Socioeconomic and health conditions associated with the family function of older adults.

OBJECTIVE: To verify the association of socioeconomic conditions, life habits, and health conditions to the family function of older adults assisted by a Family Health Team (FHT) in the city of Manhuaçu/Minas Gerais. METHOD: This is an analytical, cross-sectional, observational study carried out with 166 older adults assisted in an FHU, with data on their socioeconomic profile, lifestyle, and health conditions. The family function was assessed with the Apgar Family and classified as good family function or moderate/high dysfunction. The Chi-square test was applied. RESULTS: Good function was found in 89.7% of the families. Age between 60-69 years, being married, having 3-4 children, not being a pensioner, and being independent were associated with good family function (p<0.05). CONCLUSION: Families have good function and socioeconomic and health conditions were associated with family function, which reinforces the importance of studying families in order to promote better aging in the population.

Socioeconomic and health conditions associated with the family function of older adults / Condiciones socioeconómicas y de salud asociadas a la funcionalidad familiar de los mayores / Condições socioeconômicas e de saúde associados à funcionalidade familiar de idosos

ABSTRACT Objective: To verify the association of socioeconomic conditions, life habits, and health conditions to the family function of older adults assisted by a Family Health Team (FHT) in the city of Manhuaçu/Minas Gerais. Method: This is an analytical, cross-sectional, observational study carried out with 166 older adults assisted in an FHU, with data on their socioeconomic profile, lifestyle, and health conditions. The family function was assessed with the Apgar Family and classified as good family function or moderate/high dysfunction. The Chi-square test was applied. Results: Good function was found in 89.7% of the families. Age between 60-69 years, being married, having 3-4 children, not being a pensioner, and being independent were associated with good family function (p<0.05). Conclusion: Families have good function and socioeconomic and health conditions were associated with family function, which reinforces the importance of studying families in order to promote better aging in the population.

RESUMEN Objetivo: Verificar la asociación de condiciones socioeconómicas, hábitos de vida y condiciones de salud con la funcionalidad familiar de personas mayores atendidas por una Unidad de Salud de la Familia (USF) en Manhuaçu / Minas Gerais. Método: Se trata de un estudio observacional analítico, transversal, realizado con 166 ancianos de una USF con datos sobre su perfil socioeconómico, estilo de vida y condiciones de salud. La funcionalidad familiar se evaluó con la Familia Apgar y las familias clasificadas como de buen funcionamiento o disfunción moderada / alta. Se realizó la prueba de Chi-cuadrado. Resultados: Se encontró buena funcionalidad en el 89,7% de las familias. Tener entre 60 y 69 años, estar casado, tener 3-4 hijos, no ser pensionista y ser independiente se asociaron con una buena funcionalidad familiar (p <0,05). Conclusión: Las familias tienen buena funcionalidad y condiciones socioeconómicas y de salud, las cuales están asociadas a la funcionalidad familiar, lo que refuerza la importancia de estudiar en familia para promover un envejecimiento de mejor calidad de la población.

RESUMO Objetivo: Verificar a associação das condições socioeconômicas, hábitos de vida e condições de saúde com funcionalidade familiar de idosos assistidos por uma Unidade de Saúde da Família (USF) de Manhuaçu/Minas Gerais. Método: Trata-se de estudo observacional analítico e transversal realizado com 166 idosos de uma USF com dados do perfil socioeconômico, hábitos de vida e condições de saúde. A funcionalidade familiar foi avaliada com o Apgar Familiar e as famílias classificadas em boa funcionalidade ou moderada/alta disfunção. Realizou-se o teste do Chi-quadrado. Resultados: Verificou-se boa funcionalidade em 89,7% das famílias. Ter entre 60-69 anos, ser casado, possuir 3-4 filhos, não ser pensionista e ser independente se associaram à boa funcionalidade familiar (p<0,05). Conclusão: As famílias possuem boa funcionalidade e condições socioeconômicas e de saúde, as quais se associaram a funcionalidade familiar, o que reforça a importância de estudar as famílias a fim de promover um envelhecimento de maior qualidade para a população.

Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected: A report from an International Continence Society consensus working group.

AIM: Lower urinary tract symptoms (LUTS) are a common urological referral, which sometimes can have a neurological basis in a patient with no formally diagnosed neurological disease ("occult neurology"). Early identification and specialist input is needed to avoid bad LUTS outcomes, and to initiate suitable neurological management. METHODS: The International Continence Society established a neurological working group to consider: Which neurological conditions may include LUTS as an early feature? What diagnostic evaluations should be undertaken in the LUTS clinic? A shortlist of conditions was drawn up by expert consensus and discussed at the annual congress of the International Neurourology Society. A multidisciplinary working group then generated recommendations for identifying clinical features and management. RESULTS: The relevant conditions are multiple sclerosis, multiple system atrophy, normal pressure hydrocephalus, early dementia, Parkinsonian syndromes (including early Parkinson's Disease and Multiple System Atrophy) and spinal cord disorders (including spina bifida occulta with tethered cord, and spinal stenosis). In LUTS clinics, the need is to identify additional atypical features; new onset severe LUTS (excluding infection), unusual aspects (eg, enuresis without chronic retention) or "suspicious" symptoms (eg, numbness, weakness, speech disturbance, gait disturbance, memory loss/cognitive impairment, and autonomic symptoms). Where occult neurology is suspected, healthcare professionals need to undertake early appropriate referral; central nervous system imaging booked from LUTS clinic is not recommended. CONCLUSIONS: Occult neurology is an uncommon underlying cause of LUTS, but it is essential to intervene promptly if suspected, and to establish suitable management pathways.

Avaliação toxicológica da exposição à Cannabis e cocaína na gravidez em cordão umbilical humano: validação de método analítico e prospecção de biomarcadores proteicos de toxicidade / Toxicological assessment of Cannabis and cocaine exposure during pregnancy in human umbilical cord tissue: analytical method validation and prospection of protein biomarkers related to fetotoxicity

O abuso de drogas atinge aproximadamente 35 milhões de pessoas em todo planeta, sendo um problema alarmante em decorrência de graves danos à saúde, como a dependência química e intoxicações fatais. No Brasil, o número de usuários tem crescido principalmente para o consumo de produtos da Cannabis e cocaína, drogas amplamente consumidas, inclusive entre mulheres em período gestacional, trazendo à tona um novo grupo de risco. A exposição gestacional a drogas de abuso está diretamente relacionada a malformações fetais e complicações de saúde para mãe e bebê nos períodos pré- e pós-natal. Tradicionalmente, a avaliação toxicológica da exposição é realizada pela detecção da droga parental e de seus produtos de biotransformação em matrizes materno-fetais por meio de métodos bioanalíticos. Entretanto, estes ensaios não fornecem informações acerca dos impactos fisiológicos ocasionados pela exposição, deixando uma lacuna no que tange às informações sobre os mecanismos e moléculas subjacentes envolvidos em processos de toxicidade. Desse modo, o desenvolvimento de análises toxicológicas mais robustas utilizando tecnologia de ponta, que possam comprovar o uso drogas e também elucidar aspectos de toxicidade é de suma importância, pois auxiliam na compreensão do impacto biológico relativo à exposição humana a xenobióticos. Neste trabalho foram desenvolvidos ensaios bioanalíticos, utilizando o tecido do cordão umbilical para a avaliação da exposição in utero à canabinoides. Foi desenvolvido e validado método QuECheRS adaptado como preparo de amostra, no qual etapas simultâneas de extração e hidrólise alcalina de canabinoides são alcançadas, utilizando cromatografia em fase gasosa acoplada a espectrômetro de massas para detecção de delta-9-tetraidrocanabinol (THC), canabinol (CBN), 11-hidroxi-delta-9-tetraidrocanabinol (11-OHTHC) e 11-nor-9-carboxi-tetrahidrocanabinol (THC-COOH). Também foram desenvolvidas metodologias utilizando LC-MS/MS e Trapped Ion Mobility Mass Spectrometry para análise de proteoma de cordão umbilical humano em diferentes regiões, no intuito de identificar biomarcadores proteicos relativos à fetotoxicidade do uso de drogas na gravidez. Até o presente momento, QuECheRS é utilizado pela primeira vez como abordagem bioanalítica para avaliação de drogas ilícitas em matrizes teciduais materno-fetais e mostrou-se satisfatório para detecção de produtos da Cannabis. Nos ensaios proteômicos, foram identificados potenciais biomarcadores de fetotoxicidade, como as moléculas ACTA 2, Collagen alpha-1 (XVIII), SMC1A, KNL1, KMT2A, em tecidos expostos à Cannabis e/ou cocaína. Tais macromoléculas estão correlacionadas a malformações embriogênicas e complicações de saúde na vida intra-uterina. As metodologias desenvolvidas neste trabalho podem ser úteis para uma melhor avaliação da toxicidade do uso de drogas na gravidez, fornecendo novas pistas sobre a exposição e/ou efeitos tóxicos significativos considerados na avaliação de risco

Drug abuse affects approximately 35 million people worldwide and can be considered a significant burden on society due to severe health problems, e.g. drug addiction and fatal poisonings. In Brazil, the number of users has been growing related to Cannabis and cocaine products, drugs widely used, including among women in gestational period, bringing up a new risk group. Gestational exposure to drugs of abuse is directly related to fetal malformations and health complications for mother and babies in the pre- and postnatal periods. Traditionally, toxicological assessment of exposure is performed by detecting the parent drug and its biotransformation products in maternal-fetal matrices using bioanalytical methods. However, these assays do not provide information about the physiological impacts caused by exposure, leaving a lack of information about the pathways and molecules involved in toxicity processes. Thus, the development of robust toxicological analyzes using cutting-edge technologies in order to prove drug use and also elucidate aspects of toxicity is very important, as they help in understanding the biological impact of human exposure to xenobiotics. Herein, bioanalytical methods using umbilical cord tissue to assess in utero exposure to cannabinoids were developed. A QuECheRS method was developed fully validated as a sample preparation technique for simultaneous extraction and alkaline hydrolysis of cannabinoids, using gas chromatography coupled to mass spectrometry to detect the analytes delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), 11-hydroxydelta-9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH). LC-MS/MS based proteomics and Trapped Ion Mobility Mass Spectrometry were also developed in order to identify protein biomarkers related to fetotoxicity of drug use in pregnancy. Our works represents the first use of QuECheRS for evaluation of illicit drugs in maternal-fetal tissue and was suitable for detection of Cannabis products. In the proteomic assays, potential biomarkers of fetotoxicity were identified in the exposed tissues, such as ACTA 2, Collagen alpha-1 (XVIII), SMC1A, KNL1, KMT2A. These proteins are related to embryogenic malformations and health complications in intrauterine life. The methodologies developed in this project may be useful for a better assessment of the toxicity of drug use in pregnancy, providing new clues about exposure and/or significant toxic effects that should be considered in the risk assessment

Evaluation of a single extraction test to estimate the human oral bioaccessibility of potentially toxic elements in soils: Towards more robust risk assessment.

Intake of soil by children and adults is a major exposure pathway to contaminants including potentially toxic elements (PTEs). However, only the fraction of PTEs released in stomach and intestine are considered as bioaccessible and results from routine analyses of the total PTE content in soils, therefore, are not necessarily related to the degree of bioaccessibility. Experimental methods to determine bioaccessibility usually are time-consuming and relatively complicated in terms of analytical procedures which limits application in first tier assessments. In this study we evaluated the potential suitability of a recently developed single extract method (ISO-17586:2016) using dilute (0.43M) nitric acid (HNO3) to mimic the bioaccessible fraction of PTEs in soils. Results from 204 soils from Portugal, Brazil and the Netherlands including all major soil types and a wide range of PTEs' concentrations showed that the extraction efficiency using 0.43M HNO3 of Ba, Cd, Cu, Ni, Pb and Zn in soils is related to that of in vitro methods including the Simple Bioaccessibility Extraction Test (SBET) and Unified BARGE Method (UBM). Also, differences in the degree of bioaccessibility resulting from differences in parent material, geology and climate conditions did not affect the response of the 0.43M HNO3 extraction which is a prerequisite to be able to compare results from different soils. The use of 0.43M HNO3 as a first screening of bioaccessibility therefore offers a robust and representative way to be included in first tier standard soil tests to estimate the oral bioaccessibility. CAPSULE: The single dilute (0.43M) nitric acid extraction can be used in first tier soil risk assessment to assess both geochemical reactivity and oral bioaccessibility of PTEs.

Laboratory assessment of divaricatic acid against Biomphalaria glabrata and Schistosoma mansoni cercariae.

In this study, the molluscicidal and antiparasitic activities of divaricatic acid was evaluated, targeting the mollusc Biomphalaria glabrata and cercariae of the helminth Schistosoma mansoni. In addition, the environmental toxicity of divaricatic acid was assessed by bioassay using the microcrustacean Artemia salina. Divaricatic acid showed high toxicity against both adult snails (5µg/mL) and embryos (20µg/mL after 6h of exposure). Similar activity was observed in Schistosoma mansoni cercariae after only a short exposure time (10µg/mL after 30min of exposure). The divaricatic acid did not show toxicity in the acute test using Artemia salina at concentrations equal to or below 200µg/mL. The divaricatic acid proved to be a promising substance for the elimination of the snail Biomphalaria glabrata, an intermediate host of schistosomiasis, as well as the cercariae of the pathogen, while being non-toxic to the Artemia salina at the same concentrations. This is the first experimental observation of the molluscicidal and cercaricide activity of divaricatic acid.

Electroencephalography as a post-stroke assessment method: An updated review. / Electroencefalografía como método de evaluación tras un ictus. Una revisión actualizada.

Given that stroke is currently a serious problem in the population, employing more reliable and objective techniques for determining diagnosis and prognosis is necessary in order to enable effective clinical decision-making. EEG is a simple, low-cost, non-invasive tool that can provide information about the changes occurring in the cerebral cortex during the recovery process after stroke. EEG provides data on the evolution of cortical activation patterns which can be used to establish a prognosis geared toward harnessing each patient's full potential. This strategy can be used to prevent compensation and maladaptive plasticity, redirect treatments, and develop new interventions that will let stroke patients reach their new maximum motor levels.

Risk assessment for Cd, Cu, Pb and Zn in urban soils: chemical availability as the central concept.

To assess the geochemical reactivity and oral bioaccessibility of Cd, Cu, Pb and Zn in urban soils from the Porto area, four extractions were performed including Aqua Regia (AR; pseudototal), 0.43 M HNO3 (reactive), 0.01 M CaCl2 (available), and 0.4 M glycine at pH = 1.5, SBET method (oral bioaccessible pool). Oral bioaccessibility in urban soils was higher than in samples from rural, industrial and mining areas which is most likely related to sources of metals and parent materials of corresponding soils. The availability and reactivity were described well by non-linear Freundlich-type equations when considering differences in soil properties. The resulting empirical models are able to predict availability and reactivity and can be used to improve the accuracy of risk assessment. Furthermore, a close 1:1 relationship exists between results from the 0.43 M HNO3 method and the SBET method which substantially facilitates risk assessment procedures and reduces analytical costs.

Avaliação e tratamento da dor em oncologia pediatrica / Pain assessment and treatment in children with oncological diseases

Nos últimos anos ocorreu considerável melhora na sobrevida das crianças com câncer. Nos últimos anos ocorreu considerável melhora na sobrevida das crianças com câncer. Entretanto, apesar da crescente conscientização sobre as causas e tratamento da dor, estudos mostram que essas crianças continuam a experimentar diariamente sintomas angustiantes, físicos e emocionais causados pela doença e seu tratamento. O objetivo deste trabalho foi revisar a literatura a respeito das particularidades associadas à dor infantil relacionada ao câncer, salientando as suas principais causas assim como as possibilidades terapêuticas disponíveis. Foram revisados artigos referentes ao tema proposto, publicados nos últimos 20 anos, entre janeiro de 1990 e novembro de 2010, utilizando as bases Scientific Eletronic Library Online (SCIELO) e National Library Of Medicine ­ PubMed (MEDLINE). A chave para o controle da dor é a obtenção de uma avaliação detalhada por equipe multidisciplinar para o desenvolvimento de um plano de tratamento específico para cada criança, com frequentes reavaliações. Apesar de algumas limitações, a escada analgésica da Organização Mundial de Saúde serve como pilar para o tratamento desses pacientes, contribuindo para o alívio da dor oncológica em todo o mundo. Para melhor abordagem, terapias combinadas (farmacológicas e não farmacológicas) devem ser utilizadas adaptando-se às necessidades individuais, com o objetivo de minimizar a dor e os efeitos adversos do tratamento. (AU)

In recent years there has been a considerable improvement in survival of children with cancer. However, despite growing awareness about the causes and treatment of pain, studies show that these children continue to experience daily physical and emotional distressing symptoms caused by the disease and its treatment. The aim of this study was to review the literature regarding the particularities associated with children pain related to cancer, highlighting their main causes and therapeutic possibilities available. We reviewed articles relating to the proposed theme published from the last 20 years, between January 1990 and November 2010 using the bases Scientific Electronic Library Online (SciELO), National Library Of Medicine ­ PubMed (MEDLINE). The key to pain control is to obtain a detailed evaluation by a multidisciplinary team to develop a specific treatment plan for each child, with frequent reassessments. Despite some limitations, the analgesic ladder of the World Health Organization serves as a pillar to treat these patients, providing pain relief worldwide. For a better pain management, combined therapies (pharmacological and nonpharmacological) should be used adapted to individual needs, in order to minimize pain and side effects of treatment.(AU)

[Body composition assessment and body image perception in a group of University females of the Basque Country]. / Valoración de la composición corporal y de la percepción de la imagen en un grupo de mujeres universitarias del País Vasco.

OBJECTIVE: [corrected] To assess the body image perception and to compare the results with the true measurements in a group of university students. SUBJECTS: Participants were 28 volunteer females recruited from the degree in Human Nutrition and Dietetic from the University of the Basque Country (Spain). All participants gave their informed consent. The mean (SD) age of the participants was 22.01 (2.12) years (20,23-28,25). METHODS: Anthropometric measurement estimated directly and the derived indexes were compared with reference values. The assessment of body image perception was made using a somatomorphic software. The difference between the perceived measurements and the ideals were used as measure of body dissatisfaction. Data were analyzed using SPSS vs 14.0. RESULTS AND DISCUSSION: Prevalence of overweight and obesity was 10.7%, and of under-weight was 70.1%. The body fat perception was well, while the perception of the muscle index was significantly different from the real measure (3.91+/-2.75 kg/m2; P<0.001). The level of body dissatisfaction was higher for the body fat (6.00+/-8.61%; P<0.001) than for the muscle index (1.65+/-2.82 kg/m2; P<0.01). This result can be justified for the present canons of beauty and for the overvaluation of the thinness. Additional research is needed to further know the relation between female body image and true measurements of body composition. Future research will allow to compare the results with other populations.

Development of low-cost metal oxide pH electrodes based on the polymeric precursor method.

In this work, the polymeric precursor method was used to prepare low-cost solid-state sensors for pH determination based on iridium oxide as the main pH sensitive material. The iridium content was reduced with addition of TiO(2), forming the binary system IrO(x)-TiO(2), whose electroanalytical properties were evaluated in comparison with a commercial glass pH electrode. The minimum iridium content which gave suitable results was 30mol%, and the electrode presented Nernstian and fast response in the pH range from 1 to 13, with no hysteresis effect observed. Besides, the electrode showed high selectivity in the presence of alkali ions as Li(+), Na(+) or K(+). The amount of iridium in the prepared electrodes was very small (<0.1mg), supporting the efficiency of this method on the simple preparation of functional low-cost pH electrodes.

Validation of avoidance assays for the screening assessment of soils under different anthropogenic disturbances.

A chemical characterization of the soil compartment per se does not supply any information about the synergistic/antagonistic effects of mixtures of chemicals, resulting in an under- or overestimation of the risks. Therefore the existence of rapid and ecologically relevant toxicity assays becomes of paramount importance, allowing the evaluation of invertebrate's behavioural parameters with equal consequences in terms of functionality of the edaphic community. The aim of this study was to evaluate the sensitivity of avoidance assays, with the earthworm Eisenia andrei, in discriminating natural soils under different anthropogenic disturbances. Although earthworms were able to discriminate soils with similar contamination, it is nonetheless questionable whether the preference for some soils is determined by the reduced bioavailability of contaminants, the great affinity of the species for organic matter-rich soils, or the inability of chemoreceptors to detect some contaminants from complex environmental mixtures, usually present in natural contaminated soils.

Applicability of the 12-Item Short-Form Health Survey in patients with progressive systemic sclerosis.

OBJECTIVE: To evaluate the applicability of the 12-Item Short-Form Health Survey (SF-12) as an instrument to measure health-related quality of life in a sample of patients with progressive systemic sclerosis (PSS) through the analysis of its reproducibility and its correlation with functional and clinical parameters. METHODS: A test-retest reproducibility study for the comparative analysis of the intraclass correlation coefficients (ICCs) of the SF-12 and the SF-36. A total of 46 patients diagnosed with PSS were studied, regardless of the presence of respiratory symptoms. RESULTS: The physical component summary 12 (PCS-12) score had an ICC of 0.47 (95%CI: 0.05-0.71; p < 0.02), whereas the mental component summary (MCS-12) score had an ICC of 0.72 (95%CI: 0.49-0.84; p < 0.001). The PCS-36 score had an ICC of 0.88 (95%CI: 0.78-0.93; p < 0.001), and the MCS-36 score also had an ICC of 0.88 (95%CI: 0.78-0.93; p < 0.001). CONCLUSION: The SF-12 is a reliable instrument for measuring health-related quality of life in patients with PSS, since it has been proven to be reproducible. However, this version of the SF-12 should only be used in clinical research settings.

Aplicabilidade do questionário de qualidade de vida relacionada à saúde - the 12-Item Short-Form Health Survey - em pacientes portadores de esclerose sistêmica progressiva / Applicability of the 12-Item Short-Form Health Survey in patients with progressive systemic sclerosis

OBJETIVO: Avaliar a aplicabilidade do questionário 12-Item Short-Form Health Survey (SF-12) como instrumento de mensuração da qualidade de vida associada à saúde em uma amostra de pacientes com esclerose sistêmica progressiva (ESP) por meio da análise de sua reprodutibilidade e de sua correlação com parâmetros clínicos e funcionais. MÉTODOS: Estudo de reprodutibilidade, do tipo teste re-teste, para análise comparativa dos coeficientes de correlação intraclasse (CCI) dos questionários SF-12 e SF 36. Foram estudados 46 pacientes com diagnóstico de ESP, independentemente da presença de sintomas respiratórios. RESULTADOS: O escore do domínio físico do SF-12, conhecido como physical component summary 12 (PCS-12) em inglês, obteve um CCI de 0,47 (IC95 por cento: 0,05-0,71; p < 0,02), enquanto o escore do domínio mental do SF-12, conhecido como mental component summary 12 (MCS-12) em inglês, obteve um CCI de 0,72 (IC95 por cento: 0,49-0,84: p < 0,001). O escore do domínio físico do SF-36 (PCS-36) obteve um CCI de 0,88 (IC95 por cento: 0,78-0,93; p < 0,001) e o escore do domínio mental do SF-36 (MCS-36) também obteve um CCI de 0,88 (IC95 por cento: 0,78-0,93; p < 0,001). CONCLUSÃO: O questionário SF-12 é um instrumento confiável para medir a qualidade de vida em portadores de ESP pois demonstrou reprodutibilidade. Contudo, esta versão do SF-12 deve ser utilizada apenas em ambiente de pesquisa clínica.

OBJECTIVE: To evaluate the applicability of the 12-Item Short-Form Health Survey (SF-12) as an instrument to measure health-related quality of life in a sample of patients with progressive systemic sclerosis (PSS) through the analysis of its reproducibility and its correlation with functional and clinical parameters. METHODS: A test-retest reproducibility study for the comparative analysis of the intraclass correlation coefficients (ICCs) of the SF-12 and the SF-36. A total of 46 patients diagnosed with PSS were studied, regardless of the presence of respiratory symptoms. RESULTS: The physical component summary 12 (PCS-12) score had an ICC of 0.47 (95 percentCI: 0.05-0.71; p < 0.02), whereas the mental component summary (MCS-12) score had an ICC of 0.72 (95 percentCI: 0.49-0.84; p < 0.001). The PCS-36 score had an ICC of 0.88 (95 percentCI: 0.78-0.93; p < 0.001), and the MCS-36 score also had an ICC of 0.88 (95 percentCI: 0.78-0.93; p < 0.001). CONSLUSION: The SF-12 is a reliable instrument for measuring health-related quality of life in patients with PSS, since it has been proven to be reproducible. However, this version of the SF-12 should only be used in clinical research settings.

Avaliação da dor na criança / Pain assessment in children

Vários métodos foram desenvolvidos com o intuito de avaliar a dor infantil. Esses métodos são aplicados de acordo com a capacidade cognitiva e a condição clínica da criança. Quatro são esses métodos. Os métodos fisiológicos como avaliação da freqüência respiratória, pulso, pressão arterial, sudorese, etc; que são mais utilizados em recém nascidos. Os métodos comportamentais que são também mais largamente utilizados em recém nascidos além de lactentes. Eles revelam como a criança responde ao estímulo doloroso. Por fim, os auto-relatos que traduzem o que a criança diz sobre a intensidade de sua dor é considerado o padrão-ouro dentre todos os métodos de avaliação existente. Métodos mistos utilizam dois ou mais dos métodos descritos. Apesar das dificuldades encontradas na avaliação da dor em crianças, ela é de grande importância, sendo necessária para dar substrato à decisão de intervir nas circunstâncias estressantes e dolorosas que acometem a criança e o adolescente enfermo.

Several methods have being developed in order to evaluate chit- dren in pain. These methods are applied in aeeordanee with both the child's cognitive capacity and clinical conditions. There are four of these methods. The physiological methods, such as respiratory frequecy, pulse, blood pressure, sweating, etec, are more commonly used in neonates. The behavioral methods more widely used in newborns and infants reveal how the child answers to the painful stimulus. The self-report, which translate what the child says about the intensity of his or her pain, is considered the gold standard among ali the other available evaluation methods. Mixed methods consist of two or more of the previously deseribed methods. Despite the difficulties found in evaluating pain in children, this evaluation is of major importanee, being necessary to serve as basis to the decision of intervening and treating the stressful and painful circumstances that are often faced by the pediatric patient.

[Experiencing diversity through home care of the elderly--challenges and advances]. / Crescendo na diversidade pelo cuidado domiciliar aos idosos--desafios e avanços.

The present article is a study about the nursing care of elderly people. The diversity of experiences generated by the care of the elderly in their homes has opened news area of research, improved and promoted the nursing care. The objective of this work is to characterize the home-care of elderly as an area of interest for the work of the nursing professionals. The study describes aspects of the dynamics of this work based on a critical analysis of an experience carried out with a group of elderly and pointing out its advances and challenges. The methodology used in this investigation were records of the experience of some elderly people who had undergone surgery and were still in need of nursing care at their homes. Results show that there were improvements in terms of the nursing practices, especially the practices of educational and ethic-legal nature. The practices of educational nature could propitiate a sense of citizenship and freedom, which are prerogatives for the lives of these people. The ethic-legal practices promoted more involvement of the nursing professionals in the interdisciplinary team.

Leprosy elimination campaign, Amazonas-Brazil 1997.

A leprosy elimination campaign (LEC) was carried out in 15 endemic areas of Amazonas State, Brazil, in 1997. The LEC concentrated effort to detect leprosy cases during a multi-vaccination national campaign for serious public health problems other than leprosy, such as polio, diphtheria, hepatitis, measles, etc. The national campaign involved intensive population mobilization, giving a valuable opportunity to examine people for leprosy. The LEC personnel included 2964 individuals (municipal and state health workers and community volunteers), distributed in 688 health units and 53 reference health centres. As a result of the LEC, 74,814 person-to-person communications in the community were given; 10,297 clinical skin examinations were conducted, and 40 new leprosy cases were detected on the day of the campaign in urban areas of the municipalities. This total was low, compared to results in other states of Brazil, possibly due to the development of health education activities and regular community services in the state of Amazonas since 1987 and to the early implementation of WHO multiple drug therapy (MDT) from 1982 onwards. Despite the fact that the LEC was carried out only in the urban areas of the municipalities, the finding of no cases of leprosy in 7 out of 15 of them was surprising and may indicate that the prevalence of hidden cases of leprosy is not all that high, at least in these areas of the Amazonas State.

Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery.

OBJECTIVE: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. DESIGN: Prospective clinical trial. SETTING: A tertiary university hospital. PATIENTS: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. MEASUREMENTS: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. RESULTS: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). CONCLUSIONS: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient's pulmonary status.

[Influence of the equality of ventricular pressure in the echocardiographic determination of the ejection fraction of the left ventricle]. / Repercussão da igualdade de pressões ventriculares na determinação ecocardiográfica da fracção de ejecção do ventrículo esquerdo.

OBJECTIVES: Limited data have been reported concerning the influence of right ventricular systolic overload on the accuracy of the 2D echocardiographic (echo) determination of left ventricular (LV) ejection fraction (EF). The normal newborn at birth (high pulmonary peak systolic pressure) and just after the fall of pulmonary pressure, represent an in vivo model to study this influence. This study compares the LVEF determined by recommended 2D echocardiographic algorithms with that by 3D echo, in newborns at birth and just after the normal fall of right ventricular systolic pressure. METHODS: 100 echocardiographic studies (50 at 2 to 6 hours after birth--group I; and 50 at 7 to 14 days old--control group) were performed in 82 normal newborns, to determine LVEF by 4 geometric models (cylinder hemiellipsoid; ellipsoid biplane; single plane area length, in 4- and 2-chamber view; biplane method of discs) and visual estimation, using 3D echocardiography as the reference method. RESULTS: In group I, the correlation between 3D echo and cylinder hemiellipsoid was r = 0.62 (SEE = 4.5%); ellipsoid biplane, r = 0.69 (SEE = 4.1%); single plane area length, 4 chambers, r = 0.66 (SEE = 5.1%) and, 2 chambers, r = 0.72 (SEE = 4.0%); biplane method of discs, r = 0.83 (SEE = 3.6%), and, visual estimation, r = 0.78 (SEE = 3.5%). In the control group, the correlation between 3D echo and cylinder hemiellipsoid was r = 0.70 (SEE = 3.4%); ellipsoid biplane, r = 0.63 (SEE = 3.4%); single plane area length, 4 chambers, r = 0.79 (SEE = 3.5%) and, 2 chambers, r = 0.76 (SEE = 4.1%); biplane method of discs, r = 0.90 (SEE = 2.3%), and, visual estimation, r = 0.64 (SEE = 3.9%). IN CONCLUSION: These data suggest that the biplane method of discs and single plane area length using 2-chamber view allows a more accurate LVEF determination when significant right ventricular pressure overload is present.