Impact of Using a Precompleted Consent Form for Procedural Sedation in the Pediatric Emergency Department.

OBJECTIVES: This study aimed to compare elements discussed during the consent process for procedural sedation in the pediatric emergency department to documentation and parental recall before and after implementation of a standardized consent form. METHODS: This is a mixed-methods study combining retrospective electronic record review and cross-sectional surveys of providers and parents after consent for procedural sedation. Surveys were obtained before and after implementation of a precompleted consent form. Providers' survey responses were compared with consent documentation. Recall of consent elements discussed by linked parent-provider dyads were compared. RESULTS: Six hundred fifty-five encounters were reviewed. Pediatric emergency medicine fellows and pediatric emergency department-based pediatricians were more likely to document any benefit (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.0-2.4) or alternative (OR, 2.7; 95% CI, 1.8-3.9) compared with PEM attendings. Providers were more likely to report discussion of failure to complete the procedure (OR, 7.3; 95% CI, 2.3-23.3) and parents were more likely to recall discussion of this risk (OR, 5.3; 95% CI, 1.0-27.8) in the postintervention group. Based on provider recall, using the precompleted consent form was associated with providers discussing at least 2 of the 3 benefits (84.0% vs 97.2%, P < 0.01), 5 of the 5 risks (31% vs 67.7%, P < 0.01), and improved parental recall of risks (5.7% vs 22.9%, P = 0.03). More providers reported taking less than 1 minute to complete the form in the postimplementation group (12.0% vs 43.7%, P < 0.01). CONCLUSIONS: Implementing a precompleted consent form for procedural sedation was associated with providers reporting decreased time spent completing the consent form and better alignment of key consent elements between reported provider discussion and parental recall.

Cost-effectiveness of 3-months isoniazid and rifapentine compared to 9-months isoniazid for latent tuberculosis infection: a systematic review.

BACKGROUND: We conducted a systematic review examining the cost effectiveness of a 3-month course of isoniazid and rifapentine, known as 3HP, given by directly observed treatment, compared to 9 months of isoniazid that is directly observed or self-administered, for latent tuberculosis infection. 3HP has shown to be effective in reducing progression to active tuberculosis and like other short-course regimens, has higher treatment completion rates compared to standard regimens such as 9 months of isoniazid. Decision makers would benefit from knowing if the higher up-front costs of rifapentine and of the human resources needed for directly observed treatment are worth the investment for improved outcomes. METHODS: We searched PubMed, Embase, CINAHL, LILACS, and Web of Science up to February 2022 with search concepts combining latent tuberculosis infection, directly observed treatment, and cost or cost-effectiveness. Studies included were in English or French, on human subjects, with latent tuberculosis infection, provided information on specified anti-tubercular therapy regimens, had a directly observed treatment arm, and described outcomes with some cost or economic data. We excluded posters and abstracts, treatment for multiple drug resistant tuberculosis, and combined testing and treatment strategies. We then restricted our findings to studies examining directly-observed 3HP for comparison. The primary outcome was the cost and cost-effectiveness of directly-observed 3HP. RESULTS: We identified 3 costing studies and 7 cost-effectiveness studies. The 3 costing studies compared directly-observed 3HP to directly-observed 9 months of isoniazid. Of the 7 cost-effectiveness studies, 4 were modelling studies based in high-income countries; one study was modelled on a high tuberculosis incidence population in the Canadian Arctic, using empiric costing data from that setting; and 2 studies were conducted in a low-income, high HIV-coinfection rate population. In five studies, directly-observed 3HP compared to self-administered isoniazid for 9 months in high-income countries, has incremental cost-effectiveness ratios that range from cost-saving to $5418 USD/QALY gained. While limited, existing evidence suggests 3HP may not be cost-effective in low-income, high HIV-coinfection settings. CONCLUSION: Cost-effectiveness should continue to be assessed for programmatic planning and scale-up, and may vary depending on existing systems and local context, including prevalence rates and patient expectations and preferences.

Depression and Capacity to Withdraw from Dialysis.

A patient with a history of bipolar II disorder and end-stage renal disease who required hemodialysis for five years abruptly wished to withdraw from dialysis on day seven of her hospital admission for a urinary tract infection. She had never discussed wishing to withdraw from dialysis prior to this hospital admission. She had experienced several symptoms of depression during her stay. Her desire to withdraw from dialysis treatment was discordant with her previously expressed desires, and the psychiatry team determined that her judgment was likely altered by her depressive episode. Given her previous positive response to electroconvulsive therapy (ECT), the psychiatry team recommended that she receive ECT before she choose to withdraw from dialysis.

High glucose concentration stimulates NHE-1 activity in distal nephron cells: the role of the Mek/Erk1/2/p90RSK and p38MAPK signaling pathways.

AIMS: In models of diabetes, distal nephron cells contribute to glucose uptake and oxidation. How these cells contribute to the use of glucose for the regulation of H(+) extrusion remains unknown. We used Madin-Darby Canine Kidney (MDCK) cells to investigate the effect of acute or chronic high glucose concentration on the abundance and activity of the Na(+)/H(+) exchanger (NHE-1). METHODS: Using RT-PCR, we also evaluated the mRNA expression for sodium glucose co-transporters SGLT1 and SGLT2. Protein abundance was analyzed using immunoblotting, and intracellular pH (pHi) recovery was evaluated using microscopy in conjunction with the fluorescent probe BCECF/AM. The Na(+)-dependent pHi recovery rate was monitored with HOE-694 (50 µM) and/or S3226 (10 µM), specific NHE-1 and NHE-3 inhibitors. RESULTS: MDCK cells did not express the mRNA for SGLT1 or SGLT2 but did express the GLUT2, NHE-1 and NHE-3 proteins. Under control conditions, we observed a greater contribution of NHE-1 to pHi recovery relative to the other H(+) transporters. Acute high glucose treatment increased the HOE-694-sensitive pHi recovery rate and p-Erk1/2 and p90(RSK) abundance. These parameters were reduced by PD-98059, a Mek inhibitor (1 µM). Chronic high glucose treatment also increased the HOE-694-sensitive pHi recovery rate and p-p38MAPK abundance. Both parameters were reduced by SB-203580, a p38MAPK inhibitor (10 µM). CONCLUSION: These results suggested that extracellular high glucose stimulated NHE-1 acutely and chronically through Mek/Erk1/2/p90(RSK) and p38MAPK pathways, respectively.

How much does HIV self-testing cost in low and middle income countries? A systematic review of evidence from economic studies.

Objectives: HIV self-testing (HIVST) has been proposed as an innovative strategy to diagnose human immunodeficiency virus (HIV). While HIVST offers the potential to broaden accessibility of early HIV diagnosis and treatment initiation, this testing strategy incurs additional cost and requires confirmatory testing and treatment. We have conducted the first systematic review to summarize the current economic literature for HIVST in low- and middle-income countries (LMICs). Design: A search strategy was developed including key terms for HIV, self-testing and cost-effectiveness and was conducted in Medline and Embase databases. Studies were included that reported costs per outcome and included both cost-effectiveness and cost-utility outcome measures. The search strategy identified publications up until August 15, 2023 were included. Abstract and full text screening was conducted and a standardized data abstraction form was used for included studies. Costs are reported in USD, 2020. Results: Our search strategy identified 536 total titles from the search strategy, which were screened down to 25 relevant studies that provided both cost and outcome data on HIVST. There was significant heterogeneity in the HIVST intervention, study population, costs and outcomes reported among included studies. Cost per person tested ranged from $1.09-155. Cost per case diagnosed ranged from $20-1,277. Cost-utility estimates ranged from cost-saving to $1846 per DALY averted. Higher cost-effectiveness estimates were associated with more expensive testing algorithms with increased support for linkage to care and post-test counseling. Conclusion: All studies considered HIVST cost-effective although major drivers were identified included underlying HIV prevalence, testing cost and linkage to care. HIVST is likely to be cost-effective in a LMIC context, however policy makers should be aware of the drivers of cost-effectiveness when implementing HIVST programs as these underlying factors can impact the overall cost-effectiveness of HIVST.

Complications associated with PEAK PlasmaBlade from 2010 to 2020 from MAUDE.

The pulse-electron avalanche knife (PEAK) PlasmaBlade 3.0 and 4.0 (Medtronic, Minneapolis, MN) is an electrosurgical technology that is widely used in surgery. Our study aimed to summarize device malfunctions, patient injuries, and interventions related to PEAK PlasmaBlade 3.0 and 4.0. The US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports of PlasmaBlade adverse events from June 6, 2010, to August 30, 2020. Data were extracted from reports pertaining to PlasmaBlade 3.0 and 4.0. A total of 384 medical device reports were identified, from which 424 adverse events were extracted. Of those, 348 (82.1%) were device malfunctions, 53 (12.5%) were patient injuries, and 23 (5.4%) were operator injuries. Device malfunctions were most frequently caused by delaminated coating (110, 25.9%), followed by ignition or fire (56, 13.2%). Operator injury was most frequently caused by thermal injury (19, 4.5%), followed by laceration (4, 0.9%). Pacemakers (22, 57.9%) were the most common devices causing interference. PEAK PlasmaBlade 3.0 and 4.0 have demonstrated utility during surgeries but are associated with adverse events. Interventions that aim to educate physicians on potential risks may help reduce the incidence of complications. Future studies with standardized reporting protocols are warranted.

Long-term male-specific chronic pain via telomere- and p53­mediated spinal cord cellular senescence.

Mice with experimental nerve damage can display long­lasting neuropathic pain behavior. We show here that 4 months and later after nerve injury, male but not female mice displayed telomere length (TL) reduction and p53­mediated cellular senescence in the spinal cord, resulting in maintenance of pain and associated with decreased lifespan. Nerve injury increased the number of p53­positive spinal cord neurons, astrocytes, and microglia, but only in microglia was the increase male­specific, matching a robust sex specificity of TL reduction in this cell type, which has been previously implicated in male­specific pain processing. Pain hypersensitivity was reversed by repeated intrathecal administration of a p53­specific senolytic peptide, only in male mice and only many months after injury. Analysis of UK Biobank data revealed sex-specific relevance of this pathway in humans, featuring male­specific genetic association of the human p53 locus (TP53) with chronic pain and a male-specific effect of chronic pain on mortality. Our findings demonstrate the existence of a biological mechanism maintaining pain behavior, at least in males, occurring much later than the time span of virtually all extant preclinical studies.

Glucose-induced regulation of NHEs activity and SGLTs expression involves the PKA signaling pathway.

The effect of glucose on the intracellular pH (pH(i)) recovery rate (dpH(i)/dt) and Na(+)-glucose transporter (SGLT) localization was investigated in HEK-293 cells, a cell line that expresses endogenous NHE1, NHE3, SGLT1, and SGLT2 proteins. The activity of the Na(+)/H(+) exchangers (NHEs) was evaluated by using fluorescence microscopy. The total and membrane protein expression levels were analyzed by immunoblotting. In cells cultivated in 5 mM glucose, the pH(i) recovery rate was 0.169 ± 0.020 (n = 6). This value did not change in response to the acute presence of glucose at 2 or 10 mM, but decreased with 25 mM glucose, an effect that was not observed with 25 mM mannitol. Conversely, the chronic effect of high glucose (25 mM) increased the pH(i) recovery rate (~40%, P < 0.05), without changes in the total levels of NHE1, NHE3, or SGLT1 expression, but increasing the total cellular (~50%, P < 0.05) and the plasma membrane (~100%, P < 0.01) content of SGLT2. Treatment with H-89 (10(-6) M) prevented the stimulatory effect of chronic glucose treatment on the pH(i) recovery rate and SGLT2 expression in the plasma membrane. Our results indicate that the effect of chronic treatment with a high glucose concentration is associated with increased NHEs activity and plasma membrane expression of SGLT2 in a protein kinase A-dependent way. The present results reveal mechanisms of glucotoxicity and may contribute to understanding the diabetes-induced damage of this renal epithelial cell.

Lithobates catesbeianus (American Bullfrog) oocytes: a novel heterologous expression system for aquaporins.

Xenopus laevis oocytes are a valuable tool for investigating the function of membrane proteins. However, regulations around the world, specifically in Brazil, render the import of Xenopus laevis frogs impractical, and, in some cases, impossible. Here, as an alternative, we evaluate the usefulness of the North American aquatic bullfrog Lithobates catesebeianus, which is commercially available in Brazil, for the heterologous expression of aquaporin (AQP) proteins. We have developed a method that combines a brief collagenase treatment and mechanical defolliculation for isolating individual oocytes from Lithobates ovaries. We find that they have a similar size, shape, and appearance to Xenopus oocytes and can tolerate and survive following injections with cRNA or water. Furthermore, surface biotinylation, western blot analysis, and measurements of osmotic water permeability (Pf) show that Lithobates oocytes can express AQPs to the plasma membrane and significantly increase the Pf of the oocytes. In fact, the Pf values are similar to historical values gathered from Xenopus oocytes. Due to the presence of a mercury sensitive cysteine (Cys or C) in the throat of the water channel, the Pf of oocytes expressing human (h) AQP1, hAQP1FLAG [FLAG, short protein tag (DYKDDDDK) added to the N-terminus of AQP1], hAQP8, and rat (r) AQP9 was inhibited with the mercurial compound p-chloromercuribenzene sulfonate (pCMBS), whereas AQPs lacking this Cys - hAQP1C189S mutant [residue Cys 189 was replaced by a serine (Ser or S)] and hAQP7 - were mercury insensitive. Contrary to previous studies with Xenopus oocytes, rAQP3 was also found to be insensitive to mercury, which is consistent with the mercury-sensitive Cys (Cys 11) being located intracellularly. Thus, we consider Lithobates oocytes to be a readily accessible system for the functional expression and study of membrane proteins for international researchers who do not currently have access to Xenopus oocytes.

Strengths-based nursing and healthcare: percepção de mulheres em uma maternidade de risco habitual / Strengths-based nursing and healthcare: perception of women in a usual risk maternity hospital / Strengths-based nursing and healthcare: percepción de las mujeres en una maternidad de riesgo habitual

RESUMO Objetivo: apresentar a percepção das mulheres hospitalizadas em uma maternidade em relação aos cuidados de enfermagem recebidos, tendo como respaldo referencial teórico Strengths-Based Nursing and Healthcare, de Laurie Gottlieb. Método: estudo exploratório de abordagem qualitativa. Foram entrevistadas 20 puérperas hospitalizadas no período de novembro a dezembro de 2019, em uma maternidade de risco habitual em Curitiba-PR, Brasil. Os dados foram transcritos e categorizados, utilizando software MaxQDA®2020, sendo realizada a análise de conteúdo, segundo os passos de Creswell. Resultados: foram estabelecidas duas categorias: "ausência de elementos do referencial teórico"; e "presença de elementos do referencial teórico". Conclusão: o referencial teórico foi percebido pelas mulheres nos cuidados recebidos; estas se beneficiaram com este modelo, compreendendo o seu papel ativo no processo de parturição. Desenvolver este referencial teórico nas maternidades de risco habitual e em outras realidades assistenciais é uma janela de oportunidades para o desenvolvimento do trabalho dos enfermeiros.

ABSTRACT Objective: to present the perception of women hospitalized in a maternity hospital regarding the nursing care received, with the theoretical reference Strengths-Based Nursing and Healthcare, by Laurie Gottlieb. Method: exploratory study with a qualitative approach. Twenty puerperal women hospitalized in the period from November to December 2019, in a usual risk maternity hospital in Curitiba-PR, Brazil, were interviewed. Data were transcribed and categorized, using MaxQDA®2020 software, and content analysis was performed, according to Creswell's steps. Results: two categories were established: "absence of elements of the theoretical framework"; and "presence of elements of the theoretical framework". Conclusion: the theoretical framework was perceived by women in the care they received; they benefited from this model, understanding their active role in the delivery process. Developing this theoretical framework in usual-risk maternity hospitals and in other care realities is a window of opportunity for the development of nurses' work.

RESUMEN Objetivo: presentar la percepción de las mujeres hospitalizadas en una maternidad sobre los cuidados de enfermería recibidos, con la referencia teórica Strengths-Based Nursing and Healthcare, de Laurie Gottlieb. Método: estudio exploratorio de enfoque cualitativo. Fueron entrevistadas 20 puérperas hospitalizadas en el período de noviembre a diciembre de 2019, en una maternidad de riesgo habitual en Curitiba-PR, Brasil. Los datos se transcribieron y categorizaron, utilizando el software MaxQDA®2020, y se realizó un análisis de contenido, según los pasos de Creswell. Resultados: se establecieron dos categorías: "ausencia de elementos del marco teórico"; y "presencia de elementos del marco teórico". Conclusión: el marco teórico fue percibido por las mujeres en la atención recibida; ellas se beneficiaron de este modelo, comprendiendo su papel activo en el proceso de parto. El desarrollo de este marco teórico en las maternidades de riesgo habitual y en otras realidades asistenciales es una ventana de oportunidad para el desarrollo del trabajo de las enfermeras.

Modelo complexo hospital de clínicas de gestão de alta: concepção e implantação / Complex clinical hospital model of discharge management: conception and implementation / Modelo clínico hospitalario de gestión del alta: diseño y ejecución

RESUMO Objetivo: apresentar a concepção e implantação do Modelo de Gestão de Altas do Complexo Hospital de Clínicas da Universidade Federal do Paraná. Método: relato de experiência ocorrido entre 2017 e 2020, sobre a concepção e implantação do modelo de Gestão de Altas com apoio do modelo lógico. Resultados: continuidade do cuidado e gerenciamento de caso são operacionalizados por uma equipe exclusiva de enfermeiras de ligação que gerenciam e contrarreferenciam os cuidados para a atenção primária e outros pontos da rede de assistência à saúde. Conclusão: a gestão de altas se consolidou como uma estratégia gerencial que integra a rede de atenção à saúde, evita descontinuidades da assistência, promove segurança aos pacientes e familiares, além de otimização de leitos, e ainda insere na agenda da atenção primária os pacientes complexos. Contribui para a continuidade do cuidado e representa evidência de um novo campo de atuação do Enfermeiro.

ABSTRACT Objective: to present the conception and implementation of the Discharge Management Model of the Clinics Hospital Complex of the Federal University of Paraná. Method: experience report occurred between 2017 and 2020, about the design and implementation of the Discharge Management model with support of the logic model. Results: continuity of care and case management are operationalized by a dedicated team of liaison nurses who manage and counter-reference care to primary care and other points in the health care network. Conclusion: discharge management has been consolidated as a managerial strategy that integrates the health care network, avoids discontinuities in care, promotes patient and family safety, and optimizes beds, and inserts complex patients into the primary care agenda. It contributes to the continuity of care and represents evidence of a new field of work for nurses.

RESUMEN Objetivo: presentar la concepción e implementación del Modelo de Gestión de Alta del Complejo Hospitalario de Clínicas de la Universidad Federal de Paraná. Método: informe de experiencia ocurrida entre 2017 y 2020, sobre el diseño e implementación del modelo de Gestión del Alta con apoyo del modelo lógico. Resultados: la continuidad de los cuidados y la gestión de los casos son operados por un equipo exclusivo de enfermeras de enlace que gestionan y contra revierten los cuidados a la atención primaria y a otros puntos de la red sanitaria. Conclusión: la gestión de altas se consolida como una estrategia gerencial que integra la red de atención a la salud, evita las discontinuidades de la asistencia, promueve la seguridad de los pacientes y los familiares, además de la optimización de las camas, y aún inserta en la agenda de la atención primaria a los pacientes complejos. Contribuye a la continuidad de los cuidados y representa la evidencia de un nuevo campo de trabajo para las enfermeras.

Enfermeiras de Ligação na Gestão de Altas do Complexo Hospital de Clínicas / Liaison nurses in the discharge management of the hospital de clinicas complex / Enfermeras de enlace en la gestión de alta del complejo hospital de clinicas

Objetivo: apresentar o trabalho desenvolvido pelas enfermeiras de ligação no Serviço de Gestão de Altas do Complexo Hospital de Clínicas da Universidade Federal do Paraná. Método: estudo descritivo do tipo relato de experiência sobre a concepção, implementação e resultados de um modelo de gestão de altas. Resultados: estabelecimento de estratégias de integração com a rede, elaboração de protocolos assistenciais, gerenciamento de 13.513 altas hospitalares entre os anos de 2017 e 2020; monitoramento telefônico após a alta de usuário internados por Covid-19; instituição de campo de estagio para enfermeiros residentes; e produções científicas. Considerações finais: destacou-se o papel da enfermeira de ligação como coordenadora do planejamento da alta hospitalar. (AU)

Objective: To present the work developed by the liaison nurses at the Discharge Management Service of the Hospital de Clinicas Complex of the Federal University of Paraná. Methods: Descriptive study of the experience report type on the design, implementation and results of a discharge management model. Results: Establishment of integration strategies with the network, development of care protocols, management of 13,513 hospital discharges between 2017 and 2020; telephone monitoring after discharge of users hospitalized by Covid-19; field internship institution for resident nurses; and scientific productions. Conclusion: Highlighted the role of the liaison nurse as coordinator of hospital discharge planning. (AU)

Objetivo: Presentar el trabajo desarrollado por enfermeras de enlace del Servicio de Gestión de Egresos en el Complejo Hospital de Clínicas de la Universidad Federal de Paraná. Métodos: Estudio descriptivo del tipo narrativas de experiencia sobre la concepción, implementación y resultados de un modelo de gestión de altas. Resultados: Establecimiento de estrategias de integración con la red, elaboración de protocolos de atendimiento, gerenciamiento de 13.513 egresos hospitalarios entre 2017 y 2020; seguimiento telefónico posterior al recibimiento de alta en usuarios hospitalizados por Covid-19; institución de prácticas de campo para enfermeros residentes; y producciones científicas. Conclusión: Destacase el papel de la enfermera de enlace como coordinadora de la planificación del alta hospitalaria. (AU)

Enfermeiro de ligação de uma maternidade de risco habitual: dados de contrarreferências / Liaison nurse at a usual risk maternity hospital: counter-reference data

Objetivo: Identificar o perfil das contrarreferências realizadas pela Enfermeira de Ligação de uma maternidade de risco habitual. Método: pesquisa quantitativa, descritiva, transversal com coleta retrospectiva dos dados, realizada por levantamento documental (dados de planilhas) da Unidade de Gestão de Altas de uma maternidade pública do Paraná. Resultados: Das 988 contrarreferências realizadas, 294 estavam relacionados à recém-nascidos e 694 às mulheres. Destaca-se contrarreferências relacionadas à gestação na adolescência; multiparidade; infecções sexualmente transmissíveis (IST); síndrome hipertensiva da gestação; sangramento pós-parto; tratamento por infecção. E para os recém-nascidos: tratamento por infecção; prematuridade; contato com IST e malformações. Conclusão: as contrarreferências da maternidade de risco habitual, realizadas pela enfermeira de ligação, para os outros pontos da rede assistencial contribuem para a continuidade do cuidado. Este profissional, ao enxergar o usuário além de sua linha de cuidado, dentro da Rede de Atenção à Saúde, proporciona saúde, educação e serviços necessários a continuidade do cuidado para a puérpera ou do recém-nato. (AU)

Objective: To identify the profile of the counter-referrals performed by the Liaison Nurse at a usual risk maternity hospital. Method: quantitative, descriptive, cross-sectional research with retrospective data collection, carried out by documentary survey (spreadsheet data) of the Hospital Management Unit of a public maternity hospital in Paraná. Results: Of the 988 counter-references made, 294 were related to newborns and 694 to women. Counter-references related to adolescent pregnancy stand out; multiparity; sexually transmitted infections (STIs); hypertensive pregnancy syndrome; postpartum bleeding; infection treatment. And for newborns: treatment for infection; prematurity; contact with STIs and malformations. Conclusion: the counterreferences of the usual risk maternity, carried out by the liaison nurse, to the other points of the assistance network contribute to the continuity of care. This professional, when seeing the user beyond his line of care, within the Health Care Network, provides health, education and services necessary for the continuity of care for the puerperal woman or the newborn. (AU)

Objetivo: identificar el perfil de las contrarreferencias realizadas por la enfermera de enlace en un hospital de maternidad de riesgo habitual. Método: investigación cuantitativa, descriptiva, transversal con recolección de datos retrospectiva, realizada mediante encuesta documental (hoja de cálculo) de la Unidad de Gestión Hospitalaria de una maternidad pública en Paraná. Resultados: De las 988 contrarreferencias hechas, 294 estaban relacionadas con recién nacidos y 694 con mujeres. Se destacan las contrarreferencias relacionadas con el embarazo adolescente; multiparidad; infecciones de transmisión sexual (ITS); síndrome de embarazo hipertensivo; sangrado posparto; tratamiento de infecciones. Y para los recién nacidos: tratamiento para la infección; precocidad; contacto con ITS y malformaciones. Conclusión: las contrarreferencias de la maternidad de riesgo habitual, realizada por la enfermera de enlace, a los otros puntos de la red de asistencia contribuyen a la continuidad de la atención. Este profesional, cuando ve al usuario más allá de su línea de atención, dentro de la Red de Atención Médica, brinda la salud, la educación y los servicios necesarios para la continuidad de la atención para la mujer puerperal o el recién nacido. (AU)

Alternative splicing of TIA-1 in human colon cancer regulates VEGF isoform expression, angiogenesis, tumour growth and bevacizumab resistance.

The angiogenic capability of colorectal carcinomas (CRC), and their susceptibility to anti-angiogenic therapy, is determined by expression of vascular endothelial growth factor (VEGF) isoforms. The intracellular protein T-cell Intracellular Antigen (TIA-1) alters post-transcriptional RNA processing and binds VEGF-A mRNA. We therefore tested the hypothesis that TIA-1 could regulate VEGF-A isoform expression in colorectal cancers. TIA-1 and VEGF-A isoform expression was measured in colorectal cancers and cell lines. We discovered that an endogenous splice variant of TIA-1 encoding a truncated protein, short TIA-1 (sTIA-1) was expressed in CRC tissues and invasive K-Ras mutant colon cancer cells and tissues but not in adenoma cell lines. sTIA-1 was more highly expressed in CRC than in normal tissues and increased with tumour stage. Knockdown of sTIA-1 or over-expression of full length TIA-1 (flTIA-1) induced expression of the anti-angiogenic VEGF isoform VEGF-A165b. Whereas flTIA-1 selectively bound VEGF-A165 mRNA and increased translation of VEGF-A165b, sTIA-1 prevented this binding. In nude mice, xenografted colon cancer cells over-expressing flTIA-1 formed smaller, less vascular tumours than those expressing sTIA-1, but flTIA-1 expression inhibited the effect of anti-VEGF antibodies. These results indicate that alternative splicing of an RNA binding protein can regulate isoform specific expression of VEGF providing an added layer of complexity to the angiogenic profile of colorectal cancer and their resistance to anti-angiogenic therapy.

[Dietary care, an essential support for colon cancer treatments]. / La prise en charge diététique, un soutien essentiel aux traitements du cancer colique.

Dietetics is currently playing an increasingly important role in the treatment of cancers. Saint-Antoine hospital in Paris offers nutritional support on medical prescription to every patient undergoing treatment for colon cancer. In both digestive surgery and oncology departments, the dietician supports and monitors patients throughout their hospitalisation.

Uso da rugoscopia palatina como ferramenta biométrica: um estudo populacional em Niterói-RJ, Brasil / Use of palatine rugoscopy as biometric tool: a population study in Niteroi, RJ, Brazil

Introdução: Pesquisas por métodos biométricos auxiliares em perícias têm crescido na Odontologia Legal. Objetivo: Este estudo avaliou a eficácia da rugoscopia palatina na identificação humana. Material e método: Foram utilizados 184 modelos de gesso de estudantes voluntários em Niterói-RJ, para delineamento de suas rugosidades palatinas, sendo classificadas segundo quantidade, direção (sistema de Carrea) e formato individual (sistema de Silva), e comparadas às variáveis demográficas sexo, cor da pele e idade. A análise estatística foi realizada com o teste qui-quadrado para amostras independentes, considerando-se p<0,05. Resultado: Houve maior prevalência de 2-7 rugas em homens. O tipo IV de Carrea e o tipo 1 de Silva foram mais evidentes, porém sem diferenças intergrupos significativas, de acordo com as variáveis propostas. Conclusão: A rugoscopia palatina é uma ferramenta biométrica viável e fornece informações morfológicas individuais relevantes, embora sua análise cega e em tempo único não exiba acurácia na estratificação populacional. .

Introduction: Researches by auxiliary biometric methods for skills have grown in Forensic Dentistry. Objective: This study evaluated the effectiveness of palatal rugoscopy in human identification. Material and method: They were used 184 plaster models of students volunteers in Niterói, RJ, performing the design of their palatal rugae sorted by amount, direction (Carrea's pattern) and individual format (Silva's pattern) and compared to the demographic variables gender, skin color and age. Statistical analysis was performed using chi-square test for independent samples and considering p<0.05. Result: There was a higher prevalence of 2-7 rugae in men. Carrea's pattern IV and Silva's pattern 1 were evident, but no significant intergroup differences in accord to the proposed variables. Conclusion: The palatal rugoscopy is a practicable biometric tool and it provides relevant individual morphological information, although its blind and one-time analysis not displays accurancy in population stratification. .

Políticas públicas para a saúde do adolescente: revisão integrativa de literatura / Public policy for adolescent health: an integrative literature revision

Objetivou-se identificar as evidências científicas disponíveis na literatura sobre políticas públicas voltadas à saúde do adolescente. Para esta revisão integrativa, selecionaram-se 12 artigos (8 nacionais e 4 estrangeiros) classificados nas seguintes categorias: políticas públicas voltadas a adolescentes, políticas públicas voltadas à proteção do adolescente trabalhador, políticas públicas para reduzir a violação dos direitos dos adolescentes e políticas públicas referentes à saúde mental. Constatou-se a necessidade de fomentar políticas voltadas à integralidade do adolescente...

This study sought to identify published scientific evidence on public policies oriented towards adolescent health. This integrative review led to the retrieval of 12 articles (8 from Brazil and 4 from abroad) addressing four approaches: public policies aimed at teenagers, the protection of working adolescents, mental health, and reducing violation of adolescents' rights. The study revealed the need to promote policies with a comprehensive approach to adolescents' health...

El objetivo de este trabajo ha sido identificar las evidencias científicas disponibles en la literatura sobre políticas públicas dirigidas a la salud del adolescente. Para esta revisión integradora, se seleccionaron 12 artículos (8 nacionales y 4 extranjeros) clasificados en las siguientes categorías: políticas públicas dirigidas a adolescentes, políticas públicas dirigidas a la protección del adolescente trabajador, políticas públicas destinadas a reducir la violación de los derechos de los adolescentes y políticas públicas referentes a la salud mental. Se constató la necesidad de estimular políticas dirigidas a la integralidad del adolescente...(AU)

Projeto Vidas Paralelas: estudo sobre uma experiência de participação em saúde do trabalhador no Rio de Janeiro / Project Parallel Lives: a study on the experience of participation in occupational health in Rio de Janeiro

O objeto deste estudo é o Projeto Vidas Pararelas (PVP) no estado do Rio de Janeiro. Possui como objetivo geral estudar a experiência do PVP do Rio de Janeiro à luz dos conceitos da Educação Popular e Saúde (EPS). Como norteador da pesquisa, utilizamos o método qualitativo e para a análise dos dados, utilizamos a análise de conteúdo. O cenário da pesquisa consta de tudo que envolve o PVP, seus integrantes e o ambiente virtual. Antes de apresentarmos os resultados das entrevistas, descrevemos o componente digital do PVP (o site) e o perfil dos sujeitos da pesquisa que foi composta de 11 trabalhadores inseridos no PVP RJ. Categorizamos os achados das entrevistas em quatro tópicos: o primeiro, fala sobre a participação no PVP, onde constatamos que, quanto a participação, os trabalhadores mostraram várias formas de uso do projeto, bem como tipos de participação, com ênfase às falas que esperam que o PVP também forme multiplicadores. Dentre os ganhos para a classe trabalhadora, no segundo tópico, eles citaram a melhoria da cultura de denúncia e a oportunidade de reconhecimento da identidade de gênero de uma classe em especial. Outros trabalhadores consideram o projeto, também, como agente fortalecedor de sua ou de outras categorias profissionais. No terceiro tópico, consideram que, no futuro, o PVP será uma importante ferramenta nas mãos do trabalhador para a exposição de sua realidade de trabalho. Além disso, eles colocam a esperança na melhoria do convívio com o próprio grupo do PVP no Rio de Janeiro. Por fim, no quarto tópico como melhorias, os entrevistados apontam a necessidade de reorganização do coletivo que compõe o PVP RJ. E para que esse convívio se concretize, os trabalhadores cobram que a Rede de Apoio realize mais reuniões. Outro ponto bem enfático na fala dos entrevistados, neste tópico, foi a dificuldade em acessar o site e a dificuldade de acesso à internet

The object of this study is the Pararel Lives Project (PLP) in the state of Rio de Janeiro. It has as main objective to study the experience of PLP in Rio de Janeiro to the concepts of Popular Education and Health (EPH). As for directing the research, we used qualitative methodology and data analysis, we used content analysis. The scenario consists of all the research that involves the PLP, its members and the virtual environment. Before presenting the results of the interviews, we describe the digital component of PLP (the site) and the profile of research subjects who comprised 11 workers employed in PVP RJ. We categorized the findings of the interviews on four topics: the first, speaks about participation in PLP, where we see that, as the participation, workers showed multiple ways to use the project as well as types of participation, with emphasis on lines that expect PLP also form multipliers. Among the gains for the working class, the second topic, they cited the improvement of the culture of complaint and opportunity to recognize the gender identity of a particular class. Other workers consider the project as well as strengthening its agent or other professional categories. In the third topic, consider that in the future, the PLP will be an important tool in the hands of the worker for the exhibition of their work reality. Moreover, they place their hopes in improving the living with their own group of PLP in Rio de Janeiro. Finally, the fourth topic as improvements, respondents indicate the need for reorganization of the collective that makes up the PLP RJ. In addition, for that interaction to take place, the workers charge that the Support Network hold more meetings. Another quite emphatic speech of the interviewees, this topic was the difficulty in accessing the site and difficult access to the internet

Cuidados no atendimento odontológico aos indivíduos com Diabetes Mellitus à luz da literatura

A Diabetes Mellitus constitui-se num sério problema de saúde na atualidade e sua abrangência envolve todas as classes sociais. O objetivo deste estudo foi identificar na literatura quais os cuidados necessários a serem tomados pelos cirurgiões-dentistas quando do atendimento a indivíduos com Diabetes Mellitus na Atenção Básica. Foi realizada uma revisão bibliográfica narrativa com busca de artigos na base de dados do LILACS e MEDLINE, utilizando o unitermo "Diabetes Mellitus Saúde Bucal", sendo selecionados artigos no período de 1994 a 2009. Também foram consultadas outras fontes como livros, dissertações, teses e manuais do Ministério da Saúde, por estes serem considerados de relevância para o estudo. Como resultado, foi possível identificar que a característica debilitante e degenerativa da Diabetes Mellitus e, também, sua interferência no modo de vida, faz desta doença uma prioridade no programa de Atenção Básica. Várias alterações bucais podem ser observadas nos indivíduos com Diabetes Mellitus sendo importante o cirurgião-dentista conhecer essas alterações e promover ações de modo a impedir o agravo da mesma. Quando necessário, o tratamento odontológico no diabético deve ser realizado e norteado pela sua situação clínica. Em virtude de suas complicações, o atendimento a indivíduos com Diabetes Mellitus requer uma abordagem multidisciplinar. Frente à literatura consultada pode-se concluir que o cirurgião-dentista precisa ser capacitado para atender indivíduos com Diabetes Mellitus, pois há necessidade de estabelecer condutas necessárias de profilaxia e tratamento. A realização de ações educativas é essencial, pois se configuram como oportunidade para divulgação de informações sobre a doença e, também, para despertar nas pessoas a necessidade de adotar um estilo de vida mais saudável.