HBM4EU chromates study - Usefulness of measurement of blood chromium levels in the assessment of occupational Cr(VI) exposure.

Occupational exposures to hexavalent Chromium (Cr(VI)) can occur in welding, hot working stainless steel processing, chrome plating, spray painting and coating activities. Recently, within the human biomonitoring for Europe initiative (HBM4EU), a study was performed to assess the suitability of different biomarkers to assess the exposure to Cr(VI) in various job tasks. Blood-based biomarkers may prove useful when more specific information on systemic and intracellular bioavailability is necessary. To this aim, concentrations of Cr in red blood cells (RBC-Cr) and in plasma (P-Cr) were analyzed in 345 Cr(VI) exposed workers and 175 controls to understand how these biomarkers may be affected by variable levels of exposure and job procedures. Compared to controls, significantly higher RBC-Cr levels were observed in bath plating and paint application workers, but not in welders, while all the 3 groups had significantly greater P-Cr concentrations. RBC-Cr and P-Cr in chrome platers showed a high correlation with Cr(VI) in inhalable dust, outside respiratory protective equipment (RPE), while such correlation could not be determined in welders. In platers, the use of RPE had a significant impact on the relationship between blood biomarkers and Cr(VI) in inhalable and respirable dust. Low correlations between P-Cr and RBC-Cr may reflect a difference in kinetics. This study showed that Cr-blood-based biomarkers can provide information on how workplace exposure translates into systemic availability of Cr(III) (extracellular, P-Cr) and Cr(VI) (intracellular, RBC-Cr). Further studies are needed to fully appreciate their use in an occupational health and safety context.

[Experiencing motherhood in early adolescence]. / Vivências da maternidade na adolescência precoce.

OBJECTIVE: Although still scarcely studied in Brazil, motherhood in early adolescence among girls aged 10 to 14 years is mostly unwanted and it is an important public health issue. Most investigations are based on biomedical paradigms and few take into consideration the adolescent's point of view. This study aimed to explore the different patterns of experiencing early motherhood from the adolescent's own point of view. METHODS: William Stephenson's Q methodology was applied. The study population was selected from 2 public mother and child health units in Rio de Janeiro, Brazil, and comprised 20 adolescents who became pregnant at the age of 10 to 14 years and were followed up for a period of 6 to 24 months after giving birth. Q-sorts underwent factor analysis and then the factors were interpreted. RESULTS: Four qualitatively and statistically (p<0.01) perception patterns were found. Two factors were well defined: Factor I - Satisfied with motherhood/ Dependent on the child's affection: motherhood is a positive and rich experience; and Factor II - Depressed/ Stressed out: motherhood is a negative and stressful experience. Other two potential factors need confirmation in further studies with a larger sample size. CONCLUSIONS: It was observed that motherhood's experience is distinct and heterogeneous. For some adolescents, motherhood could be a rewarding experience

AIDS in childhood: cardiac involvement with and without triple combination antiretroviral therapy.

OBJECTIVE: To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18+/-6 months of AIDS confirmed diagnosis. METHODS: A cross-section study with a cohort after 18+/-6 months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical transmission, with no malignancies and who underwent echocardiogram (echo) during cardiologic evaluation. Cardiac abnormalities were assessed in patients who were not treated (G1) and patients who were treated (G2) with combination antiretroviral therapy. RESULTS: When diagnosed with AIDS, the children were on average 3.07 years old and 50.50% were female. The combination regimen with antiretroviral agents was used by 47 patients (G2). Cardiac involvement was present in 40 children (43.00%). The presence of left ventricular dysfunction (G1: 39.10%; G2: 10.60%) and the isolated enlargement of left ventricle (G1: 6.60%; G2: 14.90%) were the most frequent findings. We observed a significant association between the groups without and with combination antiretroviral therapy asregards the presence of left ventricular dysfunction (PR= 3.42; [1.41-8.26]; p = 0.02) and malnutrition (PR = 1.79; [1.00-3.20]; p = 0.04). CONCLUSION: Cardiac involvement was frequent in children with AIDS and left ventricular dysfunction was the most common abnormality on echocardiogram. There was a statistically significant difference between the groups with and without triple combination treatment as regards the presence of left ventricular dysfunction and malnutrition.

Integrated care of childhood disease in Brazil: mothers' response to the recommendations of health workers.

AIM: To describe the process of follow-up in primary care facilities where the Integrated Management of Childhood Illness (IMCI) strategy was implemented. IMCI was developed by WHO and UNICEF as an integrated approach to manage sick children under 5 y of age and aims to reduce mortality and morbidity. METHODS: From August 2001 to February 2002, 229 sick children who had a health condition included in the IMCI case management guidelines were seen in six family healthcare facilities in Brazil. We analysed the care provided to 153 children who were recommended for a 2- or 5-d follow-up visit. Children who did not return were visited and assessed at home. RESULTS: Only 87 children (56.9%) timely returned for follow-up: 70 had improved, eight presented the same health conditions, five were worse and four had a new problem. The main reasons given for not returning for follow-up were: the child had improved (35.1%) and other family priorities (47.4%). Home visits showed that, although most children had improved (n=49), some had a new health problem and one child was sick enough to be referred. Prescription of antibiotics was associated with increased probability of returning for a follow-up visit (RR =1.64 [1.22-2.20], p=0.001). CONCLUSION: Adherence to follow-up was just over 50%, mostly because the condition had already resolved, but some children were still sick and needed intervention. Training on counselling on the recognition of danger signs and when to return for a follow-up visit must be reinforced.

Adaptação e aplicabilidade do componente maus-tratos à estratégia da Atenção Integrada às Doenças Prevalentes na Infância no Brasil / Adaptation and applicability of the mistreatment component in Integrated Management of Childhood Illness in Brazil

OBJETIVOS: descrever o processo de adaptação ao contexto brasileiro e da aplicabilidade do conteúdo do módulo de maus-tratos no âmbito da estratégia Atenção Integrada às Doenças Prevalentes na Infância (AIDPI), a partir do original proposto pela Organização Pan-Americana da Saúde. MÉTODOS: O protocolo original foi traduzido para o português, retro-traduzido e revisado de forma independente. Foram incorporados aspectos relativos à legislação, contexto de saúde e organização dos serviços brasileiros. O material foi discutido por especialistas de diferentes áreas até obter consenso a respeito de compreensão e correspondência sobre os conceitos e os instrumentos propostos. A versão preliminar foi testada com grupo de monitores da estratégia AIDPI. Sugestões foram incorporadas ao texto. O módulo final foi aplicado com sucesso em treinamento para monitores em AIDPI na Região Nordeste. RESULTADOS: o material mostrou-se útil, claro e coerente. A classificação de gravidade para maus tratos psicológicos e negligência, além de textos com orientações aos profissionais e pais sobre o desenvolvimento psicomotor e emocional normais da criança foram incluídos. CONCLUSÕES: A incorporação desse módulo de maus-tratos em treinamentos formais na estratégia AIDPI pode preencher uma lacuna na educação do profissional de saúde na atenção primária, onde problemas relacionados à violência contra a criança são frequentes.

OBJECTIVES: to describe the process of adaptation to the Brazilian context and the applicability of the mistreatment module in the Integrated Mana-gement of Childhood Illness (IMCI) strategy, based on the Pan American Health Organization (PAHO) proposal. METHODS: the original protocol was translated into Portuguese, back-translated and reviewed by an independent observer. Features relating to legislation, the health context and the way Brazilian services are organized were incorporated. The materials were discussed by specialists from various areas until consensus was achieved with regard to the comprehensibility of the text and the correspondence between the wording and the intentions. The preliminary version was tested with a group of IMCI strategy monitors and suggestions arising from this were incorporated into the text. The final module was successfully applied during training of IMCI monitors in the Northeast region of the country. RESULTS: the material was found to be useful, clear and coherent. The ranking of degrees of severity of psychological mistreatment and negligence and texts providing guidelines for health workers and parents on the normal psychomotor and emotional deve-lopment of children were included. CONCLUSIONS: the incorporation of this module on mistreatment in the IMCI strategy's formal training sessions may fill a gap in the education of primary care health workers, who encounter problems relating to violence against children on a regular basis.

AIDS in childhood: cardiac involvement with and without triple combination antiretroviral therapy / AIDS na infância: acometimento cardíaco com e sem a terapia anti-retroviral tríplice combinada

OBJETIVO: Descrever a prevalência de alterações cardíacas ao ecocardiograma em crianças com AIDS acompanhadas em serviço de referência aos 18±6 meses do diagnóstico confirmado de AIDS. MÉTODOS: Estudo transversal, com corte aos 18±6 meses do diagnóstico de AIDS. Incluídas 93 crianças com diagnóstico confirmado de AIDS por transmissão vertical, sem doença maligna, que, na avaliação cardiológica, realizaram ecocardiograma (eco). De forma exploratória avaliaram-se as alterações cardíacas nos pacientes sem uso (G1) e com uso (G2) de terapia combinada anti-retroviral. RESULTADOS: Quando do diagnóstico de AIDS, as crianças tinham em média 3,07 anos e 50,50 por cento eram do sexo feminino. Esquema de terapia combinado com anti-retrovirais foi utilizado por 47 pacientes (G2). O acometimento cardíaco esteve presente em 40 crianças (43,00 por cento). A presença de disfunção ventricular esquerda (G1:39,10 por cento;G2:10,60 por cento) e o aumento isolado de ventrículo esquerdo (G1:6,60 por cento;G2:14,90 por cento) foram os achados mais freqüentes. Observou-se associação significativa entre os grupos sem e com terapia anti-retroviral combinada quanto à presença de disfunção ventricular esquerda (RP=3,42; [1,41-8,26]; p =0,02) e de desnutrição (RP=1,79; [1,00-3,20]; p=0,04). CONCLUSÃO: O acometimento cardíaco foi freqüente nas crianças com AIDS, sendo a disfunção ventricular esquerda a alteração mais observada ao ecocardiograma. Houve diferença estatisticamente significativa entre os grupos com e sem tratamento tríplice combinado quanto à presença de disfunção ventricular esquerda e de desnutrição.

OBJECTIVE: To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18±6 months of AIDS confirmed diagnosis. METHODS: A cross-section study with a cohort after 18±6 months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical transmission, with no malignancies and who underwent echocardiogram (echo) during cardiologic evaluation. Cardiac abnormalities were assessed in patients who were not treated (G1) and patients who were treated (G2) with combination antiretroviral therapy. RESULTS: When diagnosed with AIDS, the children were on average 3.07 years old and 50.50 percent were female. The combination regimen with antiretroviral agents was used by 47 patients (G2). Cardiac involvement was present in 40 children (43.00 percent). The presence of left ventricular dysfunction (G1: 39.10 percent; G2: 10.60 percent) and the isolated enlargement of left ventricle (G1: 6.60 percent; G2: 14.90 percent) were the most frequent findings. We observed a significant association between the groups without and with combination antiretroviral therapy asregards the presence of left ventricular dysfunction (PR= 3.42; [1.41-8.26]; p = 0.02) and malnutrition (PR = 1.79; [1.00-3.20]; p = 0.04). CONCLUSION: Cardiac involvement was frequent in children with AIDS and left ventricular dysfunction was the most common abnormality on echocardiogram. There was a statistically significant difference between the groups with and without triple combination treatment as regards the presence of left ventricular dysfunction and malnutrition.

Vivências da maternidade na adolescência precoce / Experiencing motherhood in early adolescence

OBJETIVO: Embora pouco estudada no Brasil, a maternidade na adolescência de 10 a 14 anos é considerada näo desejada e problema de saúde pública. A maior parte dos estudos tem o conceitual crono-biomédico como marco teórico, e poucos abordam esta questäo a partir do olhar do sujeito. O estudo realizado teve por objetivo explorar padröes e desvendar as diferentes formas de vivenciar a maternidade na adolescência precoce a partir da subjetividade da própria adolescente. MÉTODOS: Utilizou-se a metodologia Q de William Stephenson. Captadas em dois serviços públicos de saúde materno-infantil no Município do Rio de Janeiro, 20 adolescentes que ficaram grávidas entre 10 e 14 anos de idade foram estudadas em período de seis a 24 meses após o nascimento de seus respectivos filhos. Os Q-sorts foram submetidos a análise fatorial, e os fatores obtidos foram interpretados. RESULTADOS: Foram revelados quatro padröes de percepçäo, qualitativa e estatisticamente diferentes (p<0,01). Dois fatores foram bem definidos: Fator I - Satisfeita com a maternidade/ Dependente do afeto do filho: a maternidade como uma vivência positiva e enriquecedora e Fator II - Deprimida/ Estressada: visäo negativa e fragilizante. Os outros dois fatores, ainda incipientes, necessitam confirmaçäo em estudo posterior com amostra mais numerosa. CONCLUSOES: Foi possível observar que a vivência da maternidade näo é única nem homogênea. Para algumas adolescentes, ser mäe pode ser uma experiência gratificante

Analise da producao cientifica pediatrica brasileira publicada no "Jornal de Pediatria" no periodo de 1981 a 1990 / Analysis of the pediatric scientific production brazilian in the period of 1981 a 1990

Com o objetivo de melhor conhecer a situacao da literatura pediatrica no Brasil, procedemos a uma analise quantitativa de todos os artigos publicados no Jornal de Pediatria na decada de 80, considerando os seguintes aspectos: sua origem, tematica e a categoria profissional do autor principal. E, depois de analisar 810 artigos, observamos que a Regiao Sudeste, as Unidades da Federacao de Sao Paulo e Rio de Janeiro, as universidades publicas e os professores responderam pela maior parte dos estudos; que as acoes basicas de saude foram pouco abordadas e que os temas mais publicados se relacionaram as subareas de infectologia, perinatologia e nutricao

Gangrena de Fournier em pediatria / Fournier's gangrene in pediatrics

Os autores apresentam uma revisäo sobre gangrena de Fournier, motivados pelo relato de um caso desta doença em um menino de três anos de idade, que esteve internado no Instituto de Puericultura e Pediatria Martagäo Gesteira da UFRJ em janeiro de 1983, curiosamente 100 anos após a descriçäo desde tipo de gangrena, por Fournier, em 1883. Mostram-se os elementos clínicos que contribuíram para o diagnóstico, os achados laboratoriais e o tratamento. Discutem-se a incidência, os fatores predisponentes, a etiologia e o tratamento antimicrobiano, comparando-os com os dados referidos na literatura médica

As vivências da maternidade na adolescência menor / Experiences of motherhood in early adolescence

Objetivo: Embora pouco estudada em nosso meio, a maternidade na adolescência de 10 a 14 anos é considerada não desejada e problema de Saúde Pública. A maior parte dos estudos tem o conceitual crono-biomédico como marco teórico, e poucos abordam esta questão a partir do olhar do sujeito. Este estudo teve por objetivo explorar padrões e desvendar as diferentes formas de vivenciar a maternidade na adolescência menor a partir da subjetividade da própria adolescente. Métodos: Utilizou-se a Metodologia Q de William Stephenson. Captadas em dois serviços públicos de saúde materno-infantil no Município do Rio de Janeiro, vinte adolescentes que ficaram grávidas entre 10 e 14 anos de idade foram estudadas em período de seis a 24 meses após o nascimento de seus respectivos filhos. Os Q-sorts foram submetidos a análise fatorial, e os fatores obtidos foram interpretados. Resultados: Foram revelados quatro padrões de percepção, qualitativa e estatisticamente diferentes (P<0,01). Dois fatores foram bem definidos: Fator I - Satisfeita com a maternidade / Dependente do afeto do filho: a maternidade como uma vivência positiva e enriquecedora e Fator II - Deprimida/Estressada: visão negativa e fragilizante. Outros dois fatores, ainda incipientes, necessitam confirmação em estudo posterior com amostra mais numerosa: Fator III - Adaptada/ Dependente da família: a maternidade como experiência positiva de estreitamento de vínculos familiares; e Fator IV - Contraditória/ Em busca de identidade e apoio: vivência em conflito com os valores sociais. Conclusões: A partir da subjetividade da própria adolescente, foi possível observar que a vivência da maternidade não é única nem homogênea. Para algumas adolescentes, ser mãe pode ser uma experiência gratificante