[Use of neurodevelopmental disorder screening tool in primary care : A multicenter observational study]. / Utilisation en soins primaires d'un outil de repérage des troubles du neurodéveloppement : étude multicentrique observationnelle.

INTRODUCTION: Neurodevelopmental disorders (NDD) affect 5 to 15% of the population. Improved management largely depends on early detection in primary care. A screening tool was developed by an expert consensus and its use has been recommended since 2019. This tool has never been evaluated to date. The aim of this study was to investigate the prevalence and factors associated with the identification of neurodevelopmental disorders in primary care in children aged 6 months to 5 years. METHOD: This work is a multicentric observational study carried out in general practice in two regions of France: Île-de-France and Auvergne-Rhône-Alpes. A multivariate analysis was performed to identify the factors associated with the presence of abnormal signs on the grid. RESULTS: Five hundred and sixty-four (564) children aged 6 months to 4 years were included. The prevalence of children identified on the grid was 3.9%. The factors associated with the neurodevelopmental disorders identified in multivariate analysis were: low socio-professional status of the mother, male gender and parental concern about the child's neurodevelopment. Factors associated with identifying a developmental trajectory gap were male gender (OR = 2.10 (1.22-3.62)) and low socio-professional status of the mother (OR = 2.23 [1.05-4.70]). CONCLUSION: This original work allowed us to carry out first-line testing of a tool for the identification of NDD in primary care and to evaluate the prevalence of identification of these disorders. A complementary cohort study will be necessary to evaluate the sensitivity and specificity of this identification tool.

Do antibiotics prevent infection after third molar surgery? A network meta-analysis.

The aim of this systematic review was to determine whether antibiotics, compared to placebo, can prevent infection or dry socket after third molar surgery. A systematic review and network meta-analysis (NMA) was performed following registration of the protocol (CRD42021276266). Four databases and the grey literature were searched, and papers were selected based on the PICOS question. RoB 2 and GRADE were used to evaluate the risk of bias and certainty of the evidence, respectively. The NMA was performed using Stata. Of 58 randomized clinical trials identified, 34 were included in the NMA. Patients treated with amoxicillin (relative risk (RR) 0.56, 95% confidence interval (CI) 0.38-0.84; low quality of evidence) and those treated with metronidazole (RR 0.51, 95% CI 0.31-0.84; low quality of evidence) showed a lower risk of infection and dry socket when compared to patients given a placebo. Postoperative amoxicillin (750 mg) and amoxicillin plus clavulanate (500 mg + 125 mg, or 2000 mg + 125 mg), and preoperative metronidazole (800 mg) are useful to prevent infection or dry socket when compared to placebo. The low rate of infection after third molar surgery, the correct concept of antibiotic prophylaxis, and antibiotic resistance must be taken into account when choosing to treat healthy patients undergoing third molar surgery with antibiotics.

Desigualdade espacial na compra de alimentos da agricultura familiar para alimentação escolar no Brasil / Spatial inequality in the purchase of food from family agriculture for school feeding in Brazil

RESUMO O objetivo do estudo foi analisar o cumprimento do uso de, no mínimo, 30% dos recursos do Programa Nacional de Alimentação Escolar (PNAE) para a aquisição dos gêneros alimentícios provenientes da agricultura familiar no Brasil, no período de 2013 a 2016. Trata-se de uma pesquisa com delineamento ecológico e longitudinal. A coleta de dados foi realizada por meio de dados públicos disponibilizados no Fundo Nacional de Desenvolvimento da Educação (FNDE). Construíram-se mapas temáticos e de correlação espacial para análise da distribuição espacial da compra e realizou-se análise de tendência. Verificou-se que o percentual de municípios que cumprem com a exigência legal de compra passou de 34,3% em 2013 para 43,7% em 2016, com maior número de municípios no Sul com 72,5%, enquanto apenas 26,1% no Centro-Oeste, 27,4% no Norte e 31,6% no Nordeste. A região Sul se destaca quando comparada às regiões Norte, Nordeste e Centro-Oeste (p=<0,001). Já a análise de tendência dos recursos orçamentários anuais da união mostrou um crescimento médio de 30,8% (IC = 13,2-51,1), porém com declínio entre 2015 e 2016. Conclui-se que houve um aumento progressivo na compra direta de alimentos da agricultura familiar para alimentação escolar no Brasil de 2013 a 2016, embora de maneira desigual nas diferentes regiões do País.

ABSTRACT The study aims to analyze the fulfillment of the use of at least 30% of the National School Feeding Program (PNAE) resources for the acquisition of food from family agriculture in Brazil, from 2013 to 2016. This is a longitudinal ecological research. Data was collected through public data available at the National Education Development Fund (FNDE). Thematic and spatial correlation maps were constructed for analysis of the spatial distribution of the purchase and trend analysis. It was verified that the percentage of municipalities that comply with the legal purchase requirement increased from 34.3% in 2013 to 43.7% in 2016, with the largest number of municipalities in the Southern region of the country with 72.5%, while only 26.1% in the Midwest, 27.4% in the North and 31.6% in the Northeast. The South region stands out when compared to the North, Northeast and Midwest (p =<0.001). The trend analysis of the union's annual budget resources showed an average growth of 30.8% (CI = 13.2-51.1), but with a decline between 2015 and 2016. It is concluded that there has been a progressive increase in the direct purchase of food from family farms for school feeding in Brazil from 2013 to 2016, although in unequal manner in different regions of the country.

Complications after different methods for fixation of mandibular angle fractures: network meta-analysis of randomized controlled trials.

The aim of this review was to compare mandibular angle fracture fixation methods that were evaluated through randomized clinical trials considering postoperative complications. Additionally, different treatment methods were ranked based on their performance. A systematic review was performed based on the Cochrane and PRISMA guidelines. The quality of evidence and network meta-analysis were conducted using the GRADE tool and R software, respectively. Four databases were searched, and the papers were selected based on the PICOS strategy. A total of 3584 papers were found. After screening 15 papers were included. One plate placed on lateral border (tension zone) presented lower risk than one plate placed on superior border (tension zone) for infection [risk ratio (RR): 0.48, 95% confidence interval (CI): 0.33 to 0.71] and plate removal necessity (RR: 0.44, 95% CI: 0.28 to 0.69), with moderate quality of evidence. There were no significant differences among the mandibular angle fracture treatments for malocclusion and paraesthesia outcomes. In conclusion, one plate placed on the lateral border in the tension zone is the best choice regarding postoperative infection and plate removal necessity when fixing mandibular angle fractures. None of the tested fixation methods were associated with a significant risk of malocclusion and paraesthesia events.

Comparison between Erich arch bars and intermaxillary screws in maxillofacial fractures involving the dental occlusion: a meta-analysis.

This systematic review aimed to compare the Erich arch bars (EABs) with intermaxillary fixation (IMF) screws in maxillofacial fractures involving dental occlusion on perioperative parameters. Four electronic databases were searched: MedLine (Pubmed), Web of Science, VHL, and Cochrane Library. Inclusion criteria comprised clinical trials comparing the two IMF methods, assessing at least one of the outcomes: occlusal stability, oral hygiene, quality of life, time to apply and remove IMF appliances, and complications. Risk of bias was evaluated through the Cochrane risk of bias tool. Fifteen papers were included in the qualitative analysis and 12 of those in the meta-analysis. Times for EABs application (mean difference (MD) 46.83; 95% confidence interval (CI): 30.63-63.02) and removal (MD 22.89; 95% CI 14.61-31.17) were longer compared with IMF screws. There is higher risk of glove perforation (risk ratio (RR) 3.81; 95% CI 2.41-6.04) and lower risk of iatrogenic injuries (RR 0.21; 95% CI 0.09-0.48) when placing EABs compared with IMF screws. No significant differences in plaque index were found (MD 1.07; 95% CI -0.17 to 2.31). The quality of this evidence ranged from very low to low and was mainly compromised by risk of bias assessment. Further studies are necessary to evaluate transurgical IMF stability and postoperative occlusal quality and quality of life when comparing EABs with IMF screws.

Envelope or triangular flap for surgical removal of third molars? A systematic review and meta-analysis.

The aim of this systematic review was to compare the triangular and envelope flaps in mandibular third molar surgery with regard to pain, oedema, and trismus. Secondary outcomes assessed were dehiscence, ecchymosis, alveolar osteitis, periodontal condition, and surgical time. The PRISMA guidelines and recommendations in the Cochrane Handbook were followed, and the review was registered before commencement (PROSPERO; CRD42018112373). The literature search was conducted in the Web of Science, PubMed, Virtual Health Library, Cochrane Library, and Scopus databases and in the grey literature; randomized clinical trials, indexed through November 2018 were included. Three reviewers independently examined the studies. Twenty studies were included in the qualitative analysis, of which 18 were included in the meta-analyses. The flap design did not influence pain, oedema, trismus, dehiscence, or osteitis. The triangular flap was associated with a greater occurrence of postoperative ecchymosis (odds ratio 4.58, 95% confidence interval 1.34 to 15.91, I2=0) and lower periodontal probing depth on day 7 postoperative (standardized mean difference -1.36, 95% confidence interval -2.68 to -0.03, I2=88%) when compared to the envelope flap in mandibular third molar surgeries.

Effect of third molars in the line of mandibular angle fractures on postoperative complications: systematic review and meta-analysis.

The aim of this systematic review was to verify whether the presence of a lower third molar in the mandibular angle fracture line is associated with postoperative complications. An electronic survey was conducted in five databases. Eligibility criteria included observational and experimental studies that evaluated the association between the presence of the lower third molar in the fracture line of mandibular angle fractures and possible postoperative complications, including infection, paresthesia, necessity of plate removal, temporomandibular joint disorders, malocclusion, dehiscence, and non-union. Thirty-four papers were included in the qualitative analysis and 26 of those in the meta-analysis. The risk of bias of observational studies was assessed by Newcastle-Ottawa scale and of the clinical trials by Cochrane Collaboration risk-of-bias tool. Absence of the third molar was associated with a lower chance of postoperative infection in angle fractures compared to presence of the tooth (odds ratio 0.55, 95% confidence interval 0.34-0.88). No statistically significant difference between the groups was found for the other outcomes evaluated. The findings of this systematic review suggest that the absence of the third molar in the mandibular angle fracture line is associated with a lower postoperative infection rate when compared to angle fractures with a third molar present.

Long Survival of a Patient with Trisomy 18 and Dandy-Walker Syndrome.

Trisomy 18 is a genetic disease resulting from an extra chromosome 18, characterized by a broad clinical spectrum, poor prognosis and low rates of survival. This is the case of a 12 year-old girl diagnosed with full trisomy 18, and multiple malformations, including Dandy-Walker Syndrome and congenital heart defects on long term survival. At nine months, a new echocardiogram showed a double outlet right ventricle, significant pulmonary stenosis, patent ductus arteriosus and ventricular septal defect. Cardiac surgery was performed at one year and seven months. Early surgical intervention and multidisciplinary follow-up may change the clinical outcome of the disease. Further studies are required to evaluate the benefit of invasive procedures such as cardiac surgery on survival of patients with trisomy 18.

School of Medicine of Federal University of Rio Grande Do Norte: A traditional curriculum with innovative trends in medical education.

INTRODUCTION: The Medical School of the Federal University of Rio Grande do Norte (UFRN) is one of the biggest public medical schools in Northeast Brazil. In the last decade, significant investment in faculty development, innovative learning methodologies and student engagement has been key milestones in educational improvement at this medical school, harnessed to recent political changes that strengthened community-based and emergency education. This study describes how curriculum changes in UFRN Medical School have been responsible for major improvements in medical education locally and which impacts such transformations may have on the educational community. METHODS: A group of students and teachers revised the new curriculum and established the key changes over the past years that have been responsible for the local enhancement of medical education. This information was compared and contrasted to further educational evidences in order to define patterns that can be reproduced in other institutions. RESULTS: Improvements in faculty development have been fairly observed in the institution, exemplified by the participation of a growing number of faculty members in programs for professional development and also by the creation of a local masters degree in health education. Alongside, strong student engagement in curriculum matters enhanced the teaching-learning process. CONCLUSIONS: Due to a deeper involvement of students and teachers in medical education, it has been possible to implement innovative teaching-learning and assessment strategies over the last ten years and place UFRN Medical School at a privileged position in relation to undergraduate training, educational research and professional development of faculty staff.

Relação entre a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) e a limitação de atividades e restrição à participação de indivíduos com hanseníase / Relationship between the International Classification of Functioning, Disability and Health (ICF) and the limitation of activities and restriction of participation for individuals with leprosy

Resumo Introdução Hanseníase é uma doença infecciosa que pode levar à incapacidade física. A escala SALSA e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) podem ser úteis no manejo clínico de pacientes com essa doença. Assim, o objetivo foi relacionar a CIF com a limitação de atividade e restrição à participação de indivíduos com hanseníase, utilizando a escala SALSA. Metodologia Tratou-se de um estudo observacional transversal analítico e descritivo, com a utilização da escala SALSA, relacionado aos domínios mobilidade, autocuidado, trabalho e destreza. Após a entrevista realizada com os pacientes, os domínios foram codificados pela CIF segundo os códigos relacionados à atividade e participação. Resultados A amostra foi composta por 30 indivíduos, com média de idade de 38,4, sendo a maioria do gênero masculino. A média do escore da escala SALSA foi de 36,9 pontos, apresentando leve limitação de atividades. Os domínios da escala SALSA e o uso dos códigos da CIF mostraram dificuldade leve a moderada em sua grande maioria, com resultados significantes (p≤0,05). O único domínio que apresentou tarefa com dificuldade completa foi o de mobilidade. Conclusão A escala SALSA mostrou leve limitação de atividade em pacientes com hanseníase, porém, quando relacionado à CIF, apresentou limitações maiores, principalmente no domínio mobilidade.

Abstract Introduction Leprosy is an infectious disease that can lead to physical disability. The SALSA scale and the International Classification of Functioning, Disability and Health (ICF) may be useful in the clinical management of these patients. Thus, the objective was to correlate the ICF with the limitation of activity and restriction to participation for individuals with leprosy, using the SALSA scale. Methodology This was an analytical and descriptive cross-sectional observational study, using the SALSA scale, related to mobility, self-care, work and skill domains. After the interview with the patients, the domains were codified by the ICF, using the codes related to activity and participation. Results The sample consisted of 30 individuals, with a mean age of 38.4, the majority being male. The SALSA scale mean score was 36.9 points, presenting a slight limitation of activities. The SALSA scale domains, together with the use of the ICF codes, show a slight to moderate difficulty in the great majority, with significant results (p≤0.05). The mobility domain was the only one to present task with complete difficulty. Conclusion The SALSA scale showed a slight limitation of activity in patients with leprosy, but when related to ICF, there were larger limitations, especially in the mobility domain.

Influence of third molars in mandibular fractures. Part 1: mandibular angle-a meta-analysis.

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars on angle fractures. An electronic search was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and VHL databases, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 35 studies were included in the systematic review and 28 in the meta-analysis. Twenty studies presented a score of ≤6 stars in the Newcastle-Ottawa scale assessment, indicating a risk of bias in the analysis. The presence of a mandibular third molar increases the chance of an angle fracture (case-control and cross-sectional studies: odds ratio (OR) 3.83, 95% confidence interval (CI) 3.02-4.85, I2=83.1%; case-control studies: OR 3.27, 95% CI 2.57-4.16, I2=81.3%). The third molar positions most favourable to angle fracture according to the Pell and Gregory classification are class B (OR 1.44, 95% CI 1.06-1.96, I2=87.2%) and class II (OR 1.67, 95% CI 1.36-2.04, I2=72.4%). Class A (OR 0.60, 95% CI 0.45-0.81, I2=87.1%) and class I (OR 0.51, 95% CI 0.37-0.71, I2=89.4%) act as protective factors for angle fracture. The results suggest that the presence of the third molar increases the chance of angle fracture by 3.27 times and that the most favourable positions of the third molar for angle fracture are classes B and II, whilst classes A and I act as protective factors.

Influence of third molars in mandibular fractures. Part 2: mandibular condyle-a meta-analysis.

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle-Ottawa scale assessment. The presence of a mandibular third molar decreased the probability of condylar fracture (cross-sectional and case-control studies: odds ratio (OR) 0.26, 95% confidence interval (CI) 0.17-0.40, I2=87.8%; case-control studies: OR 0.30, 95% CI 0.16-0.58, I2=91.6%). The third molar positions most favourable to condylar fracture according to the Pell and Gregory classification are class A (OR 1.32, 95% CI 1.09-1.61, I2=0%) and class I (OR 1.37, 95% CI 1.05-1.77, I2=32.8%). Class B (OR 0.69, 95% CI 0.49-0.97, I2=56.0%) and class II (OR 0.71, 95% CI 0.57-0.87, I2=0%) act as protective factors for condylar fracture. The results suggest that the presence of a mandibular third molar decreases the chance of condylar fracture and that the positions of the third molar most favourable for condylar fracture are classes A and I, with classes B and II acting as protective factors.

Emotional Intelligence Development in Radiography Curricula: Results of an International Longitudinal Study.

This article presents the findings from the first 3 years of a longitudinal study following a cohort of radiography and radiotherapy students through their qualification programs. The aim was to demonstrate any changes in emotional intelligence (EI) and to clarify the timing of any changes. METHODS: This was an international, longitudinal cohort study of student radiographers undertaking preregistration programs at four different higher education institutions. It was a survey design using a published and validated trait EI questionnaire. A mixed analysis of variance (Greenhouse-Geissler methods) was used with age and gender included in the models, as these were considered possible confounding factors. Sensitivity analysis was also applied because responses gradually reduced throughout the years. RESULTS: Across the 3 years of the project, there were no statistically significant differences demonstrated in students' EI scores between countries or between years. The mean scores per year over time showed a small, but not statistically significant change within the second year of the study, when there was a slight fall in the mean scores. The sensitivity analysis showed that the characteristics of the questionnaire completer group was not significantly different to the noncompleter group. CONCLUSIONS: EI was not seen to change during the non-explicit EI content curricula within this study. The robustness of this finding falls away in the latter stages of this longitudinal study. Further research is recommended in curricula with explicit EI content. This study has provided a valuable benchmark for pre-explicit EI curricula.

Tripartite nonseparability in classical optics.

It is possible to prepare classical optical beams which cannot be characterized by a tensor product of vectors describing each of their degrees of freedom. Here we report the experimental creation of such a nonseparable, tripartite GHZ-like state of path, polarization, and transverse modes of a classical laser beam. We use a Mach-Zehnder interferometer with an additional mirror and other optical elements to perform measurements that violate Mermin's inequality. This demonstration of a classical optical analogue of tripartite entanglement paves the path to novel optical applications inspired by multipartite quantum information protocols.

Influence of visual and auditory biofeedback on partial body weight support treadmill training of individuals with chronic hemiparesis: a randomized controlled clinical trial.

BACKGROUND: Stroke is an important causal factor of deficiency and functional dependence worldwide. OBJECTIVE: To determine the immediate effects of visual and auditory biofeedback, combined with partial body weight supported (PBWS) treadmill training on the gait of individuals with chronic hemiparesis. DESIGN: Randomized controlled trial. SETTING: Outpatient rehabilitation hospital. POPULATIONS: Thirty subjects with chronic hemiparesis and ability to walk with some help. METHODS: Participants were randomized to a control group that underwent only PBWS treadmill training; or experimental I group with visual biofeedback from the display monitor, in the form of symbolic feet as the subject took a step; or experimental group II with auditory biofeedback associated display, using a metronome at 115% of the individual's preferred cadence. They trained for 20 minutes and were evaluated before and after training. Spatio-temporal and angular gait variables were obtained by kinematics from the Qualisys Motion Analysis system. RESULTS: Increases in speed and stride length were observed for all groups over time (speed: F=25.63; P<0.001; stride length: F=27.18; P<0.001), as well as changes in hip and ankle range of motion - ROM (hip ROM: F=14.43; P=0.001; ankle ROM: F=4.76; P=0.038), with no time*groups interaction. Other spatio-temporal and angular parameters remain unchanged. CONCLUSIONS: Visual biofeedback and auditory biofeedback had no influence on PBWS treadmill training of individuals with chronic hemiparesis, in short term. Additional studies are needed to determine whether, in long term, the biofeedback will promote additional benefit to the PBWS treadmill training. CLINICAL REHABILITATION IMPACT: The findings of this study indicate that visual and auditory biofeedback does not bring immediate benefits on PBWS treadmill training of individuals with chronic hemiparesis. This suggest that, for additional benefits are achieved with biofeedback, effects should be investigated after long-term training, which may determine if some kind of biofeedback is superior to another to improve the hemiparetic gait.

Effects of treadmill training with partial body weight support and the proprioceptive neuromuscular facilitation method on hemiparetic gait: a randomized controlled study.

BACKGROUND: Gait disturbance is common after stroke; however, there is no consensus regarding the optimal therapeutic rehabilitation of hemiparetic gait. AIM: To compare the effects of the treadmill training with partial body-weight support (TPBWS) and Proprioceptive Neuromuscular Facilitation (PNF) method on gait of subjects with chronic stroke. DESIGN: Randomized clinical trial, comparing two experimental groups (comparative study). SETTING: Laboratory for Human Movement Analysis of UFRN. POPULATION: Twenty-three subjects, with a mean age of 56.7±8.0 years and a mean time since the onset of the stroke of 27.7±20.3 months, able to walk with personal assistance or assistive devices. METHODS: Two experimental groups underwent gait training based on PNF method (N.=11) or using the TPBWS (N.=12), for twelve sessions. Evaluation of motor function (using the STREAM and motor FIM), and kinematic gait analysis were carried out before and after the interventions. RESULTS: Increases in the STREAM scores (F=49.189, P<0.001) and in motor FIM scores (F=7.093, P=0.016), as well as improvement in symmetry ratio-swing time of the paretic leg/swing time of non-paretic leg--(F=7.729, P=0.012), were observed for both groups. Speed, stride length and double-support time showed no change after training. Differences between groups were observed only for the maximum ankle dorsiflexion over the swing phase (F=6.046, P=0.024), which showed an increase for the PNF group. Other angular parameters remain unchanged. CONCLUSION: Improvement in motor function and in gait symmetry was observed for both groups, suggesting similarity of interventions. However, the sample size should be carefully considered in generalizing the results to other populations. CLINICAL REHABILITATION IMPACT: The results showed some equivalence between these two approaches with regard to motor recovery, functionality and temporal symmetry of hemiparetic gait, suggesting that the cost-effectiveness of each treatment may have a important role in this choice.

Breast cancer proteomics: a review for clinicians.

PURPOSE: Breast cancer is one of the major health problems of the Western world. Although the survival rate has improved with progress in screening and adjuvant systemic therapies, one-third of the patients with initial breast tumor have recurrence of the disease 10 years after the diagnosis, demonstrating the presence of micrometastasis. The underlying molecular mechanism of the disease needs to be better understood. Allied to genomics, proteomics technologies promise to be valuable for identifying new markers that improve screening, early diagnosis, prognosis and prediction of therapeutic response or toxicity, as well as the identification of new therapeutic targets. In this review, we present features of proteomic technology and its main implications, focusing on the protein profile in tumor tissues/cells through MALDI/SELDI, as well as on the current proteomic challenges in the breast cancer study. METHODS: We performed a research of protein profiling studies using mass spectrometry in breast cancer to identify potential biomarkers. RESULTS: Many protein peaks have been reported to bear significant diagnostic, prognostic or predictive value; however, the candidate biomarkers have not been validated for use in clinical patient care. CONCLUSIONS: Proteomics is under development and, despite technical barriers that precede the use of proteomics analysis in clinical practice and breast cancer complexity, MALDI-TOF/SELDI-TOF MS proteomic platforms with their innovations are powerful analytical tools for the detection of better protein biomarkers, since the studies are conducted with adequate statistical power and analytical rigor. In the near future, they will be able to fulfill their role in personalized medicine.

Resolução de Sommerset West: violência familiar

Tradução adaptada do texto da resolução adotada pela 48ª Assembléia Geral da Associação Médica Mundial, realizada em Somerset West, República da África do Sul, em outubro de 1996. Trata da questão da violência familiar e apresenta a posição da entidade, recomendando a adoção de diretrizes pelas entidades nacionais.

[Malaria in intravenous drug users associated with HIV seropositivity]. / Malária em usuários de drogas de administração endovenosa associada à soropositividade para HIV.

Cases of induced malaria have been notified in S. Paulo State, Brazil, in recent years. At the same time the number of cases imported from endemic regions of Brazil has been increasing. One case of induced malaria by Plasmodium vivax was registered in Presidente Prudente, located in the west of the State, in 1988 and a further eleven cases in 1989. This city is considered to be one of the main transit ports for people who come into the State from the Amazonian region. The patients declared that they had not been to any possible transmission area of malaria. All of them had, however, taken cocaine, sharing the same contaminated needle and syringe. Previously, one person with imported malaria was detected, who had transmitted the disease to the first case in 1988 and also to a further group of 3 people in 1989. One of these three latter cases then transmitted the disease to two other people. As the group of people continued to use the drug among themselves, 2 new cases arose. Afterwards, they re-infected themselves again (one of the was re-infected twice). The test for Human Immunodeficiency Virus was positive for 5 individuals, of whom one had a negative result and 2 others did not undergo the test. This information is discussed within the present context.