospital das Clí­nicas da Faculdade de Medicina da Universidade de São Paulo. A gestão de serviços de saúde é complexa e desafiadora, devido a fatores como as constantes transformações tecnológicas e terapêuticas, aumento da população idosa e de doenças crônicas, escassez de recursos e carência de gestão eficiente nas organizações. A definição de objetivos, estratégias e instrumentos de monitoramento para direcionar a organização e promover qualidade são determinantes nas ações gerenciais e no desempenho estratégico da empresa. Neste contexto, o projeto objetivou construir um mapa estratégico considerando o Balanced ScoreCard como diretriz gerencial e instrumento de análise do desempenho da Divisão de Fisioterapia. Reuniões estruturadas com membros da liderança de fisioterapia foram realizadas para definir a visão do futuro e objetivos estratégicos a médio e longo prazo, idealizados pela Divisão de Fisioterapia, tendo como base as perspectivas do Balanced ScoreCard, aprendizado e crescimento, processos internos, clientes, sustentabilidade financeira e social. O mapa estratégico foi construí­do em uma representação gráfica permitindo fácil compreensão da visão do futuro e objetivos estratégicos que irão direcionar o comportamento e o desempenho da Divisão de Fisioterapia, nos próximos anos. Além de direcionar as ações de melhorias da Divisão, o mapa estratégico elaborado também apresenta caracterí­sticas marcantes de alinhamento com o mapa estratégico institucional. (AU)

This is a case report addressing a management project developed in the Physiotherapy Division of the Central Institute of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Managing health services is complex and challenging due to factors such as constant technological and therapeutic changes, increase in the elderly population and chronic diseases, scarcity of resources, and lack of efficient organizational management. The definition of objectives, strategies, and monitoring tools to direct the organization and promote quality help to determine managerial actions and the strategic performance of the service. In this context, this project aimed to build a strategic map using the Balanced Scorecard as a managerial guideline and instrument of performance analysis for the Physiotherapy Division. Structured meetings with members of the physiotherapy leadership team were held to define the vision for the future and strategic medium - and long-term objectives. The strategic map was built as a graphical representation, allowing for easy understanding of the vision for the future and strategic objectives that will guide the behavior and performance of the Physiotherapy Division in the coming years. In addition to directing the improvement actions of the division, the strategic map also presents striking instances of alignment with the institutional strategic map.(AU)

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction / Qualidade de vida específica da doença após septoplastia e fratura bilateral de concha inferior em pacientes com obstrução nasal

Abstract Introduction: Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure. Objective: To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical-epidemiological variables associated with functional outcome. Methods: Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical-epidemiological variables with the scores obtained. Results: Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p < 0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r = −0.614, p < 0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p > 0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p > 0.05). Smokers presented greater reduction in NOSE scores during the study (p = 0.043, U-Mann-Whitney). Conclusion: Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.

Resumo Introdução: Os desvios septais podem causar obstrução nasal e impacto negativo na qualidade de vida dos indivíduos. A eficácia da septoplastia para o tratamento do desvio septal e os preditores de resultados cirúrgicos satisfatórios continuam controversos. A variabilidade técnica, a heterogeneidade das amostras de estudo e a ausência de uma ferramenta sólida para avaliação clínica são os principais obstáculos ao estabelecimento de dados estatísticos confiáveis sobre o procedimento. Objetivo: Avaliar a melhora clínica na qualidade de vida específica da doença entre pacientes submetidos a septoplastia e fratura bilateral da concha inferior sob sedação e anestesia local em um hospital terciário e possíveis variáveis clínico-epidemiológicas associadas ao desfecho funcional. Método: Cinquenta e dois pacientes consecutivamente submetidos a septoplastia e fratura bilateral da concha inferior para o tratamento da obstrução nasal preencheram formulários com informações clínicas e epidemiológicas durante a inclusão no estudo e tiveram seus sintomas quantificados objetivamente utilizando a escala de Avaliação de Sintomas de Obstrução Nasal (Nose Obstruction Symptom Evaluation - NOSE) no pré-operatório e um e três meses após o procedimento. A análise estatística objetivou determinar resultados cirúrgicos globais e estratificados e investigar correlações entre as variáveis clínico-epidemiológicas e os escores obtidos. Resultados: Foi demonstrada uma melhora estatisticamente significativa nos escores obtidos no questionário NOSE três meses após a cirurgia (p < 0,001, T-Wilcoxon), quando comparado com os escores obtidos no pré-operatório, com uma forte correlação entre o escore pré-operatório e a melhora pós-operatória durante esse período (r = -0,614, p < 0,001, Spearman). Após um mês, os pacientes atingiram em média 87,15% do resultado obtido ao término do estudo. Fumantes e pacientes com rinite e/ou comorbidade pulmonar apresentaram valores médios pré-operatórios do escore NOSE aumentados, embora sem significância estatística (p > 0,05). Sexo, idade, história de rinite e presença de comorbidade pulmonar não influenciaram significativamente os resultados cirúrgicos (p > 0,05). Os fumantes apresentaram maior redução nos escores de NOSE (p = 0,043, U-Mann-Whitney). Conclusão: A septoplastia e a fratura bilateral da concha inferior demonstraram melhorar significativamente a qualidade de vida específica da doença e este resultado favorável parece ocorrer de forma precoce.

Short-Term Audiological Results of Diode Laser in Comparison with Manual Perforation in Stapes Surgery

Abstract Introduction Diode laser is a new alternative in stapes surgery for otosclerosis. The present study is the first to compare the short-term results of the surgery performed using diode laser to those obtained through the conventional fenestration technique. Objective To use audiometry to establish a comparative analysis between the functional results obtained through surgery for otosclerosis using diode laser and the conventional technique. Method Audiometric evaluation of 12 patients submitted to stapes surgery for otosclerosis, using diode laser or conventional fenestration by needle and drills, between 2014 and 2015. Each group was composed of 6 patients. Pre and postoperative measures were compared for three months in both groups. The speech recognition threshold, the air and bone conduction threshold, as well as the gap between them at 500 Hz, 1 KHz, 2 KHz and 4 KHz were measured. Results Significant difference in bone conduction and SRT was observed when compared post- and preoperative results in the diode group. However diode and conventional technique groups presented significant differences in air conduction and air-bone gap, suggesting that both can provide functional improvement. Conclusion Laser stapedotomy is a safe technique with good results. Both laser surgery and the conventional technique have improved the hearing of patients with a discreet advantage for the diode laser. Further prospective and randomized clinical trials are required to disclose all possible benefits of the stapes surgery using diode laser.

Short-Term Audiological Results of Diode Laser in Comparison with Manual Perforation in Stapes Surgery.

Introduction Diode laser is a new alternative in stapes surgery for otosclerosis. The present study is the first to compare the short-term results of the surgery performed using diode laser to those obtained through the conventional fenestration technique. Objective To use audiometry to establish a comparative analysis between the functional results obtained through surgery for otosclerosis using diode laser and the conventional technique. Method Audiometric evaluation of 12 patients submitted to stapes surgery for otosclerosis, using diode laser or conventional fenestration by needle and drills, between 2014 and 2015. Each group was composed of 6 patients. Pre and post-operative measures were compared for three months in both groups. The speech recognition threshold, the air and bone conduction threshold, as well as the gap between them at 500 Hz, 1 KHz, 2 KHz and 4 KHz were measured. Results Significant difference in bone conduction and SRT was observed when compared post- and preoperative results in the diode group. However diode and conventional technique groups presented significant differences in air conduction and air-bone gap, suggesting that both can provide functional improvement. Conclusion Laser stapedotomy is a safe technique with good results. Both laser surgery and the conventional technique have improved the hearing of patients with a discreet advantage for the diode laser. Further prospective and randomized clinical trials are required to disclose all possible benefits of the stapes surgery using diode laser.

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction.

INTRODUCTION: Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure. OBJECTIVE: To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical-epidemiological variables associated with functional outcome. METHODS: Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical-epidemiological variables with the scores obtained. RESULTS: Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p<0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r=-0.614, p<0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p>0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p>0.05). Smokers presented greater reduction in NOSE scores during the study (p=0.043, U-Mann-Whitney). CONCLUSION: Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.

Effects of individual and group exercise programs on pain, balance, mobility and perceived benefits in rheumatoid arthritis with pain and foot deformities.

[Purpose] To verify the effects of individual and group exercise programs on pain, balance, mobility and perceived benefits of rheumatoid arthritis patients (RA) with pain and foot deformities. [Subjects and Methods] Thirty patients with RA pain and foot deformity were allocated into two groups: G1: individual exercise program and G2: group exercise program. The variables analyzed were Numerical Rating Scale (NRS) for pain, Berg Balance Scale (BBS) for balance, Timed Up & Go Test (TUG) and Functional Reach (FR) for mobility, and Foot Health Status Questionnaire (FHSQ-Br) for perceived benefits. Both exercise programs consisted of functional rehabilitation exercises and self-care guidance aimed at reducing pain and improving balance and mobility. Intragroup comparisons of variables between A1 (pre-intervention) and A2 (post-intervention) were performed. [Results] Patients in both groups were similar in A1 (pre-intervention) in all the variables analyzed. Comparison between A1 and A2 for each variable showed improvement for G1 in the NRS, BBS, FR, TUG and in four out of ten domains of FHSQ-Br. G2 showed improvement in the NRS, BBS and eight out of ten domains of FHSQ-Br. [Conclusion] Both individual and group programs revealed benefits for patients with RA, however, group exercise programs showed better perception of benefits.

Starch levels on performance, milk composition and energy balance of lactating dairy cows.

The objective of this experiment was to evaluate the effects of starch levels in diets with the replacement of citrus pulp for corn on milk yield, milk composition, and energy balance of lactating dairy cows. Twenty-eight multiparous Holstein cows were used in seven 4 × 4 Latin squares conducted concurrently, and each experimental period consisted of 20 days (16 days for adaptation and 4 days for sampling). The experimental treatments comprised four starch levels: 15, 20, 25, and 30% in the diet. The dry matter intake increased linearly with increasing starch levels. The milk yield and 3.5% fat-corrected milk yield showed quadratic response to increasing starch levels. The milk protein content and milk total solids content responded linearly to increasing starch levels. The feed efficiency, milk lactose content, milk urea nitrogen, plasma urea nitrogen, and plasma glucose concentration were not affected by starch levels. The estimated net energy for lactation (NEL) intake increased linearly as the starch level was raised. Although the milk NEL output per kilogram of milk was not affected by starch, the milk NEL output daily responded quadratically to starch levels. In addition, the NEL in body weight gain also responded quadratically to increasing starch levels. The efficiency of energy use for milk yield and the NEL efficiency for production also responded quadratically to increasing starch levels. Diets for mid-lactating dairy cows producing around 30 kg/day of milk should be formulated to provide around 25% starch to optimize performance.

Physical performance, balance, mobility, and muscle strength decline at different rates in elderly people.

[Purpose] The aim of this study was to verify the decline in functionality of elderly people. [Subjects and Methods] The study subjects comprised 152 individuals (96 women; 56 men) divided into 3 groups: G1 (60 to 69 years, n=53); G2 (70 to 79 years, n=65); and G3 (80 years or older, n=34). Physical performance, balance, mobility, and muscle strength were assessed using Short Physical Performance Battery (SPPB), Berg Balance Scale (BERG), Timed Up and Go (TUG) test, and leg press test, respectively. Comparison among age-stratified groups (G1, G2 and G3) and between genders were examined using analysis of variance with Tukey's test as a post hoc test or the Kruskal-Wallis test with Bonferroni correction. [Results] SPPB and BERG scores decreased significantly in comparison between G1 and G3, and between G2 and G3 in women. TUG and leg press scores decreased significantly in comparison between G1 and G3 and between G2 and G3. [Conclusion] People in their 60s and 70s have similar functional characteristics (physical performance, balance, mobility and muscle strength for both genders), and functionality starts to decline when people are in their 80s.

Elaboration and assessment of clinical protocols to support the evaluation of stand-to-sit activity / Elaboração e Avaliação dos Protocolos para auxílio na avaliação da atividade de sentar

Introduction Evaluation of sit-to-stand and stand-to-sit activities is used by physical therapists in patients with neurological and musculoskeletal disorders. Sit-to-stand activity presents different descriptions of phases and movements; however the phases of stand-to-sit activity have not been established yet.Objectives To describe the movements during stand-to-sit activity and create an evaluation protocol.Materials and methods Stand-to-sit activity was described on anterior and lateral views based on the observation of 27 healthy subjects. The body segments chosen to analyze were feet, ankles, knees, hips, pelvis, trunk, spine, upper limbs, head and cervical spine. The movements of body segments were described as adduction and abduction, eversion and inversion, valgus and varus, neutral position and asymmetry. The protocol was assessed with questionnaires answered by 12 physiotherapists experts in the area.Results Stand-to-sit activity was divided in 4 phases: 1- "Neutral position", 2- "Pre-squat", 3- "Squat" and 4- "Stabilization". Two models of protocols were developed considering 5 body segments to the anterior view and 7 segments for the lateral view.Conclusion Stand-to-sit activity was described in 4 phases with sequential movements of each body segment. These protocols allow physiotherapists to identify unusual movements of body segments during the stand-to-sit activity.

Introdução Levantar e sentar são movimentos comuns da vida diária, e sua avaliação é utilizada frequentemente por fisioterapeutas em pacientes com disfunções neurológicas e musculoesqueléticas. A atividade de levantar apresenta diferentes descrições quanto às fases e movimentos, enquanto a atividade de sentar ainda não apresenta suas fases estabelecidas.Objetivos Descrever os movimentos durante a atividade de sentar e elaborar protocolos de auxílio à avaliação.Materiais e métodos Esta atividade foi descrita nas vistas anterior e lateral com base nos achados de um levantamento bibliográfico e na observação das filmagens de 27 indivíduos funcionalmente independentes. Os segmentos corporais analisados foram pés, tornozelos, joelhos, quadris, pelve, tronco, coluna lombar, membros superiores, coluna cervical e cabeça. Seus movimentos e condições foram descritos: adução e abdução, eversão e inversão, valgismo e varismo, posição neutra e assimetria. Os protocolos foram avaliados por meio de questionários de avaliação, respondidos por 12 fisioterapeutas especialistas na área.Resultados A atividade de sentar foi descrita de acordo com o estabelecimento de 4 fases. 1- “Posição inicial”, 2- “Pré-agachamento”, 3- “Agachamento” e 4- “Estabilização”. Foram elaborados 2 modelos de protocolos, sendo considerados 5 segmentos corporais para a vista anterior e 7 segmentos para a vista lateral.Conclusão A atividade de sentar foi descrita em 4 fases, e em cada uma ocorrem movimentos sequenciais de cada segmento corporal. Estes protocolos permitem identificar as alterações de segmentos corporais durante a atividade de sentar por meio da comparação dos movimentos descritos. A classificação do grau de inadequação corresponde ao número de segmentos corporais com movimentos alterados.

Declínio de atividades instrumentais de vida diária associado à perda de força de preensão palmar em idosos internados em enfermaria geriátrica / Decline in instrumental activities of daily living associated with loss of hand grip strength in elderly patients hospitalized in geriatric ward

OBJETIVO: Verificar a associação entre a capacidade de executar as atividades instrumentais de vida diária (AIVDs) e a força de preensão palmar em idosos sem comprometimento cognitivo internados em enfermaria geriátrica. MÉTODOS: Estudo transversal. Foram incluídos pacientes idosos, com idade igual ou superior a 60 anos, de ambos os gêneros, admitidos em enfermaria de Geriatria. Foram excluídos indivíduos com doenças neurológicas, osteomusculares agudas e respiratórias exacerbadas; com indicação médica de repouso ou com uso de algum aparato clínico, bem como aqueles com déficits cognitivos e/ou delirium. Os dados foram coletados do prontuário e foi realizada a avaliação da capacidade de realizar atividades instrumentais de vida diária, por meio da Escala de Lawton, e a avaliação da força de preensão palmar, por meio da dinamometria do membro superior dominante. Os dados foram descritos em média e desvio- padrão. O teste de correlação de Pearson foi aplicado para verificar associação entre a capacidade de realizar AIVDs e a força de preensão palmar. RESULTADOS: Participaram do estudo 12 idosos (75% mulheres) com idade média de 80,67±6,35 anos. As médias da força de preensão palmar e pontuação total da Escala de Lawton foram 11,96±6,71 quilogramas-força (kgf) e 22,58±1,67 pontos, respectivamente. Verificou-se associação moderada e positiva entre a força de preensão palmar e a pontuação na Escala de Lawton (r=0,640; p=0,025). CONCLUSÃO: A capacidade de realizar AIVDs e a força de preensão palmar apresentaram associação na amostra estudada. .

OBJECTIVE: To verify the association between the ability to perform instrumental activities of daily living (IADL) and handgrip strength in hospitalized geriatric patients without cognitive impairment. METHODS: Cross-sectional study. Elderly patients aged over 60 years of both genders admitted to geriatric patients ward were included. On the other hand, elderly with neurological, musculoskeletal and respiratory acute exacerbated diseases; individuals with medical indication of rest or use of clinical apparatus, cognitive impairment and/or delirium were excluded. Data were collected from medical records. The ability to perform IADL was assessed by Lawton Scale and the handgrip strength was measured using handheld dynamometry on the dominant upper limb. A descriptive analysis with mean and standard deviation was carried out. The Pearson correlation test was applied to verify association between the total score of Lawton Scale and handgrip strength. RESULTS: The study included 12 patients (75% women) whose mean age were 80.67±6.35 years. The mean of handgrip strength and total Lawton Scale score were 11.96±6.71 Kgf and 22.58±1.67 points, respectively. A moderate positive association between handgrip strength and Lawton Scale score (r=0.640; p=0.025) was found. CONCLUSION: The handgrip strength and IADLs were associated in this study population. .

Chronic Low Back Pain in Women: Muscle Activation during Task Performance.

[Purpose] The aim of this study was to compare the activities of the trunk and hip muscles in chronic low back pain (CLBP) women and asymptomatic subjects during the kneeling to half-kneeling task. [Subjects] Twenty-nine CLBP women and thirty asymptomatic subjects (C) participated in this study. [Methods] Electromyography activity (EMG) of the obliquus internus abdominis (OI), the lumbar erector spinae (LES) and the gluteus medius (GM) muscles was recorded bilaterally. The peak amplitude, the time of peak amplitude and the integrated linear envelope EMG for each muscle were obtained. [Results] The C group bilateral OI and GM muscles displayed higher peak amplitudes and earlier times of peak amplitude. They also had higher integrated linear envelope EMG values. The CLBP group bilateral LES muscles had higher peak amplitudes and earlier times of peak amplitude. They also showed an increased integrated linear envelope EMG values. [Conclusion] The CLBP women activate the LES muscles in the kneeling to half-kneeling task, showing different patterns of motor planning activity.

Nandrolone androgenic hormone presents genotoxic effects in different cells of mice.

Nandrolone is an androgenic-anabolic steroid (AAS) with diverse medical applications but taken indiscriminately by some to rapidly increase muscle mass. The aim of this study was to evaluate the genotoxic and clastogenic potential of nandrolone (deca-durabolin®) in vivo in different cells of mice, using the comet assay and micronucleus test, respectively. The animals received subcutaneous injection of the three doses of the steroid (1.0, 2.5 and 5.0 mg kg⁻¹ body weight). Cytotoxicity was assessed by scoring 200 consecutive total polychromatic (PCE) and normochromatic (NCE) erythrocytes (PCE-NCE ratio). The results showed a significant dose-related increase in the frequency of DNA damage in leukocytes, liver, bone marrow, brain and testicle cells at the three tested doses and a significant increase of the micronucleated polychromatic erythrocytes at all tested doses. Under our experimental conditions, the nandrolone steroid hormone showed genotoxic and clastogenic effects when administered subcutaneously to mice.

Metais em águas, sedimentos e peixes coletados no estuário de São Vicen-te-SP, Brasil / Metals in water, sediments and fish collected in São Vicente-SP estuary, Brazil / Metales en el agua, los sedimentos y los pescados recogidos en elestuario São Vicente-Sp, el Brasil

O estuário de São Vicente, situado na Baixada Santista, vem apresentando níveis crescentes de poluição, causados pelo avanço da urbanização e instalação de fontes poluidoras. O objetivo deste trabalho foi avaliar a distribuição de alguns metais (ferro, cromo, níquel, zinco, manganês e cobre) em diferentes compartimentos ambientais que compõem o ecossistema aquático dos estuários dos rios Branco e Mariana, localizados no estuário de São Vicente. Foram analisadas amostras de águas, sedimentos e tecidos branquiais e hepáticos de paratis (Mugil curema) coletados nesses dois rios. A determinação dos metais nasamostras foi realizada em Espectrofotômetro de Absorção Atômica GBC®. As concentrações médias de cromo, níquel e zinco nas águas de ambos os rios estiveramacima dos limites estabelecidos pela legislação brasileira para águas salobras, no entanto os níveis de metais foram mais elevados nas amostras do Rio Mariana. Nos sedimentos, as maiores concentrações ocorreram nas amostras provenientes do Rio Branco, que inclusive ultrapassaram os valores orientadores propostos pela legislação internacional: Cu, Ni e Zn ultrapassam os limiares de efeito tóxico - TEL, enquanto para o Cr, o nível de efeito provável – PEL, foi ultrapassado. Nos tecidos dos peixes, Fe, Cr e Ni apresentaram maior acúmulo nas brânquias, enquanto Zn, Mn e Cu ocorreram em maiores concentrações nos fígados, o queestá relacionado com os mecanismos de depuração implicados com os diferentes elementos. Na maioria dos casos, os peixes dos dois rios apresentaram níveissimilares de metais em seus tecidos, porém os animais do Rio Branco tiveram maiores concentrações de Fe e Cu, enquanto aqueles do Rio Mariana apresentaram maiores teores de Mn nas brânquias. Não foi possível estabelecer relações entre a contaminação ambiental e os metais nos tecidos dos peixes, porém os valores encontrados nas amostras de água, sedimentos e tecidos são maiores do que os descritos pela literatura e mostram uma situação...

São Vicente estuary, located in Baixada Santista, presents increasing levels of pollution caused by urbanization and the installation of polluting sources.The objective of this work was to evaluate the distribution of some metals (iron, chromium, nickel, zinc, manganese and copper) in the different environmental compartments that compose the aquatic ecosystem of Branco and Mariana Rivers estuaries, located in São Vicente Estuary. We analyzed samples of water andbranchial and hepatic sediments and tissues of white mullet (Mugil curema) in the two rivers. The determination of metals in samples was carried through in Atomic Absorption Spectrophotometer GBC®. The average concentrations of chromium, nickel and zinc in waters of both rivers were above the limits established by the Brazilian legislation for brackish waters, but metal levels were higher in samples from Mariana River. In the sediments, the highest concentrations were insamples from Rio Branco, which also exceeded international legislation guiding values: Cu, Ni and Zn exceed the thresholds of toxic effect - TEL while for Cr the level of probable effect - PEL was exceeded. In fish tissues, Fe, Cr and Ni had presented a higher accumulation in the gills, while Zn, Mn and Cu had occurred in higher concentrations in liver tissues, and this relates to mechanisms of purification relative to the different elements. In most cases, the fish of the two riverspresented similar metal levels in their tissues, but the animals from Rio Branco had higher concentrations of Fe and Cu, while those of Mariana River presented higher quantities of Mn in the gills. It was not possible to establish relationships between environmental contamination and metals in fish tissues, but values found in samples of water, sediments and tissues are higher the ones described in the literature and show a worrying situation that requires the identificationand control of polluting sources.

El estuario de São Vicente, situado en Baixada Santista, presenta crecientes niveles de contaminación causados por la urbanización y la instalaciónde fuentes de contaminación. El objetivo de este trabajo fue evaluar la distribución de algunos metales (hierro, cromo, níquel, zinc, manganeso y cobre) en los diversos compartimientos ambientales que componen el ecosistema acuático de los estuarios de los ríos Branco y Mariana, situados en el estuario de São Vicente. Analizámos muestras de agua y de sedimentos branchiales y hepáticos y tejidos del salmonete blanco (Mugil curema) en los dos ríos. La determinación de metalesen muestras fue ejecutada por Atomic Absorption Spectrophotometer GBC®. Las concentraciones medias de cromo, de níquel y de zinc en las aguas de ambos ríos estaban arriba los límites establecidos por la legislación brasileña para las aguas salobres, pero los niveles de metal eran más altos en muestras del río Mariana.En los sedimentos, las concentraciones más altas estaban en muestras de Río Branco, que también excedió valores indicativos de la legislación internacional: Cu,Ni y Zn exceden los umbrales de efecto tóxico - TEL, mientras que para el Cr el nivel de efecto probable - PEL fue excedido. En tejidos de los pescados, el Fe, Cr y Ni han presentado una acumulación más alta en las papadas, mientras que el Zn, el manganeso y el Cu han ocurrido en concentraciones más altas en tejidos del hígado, y eso se relaciona con los mecanismos de purificación concernientes a los diversos elementos. En la mayoría de los casos, los pescados de los dos ríos presentaron niveles de metal similares en sus tejidos, pero los animales de Río Branco tenían concentraciones más altas de Fe y de Cu, mientras que los del río Mariana presentaron cantidades más altas de manganeso en las papadas. No se ha podido establecer relaciones entre la contaminación del medio ambiente y losmetales en tejidos de los pescados, pero los valores encontrados...

Physical violence as educational practice

This descriptive and correlational study, carried out at a teaching hospital in 2004, aimed to get to know if, in the context of domestic violence, parents use physical violence as an educational practice. Semistructured interviews were used to characterize the population, and situations of daily family life to identify parents' attitude in the education process. Results: the most vulnerable situation to use physical punishment was disobedience to parents' predetermined orders (40 percent), followed by the situation when the child steals something (31.7 percent). The use of physical violence as a disciplinary practice was significant (p=0.020), associated with unemployment. Forty percent of the population reported they imposed their will on their child, and 57 percent mentioned they had been physically punished by their parents in limit-imposing situations. Knowledge and reflection on factors involving domestic violence are very important to consolidate prevention programs and which could generate a collective consciousness.

Estudio descriptivo y correlacional realizado en un hospital de enseñanza, en 2004, con el objetivo de conocer, si dentro del contexto de violencia doméstica, los padres utilizan la violencia física como práctica educativa. Se utilizó una entrevista semi-estructurada para caracterizar la población y situaciones del cotidiano familiar para identificar la actitud de los padres en el proceso de educación. Resultados: la situación donde hubo gran vulnerabilidad para el uso de la violencia física fue la de desobediencia a órdenes preestablecidas (40 por ciento), acompañada por la situación donde el niño hurta cualquier cosa, con el 31.7 por ciento de los casos. Fue significante (p= 0.020) el uso de la violencia física como práctica disciplinadora, asociada al desempleo. El 40 por ciento de la población afirmó imponer su voluntad sobre el hijo, y el 57 por ciento de haber sido físicamente punido por sus padres en situaciones para imponer límites. Es importante el conocimiento y la reflexión sobre los factores involucrados en la violencia doméstica, para consolidar programas de prevención que sean capaces de generar una conciencia colectiva.

Estudo descritivo e correlacional, realizado em um hospital de ensino, em 2004, objetivando conhecer se, dentro do contexto de violência doméstica, os pais utilizam a violência física como prática educativa. Utilizou-se entrevista semi-estruturada para caracterizar a população, e situações do cotidiano familiar para identificar a atitude dos pais no processo de educação. Resultados: A situação de maior vulnerabilidade para o uso de violência física foi a de desobediência às ordens pré-determinadas (40 por cento), seguida pela situação na qual a criança furta algo, com 31,7 por cento dos casos. Foi significante (p= 0,020) o uso da violência física como prática disciplinadora, associado ao desemprego. Quarenta por cento da população afirma impor sua vontade sobre seu filho, e 57 por cento ter apanhado de seus pais em situações de impor limites. Julga-se importante o conhecimento e a reflexão dos fatores que envolvem a violência doméstica, para alicerçar programas de prevenção e que sejam capazes de gerar uma consciência coletiva.