Baryon Acoustic Oscillations from Integrated Neutral Gas Observations: an instrument to observe the 21cm hydrogen line in the redshift range 0.13 < z < 0.45 - status update.

BINGO (BAO from Integrated Neutral Gas Observations) is a unique radio telescope designed to map the intensity of neutral hydrogen distribution at cosmological distances, making the first detection of Baryon Acoustic Oscillations (BAO) in the frequency band 980 MHz - 1260 MHz, corresponding to a redshift range 0.127 < z < 0.449. BAO is one of the most powerful probes of cosmological parameters and BINGO was designed to detect the BAO signal to a level that makes it possible to put new constraints on the equation of state of dark energy. The telescope will be built in Paraíba, Brazil and consists of two \thicksim 40m mirrors, a feedhorn array of 50 horns, and no moving parts, working as a drift-scan instrument. It will cover a 15 ^{\circ} ∘ declination strip centered at \sim \delta ∼ δ =-15 ^{\circ} ∘ , mapping \sim ∼ 5400 square degrees in the sky. The BINGO consortium is led by University of São Paulo with co-leadership at National Institute for Space Research and Campina Grande Federal University (Brazil). Telescope subsystems have already been fabricated and tested, and the dish and structure fabrication are expected to start in late 2020, as well as the road and terrain preparation.

Atuação de psicólogos nos CRAS do nordeste: uma revisão sistemática / Psychologist performance in brazilian northeast social assistance reference centers (CRAS): a systematic review / Actuación de psicólogos en los centros de referencia de asistencia social (CRAS) del nordeste: un revisión sistemática

RESUMO O artigo apresenta uma revisão sistemática sobre a atuação de psicólogos nos CRAS no Nordeste brasileiro, de 2009 a 2018. O levantamento realizou-se nas bases de dados: Periódicos CAPES, REDALYC, LILACS, SciELO e PEPSIC, selecionando 12 artigos. O estado do Rio Grande do Norte se destacou nas publicações com os estudos apontando um interesse pela interiorização da atuação e assumindo preferência pela metodologia da pesquisa qualitativa, com prevalência da análise de conteúdo. Sobre as atuações descritas, embora algumas ações essenciais ainda sejam incipientes, como no caso da territorialização e da vigilância social, as práticas corroboram com as orientações normativas. Assim, entende-se que as práticas vêm se transformando, porém é preciso investir na formação para o trabalho social e no compromisso ético-político para uma atuação verdadeiramente transformadora.

ABSTRACT The article presents a systematic review about the performance of psychologists in CRAS in the Brazilian Northeast region, from 2009 to 2018. The survey was carried out in the databases Periódicos CAPES, REDALYC, LILACS, SciELO and PEPSIC, selecting 12 articles. The state of Rio Grande do Norte stood out in the publications, showing an interest for the internalization of the performance, and assuming a preference for qualitative methodology and content analysis. The studies showed that some essential actions are still incipient, as in the case of territorialization and social vigilance, but practices seek to follow normative guidelines. Thus, it is understood that the practices have been transforming, but there is a need for investing in a social work qualification and in the ethical-political commitment for a truly transforming professional performance.

RESUMEN Resumen El artículo presenta una revisión sistemática sobre la actuación de psicólogos en los CRAS en el Nordeste brasileño, de 2009 a 2018. El levantamiento se realizó en las bases de datos: Periódicos CAPES, REDALYC, LILACS, SciELO y PEPSIC, seleccionando 12 artículos. El estado del Rio Grande do Norte se destacó en las publicaciones, con los estudios apuntando un interés por la interiorización de la actuación y la investigación cualitativa asume la preferencia metodológica con prevalencia del análisis de contenido. Sobre las actuaciones descritas, aunque algunas acciones esenciales aún son incipientes, en el caso de la territorialización y vigilancia social, las prácticas corroboran con las orientaciones normativas. Así, se entiende que las prácticas se vienen transformando, pero hay que invertir en la formación para el trabajo social y en el compromiso ético-político para una actuación verdaderamente transformadora.

ABCC Transporters Mediate the Vacuolar Accumulation of Crocins in Saffron Stigmas.

Compartmentation is a key strategy enacted by plants for the storage of specialized metabolites. The saffron spice owes its red color to crocins, a complex mixture of apocarotenoid glycosides that accumulate in intracellular vacuoles and reach up to 10% of the spice dry weight. We developed a general approach, based on coexpression analysis, heterologous expression in yeast (Saccharomyces cerevisiae), and in vitro transportomic assays using yeast microsomes and total plant metabolite extracts, for the identification of putative vacuolar metabolite transporters, and we used it to identify Crocus sativus transporters mediating vacuolar crocin accumulation in stigmas. Three transporters, belonging to both the multidrug and toxic compound extrusion and ATP binding cassette C (ABCC) families, were coexpressed with crocins and/or with the gene encoding the first dedicated enzyme in the crocin biosynthetic pathway, CsCCD2. Two of these, belonging to the ABCC family, were able to mediate transport of several crocins when expressed in yeast microsomes. CsABCC4a was selectively expressed in C. sativus stigmas, was predominantly tonoplast localized, transported crocins in vitro in a stereospecific and cooperative way, and was able to enhance crocin accumulation when expressed in Nicotiana benthamiana leaves.plantcell;31/11/2789/FX1F1fx1.

Oxidative stress in ryegrass growing under different air pollution levels and its likely effects on pollen allergenicity.

In the present work, for the first time in the literature, the relationship between the degree of air pollution, the physiological state of the plants and the allergenic capacity of the pollen they produce has been studied. The physiological state of Lolium perenne plants growing in two cities with a high degree of traffic, but with different levels of air pollution, Madrid and Ciudad Real, have been explored. The photosynthetic efficiency of the plants through the emission of fluorescence of PSII, the degree of oxidative stress (enzymatic activities related to the ascorbate-glutathione cycle), the redox state (reduced and oxidized forms of ascorbate and glutathione) and the concentration of malondialdehyde have been evaluated. During the development period of the plants, Madrid had higher levels of NO2 and SO2 than Ciudad Real. The greater degree of air pollution suffered by Madrid plants was reflected on a lower photosynthetic efficiency and a greater degree of oxidative stress. In addition, NADPH oxidase activity and H2O2 levels in pollen from Madrid were significantly higher, suggesting a likely higher allergenic capacity of this pollen associated to a higher air pollution.

Atuação dos Profissionais de Psicologia nos CRAS do Interior da Paraíba / La Actuación de los Profesionales de la Psicología en los CRAS en Pueblos de Paraíba / The Performance of Psychology Professionals in CRAS in the Countryside of Paraíba

Resumo Objetiva-se no presente estudo analisar a atuação dos profissionais de Psicologia na Proteção Social Básica das Políticas Públicas de Assistência Social. Para dar conta de tal objetivo buscou-se suporte teórico na Psicologia Histórico-Cultural. Participaram do estudo oito profissionais de Psicologia que atuavam no Centro de Referência da Assistência Social (CRAS) do interior da Paraíba, Nordeste do Brasil. Recorreu-se a entrevistas semiestruturadas, realizadas individualmente. Para analisar os dados recorreu-se à análise de conteúdo. Dados empíricos revelaram formação acadêmica voltada para a atuação clínica individualizante, limitado suporte teórico-metodológico para atuação dos profissionais, demandas decorrentes da condição de vulnerabilidade social, violação de direitos, mas também de saúde mental e predomínio de atuação psicossocial e diversas limitações que dificultam a realização do trabalho do profissional de Psicologia. Conclui-se pela necessidade tanto de avanços na formação acadêmica dos profissionais de Psicologia, quanto de atuação engajada na luta por avanços na consolidação de um sistema de garantia de direitos.

Resumen Este estudio tiene como objetivo analizar la actuación de los profesionales de Psicología en la Protección Social Básica de las Políticas Públicas de Asistencia Social. Para ello, fue utilizado como soporte teórico la Psicología Histórico-Cultural. En el estudio participaron ocho profesionales de Psicología que actuaban en los Centros de Referencia de Asistencia Social - CRAS en pueblos del estado de Paraíba, noreste de Brasil. Entrevistas semiestructuradas fueran utilizadas, hechas individualmente. Para analizar los datos, se utilizó el análisis de contenido. Los datos empíricos revelaron que: los profesionales cuentan con una formación académica direccionada hacía la actuación clínica individualizada; tienen un respaldo teórico y metodológico muy limitado para sus actuaciones como profesionales; las demandas son decurrentes de la condición de vulnerabilidad social, violación de los derechos y de la salud mental; predominó la actuación psicosocial; además, emergieran diversas limitaciones que dificultaban la realización de su trabajo como profesional de Psicología. Se concluye entonces que hay una gran necesidad de avances en la formación académica de los profesionales de Psicología, a ello se añade una actuación profesional más comprometida en la lucha por los avances en la consolidación de un sistema de garantía de derechos.

Abstract This study aims to analyze the performance of Psychology professionals in the Basic Social Protection of the Social Assistance Public Policies. To meet this objective, Cultural-Historical Psychology was used as theoretical support. Eight Psychology professionals who worked at the Reference Center for Social Assistance (CRAS) in the countryside of Paraíba, northeast of Brazil, were interviewed. Semi-structured interviews were made, individually. Content analysis was used to analyze data. Empirical data revealed: Academic background oriented to individualizing clinical practice; Limited theoretical and methodological support for the professionals' performance; Demands arising from social vulnerability conditions, violation of rights and mental health; Predominance of psychosocial performance; and several limitations that make the work of the Psychology professional difficult. The conclusion is that both, improvements in the academic background of the Psychology professionals and a more engaged work of professionals regarding the fight for improvements in consolidating a system of rights guarantee, are needed.

Diálogos entre saúde mental e atenção básica: relato de experiência do Pet-Saúde no município de Parnaíba-PI / Dialogues between mental health and primary health care: a Brazilian educational program for health work case report / Diálogos entre salud mental y atención básica: relato de experiencia del Pet-Salud en la ciudad de Parnaíba-PI

O presente artigo pretende apresentar o relato de experiência de integrantes do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) - Rede de Atenção Psicossocial (RAPS), em uma Unidade Básica de Saúde da cidade de Parnaíba-PI. A experiência possibilitou aos participantes observar os desafios na construção de uma atenção integral à saúde mental, na efetivação de linhas de cuidado e de implantação de tecnologias de cuidado, como o Apoio Matricial, bem como as dificuldades dos profissionais da Atenção Básica ao trabalhar a Saúde Mental. Com a observação participante, que supôs visitas domiciliares, rodas de conversa intersetoriais e multiprofissionais, e a corresponsabilização pelos casos, pôde-se conhecer a rede de atenção psicossocial e entender os processos que levam a uma fragilidade e não efetivação das propostas da Reforma Psiquiátrica na realidade local. Percebe-se a necessidade de uma mudança cultural no sentido de incorporar uma visão psicossocial.

The aim of this paper is to report the experience of members of the Educational Program for Health Work (PET-Saúde), Psychosocial Care Network, in a Primary Health care facility in the city of Parnaíba, Brazil. The experience enabled participants to observe the challenges in creating comprehensive mental health care, in the implementation of the effectiveness of care strategies and care technology deployment, such as the Multiprofessional Support, and the difficulties of professionals in primary care when working with Health Mental Care. Through participant observation, which supposed homecare, intersectoral and multidisciplinary meetings, and co-responsibility for the cases, it was possible to know the psychosocial care network and understand the processes which lead to fragility and non-effectiveness of the proposals of the Brazilian psychiatric reform in local reality. There is a need for a cultural change in the sense of incorporating a psychosocial vision.

El presente artículo pretende presentar el relato de la experiencia de los miembros del Programa de Educación por el Trabajo para la Salud (PET-Salud) - Red de Atención Psicosocial, en una Unidad Básica de Salud de la ciudad de Parnaíba-PI. La experiencia ha posibilitado a los participantes observar los desafíos en la construcción de una atención integral a la salud mental, la efectuación de líneas de cuidado e de implantación de tecnologías de cuidado, como el Apoyo Matricial, bien como las dificultades de los profesionales de la Atención Básica al trabajar la Salud Mental. A través de la observación participante, que ha supuesto visitas domiciliares, reuniones intersectoriales y multiprofesionales, y la corresponsabilización por los casos, se pudo conocer la red de atención psicosocial y comprender los procesos que llevan a una fragilidad y no efectuación de las propuestas de la Reforma Psiquiátrica en la realidad local. Se percibe la necesidad de un cambio cultural en el sentido de incorporar una visión psicosocial.

Metagenomics analysis of red blood cell and fresh-frozen plasma units.

BACKGROUND: Although the risk of transmitting infectious agents by blood transfusion is dramatically reduced after donor selection, leukoreduction, and laboratory testing, some could still be present in donor's blood. A description of metagenomes in blood products eligible for transfusion represents relevant information to evaluate the risk of pathogen transmission by transfusion. STUDY DESIGN AND METHODS: Detection of viruses, bacteria, and fungi genomes was made by high-throughput sequencing (HTS) of 600 manufactured blood products eligible for transfusion: 300 red blood cell (RBC) and 300 fresh-frozen plasma (FFP) units. RESULTS: Anelloviruses and human pegivirus, frequent in the blood of healthy individuals, were found. Human papillomavirus type 27 and Merkel cell polyomavirus, present on the skin, were also detected. Unexpectedly, astrovirus MLB2 was identified and characterized in a FFP unit. The presence of astrovirus MLB2 was confirmed in donor's blood and corresponded to an asymptomatic acute viremia. Sequences of bacteria and fungi were also detected; they are likely the result of environmental contamination. CONCLUSION: This study demonstrates that HTS is a promising tool for detecting common and less frequent infectious pathogens in blood products.

Sutura circunferencial da mama com agulha de Brito-Moscozo: técnica alternativa para sutura dos pilares nas mamoplastias / Circumferential suture of the breast with the Brito-Moscozo needle: an alternative suture technique for the breast pillars during mammoplasty

INTRODUÇÃO: A mamoplastia é uma das cirurgias plásticas mais realizadas no mundo. Diversas técnicas são descritas para redução do volume mamário e mastopexia. A fixação dos pilares da mama tem sido feita tradicionalmente com suturas a partir do centro da mama, empregando agulhas padronizadas, comercialmente disponíveis, com objetivo de manter a forma cônica da mama. O artigo relata uma técnica alternativa para sutura dos pilares da mama nas mamoplastias, empregando suturas circunferenciais, utilizando a agulha de Brito-Moscozo. MÉTODO: Foi descrita a técnica de sutura circunferencial dos pilares da mama e material empregado. RESULTADOS: No período de dezembro de 2013 a janeiro de 2015 foram operados 22 casos de Mamoplastia redutora e mastopexia com sutura circunferencial dos pilares. Não houve complicações relacionadas à técnica empregada. CONCLUSÃO: Pôde-se constatar a aplicabilidade da sutura circunferencial dos pilares da mama com emprego da agulha de Brito-Moscozo, como alternativa à sutura clássica no centro da mama, em todos os casos operados, com menos uso de suturas e menor tempo cirúrgico.

INTRODUCTION: Mammoplasty is one of the most common plastic surgeries in the world. Several techniques have been described for breast volume reduction and mastopexy. For maintaining the conical shape of the breast, breast pillars have been traditionally fixed with sutures from the center of the breast by using commercially available standardized needles. This paper reports an alternative suture technique that uses a Brito-Moscozo needle to create circumferential sutures around the breast pillars during mammoplasty. METHODS: We describe a circumferential suture technique for the breast pillars and the material used. RESULTS: From December 2013 to January 2015, 22 cases of reduction mammoplasty and mastopexy were performed with circumferential sutures around the breast pillars. No complications related to the technique were observed. CONCLUSION: This study verified the applicability of our circumferential suture technique that used a Brito-Moscozo needle to fix the breast pillars. In all the patients who underwent the procedure as an alternative to conventional suture in the center of the breast, fewer sutures and shorter surgical time were required.

Agreement of skin test with IL-4 production and CD40L expression by T cells upon immunotherapy of subjects with systemic reactions to Hymenoptera stings.

Venom immunotherapy is the only curative intervention for subjects with Hymenoptera venom allergy who suffering systemic reactions upon bee or wasp stings. Venom immunotherapy can restore normal immunity against venom allergens, as well as providing to allergic subjects a lifetime tolerance against venoms. Nevertheless, it is necessary using safety assays to monitoring the development of tolerance in the VIT protocols to avoid fatal anaphylactic reactions. The purpose of this study was to assess the modifications in several markers of tolerance induction in subjects with Hymenoptera venom allergy undergoing immunotherapy. The studies were performed at baseline time and after six month of VIT. Intradermal skin tests, basophil activation tests, specific IgE levels; and the T-cell markers (IL-4 and IFN-γ producing cells; and expression of the surface activation markers CD40L and CTLA-4) were assayed. At six month of immunotherapy all parameters studied had significant alterations. All decreased, except the IFN-γ producing cells. In addition, modifications in intradermal skin test showed a significant correlation with both, CD40L expression on CD4 T lymphocytes (p=0.043) and IL-4 producing T lymphocytes (p=0.012). Neither basophil activation test nor serum levels of sIgE demonstrated any correlation with the immunological parameters studied nor among them. These results suggest that both IL-4 production and CD40L expression could be two good indicators of the beneficial effects of venom immunotherapy which translate into skin tests.

Desarterialización hemorroidal transanal. Una nueva alternativa quirúrgica / Transanal hemorrhoidal dearterialization. A new surgical alternative

La desarterialización hemorroidal es una técnica desarrollada en la última década, que consiste en la ligadura de la arteria hemorroidal a través de un proctoscopio que contiene un Doppler, con la subsecuente pexia de la mucosa. Objetivo: Analizar la factibilidad de la generalización de este procedimiento, mencionando sus ventajas y posibles desventajas en la utilización del mismo. Métodos: Se realizó un estudio descriptivo en el cual se incluyeron 41 pacientes (20 masculinos y 21 femeninas) en edades entre 23 y 55 años, con hemorroides II, III sintomáticas y IV sin síntomas de defecación obstruida, intervenidos en el Servicio de Cirugía 2 del Hospital Domingo Luciani y en la Unidad de Colon, Recto y Ano del Centro Clínico Leopoldo Aguerrevere, desde junio de 2012 hasta marzo de 2014. La técnica consiste en la ligadura de las ramas terminales de las arterias hemorroidales en radiales 1, 3, 5, 7,9 y 11. El tiempo promedio del procedimiento fue de 39.26 minutos. El seguimiento de los pacientes se realizó a la semana, a los quince días, al mes y a los 3 meses, valorando satisfacción de la técnica en base a dolor, reducción del prolapso y complicaciones. Resultados: Se logró el seguimiento de 41 pacientes en consulta, el 48.8% con rango de edad entre 31-40 años, 61% con hemorroides III, 27% hemorroides II y el 12% hemorroides IV. Durante el procedimiento quirúrgico se realizaron 6 pexias en el 80.5%. Los plicomas se resecaron en todos los pacientes que lo presentaban. Los síntomas referidos en los primeros 7 días en forma individual o asociado a otro síntoma fueron tenesmo 68.3%, molestia perianal en 39%, dolor moderado en 21.9%, dolor intenso en 14.6%, dolor leve y sangrado en 9.7% y trombosis en 2.4%, igualmente 14.6% no refirieron ninguna sintomatología. Al relacionar la exéresis de los plicomas con el dolor perianal observamos dolor intenso en 15.4% de los pacientes a quienes se le retiraron los plicomas y en el 25% de los pacientes a quien no se le realizó exéresis. El grado de satisfacción de la técnica en el post operatorio inmediato es bueno en 39% y muy bueno en 34%, solo fue malo en 3%. Al aplicar una escala de visualización análoga del dolor se observa una tendencia progresiva en los controles sucesivos en EVA 0-1 19.5% a los 15 días, 78% a los 30 días y 85.3% a los 90 días. En los pacientes sometidos a manometría anorrectal se evidencio un incremento en las presiones de reposo. El 83% se reintegró a sus actividades habituales en promedio a las 3 semanas del postoperatorio. No se presentaron complicaciones mayores, el prolapso de algún paquete hemorroidal se presentó en el 29.4% de los pacientes. Conclusiones: THD es un método seguro, poco invasivo, con buenos resultados para el tratamiento de pacientes, bien seleccionados, con hemorroides II, III y IV. Se deben realizar futuros ensayos controlados comparando con otros procedimientos, para demostrar la ventaja real y definir las indicaciones adecuadas realizando pruebas fisiológicas, además de llevar un control a largo plazo(AU)

Hemorrhoid dearterialisation is a technique developed in the last decade, consisting of ligation of hemorrhoidal artery through a proctoscope which contains a Doppler, with the subsequent mucosal pexy. Objective: To analyze the feasibility of the generalization of this procedure, mentioning its advantages and possible disadvantages in the use of the same. Methods: We conducted a descriptive study which included 41 patients (20 male and 21 female) ages between 23 and 55 years, with II, symptomatic III and IV haemorrhoids without symptoms of obstructed defecation, operated in the service of Surgery 2 of the Hospital Domingo Luciani and Unit of Colon, Rectum and Anus at the Centro Clínico Leopoldo Aguerrevere, from June 2012 to March 2014. The technique involves the ligation of terminal branches of the hemorrhoidal arteries in radial 1, 3, 5, 7.9 and 11. The average time of the procedure was 39.26 minutes. The follow-up of the patients was carried out a week, fifteen days, a month and three months, assessing satisfaction of the technique based on pain, reduction of prolapse and complications. Results: Were follow-up 41 patients in consultation, the 48.8% with age range between 31-40 years, 61% with hemorrhoids III, 27% hemorrhoid II and 12% hemorrhoid IV. During the surgical procedure were 6 pexy the 80.5%. The plicomas be resected in all patients presenting with it. The symptoms referred to in the first 7 days individually or associated to other symptoms were tenesmus 68.3%, 39%, moderate in 21.9 pain perianal discomfort %, severe pain in 14.6%, bleeding and mild pain in 9.7% and thrombosis in 2.4%, also 14.6% not reported any symptoms. To relate the resection of plicomas with perianal pain it was observed severe pain in 15.4% of the patients resected to 25% of patients not resected. Immediate postoperative satisfaction was good at 39 % and very good at 34 %, it was just bad at 3 %. To apply a scale of analog display of pain there is a progressive tendency in the successive controls at 0-1 19.5% at 15 days, 30 days 78% and 85.3% at 90 days. In patients undergoing anorectal manometry were demonstrated an increase in resting pressures. 83% returned to their usual activities on average at 3 weeks of the postoperative period. There were no major complications, some package hemorrhoidal prolapse was presented at the 29.4% of the patients. Conclusions: THD is a safe method, minimally invasive, with good results in the treatment of well selected patients with hemorrhoids II, III and IV. Future controlled trials comparing with other procedures, to demonstrate the real advantage and define appropriate physiological indications, as well as to control long-term studies should be performed(AU)

Perfil sexual de adolescentes universitários de um curso de graduação em enfermagem / Perfil sexual de los adolescentes de la universidad de un curso de la graduacion en el oficio de enfermera / Sexual profile of university adolescents of a course of graduation in nursing

Trata-se de um estudo descritivo, transversal, realizado com 79 adolescentes universitários do curso de enfermagem de uma universidade pública do interior do Piauí, no período de agosto a setembro de 2010. O objetivo foi caracterizar os adolescentes universitários quanto aos aspectos sociodemográficos e sexuais. O perfil dos adolescentes investigados foi ser do sexo feminino, solteiro, com renda individual mensal de até um salário mínimo, possuir idade média de 18,4 anos, não possuir filhos e coabitar com os familiares. Quanto aos comportamentos sexuais, verificou-se que a idade média da menarca foi de 12,2 anos e a da coitarca, 16,9. O preservativo foi o método mais difundido entre os adolescentes, seguido do anticoncepcional oral combinado. Dos que iniciaram a vida sexual, mais da metade relatou ter sido planejada. Assim, percebe-se que a implementação da saúde sexual e reprodutiva na adolescência deve ser considerada uma ação prioritária para eliminar os riscos a que os jovens estão propensos.

This is a descriptive, transversal study, carried through with 79 adolescents university of nursing course in a Public University of the backlands of Piauí state, in the period of August to September of 2010. The objective was to characterize the adolescents university about to the sociodemographic and sexual aspects.The profile of the investigated adolescents was to be feminine, maiden, with individual monthly income to 1 minimum salary, with an average age of 18,4 years, not to possess children and to cohabit with the familiar ones. About to the sexual behaviors the average age of the menarche was 12,2 years and 16,9 years to the first sexual intercourse. The condom was the most referred method between the adolescents, followed by the combined oral contraceptive. Between the adolescents that had the sexual initiation more than half reported being planned. Thus, it is perceived that the implementation of the sexual and reproductive health in the adolescence must be considered a priority action to eliminate the risks the one that the current young is inclined.

Es un estudio descriptivo, transversal, realizado con 79 adolescentes universitarios del curso de enfermería en una universidad pública del interior del estado de Piauí, en el período de agosto a septiembre de 2010. El objetivo fue caracterizar los adolescentes universitarios sobre los aspectos sociodemográficos y sexuales. El perfil de los adolescentes investigados fue ser femenino, soltera, con el ingreso mensual hasta un salario mínimo, con una edad media de 18,4 años, no poseen niños y conviven con los familiares. Acerca de las conductas sexuales, la media de edad de la menarca fue 12,2 años y 16,9 años para la primera relación sexual. El condón es el método más mencionado entre los adolescentes, seguido por los anticonceptivos orales combinados. Entre los adolescentes que ya tenían la iniciación sexual más de la mitad reportaron haber sido planeado. Por lo tanto, se percibe que la aplicación de la salud sexual y reproductiva en la adolescencia debe ser considerada como una acción prioritaria para eliminar los riesgos a los que los jóvenes actuales se inclinan.

Intervenção da Terapia Ocupacional com idosos que apresentam queixas de memória da Liga de Saúde do Idoso da Faculdade de Medicina do ABC / Occupational Therapy intervention in elderly patients who present memory complaints of the Elderly Health League of the Faculdade de Medicina do ABC

Introdução: A Terapia Ocupacional foi incorporada à Liga de Saúde do Idoso (LSI) da Faculdade de Medicina do ABC (FMABC), juntamente com profissionais de Medicina, Enfermagem e Fisioterapia, para realizar assistência integral ao idoso, possibilitando àqueles com queixas de memória a realização de atividades com significado para descobrir seus interesses, habilidades e capacidades na construção e resgate dos afazeres cotidianos. Objetivo: Incentivar a independência e autonomia dos idosos, bem como estimular o desenvolvimento da memória, facilitando a produção da história de vida de cada indivíduo. Material e método: Foram realizados 15 encontros semanais de 60 minutos cada, com 8 idosos, no Ambulatório de Especialidades da FMABC. Resultados: Constatou-se que a assistência integral destinada a essa população auxiliou na promoção da saúde e qualidade de vida. Com relação à memória, durante os encontros, os idosos disseram perceber sua melhora, uma vez que iniciaram seu treino no grupo e em suas casas. Também verificou-se que, para além das queixas de memória, o grupo teve papel importante na ampliação das redes sociais dos idosos e alguns demonstraram motivação para pensar e executar outros projetos de vida para o futuro. Conclusões: Houve diminuição de queixa da memória, promoção da participação social, autonomia e criação de projetos de vida frente a essa etapa, que nem sempre é permeada somente por perdas.

Introduction: The Occupational Therapy was incorporated to the Elderly Health League of Faculdade de Medicina do ABC (FMABC) jointly to medical, nursery and physiotherapy professionals to integrally assist the elderly, thus enabling those with memory complaints to do significant activities to find their interests, abilities, and capabilities in the construction and recovery of daily activities. Objective: To enhance elderly independence and autonomy, as well as to stimulate memory development, facilitating life history production of each individual. Material and method: We carried out 15 weekly meetings of 60 minutes each, with 8 elderly, in the Specialty Outpatient Clinic of FMABC. Results: Our data ascertained that integral assistance assigned to this population improved health promotion and quality of life. Regarding memory, the elderly reported they have noticed their improvement during the meetings, as they started the training activities within the group and also at home. We also verified that, beside the complaints related to memory problems, the group had an important role in enlarging the elderly social networks, and some of them became motivated to think about and to execute other future life projects. Conclusions: The memory problems diminished, social participation increased, and also occurred the development of autonomy and creation of life projects in this life stage, which is not always permeated only by losses.

Desafios da atenção básica em saúde: a experiência de Vila Mariana, São Paulo, Brasil / Challenges in primary health care: the experience in Vila Mariana District, São Paulo, Brazil

Este artigo apresenta resultados de estudo de caso visando identificar desafios na oferta de atenção básica à saúde em um distrito de saúde da cidade de São Paulo, Brasil, considerando integralidade como dispositivo organizador do trabalho neste nível de atenção. Foram estudadas as cinco unidades que compõem a rede de atenção básica à saúde no distrito considerado. Os dados foram coletados mediante observação dos fluxos e rotinas de atendimento, realização de entrevistas com gerentes e profissionais de diferentes formações e ainda realização de grupos focais com equipes de saúde da família. A análise mostra um descompasso entre as características da clientela e suas necessidades presumidas e as ofertas dos serviços, e heterogeneidade nas percepções dos profissionais sobre seu trabalho. Falta de profissionais, de tempo, e dificuldades para encaminhamentos foram os principais problemas apontados pelos entrevistados.

This article presents the results of a case study aimed at identifying challenges for the delivery of primary health care in a health district in the city of São Paulo, Brazil, considering comprehensiveness as a central device for organizing work at this level of care. Five units in the district's primary care network were studied. We collected the data by observing work routines and flows, conducting interviews with managers and health professionals from different backgrounds, and through focus groups with family health teams. The analysis shows a mismatch between users' characteristics and their presumed needs and the heterogeneity of the health professionals' perceptions concerning their work. Lack of staff and time and difficulties with referrals were the main problems identified by interviewees.

Reconstrução microcirúrgica em cirurgia de cabeça e pescoço

Objetivo: Exemplificar a importância da reconstrução plástica microcirúrgica para o tratamento cirúrgico pleno de pacientes com tumores malignos avançados em cabeça e pescoço e crânio-maxilo-facial. Método: Relato de quatro casos de doença maligna em cabeça e pescoço em pacientes com doença avançada, a maioria recidivada e que pode ser tratada cirurgicamente em razão da reconstrução plástica microcirúrgica. Resultados: Caso 1-E.S., sexo masculino, 27 anos, atendido em julho de 2005, apresentando dermatofibrosarcoma protuberante acometendo toda região frontal, tendo sido submetido a três cirurgias prévias com recidivas, estadiado como T4N0M0 de pele. Feito remoção ampla do tumor com ressecção de periósteo e segmento de tábua externa de osso frontal e reconstrução com retalho livre de antebraço esquerdo, em seguimento há três anos livre de doença. Caso 2 -J.B.L.S., sexo masculino, 22 anos, atendido em agosto de 2005, com diagnóstico de ameloblastoma de mandíbula, já operado por duas vezes com recidiva local e há três meses com crescimento acelerado acometando todo arco mandibular direito do paciente. Submetido a ressecção tumoral e esvaziamento cervical ipsilateral com reconstrução microcirúrgica com retalho livre de fíbula. O laudo anatomopatológico revelou transformação maligna para carcinoma amelablástico com seis gânglios metastáticos pT4pN2bpMx. O paciente foi encaminhado para complementação terapêutica com radio e quimioterapia, evoluindo com confirmação de metástase pulmonar bilateral seis meses após e óbito em oito meses após a cirurgia. Caso 3 - L.S., sexo masculino, 13 anos, negro, atendido no HAM, em abril de 2005, com história de carcinoma escamocelular em região submentoniana. O paciente havia sido operado por duas vezes, a primeira aos nove anos e com recidiva e quelóide nas cicatrizes, estadiado como T4N0M0 de pele...

Treatment of chronic neuropathic pain by motor cortex stimulation: results of a bicentric controlled crossover trial.

BACKGROUND: Chronic motor cortex stimulation (MCS) with surgically implanted epidural electrodes has been proposed as a treatment for neuropathic pain refractory compared with medical treatment. However, no prospective controlled trial has been published to provide convincing evidence of MCS analgesic efficacy. OBJECTIVE: To compare MCS analgesic efficacy between "ON"- and "OFF"-stimulation conditions in a double-blinded crossover trial. METHODS: Ten patients with chronic neuropathic pain of either peripheral or central origin underwent MCS implantation in two centers (Créteil, France, and Mexico City, Mexico). At the end of the second postoperative month, patients were randomly assigned into two groups. In the first group, the stimulator was switched "OFF" for two weeks and then was switched "ON" for the next 2 weeks. The opposite sequence was applied in the second group. Preoperative and postoperative assessment (until 1 year after surgery) was performed using visual analogue scale (VAS), verbal scale (VS), Wisconsin brief pain questionnaire (WBPQ), McGill pain questionnaire (MPQ), McGill quality of life scale, and medication quantification scale. RESULTS: During the crossover trial, VAS, VS, WBPQ, and MPQ scores were significantly reduced in the"ON"- compared with the "OFF"-stimulation condition. One year after surgery, all clinical scores were significantly reduced compared with preoperative values. In particular, MCS decreased the affective MPQ subscore relative to the sensory MPQ subscore. Six of the 10 patients clearly benefited from MCS treatment. CONCLUSIONS: These results were in favor of real analgesic effects produced by MCS with no loss of benefit over time. The differential changes in MPQ subscores suggested that MCS relieved pain by acting predominantly on its affective aspect. The decrease in pain intensity was associated with improved daily living activities and quality of life and reduced consumption of analgesic medication.

Double-blind, randomized controlled pilot study of bilateral cerebellar stimulation for treatment of intractable motor seizures.

PURPOSE: The efficacy and safety of cerebellar stimulation (CS) was reevaluated in a double-blind, randomized controlled pilot study on five patients with medically refractory motor seizures, and especially generalized tonic-clonic seizures. METHODS: Bilateral modified four-contact plate electrodes were placed on the cerebellar superomedial surface through two suboccipital burr holes. The implanted programmable, battery-operated stimulator was adjusted to 2.0 microC/cm(2)/phase with the stimulator case as the anode; at this level, no patient experienced the stimulation. Patients served as their own controls, comparing their seizure frequency in preimplant basal phase (BL) of 3 months with the postimplant phases from 10 months to 4 years (average, eight epochs of 3 months each). During the month after implantation, the stimulators were not activated. The patient and the evaluator were blinded as to the next 3-month epoch, as to whether stimulation was used. The patients were randomized into two groups: three with the stimulator ON and two with the stimulator OFF. After a 4-month postimplantation period, all patients had their stimulator ON until the end of the study and beyond. Medication was maintained unchanged throughout the study. EEG paroxysmal discharges also were measured. RESULTS: Generalized tonic-clonic seizures: in the initial 3-month double-blind phase, two patients were monitored with the stimulation OFF; no change was found in the mean seizure rate (patient 1, 100%, and patient 5, 85%; mean, 93%), whereas the three patients with the stimulation initially ON had a reduction of seizures to 33% (patient 2, 21%; patient 3, 46%; patient 4, 32%) with a statistically significant difference between OFF and ON phase of p = 0.023. All five patients then were stimulated and monitored. At the end of the next 6 months of stimulation, the five patients had a mean seizure rate of 41% (14-75%) of the BL. The second patient developed an infection in the implanted system, which had to be removed after 11 months of stimulation; the seizures were being reduced with stimulation to a mean of one per month from a mean of 4.7 per month (BL level) before stimulation. At the end of 24 months, three patients were monitored with stimulation, resulting in a further reduction of seizures to 24% (11-38%). Tonic seizures: four patients had these seizures, which at 24 months were reduced to 43% (10-76%). Follow-up surgery was necessary in four patients because of infection in one patient and lead/electrode displacement needing repositioning in three patients. The statistical analysis showed a significant reduction in tonic-clonic seizures (p < 0.001) and tonic seizures (p < 0.05). CONCLUSIONS: The superomedial cerebellar cortex appears to be a significantly effective and safe target for electrical stimulation for decreasing motor seizures over the long term. The effect shows generalized tonic-clonic seizure reduction after 1-2 months and continues to decrease over the first 6 months and then maintains this effectiveness over the study period of 2 years and beyond.