Epidemiology, patient journey and unmet needs related to hemophilia in Brazil: a scoping review with evidence map.

INTRODUCTION: Brazil is one of the countries with the largest population of people with hemophilia (PwH) worldwide. In this scoping review, we aim to investigate the Brazilian context for hemophilia regarding three predefined concepts: (i) clinical-epidemiological profile, (ii) burden of disease and (iii) patient journey and unmet needs. METHODS: Three questions in each concept guided the screening of references retrieved by systematic searches carried out in MEDLINE, LILACS and the Digital Library of Theses and Dissertations. Quantitative and qualitative studies conducted in Brazil from 2002 onwards were assessed for eligibility. MAIN RESULTS: Ninety-two studies were included. A total of 66 studies addressed the concept "Clinical-epidemiological profile", 31 investigated the concept of "Burden of disease" and 26 addressed the concept "Patient journey and unmet needs". Based on these studies, pain and arthropathy affect a substantial proportion of the PwH, with physical functioning, pain and school or work being the domains of quality of life with the greatest impact. About 43 % to 82.6 % of the PwH are unemployed. Rates of inhibitor development are highly variable across studies, especially in hemophilia A. Adherence to prophylactic treatment ranges from 25 % to 72 %. The annualized bleeding rate is estimated at 2.4 ± 4.1. The barriers to treatment identified include distance to reference centers, lack of coordination of specialized and emergency care and restricted access to rehabilitation. CONCLUSIONS: Hemophilia poses a considerable burden on the PwH. Despite the available modalities of treatment, there are remaining unmet needs that should be addressed by researchers and policy makers in the future.

Prediction of Multimorbidity in Brazil: Latest Fifth of a Century Population Study.

BACKGROUND: Multimorbidity is characterized by the co-occurrence of 2 or more chronic diseases and has been a focus of the health care sector and health policy makers due to its severe adverse effects. OBJECTIVE: This paper aims to use the latest 2 decades of national health data in Brazil to analyze the effects of demographic factors and predict the impact of various risk factors on multimorbidity. METHODS: Data analysis methods include descriptive analysis, logistic regression, and nomogram prediction. The study makes use of a set of national cross-sectional data with a sample size of 877,032. The study used data from 1998, 2003, and 2008 from the Brazilian National Household Sample Survey, and from 2013 and 2019 from the Brazilian National Health Survey. We developed a logistic regression model to assess the influence of risk factors on multimorbidity and predict the influence of the key risk factors in the future, based on the prevalence of multimorbidity in Brazil. RESULTS: Overall, females were 1.7 times more likely to experience multimorbidity than males (odds ratio [OR] 1.72, 95% CI 1.69-1.74). The prevalence of multimorbidity among unemployed individuals was 1.5 times that of employed individuals (OR 1.51, 95% CI 1.49-1.53). Multimorbidity prevalence increased significantly with age. People over 60 years of age were about 20 times more likely to have multiple chronic diseases than those between 18 and 29 years of age (OR 19.6, 95% CI 19.15-20.07). The prevalence of multimorbidity in illiterate individuals was 1.2 times that in literate ones (OR 1.26, 95% CI 1.24-1.28). The subjective well-being of seniors without multimorbidity was 15 times that among people with multimorbidity (OR 15.29, 95% CI 14.97-15.63). Adults with multimorbidity were more than 1.5 times more likely to be hospitalized than those without (OR 1.53, 95% CI 1.50-1.56) and 1.9 times more likely need medical care (OR 1.94, 95% CI 1.91-1.97). These patterns were similar in all 5 cohort studies and remained stable for over 21 years. A nomogram model was used to predict multimorbidity prevalence under the influence of various risk factors. The prediction results were consistent with the effects of logistic regression; older age and poorer participant well-being had the strongest correlation with multimorbidity. CONCLUSIONS: Our study shows that multimorbidity prevalence varied little in the past 2 decades but varies widely across social groups. Identifying populations with higher rates of multimorbidity prevalence may improve policy making around multimorbidity prevention and management. The Brazilian government can create public health policies targeting these groups, and provide more medical treatment and health services to support and protect the multimorbidity population.

Aurelianolides from Aureliana fasciculata var. fasciculata Trigger Apoptosis With Caspase Activation in Human Leukemia Cells.

BACKGROUND/AIM: Aurelianolide A and B were identified and isolated from Aureliana fasciculata var. fasciculata leaves. Withanolides are naturally occurring C-28 steroidal lactone triterpenoids with cytotoxic and anticancer properties, among other relevant pharmacological activities. Herein we have described, for the first time, the cytotoxic effects of aurelianolides on human cancer cells. MATERIALS AND METHODS: Aurelianolide A and B were tested on human leukemia cell lines: THP-1, MOLT-4, Jurkat, K562 and K562-Lucena 1. RESULTS: For aurelianolide A, MOLT-4 had the lower IC50 (1.17 µM) and for aurelianolide B, Jurkat was the most susceptible cell line (IC50 2.25 µM). On the other hand, the multidrug resistant (MDR) cell line K562-Lucena 1 showed higher IC50 for both aurelianolides. Using 293T, a non-tumor embryonic kidney cell line, we observed an excellent selectivity index for both aurelianolides, from 2.24 (aurelianolide B in K562-Lucena 1) to 45.5 (aurelianolide A in MOLT-4). Aurelianolide A and B activated caspase 3/7 with consequent induction of apoptosis on Jurkat and K562-Lucena 1 cell lines. We have not observed induction of necrosis. CONCLUSION: Aurelianolides A and B have important cytotoxic effects on human leukemia cell lines by the activation of the caspase pathway.

Effects of consumption of mauritia flexuosa fruits on renal and hepatic functions in growing rats

INTRODUCTION: Previous studies have reported that buriti (Mauritia flexuosa L. f.) is a typical fruit from the Brazilian cerrado ecosystem and an important food source for low-income populations. Its composition is rich in carotenoid polyphenols, monounsaturated fatty acids, and ascorbic acid. However, studies on the biological effects resulting from the consumption of this fruit are scarce. OBJECTIVE: To evaluate the effects of a diet supplemented with buriti (Mauritia flexuosa L. f.) on kidney and liver functions in growing rats. METHODS: Determination of centesimal composition, carotenoids, and fatty acids content for buriti pulp, standard chow, and butiti-supplemented chow were performed. Then, Wistar rats of both sexes were fed a standard diet or supplemented with buriti pulp. Blood samples were collected at the end of the experiment to determine biochemical parameters. The unpaired t-test was applied, and differences were considered significant when p<0.05. RESULTS: A diet enriched with buriti pulp did not interfere with kidney function and most markers of liver function in animals. Alkaline phosphatase showed significantly higher plasma concentration in female rats, and albumin and uric acid showed lower concentrations in male rats in both experimental groups. CONCLUSION: The changes observed in biochemical markers did not provide evidence of adverse effects of buriti pulp supplementation on liver function. Thus, the intake of buriti pulp can be encouraged as it is a low-cost food source for the general population.

Genetic polymorphisms related to the vitamin D pathway in patients with cirrhosis with or without hepatocellular carcinoma (HCC).

Objective: To evaluate the association of genetic polymorphisms of vitamin D transporter protein (DBPrs4588 and DBP-rs7041) and cytochrome P450-24A1 (CYP24A1-rs6013897) in patients with cirrhosis with or without hepatocellular carcinoma (HCC), including demographic/clinical/biochemical profiles. Methods: A total of 383 individuals were studied, considering the total group (TotalG) of patients with cirrhosis (TotalG: N = 158) with or without HCC, distributed into Group 1 (G1): cirrhosis and HCC; Group 2 (G2): isolated cirrhosis; and 225 individuals without hepatopathies (G3). Polymorphisms were analysed by real-time polymerase chain reaction. An alpha error of 5% was admitted. Results: CYP24A1-rs6013897 predominated the genotype with at least one polymorphic allele (_/T) in G1 (98.3%) versus G2 (88.8%; p = 0.0309). There was a moderate positive correlation between vitamin D and parathyroid hormone in patients (TotalG: R 2 = 0.3273). Smoking, alcoholism and diabetes mellitus (DM) stood out as independent factors for cirrhosis, as well as for cirrhosis with HCC, except for smoking, adding, in this case, advanced age, male gender, polymorphic allele of CYP24A1-rs6013897, viral hepatitis and high levels of serum gamma-glutamyl transferase (GGT), alpha-fetoprotein (AFP) and creatinine. An increase in survival was observed in the presence of the polymorphic allele of DBP-rs7041 (p = 0.0282). Conclusion: CYP24A1-rs6013897 is associated with cirrhosis and HCC as a predictor, while DBP-rs4588 is associated with reduced vitamin D, and DBP-rs7041 provides increased survival, suggesting a protective characteristic. Advanced age, alcoholism, DM, viral hepatitis and high levels of GGT, AFP and creatinine are also confirmed as predictors of HCC and cirrhosis, while smoking, alcoholism and DM for isolated cirrhosis only.

Aging in a rural area in southern Brazil: designing a prospective cohort study.

INTRODUCTION: This article presents the methods used to design a prospective cohort study with older adults from a rural area in the far south of Brazil (EpiRural Cohort Study), as well as to describe the cohort profile. METHODS: The cohort study began in 2017 and evaluated older adults (≥60 years) living in rural area. The first follow-up of the cohort was carried out between September 2018 and March 2019. Data collection at baseline and first follow-up was performed through an electronic questionnaire containing demographic, socioeconomic and health-related questions, such as alcohol and cigarette consumption, morbidities and self-perceived health status. RESULTS: At baseline, 1130 older adults were sampled, 1029 of whom were interviewed (91.1%). The age of almost 17% was 80 years or more, and 55.2% were male. At first follow-up, 862 individuals were followed (83.8%) and the characteristics of the older adults interviewed compared to those not interviewed at follow-up were similar. Between baseline and follow-up, the proportion of individuals aged 70-79 years increased, as well as the proportion of those who had consumed alcoholic beverages in the previous week and who had hypertension. The male-to-female ratio, those who were living alone, working, smokers, diabetics, who had stroke and who reported their health as being very good/good were comparable between the baseline and follow-up. CONCLUSION: With a reasonable follow-up rate, it was possible to transform a cross-sectional study into a prospective cohort study. However, new strategies will be needed to help locate participants more successfully and ensure a good response rate in future follow-ups.

Vulnerability to COVID-19 in Pernambuco, Brazil: A geospatial evaluation supported by multiple-criteria decision aid methodology.

The paper presents an innovative application to identify areas vulnerable to coronavirus disease 2019 (COVID-19) considering a combination of spatial analysis and a multi-criteria learning approach. We applied this methodology in the state of Pernambuco, Brazil identifying vulnerable areas by considering a set of determinants and risk factors for COVID-19, including demographic, economic and spatial characteristics and the number of human COVID-19 infections. Examining possible patterns over a set number of days taking the number of cases recorded, we arrived at a set of compatible decision rules to explain the relation between risk factors and COVID-19 cases. The results reveal why certain municipalities are critically vulnerable to COVID-19 highlighting locations for which knowledge can be gained about environmental factors.

Home-based training program during the SARS-CoV-2 quarantine: training load, motivation, and wellbeing in professional elite female basketball players.

BACKGROUND: Due to the quarantine caused by the Coronavirus disease 2019 (COVID-19), professional team-sports adapted their training routine to maintain the athletes' performance and minimize the negative emotional effects. The aim of the present study was to describe a home-based training program and extra-activities applied during the quarantine in elite professional female basketball players, and to compare the internal training load (ITL), session rating of perceived exertion (s-RPE), motivation, and wellbeing responses before and during the quarantine. METHODS: Nine female elite players (25.7±7.0 years; 180.0±8.0 cm; 79.0±11.0 kg) belonging to a professional basketball team performed a home-based training program during the quarantine. ITL, s-RPE, training motivation, and wellbeing were examined before (phase 1), at the beginning (phase 2), and during (phase 3) the quarantine. RESULTS: ITL was higher (main effect) in phase 1 (449.5±62.8 a.u.) compared to phase 2 (265.5±39.0 a.u.) and phase 3 (423.1±18.7 a.u.); s-RPE was higher in phase 1 (4.50±0.63 a.u.) compared to phase 2 (3.8±0.6 a.u.), but not to phase 3 (4.37±0.79 a.u.). Motivation was higher in phase 1 (3.6±0.3 a.u.) compared to phase 2 (2.3±0.6 a.u.) and phase 3 (2.4±0.5 a.u.). CONCLUSIONS: The results of the study demonstrated that extra-activities involving online athletes' socialization were implemented to rouse the motivation, but the quarantine period induced a reduction in ITL and influenced the player's training motivation.

Effects of "Bacuri" Seed Butter (Platonia insignis Mart.) on Metabolic Parameters in Hamsters with Diet-Induced Hypercholesterolemia.

This study aimed to evaluate the effects of the treatment with bacuri seed butter (BB) on body weight, growth, body mass index, lipid profile, atherosclerotic indices, and liver function in dyslipidemic hamsters. Freshly weaned, male hamsters were divided into four groups: (1) normal group (NG)-maintained with standard chow (AIN-93G); (2) dyslipidemia group (DG)-maintained with hyperlipidemic chow (AIN-93G modified) throughout the follow-up period; (3) bacuri seed butter 25 mg/kg/day (BB-25); and (4) bacuri seed butter 50 mg/kg/day (BB-50). BB groups (25 and 50 mg/kg/day) were also maintained with hyperlipidemic chow throughout the follow-up period, and the treatment started after 21 days receiving a hyperlipidemic diet to induce hypercholesterolemia and maintained for 28 days. No significant differences in triglycerides and total cholesterol were observed for BB-25 and BB-50 groups when compared with NG and DG groups. On the contrary, BB-25 and BB-50 induced both increase of HDL-c (51.40 ± 1.69 and 51.00 ± 2.34, respectively) and decrease of LDL-c (103.80 ± 6.87 and 100.50 ± 3.95, respectively) when compared with DG (41.00 ± 2.94 and 132.70 ± 9.41, respectively). In addition, BB promoted a reduction in the risk of atherosclerotic disease by decreasing (p < 0.05) the atherogenic index, coronary artery risk index, and LDL/CT ratio (p < 0.05) and increasing HDL/CT ratio. On the contrary, no changes were observed in total cholesterol and triglyceride levels or in body weight, growth, body mass index, or liver function parameters. Thus, bacuri seed butter at doses of 25 and 50 mg/kg/day has positive repercussions on the lipid profile, more precisely on plasma HDL-c and LDL-c, and additionally promotes reduction in the risk of atherosclerosis in hamsters.

Prevalence of Multimorbidity of Chronic Noncommunicable Diseases in Brazil: Population-Based Study.

BACKGROUND: Multimorbidity is the co-occurrence of two or more chronic diseases. OBJECTIVE: This study, based on self-reported medical diagnosis, aims to investigate the dynamic distribution of multimorbidity across sociodemographic levels and its impacts on health-related issues over 15 years in Brazil using national data. METHODS: Data were analyzed using descriptive statistics, hypothesis tests, and logistic regression. The study sample comprised 679,572 adults (18-59 years of age) and 115,699 elderly people (≥60 years of age) from the two latest cross-sectional, multiple-cohort, national-based studies: the National Sample Household Survey (PNAD) of 1998, 2003, and 2008, and the Brazilian National Health Survey (PNS) of 2013. RESULTS: Overall, the risk of multimorbidity in adults was 1.7 times higher in women (odds ratio [OR] 1.73, 95% CI 1.67-1.79) and 1.3 times higher among people without education (OR 1.34, 95% CI 1.28-1.41). Multiple chronic diseases considerably increased with age in Brazil, and people between 50 and 59 years old were about 12 times more likely to have multimorbidity than adults between 18 and 29 years of age (OR 11.89, 95% CI 11.27-12.55). Seniors with multimorbidity had more than twice the likelihood of receiving health assistance in community services or clinics (OR 2.16, 95% CI 2.02-2.31) and of being hospitalized (OR 2.37, 95% CI 2.21-2.56). The subjective well-being of adults with multimorbidity was often worse than people without multiple chronic diseases (OR=12.85, 95% CI: 12.07-13.68). These patterns were similar across all 4 cohorts analyzed and were relatively stable over 15 years. CONCLUSIONS: Our study shows little variation in the prevalence of the multimorbidity of chronic diseases in Brazil over time, but there are differences in the prevalence of multimorbidity across different social groups. It is hoped that the analysis of multimorbidity from the two latest Brazil national surveys will support policy making on epidemic prevention and management.

Biflavones from Platonia insignis Mart. Flowers Promote In Vitro Antileishmanial and Immunomodulatory Effects against Internalized Amastigote Forms of Leishmania amazonensis.

Leishmaniasis is an infectious disease that affects millions of people worldwide, making the search essential for more accessible treatments. The species Platonia insignis Mart. (Clusiaceae) has been extensively studied and has gained prominence for its pharmacological potential. The objective of this work was to evaluate the antileishmania activity, cytotoxic effect and activation patterns of macrophages of hydroalcoholic extract (EHPi), ethyl acetate fractions (FAcOEt) and morelloflavone/volkensiflavone mixture (MB) from P. insignis flowers. EHPi, FAcOEt and MB demonstrated concentration-dependent antileishmania activity, with inhibition of parasite growth in all analyzed concentrations. EHPi exhibited maximum effect at 800 µg/mL, while FAcOEt and MB reduced the growth of the parasite by 94.62% at 800 µg/mL. EHPi, FAcOEt and MB showed low cytotoxic effects for macrophages at 81.78, 159.67 and 134.28 µg/mL, respectively. EHPi (11.25 µg/mL), FAcOEt (11.25 and 22.5 µg/mL) and MB (22.5 µg/mL) characterized the increase in lysosomal activity, suggesting a possible modulating effect. These findings open for the application of flowers from a P. insignis flowers and biflavones mixture thereof in the promising treatment of leishmaniasis.

Biomarkers of the early response to treatment of visceral leishmaniasis: A prospective cohort study.

BACKGROUND: Early biomarkers of the response to treatment are lacking and may help to reduce mortality by the vector-borne disease visceral leishmaniasis (VL). METHODS: A prospective cohort study was conducted to investigate plasma cytokines and clinical laboratory data as biomarkers of the early response to specific treatment for VL in 36 patients. RESULTS: The mean interleukin 6 (IL-6) concentration on the 7th day was 2.3% of the pre-treatment concentration, interleukin 10 (IL-10) was 8.0%, and interleukin 8 (IL-8) was 8.2%. On the 7th day, IL-10 was below half of the pre-treatment concentration in 100.0%, IL-8 in 95.5% and IL-6 in 90.9%. The spleen and liver sizes, haemoglobin, interleukin 1 beta (IL-1ß) and tumour necrosis factor alpha (TNF-α) showed a slower recovery. Fever disappeared in 91% on the 7th day, 69.4% had a normal white cell count, and 77.8% had a normal platelet value by this time. CONCLUSIONS: The plasma cytokines IL-6, IL-10 and IL-8 were demonstrated to be excellent markers of the early response to VL treatment and if tested before the 7th day, will likely prove to be better than fever measurement.

Cytogenetic abnormalities in couples with a history of primary and secondary recurrent miscarriage: a Brazilian Multicentric Study.

Objective: To evaluate the difference between chromosomal abnormalities between the gender of couples affected by Recurrent miscarriage (RM) and if there is an association between previous obstetric history and chromosomal abnormalities of the parents.Methods: Multicenter, retrospective, observational study from seven different RM clinics between 2006 and 2016. We enrolled 707 couples (1014 participants) with a history of RM. We compared the frequency of chromosomal abnormalities between groups of couples with primary and secondary RM and separated between women and their partners. Furthermore, we compared the prevalence of chromosomal abnormalities between groups based on the number of previous spontaneous abortions.Results: The overall prevalence of all cytogenetic abnormalities was 5.59% (n = 1414, women and their partners). Excluding cases of polymorphism and inversion of chromosome 9, which are considered variants of normality, the prevalence in all individuals was 2.26% (n = 32/1414). The comparative analysis of cases of chromosomal abnormalities among couples with primary and secondary RM based on the number of previous miscarriages (PM) revealed a similar frequency between groups. The statistical analysis of the total cases (primary PM + secondary PM) in these three groups were as follows: (a) couple, 2 pm versus 3 pm vs. ≥4 PM, p = .514; (b) women, 2 pm versus 3 pm vs. ≥4 PM, p = .347; and (3) partner, 2 pm versus 3 pm vs. ≥4 PM, p = .959. Chromosomal abnormalities were significantly more prevalent among women than among their partners (6.9 versus 4.2%; p = .027). Moreover, the distribution of leading chromosomal abnormalities among women was different compared with their partners. Among women, we observed these abnormalities in the following frequency order: mosaicism (38.8%), polymorphism (32.6%), translocation (16.3%), and inversion (12.3%). Among their partners, these abnormalities were polymorphism (73.3%), inversion (13.3%), mosaicism (6.7%), and translocation (6.7%).Conclusion: The number of PM and the history of full-term pregnancy does not correlate with an increase or decrease in the prevalence of cytogenetic abnormalities in couples with RM.

Gestational and perinatal outcomes in recurrent miscarriages couples treated with lymphocyte immunotherapy.

OBJECTIVE: This study aims to elucidate which types of recurrent miscarriage (RM) patients experienced a livebirth after paternal lymphocyte immunotherapy (LIT) and to evaluate the perinatal outcome. STUDY DESIGN: Retrospective analysis of a multicenter, observational study which enrolled 1096 couples with a history of two or more spontaneous miscarriages without any intercalated delivery. We conducted an intention-to-treat analysis of couples with RM treated with or without LIT regarding to gestational and perinatal outcomes. We compared groups by using the Student's t-test or Kruskal-Wallis test, Fisher's exact-test and χ 2 test when appropriate. RESULTS: The success of gestation was significantly higher in the LIT group (60.1% vs. 33.1%; p < 0.001). A sub-analysis of four different immune disorder groups revealed a significantly higher success in the LIT group in all immune categories, except in patients who had autoantibodies positive. We observed no significant differences in perinatal outcomes such as gestational age at birth, preterm and extreme preterm birth, and birth weight in successful pregnancy in both groups. The success rate was significantly higher when LIT was administrated before and during pregnancy and only during pregnancy compared to only before pregnancy (p < 0.01). CONCLUSIONS: Careful laboratory test phenotyping of RM patients may identify subgroups most likely to benefit and exclude those with little likelihood of benefit, and LIT during a pregnancy may significantly improve success rates.

Imunophenotypic Evaluation as a Tool for Monitoring Risks for Blood Malignancies in Gas Station Workers.

Background: Gas station workers are exposed to carcinogenic substances with impact on the hematologic and immune systems. The aim was to apply the immunophenotyping as a tool in the biological monitoring. Methods: This is a workplace-based case-control study with 49 workers and 26 controls. Medical interviews, hematological exams, and immunophenotyping analyses were performed. According to risk behavior (cleaning flannel and mistrust in the automatic fuel supply) the workers were divided into two groups: low risk (group 1) and high risk (group 2). Results: The results showed that CD16, HLA-DR, CD25, CD56+, CD16 CD56 low, and CD56 high expressions were higher in workers when compared to the control group (P =0.020, P =0.001, P =0.001; P =0.034, P=0.023, and P =0.008, respectively). The expressions of CD2, CD8, CD10, CD8low, and CD4/CD8 ratios were lower (P =0.016, P =0.001, P=0.001, P= 0.017, P = 0.0259, and P =0.029, respectively). Headache and paresthesia complaints were associated with workers when compared to the control group (OR = 4.091, 95% CI, 1.400 -11.951, P = 0.014; OR =12.12, 95% CI, 1.505 - 97.61, P =0.004). Using cleaning flannel and mistrust in the automatic fuel supply (risk behaviors) were associated with group 2 (OR = 9.71, 95% CI, 2.60-36.26, P = 0.005; OR = 18.18, 95% CI, 2.04-161.37, P = 0.004). Conclusions: The results strengthen the worker's immunosuppression hypothesis, which may contribute to some disorders and the carcinogenesis process. The evaluation of the immune system by flow cytometry is a promising tool for monitoring blood malignancy risk in addition to regular classic hematological exams.

Avaliação da adequação ao sistema de Boas Práticas de Fabricação de alimentos em uma Unidade de Alimentação e Nutrição no município de São Raimundo das Mangabeiras - MA / Evaluation of the adequacy to the system os good manufacturing pratices in a food and nutrition unit in town of São Raimundo das Mangabeiras, Maranhão

As unidades de alimentação e nutrição são responsáveis pelo fornecimento derefeições balanceadas e dentro de condições higiênico-sanitárias satisfatórias. O presenteestudo teve como objetivo avaliar as condições de higiene no preparo e manipulação dealimentos na Unidade de Alimentação e Nutrição do IFMA campus São Raimundo dasMangabeiras, através da aplicação de um check-list, baseado na resolução RDC 275/2002.O estudo exploratório foi realizado por meio de um guia de verificação. A avaliação por itensmostrou que o maior percentual de adequação foi verificado na matéria-prima, ingredientese embalagens e o maior percentual de inadequação foi para o item do controle de qualidadedo produto final. A referida UAN encontra-se deficiente em relação ao nível de adequaçãocom legislação. Assim, constatou-se a necessidade de se implantar as Boas Práticas defabricação (BPF).

Avaliação das condições higiênico-sanitárias na produção da merenda ofertada em creches públicas no município de Bacabal - MA / Evaluation of hygienic-sanitary conditions in the production of lunch offered in publics daycares in the municipality of Bacabal - MA

Segurança alimentar é a garantia do acesso a alimentos considerados seguros para o consumo. Uma vez que ao longo da sua cadeia produtiva, haja falhas nas condições de armazenamento, manuseio, produção ou distribuição, este alimento pode ser considerado não apto para consumo. Este trabalho objetivou avaliar as condições higiênico-sanitárias em que são produzidas a merenda escolar em creches públicas do Município de Bacabal - MA. Os dados foram coletados em três creches do município, por meio de aplicação de lista de verificação das Boas Práticas, elaborada com base na RDC 216/04 e RDC nº 275 de 2004 da ANVISA de acordo com a metodologia proposta por Bastos, 2008. Foi possível verificar o atendimento parcial à legislação vigente.

Avaliação higiênico sanitária de estabelecimentos comercias de açai (Euterpe Oleácea Mart. ) no municipio de Bacabal-MA / Evaluation hygienic-sanitary of commercial establishments that sells açaí (Euterpe Oleácea Mart. ) in municipality of Bacabal-MA

Os problemas relacionados à contaminação do açaí se dão desde a sua colheita e transporte. Devem-se respeitar corretamente todas as etapas de produção. Com isso o presente trabalho tem como objetivo verificar as questões higiênico-sanitárias dos estabelecimentos que comercializam açaí no município de Bacabal – MA. Foram analisados quatro estabelecimentos denominados A, B, C e D. Foi aplicado um check-list, adaptado da RDC nº 275 e da RDC nº 267– ANVISA, para avaliação efetuou-se o percentual de atendimento dos itens conforme a RDC nº 275° – ANVISA. A média geral dos estabelecimentos obtiveram um resultado regular, com a média percentual de 62,8% de atendimento. Os estabelecimentos atendem a legislação segundo o quesito infraestrutura, mas quando se trata da manipulação e processamento do açaí, os mesmos não respondem a legislação vigente.

Percepção de mulheres quanto à prática do aleitamento materno: uma revisão integrativa / Perception of women regarding the practice of breastfeeding: an integrative review / Percepción de la mujer en cuanto a la práctica de la lactancia materna: una revisión integradora

Objetivo: Identificarel conocimiento científico acerca de la percepción de las mujeres con respecto a la lactancia materna. Método: Una revisión integradora para buscar artículos en MEDLINE, Pub / Med, LILACS, BDENF base de datos central de PubMed se realizó: PMCE CINAHL, de 2008 a 2015, se seleccionaron 30 artículos. Resultado: Surgió a partir del análisis las categorías: Beneficios de la lactancia materna; mitos y tabúes que rodean a la lactancia materna; sentimientos contradictorios durante la lactancia, aspectos culturales,la gestión de la lactancia materna y recomendaciones para la práctica. Conclusión:Percepciones de las mujeres sobre la lactancia materna, pueden contribuir a la formulación de recomendaciones con el fin de ayudar a la enfermera en una perspectiva que va más allá de la técnica respetando los significados y prácticas atribuidas a las mujeres que amamantan

Objective: Identify the contribution of the research on the scientific knowledge about the perception of women regarding breastfeeding. Method: An integrative review was carried and the search for articles occurred in MEDLINE, Pub/Med, LILACS, BDENF, PubMed Central: PMCe CINAHL, from 2008 to 2015, containing 30 articles. Results: Emerging from the analysis were the following categories: benefits of breastfeeding, myths and taboos surrounding breastfeeding; contradictory feelings when breastfeeding; cultural aspects and management of breastfeeding. Conclusion: The results indicate aspects about women's perceptions regarding breastfeeding, which may contribute to the development of recommendation sin order to assist the breast feeder in a perspective that goes beyond the technical, respecting the perceptions, meanings and practices attributed to breastfeeding by women

Objetivo: Identificar o conhecimento científico produzido acerca da percepção das mulheres quanto à prática do aleitamento materno.Método:Revisão integrativa com busca dos artigos nas bases de dados MEDLINE, Pub/Med, LILACS, BDENF, PubMed Central: PMC e CINAHL, de 2008 a 2015, sendo selecionados 30 artigos. Resultados: Da análise, emergiram as categorias: vantagens do aleitamento materno; mitos e tabus em torno da amamentação; sentimentos contraditórios ao amamentar; aspectos culturais; manejo da amamentação; e recomendações para a prática. Conclusão: As percepções das mulheres em relação à amamentação podem contribuir para a elaboração de recomendações com vistas a assistir a nutriz numa perspectiva que vai além da técnica, respeitando os significados e práticas atribuídas à amamentação pelas mulheres

Tratamento odontológico em gestantes: revisão integrativa / Dental treatment in pregnant women: integrative review

Objetivo: identificar os conhecimentos científicos desenvolvidos acerca do atendimento clínico odontológico em gestantes. Material e Métodos: revisão integrativa com busca de artigos, teses e dissertações nas bases de dados Scielo, LILACS e Pubmed, de 2012 a 2017, sendo selecionados 6 estudos. Resultados: Cinco estudos enfatizaram como deve ser realizado esse atendimento, os procedimentos e materiais considerados seguros. Um estudo trouxe reflexões sobre a insegurança enfrentada pelos dentistas e possíveis soluções para isso. Conclusão: a gestação é um período de inúmeras alterações no corpo da mulher e o cirurgião-dentista precisa estar atualizado e deve buscar sempre na literatura evidências para realizar o atendimento clínico de forma segura, uma vez que poderá contribuir para uma melhor qualidade de vida dessas pacientes

Objective: identify the scientific knowledge developed about dental care in pregnant women. Material and Methods: an integrative review with search of articles, thesis and dissertations in the databases SciELO, LILACS and Pubmed, from 2012 to 2017, being selected 6 studies. Results: five studies emphasized how this care should be performed, procedures and materials considered safe. One study brought insights into an insecurity faced by dentists and solutions to it. Conclusion: gestation is a period of innumerable changes in the woman's body, so the dentist needs to be up to date and must seek evidence in the literature to perform clinical care safely, since it may contribute to improve the quality of life of these patients