Understanding the Professional Care Experience of Patients with Stroke: A Qualitative Study Using In-Depth Interviews.

Background: Professional support and communication stimulates the professional-patient relationship and supports the recovery of stroke patients. Objectives: To describe the perspectives of patients with stroke regarding communication, professional support, and their ability to participate in processes and integrated care with health providers. Methods: A qualitative study was conducted. A purposeful sampling and snowball-technique were used. Patients diagnosed with moderate or severe stroke in the post-acute or chronic stage of the disease were included. Data collection consisted of in-depth interviews and researcher field notes. A thematic analysis was performed. Results: Thirty-one patients were included. Three themes were identified: 1) Providing support, with four categories, professional behavior, personalized attention, the heart of the professional and building a bond with the patient; 2) Facilitating communication, with three categories, the patient as the recipient, the content of the message and the channel, and the professional as the person that conveys the message; and 3) Promoting participation, with two categories, barriers, and incentives to participate. Conclusions: When providing support, professionals should consider communicating information and encouraging the participation of stroke patients for integrated care.

Estudio comparativo de la actividad anti-fúngica de extractos secuenciales de Fuchsia lycioides contra Candida sp / comparative study of the antifungal activity of sequencial extracts of Fuchsia lycioides against Candida sp

The genus Fuchsia is generally used in herbal preparations to treat conditions caused by microorganisms. Based on the popular use of this type of plants, the objective of this study was to obtain sequential extracts of increasing polarity from the branches of Fuchsia lycioides by maceration at room temperature and by the Soxhlet method at 60ºC, to later evaluate the antifungal capacity of the extracts against different clinical isolates of the Candida genus. The ethyl acetate extract exhibited strong anti-fungal activity, selectively inhibiting C. albicans strains with MIC and CMF values of 10 and 15 µg/mL, respectively; comparable with the drug itraconazole®. The analysis of the extract by GC-MS showed a high concentration of terpenoids (mainly phytol) and phenylpropanoids (mainly cinnamic acid), possibly responsible for the antifungal activity of the ethyl acetate extract of F. lycioides.

El género Fuchsia se usa generalmente en preparaciones de hierbas para tratar afecciones provocadas por microorganismos. En base al uso popular de este tipo de plantas, el objetivo de este estudio fue obtener los extractos secuenciales de polaridad creciente de las ramas de Fuchsia lycioides por maceración a temperatura ambiente y por el método Soxhlet a 60ºC, para luego evaluar la capacidad antifúngica de los extractos frente a diferentes aislados clínicos del genero Candida. El extracto de acetato de etilo exhibió una fuerte actividad antifúngica inhibiendo en forma selectiva las cepas de C. albicans con valores de CMI y de CMF de 10 y 15 µg/mL, respectivamente; comparables con el fármaco itraconazol®. El análisis del extracto por CG-EM mostró una alta concentración de terpenoides (principalmente fitol) y fenilpropanoides (principalmente ácido cinámico), posibles responsables de la actividad antifúngica del extracto de acetato de etilo de F. lycioides.

Randomized controlled trial comparing mini-sling with transobturator sling for the treatment of stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is the involuntary loss of urine on effort and is a condition that negatively interferes with various aspects of a woman's life. This study aimed to demonstrate the non-inferiority of the less invasive single-incision mini-sling (SIMS) method in objective and subjective cures in relation to tension-free transobturator tape (TOT) in two analyses, per protocol and intention to treat, and secondarily to evaluate complications and quality of life. METHODS: This study was a randomized controlled trial (RCT). Participants in this study included 105 women with a clinical diagnosis of stress predominant urinary incontinence and urodynamic results demonstrating SUI and absence of detrusor overactivity. Patients were evaluated pre- and postoperatively through anamnesis, physical examination, urinalysis, urine culture and susceptibility testing, simplified pad test, the Urinary Incontinence-Specific Quality of Life Instrument (I-QOL) and Urogenital Distress Inventory Short Form (UDI-6). RESULTS: Regarding the objective cure, SIMS was non-inferior to TOT (p < 0.05). However, the same was not found for the subjective cure (p > 0.05). There were no differences in the complication rates (p > 0.05). However, in the TOT group, bladder perforation (2.4%), tape exposure (2.4%) and urinary retention occurred, lasting > 7 days (2.4%). In both groups, there was improvement in quality of life after surgery, without significant differences (p > 0.05). CONCLUSIONS: The non-inferiority of SIMS in relation to TOT was only demonstrated in the objective cure. There were no significant differences between groups regarding complications and quality of life.

O paradoxo da institucionalização infantil: proteção ou risco? / The paradox of child institutionalization: protection or risk? / La paradoja de la institucionalización de niños: ¿protección o riesgo?

Desde meados do século XX, ganhou destaque o debate acerca dos efeitos da institucionalização de crianças. O abrigo adquire relação paradoxal entre proteção e risco, podendo ser facilitador ou dificultador para o desenvolvimento de crianças acolhidas. Assim, os objetivos do trabalho foram (1) analisar a produção científica sobre a institucionalização infantil, discutindo os benefícios e efeitos da institucionalização sobre o desenvolvimento de crianças e adolescentes; e (2) compreender como os artigos analisados identificam possíveis fatores de risco e de proteção. Como método, realizou-se uma revisão bibliográfica utilizando os descritores "abrigo"; "institucionalização infantil"; "fatores de risco e fatores de proteção"; "abrigamento prolongado"; "vínculo"; "apego"; "abrigo". Como resultado, 11 trabalhos foram selecionados. As produções analisadas apontaram que, embora o abrigo seja um local para acolhimento, assistência e proteção, deve-se estar atento aos fatores de risco e aos impactos negativos da institucionalização. Conclui-se que a institucionalização se faz necessária em alguns casos, devendo ocorrer com qualidade e responsabilidade junto às famílias e com o respaldo de políticas públicas.

Since the mid-twentieth century, the debate about the effects of children institutionalization has been on the spot. The institutional shelter has been getting into a paradoxical relationship between protection and risk and may be understood as either a facilitator or an impediment to children’s development. Thus, the objectives of this study are to (1) review scientific literature on child institutionalization, debating the benefits and effects of institutionalization on children’s and adolescents’ development; (2) understand how the articles analyzed identify possible risk and protection factors. Concerning methodology, we carried out a literature review using the descriptors "shelter"; "child institutionalization"; "risk factors and protective factors"; "prolonged shelter"; "bond"; "attachment"; "shelter". As a result, eleven articles were selected. Result analysis pointed out that although the shelter is a place for refuge, care and protection, one should be aware of the risk factors and the negative impact of institutionalization. It concludes that institutionalization is necessary in some cases, and it should occur with quality and responsibility together with the families and with the support of public policies.

Desde mediados del siglo XX, se hizo destacado el debate sobre los efectos de la institucionalización de los niños. El refugio adquiere una relación paradójica entre la protección y el riesgo, y puede ser un facilitador o un obstáculo para el desarrollo de los niños. Los objetivos del estudio fueron (1) revisar la literatura científica sobre la institucionalización de niños, la discusión de los beneficios y los efectos de la institucionalización en el desarrollo de los niños y adolescentes y (2) entender cómo los artículos analizados identifican posibles factores de riesgo y protección. Como método, se realizó una revisión de la literatura utilizando los descriptores "refugio"; "institucionalización de niños"; "factores de riesgo y factores de protección"; "refugio prolongado"; "vínculo"; "el apego", "la vivienda". Como resultado, fueron seleccionados once artículos. Las producciones analizadas señalaron que si bien el abrigo es un lugar de refugio, cuidado y protección, debe ser consciente de los factores de riesgo y el impacto negativo de la institucionalización. Se concluye que la institucionalización es necesaria en algunos casos, debe ocurrir con la calidad y la responsabilidad de las familias y con el apoyo de políticas públicas.

Schooling of Students with Intellectual Disabilities: Family and School Perspectives / Escolarização de Alunos com Deficiência Intelectual: Perspectivas da Família e Escola / La Escolarización de Alumnos con Discapacidad Intelectual: Perspectivas de la Familia y de la Escuela

Abstract Educational policies aimed at school inclusion have led to an increased enrollment of students with special education needs (SEN) in mainstream schools and, as a result, there is an increase in transfers from specialized institutions to mainstream schools. This study analyzed the perspectives of school professionals and family members on school transfers of students with intellectual disabilities (ID). Six family members and ten school professionals participated in the study. All attended semi-structured interviews, whose analysis allowed us to identify five thematic axes: teacher training; lack of preparation and information; lack of supports; lack of preparation for transfer; expectations regarding the ID student, mainly concerning behavioral characteristics, learning and performance. Results confirm data from research on the implementation of special education in inclusive environments, indicating that teachers', managers' and families' conceptions of inclusion depend on the severity of the student's disability, and on the skills and attitudes of the professionals.

Resumo Políticas educacionais voltadas à inclusão escolar têm levado ao aumento de matrículas de alunos público alvo da educação especial (PAEE) na escola comum e como resultado observa-se aumento de transferências das instituições especializadas para escolas comuns. O estudo analisou as perspectivas de profissionais da escola e familiares sobre as transferências escolares de alunos com deficiência intelectual (DI). Participaram seis familiares e dez profissionais da escola. Todos responderam a uma entrevista semiestruturada, cuja análise permitiu identificar cinco eixos temáticos: formação do professor, despreparo e falta de informação; falta de suportes; ausência de preparo para a transferência; expectativas quanto ao aluno com DI em relação às características comportamentais, aprendizagem e desempenho. Os resultados ratificam dados presentes em pesquisas sobre a implementação da educação especial em ambientes inclusivos, sinalizando que concepções dos professores, gestores e familiares frente à inclusão dependem da severidade da deficiência do aluno, das habilidades e atitudes dos profissionais.

Resumen Las políticas educativas hacia la inclusión escolar están aumentando las matrículas de alumnos, público objetivo de la educación especial, en la escuela común, y como consecuencia se observa un incremento de transferencias de las instituciones especializadas para las escuelas comunes. El estudio analizó las perspectivas de profesionales de la escuela y de familiares sobre las transferencias escolares de alumnos con discapacidad intelectual (DI). En él participaron seis familiares y diez profesionales de la escuela. Todos los participantes respondieron a una entrevista semiestructurada, cuyo análisis permitió identificar cinco ejes temáticos: la formación del profesor, falta de preparación y de información; la ausencia de soportes; la ausencia de preparación para la transferencia; las expectativas en cuanto al alumno con DI en relación a las características conductuales, de aprendizaje y de desempeño. Los resultados confirman datos presentes en investigaciones sobre la implementación de la educación especial en ámbitos inclusivos, señalando que las concepciones de los profesores, gestores y familiares frente a la inclusión dependen de la severidad de la discapacidad del alumno, de las habilidades y actitudes de los profesionales.

Prospective and randomized clinical trial comparing transobturator versus retropubic sling in terms of efficacy and safety.

INTRODUCTION AND HYPOTHESIS: The midurethral sling is the most commonly performed surgical procedure for stress urinary incontinence (SUI). We compared the efficacy of transobturator tape (TOT) and retropubic (RP) slings by evaluating objective and subjective cure rates at 12 months postsurgery and evaluate the impact on quality of life (QoL) and record intra- and postoperative complications. METHODS: This was a randomized, controlled, prospective, clinical trial with analysis of noninferiority. The hypothesis was that the TOT sling is not inferior to the RP sling. A total of 92 women with SUI were selected and randomized into two groups: TOT and RP slings. RESULTS: Eighty-one patients maintained follow-up 12 months postoperatively. In the per-protocol analysis, the objective cure rates were 100% for the RP sling and 93% for the TOT sling (p = 0.029). The subjective cure rates were 92% for the RP sling and 90% for the TOT sling (p = 0.02). Because none of the upper limits of the confidence interval (CI) were above the noninferiority margin, noninferiority of the TOT sling could be concluded. In contrast, the intention-to-treat analysis could not show that the TOT sling was not inferior to the RP sling, because the upper limit of the CI surpassed the noninferiority margin. Postoperative complications were similar for both groups, except for higher urinary retention rates in the RP group. Regarding QoL, there was a significant improvement. CONCLUSIONS: The cure rates of the per-protocol analysis showed the noninferiority of the TOT relative to the RP sling. The RP sling group exhibited higher urinary retention. Quality of life improved significantly in both groups.

Analysis of PEDI Normative Data Between Spain and the United States.

PURPOSE: To analyze the applicability of the Pediatric Evaluation of Disability Inventory (PEDI) to the Spanish population, and to assess the influence of demographic variables on the functional performance of the child. METHOD: The Spanish version of the PEDI was administered via interview representing a sample of 199 children without disability. The applicability of the PEDI was analyzed with the Welch t test and differences between the variables were analyzed using single-factor analysis of variance. RESULTS: Significant differences in overall and domain-specific performance were found between Spanish and American samples. The Spanish sample's average score was lower than the American sample. Differences in performance within the Spanish sample were found by age, sex, and rural/urban living environment. CONCLUSIONS: The normative values of the PEDI should be applied with caution in the Spanish population until further data are available; however, the PEDI remains a useful instrument for monitoring functional change.

Educação especial e a relação família - escola: análise da produção científica de teses e dissertações / Special education and the family relationship - school: analysis of scientific production of theses and dissertations / Educación especial y la relación familia - escuela: análisis de la producción científica de tesis y disertaciones

O relacionamento família-escola vem sendo apontado pela literatura nas áreas da educação especial e psicologia como um dos principais fatores facilitadores no processo de inclusão escolar. Tendo em vista esses fatores, esta pesquisa teve o objetivo de identificar e analisar a produção científica de teses e dissertações produzidas no período de 2001-2011 sobre a relação entre família-escola de crianças público alvo da educação especial. Para tanto, foi realizada uma busca sistemática no Banco de Teses da CAPES e utilizada uma ficha adaptada para a análise da temática, da metodologia e dos resultados de cada produção. Foram analisadas ao todo 20 produções. Os resultados encontrados apontam que grande parte das pesquisas está em programas de pós-graduação do sudeste, apresenta metodologia descritiva, adota uma concepção social da deficiência e que o tema principal foi o de "atitude/percepção" de familiares e membros da escola sobre o processo de inclusão. Foi possível observar a carência em estudos de intervenção na área.

The family-school relationship has been pointed out by the literature in the areas of special education and psychology as a major facilitating factors in the school inclusion process. Considering these factors, this research aimed to identify and analyze the scientific production of theses and dissertations produced in the 2001-2011 period on the relationship between children of family-school target audience of special education. This requires a systematic search at the Bank of CAPES Theses and used a plug adapted for the analysis of the subject, the methodology and the results of each production was performed. They analyzed a total of 20 productions. The results show that much of the research is in southeastern graduate programs, presents descriptive methodology, adopts a social conception of disability and the main theme was the "attitude / perception" of family and school members on the inclusion process. It observed the lack of intervention studies in the area.

El relacionamiento familia-escuela viene siendo apuntado por la literatura en las áreas de la educación especial y psicología como uno de los principales factores facilitadores en el proceso de inclusión escolar. Teniendo en vista esos factores, esta investigación tuvo el objetivo de identificar y analizar la producción científica de tesis y disertaciones producidas en el período de 2001-2011 sobre la relación entre familia-escuela de niños público diana de la educación especial. Para tal, se realizó una búsqueda sistemática en el Banco de Tesis de la CAPES y utilizada una ficha adaptada para el análisis de la temática, de la metodología y de los resultados de cada producción. Se analizaron al total 20 producciones. Los resultados encontrados apuntan que gran parte de las investigaciones está en programas de post-graduación del sudeste, presenta metodología descriptiva, adopta una concepción social de la deficiencia y que el tema principal fue el de "actitud/percepción" de familiares y miembros de la escuela sobre el proceso de inclusión. Fue posible observar la carencia en estudios de intervención en el área.

[Poliomyelitis in literature, cinema and television]. / La poliomielitis en la literatura, el cine y la television.

INTRODUCTION: Poliomyelitis is an infectious disease whose initial symptoms are fever, fatigue, headaches, vomiting, a stiff neck and pains in the limbs. In many cases, the sequelae are irreversible paralysis and may result in death if there is bulbar or respiratory compromise. A set of symptoms, called post-polio syndrome, which appears years after the acute infection, are also described. AIM: To analyse the way poliomyelitis has been dealt with in literature, cinema and television. DEVELOPMENT: Film and television writers and directors have shown an interest in poliomyelitis and have portrayed it in a correct and realistic manner, both in fiction and in biographies or documentary-type works. Nemesis, Silver wattle, Leave her to heaven or The fall are some examples of literary works on the subject. Cinema has also portrayed polio all the way back to silent movies, with titles such as The woman in his house, The Silver Streak, Sister Kenny or The sessions. This disease and its sequelae have also been portrayed on television in series such as Hospital Central, Grey's anatomy, House M.D. or Amar en tiempos revueltos, and in TV films like El asunto, Eleanor and Franklin or Warm Springs. CONCLUSIONS: Poliomyelitis has been portrayed in literature, cinema and television in a realistic manner, showing its symptoms, sequelae, and the personal, familial and social impact of this disease.

TITLE: La poliomielitis en la literatura, el cine y la television.Introduccion. La poliomielitis es una enfermedad infecciosa cuyos sintomas iniciales son fiebre, cansancio, cefalea, vomitos, rigidez de cuello y dolores en los miembros. En muchos casos, las secuelas son paralisis irreversibles, y puede producirse la muerte si hay afectacion bulbar o respiratoria. Se describe tambien un conjunto de sintomas, llamado sindrome pospolio, que aparece años despues de la infeccion aguda. Objetivo. Analizar el abordaje que la literatura, el cine y la television han hecho de la poliomielitis. Desarrollo. Los escritores y los directores de cine y television han mostrado interes por la poliomielitis y la han reflejado de manera correcta y realista, tanto en las obras de ficcion como en las biograficas o de tipo documental. Nemesis, Secreto de hermanas, Que el cielo la juzgue u Oscura son algunos ejemplos de obras literarias. El cine ha mostrado la poliomielitis desde su epoca silente con titulos como The woman in his house, The Silver Streak, Amor sublime o Las sesiones. Tambien la television ha reflejado esta enfermedad y sus secuelas en series como Hospital Central, Anatomia de Grey, House o Amar en tiempos revueltos, y en telefilmes como El asunto, Eleanor y Roosevelt o Warm Springs. Conclusiones. La poliomielitis se ha mostrado en la literatura, el cine y la television de forma realista, presentando la sintomatologia, las secuelas, y el impacto personal, familiar y social de esta enfermedad.

[Study of the pre- and post-treatment functionality of unilateral acquired brain injuries]. / Estudio de la funcionalidad pre y postratamiento de las lesiones cerebrales adquiridas unilaterales.

INTRODUCTION: Most of the people who have survived a lateralized brain injury have sequelae components affecting sensorimotor, cognitive or behavioral. These deficits affect the proper execution of daily living activities. The aim of this study is to analyze and compare the occupational profile of people with unilateral acquired brain injury, both people with traumatic brain injury (TBI) and cerebrovascular accidents (CVA), with functional independence, ability, participation and the quality of performance of everyday activities, before and after a multidisciplinary treatment. PATIENTS AND METHODS: Cohort quasi-experimental design with pre-cutting measures after treatment with a sample of 58 people, 28 TBI and 30 CVA, both lateralized. The measures used were the FIM+FAM, ICF, and AMPS. RESULTS: Considering the groups analyzed (lateralized full sample, sample diagnosis) analysis results indicate the existence of significant differences and a moderate effect size in the two cross-sectional estimates, providing greater levels of independence to injuries occurring in the right hemisphere (p < 0.001). However, when it is divided the sample by diagnosis appears no significant differences, except in motor skills, where higher scores for TBI are showed (p < 0,05). CONCLUSIONS: We suggest that this justifies the differences is not the mode of injury (TBI or CVA), but the hemispheric location. Therefore, it is suggested that people with acquired brain injury in the left hemisphere require more intensive intervention.

TITLE: Estudio de la funcionalidad pre y postratamiento de las lesiones cerebrales adquiridas unilaterales.Introduccion. La mayoria de las personas que han sobrevivido a un daño cerebral lateralizado presenta secuelas que afectan a componentes sensoriomotores, cognitivos o conductuales. Estos deficits repercuten en la correcta ejecucion de actividades de la vida diaria, antes y despues de un tratamiento multidisciplinar. El objetivo de este estudio es analizar y comparar el perfil ocupacional de las personas con daño cerebral adquirido unilateral, tanto en personas con traumatismo craneoencefalico (TCE) como accidentes cerebrovasculares (ACV), mediante la independencia funcional, la capacidad, la participacion y la calidad del desempeño de las actividades cotidianas. Pacientes y metodos. Diseño cuasi experimental de cohortes con medidas transversales pre y postratamiento con una muestra de 58 personas, 28 con TCE y 30 con ACV, en ambos casos lateralizados. Las medidas utilizadas fueron la Functional Independence Measure + Functional Assessment Measure, la clasificacion internacional del funcionamiento, la discapacidad y la salud, y el Assessment of Motor and Process Skills. Resultados. Teniendo en cuenta los grupos analizados (muestra completa lateralizada, muestra por diagnostico), los resultados del analisis apuntan hacia la existencia de diferencias significativas y un moderado tamaño del efecto en las dos estimaciones transversales, otorgando mayores niveles de independencia a las lesiones sobrevenidas en el hemisferio derecho (p < 0,001). Sin embargo, al dividir la muestra segun el diagnostico, no aparecen diferencias significativas, salvo en las habilidades motoras, donde se muestran mayores puntuaciones en los TCE (p < 0,05). Conclusiones. Se piensa que lo que justifica las diferencias no es la modalidad de la lesion (TCE o ACV), sino la localizacion hemisferica. Por ello, se sugiere que las personas con daño cerebral adquirido en el hemisferio izquierdo requeriran una intervencion mas intensa.

[Treadmill training with or without partial body weight support in children with cerebral palsy: systematic review and meta-analysis]. / Pasarela rodante con o sin sistema de suspension del peso corporal en ninos con paralisis cerebral infantil: revision sistematica y metaanalisis.

INTRODUCTION: The limitations of gait in children with cerebral palsy are common. In fact, the training of locomotion is an essential therapeutic goal. There are various treatment approaches, but in recent years, the treadmill training, framed within the motor learning task-oriented, has increased its presence at the clinical level. AIM: To determine whether treadmill training with or without partial body weight support, improves the ability to walk, the motor function of the lower limb, the disability and the quality of life in children with cerebral palsy. MATERIALS AND METHODS: We selected only those articles with the highest level of evidence for each type of intervention. We searched in the National Guideline Clearinghouse, Trip Database, SUMsearch, Medline, CINHAL, Embase, Amed, Cochrane Library Plus and PEDro. Data were extracted from these six studies, which recruited 127 participants. Only a meta-analysis was given. We used a fixed effects model, data were not significant between increased of speed and treadmill training. RESULTS: According to the individual studies, the intervention improved lower extremity function and spatiotemporal parameters during gait. However, the differences between groups in favor of the experimental condition, were mostly not significant. CONCLUSIONS: The systematic review shows some limitations. Firstly, it includes a small number of studies, which is also a small sample of participants. In addition, among the studies, there is a great clinical diversity and many articles did not described relevant data exactly for critical reading.

[Treatment on fatigue of patients with postpolio syndrome. A systematic review]. / Tratamiento de la fatiga en el síndrome pospoliomielitis. Revisión sistemática.

INTRODUCTION: Fatigue is the most common symptom and the most disabling in patients with post-polio syndrome. AIM: To analyze the effectiveness of various treatments used to improve fatigue syndrome patients post-polio. MATERIALS AND METHODS: Systematic review. Is defined a bibliographic search strategy in Medline (from 1961), EMBASE (from 1980), ISI Web of Knowledge and Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), AMED (January 1985), EMI and Physiotherapy Evidence Database (PEDro) until February 2008, the population defined (post-polio syndrome patients) and intervention (any treatment for fatigue in these patients). Outcome were selected as different scales of fatigue and fatigue or vitality dimension scales quality of life. Clinical trials were selected. RESULTS: We retrieved 396 articles, of which 23 were analyzed in detail. Finally, 19 were included in the analysis, a total of 705 patients. CONCLUSIONS: Lamotrigine, bromocriptine, aerobics and flexibility exercises, hydrokinesitherapy and technical aids are treatment techniques that reduce more fatigue in these patients.

[Effectiveness of physical exercise programs in patients with diabetes mellitus]. / Efectividad de los programas de ejercicio físico en los pacientes con diabetes mellitus.

Clinical studies with methodological rigor have shown that the strategies for lifestyle modification and drug therapies can prevent or at least delay the development of type 2 diabetes mellitus (DM) in individuals at high risk. Combination of regular physical exercise and diet is more effective than each one separately to achieve modest weight loss and improve metabolic control in patients with DM. Our objective is to describe the role of exercise in patients with DM and the exercise programs in relation to the previous considerations, taking into account the intensity of the exercise, components of the program, duration, frequency and precautions.

Avaliação da assistência ao parto em gestantes infectadas pelo HIV / Evaluation of delivery assistance in HIV infected pregnant women

Introdução: A transmissão vertical é a principal via de infecção pelo HIV em crianças. A maior parte dos casos de transmissão vertical do HIV (cerca de 65%) ocorre durante o trabalho de parto e no parto, e os 35% restantes ocorrem intra-útero e através do aleitamento materno. Atualmente, a taxa de transmissão vertical do HIV, sem qualquer intervenção, é de aproximadamente 20%, porém, diversos estudos publicados na literatura demonstram uma redução para níveis entre zero e 2% com o uso de antiretrovirais durante a gestação e o parto, cesárea eletiva em casos selecionados, uso de AZT xarope para o recém-nascido e contra-indicação do aleitamento materno. Objetivo: Avaliar a assistência ao parto das gestantes do Hospital Municipal Universitário de São Bernardo do Campo (HMUSBC) infectadas pelo HIV. Método: Estudo retrospectivo de 54 gestantes HIV-positivo, admitidas no HMUSBC para assistência ao parto, no período de Janeiro de 1999 a Junho de 2005. Resultados: Dentre as parturientes, 59% tinham idade entre 25 e 34 anos; 72% apresentavam idade gestacional maior ou igual a 38 semanas; 94% fizeram acompanhamento pré-natal; 52% utilizaram Zidovudina (AZT) associado a outros antiretrovirais durante a gestação. Quanto ao parto, 41% foram cesáreas eletivas e 78% receberam AZT intraparto. Para os recém-nascidos, 91% pesavam mais que 2.500 g. De todas as parturientes que fizeram pré-natal (n = 51) 80% recebeu AZT intraparto (p = 0,05) e 95% das parturientes que foram submetidas à cesariana receberam AZT intraparto (p = 0,001). Conclusão: A cesárea eletiva contribui significativamente para a administração de AZT intraparto; a realização do pré-natal favoreceu ao uso de AZT intraparto; de modo geral, o HMUSBC segue as orientações do Ministério da Saúde.