Three-year survival and recurrence after first-ever stroke: the Joinville stroke registry.

BACKGROUND: Data estimating the recurrence and risk of death are lacking in low and middle income countries, where two thirds of the stroke burden occurs. Previously we had shown that the incidence and mortality have been decreasing over the last 18 years in Joinville, Southern Brazil. In this study, we aim to determine the recurrence rates, survival rates and the cause of death in 3 years after their first-ever incident in a urban population-based setting. METHODS: From the Joinville Stroke Registry, we identified all the cases of first-ever stroke that occurred from October 2009 to September 2010. Multiple overlapping sources of information were used to ensure the completeness of case identification. Patients were followed up prospectively at regular intervals from 30-days to 3 years after the index event. Kaplan-Meir and Cox proportional hazards were used to assess the cumulative risk of death and recurrence. RESULTS: We registered 407 first-ever stroke patients. After 3 years, 136 (33%) had died. In the first year of stroke the risk of death was 28% (95% CI, 25 to 32). Beyond the first year, approximately 3 to 5% of survivors died each year. The cumulative risk of death in ischemic stroke (IS) subtypes was 3.6 higher for cardioembolic (CE) IS (hazard ratio 3.6, 95% CI, 2.1 to 6.4; p = 0.001) and 3.3 times higher for undetermined IS (HR 3.3, 95% CI 1.9 to 5.8; p = 0.001) compared to small artery occlusion IS. Over 3 years, the overall stroke recurrence risk was 9% (35/407). We found no difference in stroke recurrence risk between IS subtypes. Cardiovascular disease was the main cause of death all follow up time. CONCLUSIONS: Compared to other cohort studies conducted between 10 and 20 years ago in high-income countries, our recurrence rates and 3-year risk of death were similar. Among IS subtypes, we confirmed that CE has highest risk of death. The most common cause of death after a first-ever stroke is cardiovascular disease. This has implications for the uptake of current secondary preventive strategies and the development of new strategies.

Antimicrobial activity of Brazilian propolis extracts against rumen bacteria in vitro.

The antimicrobial activity of three Brazilian propolis extracts was evaluated on bacterial strains representing major rumen functional groups. The extracts were prepared using different concentrations of propolis and alcohol, resulting in different phenolic compositions. The propolis extracts inhibited the growth of Fibrobacter succinogenes S85, Ruminococcus flavefaciens FD-1, Ruminococcus albus 7, Butyrivibrio fibrisolvens D1, Prevotella albensis M384, Peptostreptococcus sp. D1, Clostridium aminophilum F and Streptococcus bovis Pearl11, while R. albus 20, Prevotella bryantii B14 and Ruminobacter amylophilus H18 were resistant to all the extracts. The inhibited strains showed also different sensitivity to propolis; the hyper-ammonia-producing bacteria (C. aminophilum F and Peptostreptococcus sp. D1) being the most sensitive. Inhibition of hyper-ammonia-producing bacteria by propolis would be beneficial to the animal. The extract containing the lowest amount of phenolic compounds (LLOS C3) showed the lowest antimicrobial activity against all the bacteria. The major phenolic compounds identified in the propolis extracts (naringenin, chrysin, caffeic acid, p-coumaric acid and Artepillin C) were also evaluated on four sensitive strains. Only naringenin showed inhibitory effect against all strains, suggesting that naringenin is one of the components participating to the antibacterial activity of propolis.

The Brazilian Family Health Program and secondary stroke and myocardial infarction prevention: a 6-year cohort study.

OBJECTIVES: We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil's government-run Family Health Program (FHP) with those using non-FHP models of care. METHODS: From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units. RESULTS: In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85; 95% confidence interval [CI] = 0.61, 1.18; P = .39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68; 95% CI = 0.50, 0.92; P = .01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P = .005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%. CONCLUSIONS: FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction.

Study of the effectiveness of propolis extract as a storage medium for avulsed teeth.

The purpose of the present study was to evaluate the efficacy of propolis extract in maintaining the viability of human periodontal ligament (PDL) cells, and to radiographically analyze tooth replantation and the adjacent periodontium in dogs after storage in this extract. Human PDL cells were incubated with the experimental media propolis, milk, saliva, Hank's balanced salt solution (HBSS), and Dulbecco's modified Eagles medium (DMEM, positive controls), and distilled water (negative control). Cell viability was determined 0, 1, 3, 6, 12, and 24 h later by colorimetric MTT assay. Thirty incisors from dogs were divided into two storage time blocks (1 and 3 h) and were maintained in the experimental media. HBSS served as a positive control, and dry teeth (on gauze) as a negative control. The replanted teeth were radiographed once per month for 6 months. The radiographic images were standardized by the shortening/lengthening factor, and were both qualitatively and quantitatively analyzed. The in vitro results showed that the efficacy of propolis in maintaining functional viability of PDL cells was similar to that of milk. Propolis and milk were significantly better than controls from the 6-h time period. The in vivo results showed that teeth maintained in propolis medium exhibited replacement resorption with significant reduction in tooth length, similar to teeth maintained in saliva and dried teeth. This resorption was less intense with the 3-h storage time than the 1-h storage time. Conditions close to normal were found in teeth maintained in milk, similar to the HBSS control. Therefore, although propolis was effective in maintaining the viability of human PDL cells, resorption of the tooth replantation in dogs occurred under these experimental conditions.

Differences in the diagnosis of primary cutaneous melanoma in the public and private healthcare systems in Joinville, Santa Catarina State, Brazil.

BACKGROUND: Cutaneous melanoma accounts for up to 80% of deaths caused by skin cancer. Diagnostic suspicion and access to medical care and early intervention in suspected cases is vital to the patient's prognosis. OBJECTIVES: To compare demographic and histopathological characteristics of primary cutaneous melanoma diagnosed in the public healthcare system (Sistema Único de Saúde SUS) and the private system in Joinville, Santa Catarina State, Brazil. METHODS: This cross-sectional retrospective study analyzed primary cutaneous melanoma cases recorded from 2003 to 2014 in the resident population of Joinville. Ethical approval was obtained from the local Research Ethics Committee. RESULTS: 893 cases of primary cutaneous melanoma were identified. Patients in the private system were mostly younger, while there were more elderly patients in the public healthcare system (p <0.001). There was no statistically significant association between type of care (public/private) and gender or presence of multiple primary cutaneous melanomas. Histological diagnosis of superficial spreading melanoma was more common in patients treated in private healthcare, while nodular melanoma was more frequent in patients in the public healthcare system (p <0.001). Mean Breslow depth in patients treated in private healthcare was 1.35mm, compared to 2.72mm in the public system (p <0.001). STUDY LIMITATIONS: This was a retrospective study using secondary databases. CONCLUSIONS: thin cutaneous melanoma (in situ cutaneous melanoma and Breslow T1) showed the strongest association with the private healthcare system, while thick cutaneous melanoma was more frequent in the public system (Breslow category T3 and T4) (p <0.001).

Epidemiological and histopathological aspects of primary cutaneous melanoma in residents of Joinville, 2003-2014.

BACKGROUND: The worldwide incidence of cutaneous melanoma (CM) has been continuously increasing over the last decades. Primary and secondary prevention, with attention to risk factors and early diagnosis, remain the cornerstone for reducing the burden of cutaneous melanoma. Detailed information with respect to clinical and pathological data on cutaneous melanoma is scarce in Brazil. OBJECTIVE: The purpose of our study was to analyze epidemiological and pathological characteristics of primary cutaneous melanoma in Joinville, southern Brazil. METHODS: Observational, cross-sectional, retrospective study in which 893 reports of primary cutaneous melanoma from the local population were analyzed in the period 2003-2014. The study was approved by the local Ethics and Research Committee. RESULTS: We observed a female predominance of cutaneous melanoma (56.3%). The age standardized incidence rate of primary cutaneous melanoma for the world population in the period 2003-06 was 11.8 per 100,000 population (CI 95%, 10.3-13.4), and 17.5 (CI 95%, 15.7-19.3) in 2011-14, revealing a significant increase of 48.3% (p < 0,05). Six and a half percent of patients had multiple cutaneous melanomas (mean 2.2 years and a maximum of 10.0 years between diagnoses). We observed significant differences between the location head/neck and cutaneous melanoma in situ, lower limb with Breslow depth S III and upper limb with Breslow depth S I. The comparison of the characteristics of cutaneous melanoma in the elderly and non-elderly (< 60 years old) showed significant differences with respect to all the variables studied. STUDY LIMITATIONS: Using secondary data source. CONCLUSION: Joinville has high incidence coefficients for Brazilian standards, showing an increase in the incidence of cutaneous melanoma.

FACTORS ASSOCIATED WITH INFANT MORTALITY IN A BRAZILIAN CITY WITH HIGH HUMAN DEVELOPMENT INDEX. / FATORES ASSOCIADOS À MORTALIDADE INFANTIL EM MUNICÍPIO COM ÍNDICE DE DESENVOLVIMENTO HUMANO ELEVADO.

OBJECTIVE: To identify factors associated with infant mortality in a city with good socioeconomic development. METHODS: A retrospective cohort study with 7,887 live births in the year of 2012 recorded in the Live Births Information System (SINASC) and associated by linkage with the Mortality Information System (SIM) to identify the deaths in the first year of life. The risk factors were ranked in three levels of determination: distal, intermediate and proximal. The logistic binomial regression models and the multivariate model quantified the impact of the individual variables tested and adjusted the effect of confounding variables. The magnitude of the effect of the explanatory variables was estimated by calculating the crude and adjusted Odds Ratio (OR) and their respective 95% confidence intervals (95%CI), being significant p<0.05. RESULTS: There were 61 deaths in the cohort and the infant mortality rate was 7.7 per thousand live births. Teenage mother (adjOR 3.75; 95%CI 1.40-10.02), gestational age <32 weeks (adjOR 12.08; 95%CI 2.30-63.38), weight at birth <1500g (adjOR 8.20; 95%CI 1.52-44.23), Apgar score at 1 and 5 minutes of life <7 (adjOR 4.82; 95%CI 2.01-11.55 and adjOR 6.26; 95%CI 1,93-20,30, respectively) and the presence of congenital malformation (adjOR 21.49; 95%CI 7.72-59.82) were risk factors for infant mortality. CONCLUSIONS: The lower relevance of socioeconomic and health care variables and the greater importance of biological factors in determining infant mortality may reflect the protective effect of high economic and social development of the locality.

OBJETIVO: Identificar os fatores associados à mortalidade infantil em município com bom desenvolvimento socioeconômico. MÉTODOS: Estudo de coorte retrospectivo com 7.887 nascidos vivos do ano de 2012 registrados no Sistema de Informação sobre Nascidos Vivos (SINASC) e associados por meio de linkage com o Sistema de Informações sobre Mortalidade (SIM) para identificação dos óbitos ocorridos no primeiro ano de vida. Os fatores de risco foram hierarquizados em três níveis de determinação: distal, intermediário e proximal. Os modelos de regressão logística binomial e o modelo multivariado quantificaram o impacto individual das variáveis testadas e ajustaram o efeito das variáveis de confundimento. A magnitude do efeito das variáveis explicativas foi estimada pelo cálculo do Odds Ratio (OR) bruta e ajustada e de seus respectivos intervalos de confiança de 95% (IC95%), sendo significante p<0,05. RESULTADOS: Identificou-se 61 óbitos na coorte e o coeficiente de mortalidade infantil foi de 7,7 por mil nascidos vivos. Mãe adolescente (ORaj 3,75; IC95% 1,40-10,02), duração da gestação <32 semanas (ORaj 12,08; IC95% 2,30-63,38), peso ao nascer <1.500 g (ORaj 8,20; IC95% 1,52-44,23), Apgar no 1º e no 5º minuto de vida <7 (ORaj 4,82; IC95% 2,01-11,55 e ORaj 6,26; IC95% 1,93-20,30, respectivamente) e presença de malformação congênita (ORaj 21,49; IC95% 7,72-59,82) constituíram fatores de risco para os óbitos. CONCLUSÕES: A menor relevância dos fatores socioeconômicos e assistenciais e a maior importância dos fatores biológicos na determinação dos óbitos infantis podem refletir o efeito protetor do elevado desenvolvimento econômico e social dessa localidade.

Self-compassion and Positive and Negative Affect in Medical Students during the Covid-19 Pandemic / Autocompaixão e afetos positivos e negativos de estudantes de medicina durante a pandemia de COVID-19

Introduction: studies demonstrate a higher rate of anxiety, depression and stress symptoms among Medical students when compared to the general population. The context of the coronavirus pandemic (SARS-CoV-2) generated additional stress to these students. Objective: the present study aimed to evaluate the emotional health of medical students at a Community University.Methods: there were 437 participants, that answered a sociodemographic questionaire, the Positive and Negative Affect Schedule (PANAS) and the Scale of Self-compassion ­ Brazil.Results: most (69%) are female, 63% live with their family, 35% have student loans, 59% practice some religion, 45% reported a diagnosis of psychological disorder, 27% use psychiatric medication and 9% use of psychoactive substances. More than 72% of women and 58% of men, presented scores of positive affects (PA), negative affects (NA), and self-compassion (SC) that were below the population mean. The report of psychological disorders and use of psychiatric drugs were also found to be significantly associated to lower rates of PA (respectively, p<0,0001 and p=0,030) and SC (p<0,001 in both) and higher rates of NA (p<0,001 in both).Conclusion: the results point to greater vulnerability of the psychological health of medical students during the pandemic and indicate the importance of adopting measures aimed at emotional well-being at the institutional level.

Introdução: estudos apontam maior índice de sintomas de ansiedade, depressão e estresse entre estudantes de Medicina quando comparados à população geral. O contexto da pandemia pelo novo coronavírus (SARS-CoV-2) gerou uma carga adicional de estresse a estes estudantes.Objetivo: o presente artigo objetivou avaliar a saúde emocional de estudantes de medicina durante a pandemia.Método: participaram 437 estudantes, aos quais foi administrado um questionário sociodemográfico, a Escala de Afetos Positivos e Afetos Negativos (PANAS) e a Escala de Autocompaixão ­ Brasil.Resultados: a maioria (69%) é do sexo feminino, 63% reside com a família, 35% possui financiamento estudantil, 59% pratica alguma religião, 45% relatou diagnóstico de transtorno psicológico, 27% faz uso de medicamento psiquiátrico e 9% faz uso de substâncias psicoativas. Mais de 72% das mulheres e 58% dos homens apresentaram escores de afetos positivos (AP), afetos negativos (AN) e autocompaixão (AC) abaixo da média populacional. O relato de transtorno psicológico e uso de medicamentos psiquiátricos demonstrou-se significativamente associado a menores índices de AP (respectivamente, p<0,0001 e p=0,030) e AC (p<0,001 em ambos) e maiores índices de AN (p<0,001 em ambos).Conclusão: os resultados apontam maior vulnerabilidade da saúde psicológica dos estudantes de Medicina durante a pandemia e indicam a importância da adoção de medidas que visem o bem-estar emocional no âmbito institucional.

How Many Patients Become Functionally Dependent after a Stroke? A 3-Year Population-Based Study in Joinville, Brazil.

The decrease in stroke mortality will increase the burden of survivors with functional dependence (FD). The aim of this study was to evaluate how many patients become functionally dependent over 3 years after an incident event in Joinville, Brazil. The proportion of FD (defined as a modified Rankin score 3 to 5) among stroke survivors from the Joinville Stroke Registry was assessed using a validated telephone interview. Incidence of FD after stroke in Joinville in one year was 23.24 per 100,000 population. The overall proportion of FD among stroke survivors at discharge was 32.7%. Of 303 patients with first-ever ischaemic stroke (IS), one-third were FD at discharge, and 12%, 9% and 8%, respectively at 1, 2 and 3 years. Among 37 patients with haemorrhagic stroke (HS), 38% were dependent at discharge, 16% after 1 and 2 years and 14% after 3. Among 27 patients with subarachnoid haemorrhage (SAH), 19% were dependent at discharge and 4% from 1 to 3 years. Among IS subtypes, cardioembolic ones had the worst risk of FD. (RR 19.8; 95% CI: 2.2 to 175.9). Our results showed that one-third of stroke survivors have FD during the first year after stroke in Brazil. Therefore, a city with half a million people might expect 120 new stroke patients with FD each year.

Analysis of neolignans compounds of Piper regnellii (Miq.) C. DC. var. pallescens (C. DC.) Yunck by HPLC.

A high performance liquid chromatographic (HPLC) method was developed and validated for quantitative determination of neolignans in extracts of Piper regnellii var. pallescens. The analysis were carried out on a Metasil ODS column (150 mm x 4.6 mm, 5 microm) at 30 degrees C, using as mobile phase acetonitrile-water (60:40, v/v) containing 2% acetic acid. The flow rate was 1.0 ml/min and the detection was at 280 nm. The validation using conocarpan as standard demonstrated that the method presents linearity (linear correlation coefficient=0.9991), precision (relative standard deviation <5%) and accuracy (mean recovery=104.55%) in the concentration range 31.25-500 microg/ml. The limit of detection (LOD) was 1.68 microg/ml and the limit of quantitation was 5.60 microg/ml. This method allowed the identification and quantification of conocarpan, eupomatenoid-5 and eupomatenoid-6 in the hydroethanolic extracts obtained from the leaves, stems and roots by maceration process. All the extracts showed the same chromatographic profile, being that the extract of the roots presented the highest concentration of neolignans.

Cognitive performance after ischaemic stroke.

Cognitive impairment after stroke affects the patient recovery process. Therefore, the identification of factors associated with cognitive outcomes is important since it allows risk profiles of stroke survivors to be determined. OBJECTIVE: To assess cognitive outcome of stroke outpatients and investigate associations among clinical and demographic variables, vascular risk factors, depression symptoms and functional ability; and to describe the neuropsychological profile of these patients. METHODS: A cross-sectional design study was conducted. Subjects who suffered a first-ever ischaemic stroke 6 to 10 months prior to data collection underwent neuropsychological assessment and screening for depressive symptoms and functional ability. The outcome "cognitive performance" was analyzed considering two groups: "cognitive impairment" and "no cognitive impairment". RESULTS: There was a statistically significant association between cognitive impairment and female gender, age, stroke severity and functional ability. Regarding neuropsychological profile, the cognitive impairment group exhibited more generalized deficits in attention, visuospatial organization, verbal functions and verbal memory domains compared to the community control group. CONCLUSION: The occurrence of cognitive impairment among patients was high, especially in women, older participants, individuals with more severe stroke, and greater impairment in functional ability. Multiple cognitive domains are affected and this may hamper recovery and negatively impact independence and quality of life after stroke.

O prejuízo na cognição após evento de Acidente Vascular Cerebral Isquêmico (AVCI) afeta a recuperação dos pacientes. Dessa forma, a identificação de fatores associados ao desfecho cognitivo torna-se relevante ao permitir traçar perfis de risco para os pacientes acometidos. OBJETIVO: Avaliar o desfecho cognitivo dos pacientes vitimados por AVCI em seguimento ambulatorial, verificar associação com variáveis clínicas e demográficas dos pacientes, sintomas de depressão e capacidade funcional, e descrever seu perfil neuropsicológico. MÉTODOS: Foi realizado um estudo transversal, cuja amostra foi composta por 45 pacientes que apresentaram primeiro evento de AVCI nos 6 a 10 meses anteriores à coleta de dados. Os sujeitos foram entrevistados e submetidos à avaliação neuropsicológica e da capacidade funcional e à verificação da presença de sintomas de depressão. O desfecho "desempenho cognitivo" foi analisado considerando dois grupos: "com prejuízo cognitivo" e "sem prejuízo cognitivo". RESULTADOS: Identificou-se associação estatisticamente significativa entre prejuízo cognitivo e sexo feminino, idade, gravidade do AVC e capacidade funcional. Considerando o perfil neuropsicológico, o grupo de sujeitos que apresentou prejuízo cognitivo exibiu déficits mais generalizados, nos domínios de atenção, organização visuoespacial, funções verbais e memória verbal, quando seu desempenho foi comparado aos controles da comunidade. CONCLUSÃO: A ocorrência de prejuízo cognitivo entre os pacientes é elevada, especialmente em mulheres, pessoas com maior idade, naqueles que sofreram AVC mais graves e naqueles que mostraram maior prejuízo na capacidade funcional. Diversos domínios cognitivos são afetados. Isto pode dificultar a recuperação, a independência e a qualidade de vida após o AVC.

Perfil e evolução da mortalidade por causas externas em Joinville (SC), 2003 a 2016 / Profile and trend in mortality due to external causes in Joinville (SC) from 2003 to 2016

Resumo Introdução A mortalidade por causas externas está entre as principais causas de óbito no mundo, com acentuada expressão em faixas etárias jovens. Objetivo Descrever o perfil das mortes por causas externas em município do Sul do país e verificar sua tendência nos últimos anos. Método Estudo retrospectivo dos óbitos por causas externas usando os coeficientes de mortalidade por sexo, grupo etário e causa da morte com análise por regressão quasi Poisson. Resultados O coeficiente de mortalidade foi de 46,3 por 100 mil habitantes, predominando os acidentes por transporte terrestre (40%) e agressões (30,5%). Identificou-se aumento de 53% nos coeficientes de mortalidade, com variações segundo sexo, grupo etário e tipo. Conclusão Necessitam-se intensificar políticas públicas conforme as especificidades na determinação dos tipos de morte em cada grupo etário.

Abstract Background Mortality due to external causes is among of the leading causes of death worldwide, with great expression in young age groups. Objective: To describe the profile of deaths from external causes in a southern municipality of Brazil and verify its trend in the last years. Method It was carried out a retrospective study of external causes deaths using mortality rates by gender, age group and cause of with quasi Poisson regression analysis. Results Mortality coefficient was 46 per 100,000 inhabitants prevailing transport accidents (40%) and aggressions (30.5%). Increase of 53% in mortality rate was detected with variations by gender, age group and type. Conclusion Social policies are necessary encompassing intersectoral actions and taking into account the specificities in determination of each age group's types of death.

[Social capital and quality of healthcare: the experiences of Brazil and Catalonia]. / Capital social e qualidade da atenção à saúde: as experiências do Brasil e da Catalunha.

Distinct models of health management reflect the core principles upon which they were founded and their institutional arrangement can lead to the improvement of health policy. This paper seeks to reflect on the potential benefits and limitations of the organizational structure and the social capital to lead to changes in the performance of public health organizations in the quest for enhanced quality of care. The description and analysis of two experiences of universal public health systems, in Catalonia and in Brazil, reveal similarities in the legal basis of both health systems. However, the mode of deployment differed greatly, which gave rise to divergent management experiences. One prioritized managerial organization, while the other concentrated on the importance of the social actors promoting the institutionalization of social capital. It is suggested that models of management with dialogue between an efficient organizational design and citizen participation capable of constructing social capital may lead to change in the organizational culture and enhance the quality of care.

Use of propolis hydroalcoholic extract to treat colitis experimentally induced in rats by 2,4,6-trinitrobenzenesulfonic Acid.

This study focused on the therapeutic effect of a propolis SLNC 106 (PI) extract on experimental colitis. Wistar adult rats received 0.8 mL rectal dose of one of the following solutions: saline (group S), 20 mg TNBS in 50% ethanol (group TNBS), 20 mg TNBS in 50% ethanol and propolis extract in saline (group TNBS-P), propolis extract in saline (group SP), and 20 mg TNBS in 50% ethanol and 50 mg/kg mesalazine (group TNBS-M). The animals were euthanized 7 or 14 days after the colitis induction. Samples of the distal colon were harvested for the analysis of myeloperoxidase (MPO) enzyme activity and for morphometric analysis in paraffin-embedded histological sections with hematoxylin-eosin or histochemical staining. The animals treated with TNBS exhibited the typical clinical signs of colitis. Increased MPO activity confirmed the presence of inflammation. TNBS induced the development of megacolon, ulceration, transmural inflammatory infiltrate, and thickened bowel walls. Treatment with propolis moderately reduced the inflammatory response, decreased the number of cysts and abscesses, inhibited epithelial proliferation, and increased the number of goblet cells. The anti-inflammatory activity of the propolis SLNC 106 extract was confirmed by the reductions in both the inflammatory infiltrate and the number of cysts and abscesses in the colon mucosa.

Differences in the diagnosis of primary cutaneous melanoma in the public and private healthcare systems in Joinville, Santa Catarina State, Brazil

Abstract: Background: Cutaneous melanoma accounts for up to 80% of deaths caused by skin cancer. Diagnostic suspicion and access to medical care and early intervention in suspected cases is vital to the patient's prognosis. Objectives: To compare demographic and histopathological characteristics of primary cutaneous melanoma diagnosed in the public healthcare system (Sistema Único de Saúde SUS) and the private system in Joinville, Santa Catarina State, Brazil. Methods: This cross-sectional retrospective study analyzed primary cutaneous melanoma cases recorded from 2003 to 2014 in the resident population of Joinville. Ethical approval was obtained from the local Research Ethics Committee. Results: 893 cases of primary cutaneous melanoma were identified. Patients in the private system were mostly younger, while there were more elderly patients in the public healthcare system (p <0.001). There was no statistically significant association between type of care (public/private) and gender or presence of multiple primary cutaneous melanomas. Histological diagnosis of superficial spreading melanoma was more common in patients treated in private healthcare, while nodular melanoma was more frequent in patients in the public healthcare system (p <0.001). Mean Breslow depth in patients treated in private healthcare was 1.35mm, compared to 2.72mm in the public system (p <0.001). Study limitations: This was a retrospective study using secondary databases. Conclusions: thin cutaneous melanoma (in situ cutaneous melanoma and Breslow T1) showed the strongest association with the private healthcare system, while thick cutaneous melanoma was more frequent in the public system (Breslow category T3 and T4) (p <0.001).

Epidemiological and histopathological aspects of primary cutaneous melanoma in residents of Joinville, 2003-2014

Abstract: Background: The worldwide incidence of cutaneous melanoma (CM) has been continuously increasing over the last decades. Primary and secondary prevention, with attention to risk factors and early diagnosis, remain the cornerstone for reducing the burden of cutaneous melanoma. Detailed information with respect to clinical and pathological data on cutaneous melanoma is scarce in Brazil. Objective: The purpose of our study was to analyze epidemiological and pathological characteristics of primary cutaneous melanoma in Joinville, southern Brazil. Methods: Observational, cross-sectional, retrospective study in which 893 reports of primary cutaneous melanoma from the local population were analyzed in the period 2003-2014. The study was approved by the local Ethics and Research Committee. Results: We observed a female predominance of cutaneous melanoma (56.3%). The age standardized incidence rate of primary cutaneous melanoma for the world population in the period 2003-06 was 11.8 per 100,000 population (CI 95%, 10.3-13.4), and 17.5 (CI 95%, 15.7-19.3) in 2011-14, revealing a significant increase of 48.3% (p < 0,05). Six and a half percent of patients had multiple cutaneous melanomas (mean 2.2 years and a maximum of 10.0 years between diagnoses). We observed significant differences between the location head/neck and cutaneous melanoma in situ, lower limb with Breslow depth S III and upper limb with Breslow depth S I. The comparison of the characteristics of cutaneous melanoma in the elderly and non-elderly (< 60 years old) showed significant differences with respect to all the variables studied. Study limitations: Using secondary data source. Conclusion: Joinville has high incidence coefficients for Brazilian standards, showing an increase in the incidence of cutaneous melanoma.

Fatores associados à mortalidade infantil em município com índice de desenvolvimento humano elevado / Factors associated with infant mortality in a brazilian city with high human development index

RESUMO Objetivo: Identificar os fatores associados à mortalidade infantil em município com bom desenvolvimento socioeconômico. Métodos: Estudo de coorte retrospectivo com 7.887 nascidos vivos do ano de 2012 registrados no Sistema de Informação sobre Nascidos Vivos (SINASC) e associados por meio de linkage com o Sistema de Informações sobre Mortalidade (SIM) para identificação dos óbitos ocorridos no primeiro ano de vida. Os fatores de risco foram hierarquizados em três níveis de determinação: distal, intermediário e proximal. Os modelos de regressão logística binomial e o modelo multivariado quantificaram o impacto individual das variáveis testadas e ajustaram o efeito das variáveis de confundimento. A magnitude do efeito das variáveis explicativas foi estimada pelo cálculo do Odds Ratio (OR) bruta e ajustada e de seus respectivos intervalos de confiança de 95% (IC95%), sendo significante p<0,05. Resultados: Identificou-se 61 óbitos na coorte e o coeficiente de mortalidade infantil foi de 7,7 por mil nascidos vivos. Mãe adolescente (ORaj 3,75; IC95% 1,40-10,02), duração da gestação <32 semanas (ORaj 12,08; IC95% 2,30-63,38), peso ao nascer <1.500 g (ORaj 8,20; IC95% 1,52-44,23), Apgar no 1º e no 5º minuto de vida <7 (ORaj 4,82; IC95% 2,01-11,55 e ORaj 6,26; IC95% 1,93-20,30, respectivamente) e presença de malformação congênita (ORaj 21,49; IC95% 7,72-59,82) constituíram fatores de risco para os óbitos. Conclusões: A menor relevância dos fatores socioeconômicos e assistenciais e a maior importância dos fatores biológicos na determinação dos óbitos infantis podem refletir o efeito protetor do elevado desenvolvimento econômico e social dessa localidade.

ABSTRACT Objective: To identify factors associated with infant mortality in a city with good socioeconomic development. Methods: A retrospective cohort study with 7,887 live births in the year of 2012 recorded in the Live Births Information System (SINASC) and associated by linkage with the Mortality Information System (SIM) to identify the deaths in the first year of life. The risk factors were ranked in three levels of determination: distal, intermediate and proximal. The logistic binomial regression models and the multivariate model quantified the impact of the individual variables tested and adjusted the effect of confounding variables. The magnitude of the effect of the explanatory variables was estimated by calculating the crude and adjusted Odds Ratio (OR) and their respective 95% confidence intervals (95%CI), being significant p<0.05. Results: There were 61 deaths in the cohort and the infant mortality rate was 7.7 per thousand live births. Teenage mother (adjOR 3.75; 95%CI 1.40-10.02), gestational age <32 weeks (adjOR 12.08; 95%CI 2.30-63.38), weight at birth <1500g (adjOR 8.20; 95%CI 1.52-44.23), Apgar score at 1 and 5 minutes of life <7 (adjOR 4.82; 95%CI 2.01-11.55 and adjOR 6.26; 95%CI 1,93-20,30, respectively) and the presence of congenital malformation (adjOR 21.49; 95%CI 7.72-59.82) were risk factors for infant mortality. Conclusions: The lower relevance of socioeconomic and health care variables and the greater importance of biological factors in determining infant mortality may reflect the protective effect of high economic and social development of the locality.

A populational based study on the prevalence of neonatal near miss in a city located in the South of Brazil: prevalence and associated factors / Estudo de base populacional sobre a prevalência de near miss neonatal em município do sul do Brasil: prevalência e fatores associados

Abstract Objectives: to identify the prevalence of neonatal near miss morbidity in the city of Joinville, SC and the associated factors. Methods: a populational based cross-sectional study including all live births in 2012 registered at SINASC. The near miss cases were identified based on the weight <1500g, Apgar scores at 5th minute <7, gestational age <32 weeks, use of mechanical ventilation or presence of congenital malformation. The gross odds ratios (OR) and its respective 95% confidence intervals (95% CI) were calculated and the logistic regression was performed to obtain the adjusted odds ratios and its respective 95% CI. Results: the prevalence of near miss was 33 per thousand live births (95% CI: 29-37). In the final model, a risk classification of live births according to the City Program (Programa Municipal) (ORaj= 19.7; 95% CI: 14.2 to 27.2), cesarean section (ORaj= 2.1; 95% CI:1.5 to 2.8) and public hospital (ORaj= 1.7; 95% CI: 1.2 to 2.3) remained associated to morbidity near miss. Conclusions: near miss morbidity was 7.3 times higher than neonatal mortality. To know its determinants in different national contexts may include some changes in the focus of public health actions by redirecting to preventive interventions.

Resumo Objetivos: identificar a prevalência de morbidade neonatal near miss no município de Joinville, SC e os fatores associados. Métodos: estudo transversal de base populacional com todos os nascidos vivos do ano de 2012 registrados no SINASC. Os casos de near miss foram identificados com base no peso < 1500g, Apgar de 5º minuto < 7, idade gestacional < 32 semanas, uso de ventilação mecânica ou presença de malformação congênita. Calculou-se o odds ratio (OR) bruto e seus respectivos intervalos de confiança de 95% (IC95%) e realizou-se regressão logística para a obtenção dos odds ratios ajustados e seus respectivos IC95%. Resultados: a prevalência de near miss foi de 33 por mil nascidos vivos (IC95%: 29-37). No modelo final, permaneceram associados à morbidade near miss, a classificação de risco do nascido vivo conforme o Programa Municipal (ORaj = 19,7; IC95%: 14,2-27,2), parto cesáreo (ORaj = 2,1; IC95%: 1,5-2,8) e hospital público (ORaj =1,7; IC95%: 1,2-2,3). Conclusões: a morbidade near miss foi 7,3 vezes maior que a mortalidade neonatal. Conhecer seus determinantes em diferentes contextos nacionais pode propiciar mudança no foco das ações de saúde pública, redirecionando-as para intervenções preventivas.

[Pain and the protagonism of women in parturition]. / El dolor y el protagonismo de la mujer en el parto.

BACKGROUND AND OBJECTIVES: To understand through the theory of social representations the sociocultural dimensions of pain and its impact on the protagonism of women in parturition. METHODS: In this investigation, we used a qualitative methodology with the theoretical reference of phenomenology and the theory of social representation. Forty-five semi-structured interviews were conducted with gravidas in public and private health services of Joinville, SC, Brazil, who had at least four prenatal visits and were in the third trimester of pregnancy. RESULTS: From analysis of content reported in interviews, three empirical categories were formed: fears and concerns, experience, and sociocultural influence, which allowed the building of three interpretative categories: biomedical model, lack of information, and the role of women in the decision regarding the mode of delivery. The findings reported here indicate pain as one of the elements that form female social representations in parturition. It was observed that pain influences the behavior of gravidas from fear and becomes the genesis of other aversive feelings and concerns that involve parturition. CONCLUSIONS: In this context, pain represented one of the main building blocks of female social representations on parturition, contributing to the ascending curve of cesarean section indices in Brazil.

Therapeutic inertia and control of high blood pressure in primary health care units.

BACKGROUND: The importance of adequate management and control of high blood pressure (HBP). OBJECTIVE: To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at primary health care units (PHCU) in the city of Joinville, as well as the associated factors. METHODS: A cross-sectional study, which included cluster sampling and analysis of medical records, with the evaluation of 415 patients with high blood pressure. We evaluated the blood pressure (BP), increments of therapy, risk factors and comorbidities. RESULTS: There was prevalence of females and nursing appointments. The age ranged between 28 and 90 years (mean of 61.5 years). There was a reduction in the mean BP (155.8 ± 20.8/95.7 ± 10.6 mmHg to 140.3 ± 22/84.1 ± 12.4 mmHg) between the first and last record and the final normal BP in 36.6% of patients, with similar results for men and women. Over the past 12 months, the BP was high on 1,295 occasions, and there was a therapeutic increment on only 156 occasions (12.0%). 1.85 drugs were used per patient, mainly diuretics and ACE inhibitors. There was high prevalence of obesity (40%), diabetes (41%), high LDL (46%) and left ventricular hypertrophy (25.5%). CONCLUSION: The high therapeutic inertia, low control of high blood pressure and the large number of comorbidities suggest the need for continuing education programs for health professionals and other measures to improve the disease control in primary health care units.