Exercise-induced anti-inflammatory effects in overweight/obese women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is characterized by exacerbated inflammation, which is implicated in cardiometabolic dysfunction. This study aimed to examine the potential effects of acute exercise on inflammatory responses in obese/overweight PCOS women and their controls. Participants underwent a single bout of moderate-intensity aerobic exercise (30 min at ∼65% of VO2peak). Blood and muscle samples were collected immediately before (PRE) and 60 min after the exercise session. Cytokines (i.e., IL-1ß, IL-6, IL-4, IL-10, TNF-α) were measured both in plasma and in skeletal muscle, and proteins related to inflammatory signaling (IKKα/ß and JNK) were assessed in skeletal muscle. At PRE, PCOS showed elevated muscle TNF-α (+62%, p = 0.0012) and plasma IL-1ß (+76%, p = 0.0010) compared to controls. In PCOS, exercise decreased plasma and muscle TNF-α (-14%, p = 0.0003 and -46%, p = 0.0003), as well as increased plasma and muscle IL-4 (+147%, p = 0.0018 and +62%, p = 0.0474) and plasma IL-10 (+38%, p = 0.0029). Additionally, IKKα/ß and JNK phosphorylation in skeletal muscle, which was higher in PCOS at PRE, was significantly reduced by exercise (-58%, p < 0.0001 and -46%, p < 0.0001, respectively), approaching control levels. Person's correlations between PRE values and delta changes (i.e., exercise effect) showed significant, negative associations for plasma IL-1ß (r = -0.92, p < 0.0001), TNF-α (r = -0.72, p = 0.0100) and IL-6 (r = -0.58, p = 0.05), and muscle TNF-α (r = -0.95, p < 0.0001), IKKα/ß (r = -0.75, p = 0.005), and JNK (r = -0.94, p < 0.0001) in PCOS. In conclusion, exercise can mitigate the inflammatory milieu in women with PCOS. The anti-inflammatory role of exercise could underlie its cardiometabolic protection in PCOS.

Relative Age Effect and ACTN3 R577X and ACE I/D Polymorphisms in Brazilian Football Players: An Association Genetic Study.

The Relative Age Effect (RAE) suggests older athletes within an annual cohort have advantages over their younger peers. We hypothesized that younger athletes could overcome these disadvantages through favorable α-actinin-3 (ACTN3) and angiotensin converting enzyme (ACE) polymorphisms. This study aimed to: 1) examine RAE prevalence among Brazilian football players; 2) investigate the distribution of the ACTN3 and ACE polymorphisms; and 3) explore the association between polymorphisms and RAE across competitive levels and positions. The sample included 627 male players from first-division Brazilian teams in four age categories: U15 (n = 172), U17 (n = 166), U20 (n = 161), and Professionals (n = 128). A control group was established using data from the general Brazilian population documented in previous studies Results showed RAE presence across all competitive levels and positions. Players with the ACTN3 R allele, especially the RR genotype, had the strongest associations with football players, particularly among defenders. On the other hand, the distribution of ACE polymorphism was not significantly different between controls and players, except in the U17 category, where the I/I genotype was more common. Relatively older players had higher total genotype scores than younger counterparts in the overall sample and defender subgroups. In conclusion, RAE is prevalent among Brazilian football players, with older athletes benefiting from favorable ACTN3 and ACE polymorphisms, contrary to our initial hypothesis.

Metabolic disturbance in PCOS: clinical and molecular effects on skeletal muscle tissue.

Polycystic ovary syndrome is a complex hormonal disorder affecting the reproductive and metabolic systems with signs and symptoms related to anovulation, infertility, menstrual irregularity and hirsutism. Skeletal muscle plays a vital role in the peripheral glucose uptake. Since PCOS is associated with defects in the activation and pancreatic dysfunction of ß-cell insulin, it is important to understand the molecular mechanisms of insulin resistance in PCOS. Studies of muscle tissue in patients with PCOS reveal defects in insulin signaling. Muscle biopsies performed during euglycemic hyperinsulinemic clamp showed a significant reduction in glucose uptake, and insulin-mediated IRS-2 increased significantly in skeletal muscle. It is recognized that the etiology of insulin resistance in PCOS is likely to be as complicated as in type 2 diabetes and it has an important role in metabolic and reproductive phenotypes of this syndrome. Thus, further evidence regarding the effect of nonpharmacological approaches (e.g., physical exercise) in skeletal muscle of women with PCOS is required for a better therapeutic approach in the management of various metabolic and reproductive problems caused by this syndrome.

Translation, reliability, and validity of the Brazilian-Portuguese version of the Brachial Plexus Outcome Measure scale (BPOM-Br).

PURPOSE: To translate and investigate inter-rater reliability, internal consistency, content validity, and construct validity of the Brazilian-Portuguese Version of the Brachial Plexus Outcome Measure Scale (BPOM-Br). MATERIAL AND METHODS: The translation followed international guidelines. Inter-rater reliability was tested with 51 individuals with Neonatal Brachial Plexus Palsy (NBPP), aged between 4 to 16 years old. To determine concurrent construct validity, children were also assessed with the Mallet Scale. Statistical analysis included Bland-Altman, Intraclass Correlation Coefficient (ICC), Floor and Ceiling and effect, and Pearson correlation. RESULTS: The majority of the sample consisted of children with upper NBPP (75.2%), mean age of 8.9 years old. BPOM-Br showed appropriate content validity (comprehensiveness) according to rehabilitation professionals. It also showed excellent inter-rater reliability (ICC = 0.90) and internal consistency (α = 0.91). Bland-Altman analysis showed bias close to zero. Finally, BPOM-Br showed overall significant positive correlations with the Mallet scale items (rs= 0.31 to 0.78 p < 0.05), indicating adequate concurrent validity. CONCLUSIONS: BPOM-Br is a consistent, reliable, and valid instrument to assess activity of school-aged children with NBPP.IMPLICATIONS FOR REHABILITATIONThe Brazilian-Portuguese Version of the Brachial Plexus Outcome Measure Scale (BPOM-Br) presents understandable items and no ceiling and floor effects.The BPOM-Br provides a valid and reliable version for use in Brazilian school-aged children with neonatal brachial plexus palsy.It is important to promote its use both in clinical practice and in research as a specific evaluation of activity domain.

Folic acid and sodium folate salts: Thermal behavior and spectroscopic (IR, Raman, and solid-state 13C NMR) characterization.

Folic acid (FA; vitamin B9) and its associated sodium salts, strongly relevant for many scientific and technological applications - from nutrition to pharmacology and nanomedicine, suffer from a lack of characterization combining experimental and theoretical. In this work, a spectroscopic investigation of FA and its synthesized sodium salts in the form of dianion (Na2HFol) or trianion (Na3Fol) was scrutinized in their solid state. The spectroscopic (infrared, Raman, and solid state 13C-nuclear magnetic resonance) data interpretation was supported by theoretical calculations using the Density Functional Theory (DFT). Additionally, the compounds were characterized by UV-VIS diffuse-reflectance spectroscopy, combined thermal analysis (TG/DTG-DSC) coupled to mass spectrometry, and X-ray diffractometry. The main signatures of each species were identified, as well as the influence of the protonation level on their physicochemical properties. These distinct properties for the three compounds are mainly based on signals assigned to glutamic acid (glutamate) and pterin (neutral or anionic) moieties. This work should help developing new products based on FA or its anionic forms, such as theragnostic/drug delivery systems, supramolecular structures, nanocarbons, or metal complexes.

Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort.

The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.

Prevalence of pressure injury and associated factors in hospitalized adult patients with cancer.

INTRODUCTION: Hospitalized cancer patients experience limitations in their daily activities resulting from the severity of their condition. Such changes alter patients' sensory perception and hinder their mobility, thus predisposing them to the development of PI. OBJECTIVE: The goal of this study was to analyze the prevalence of PI and associated factors in hospitalized cancer patients. MATERIALS AND METHODS: This observational, epidemiological, cross-sectional, descriptive study was carried out in the inpatient and ICU settings of an oncological hospital in São Paulo, Brazil. RESULTS: A total of 341 patients who met the inclusion criteria and agreed to participate in the study were interviewed and assessed. Data obtained in the interviews were analyzed for logistic regression analysis. Pressure injury prevalence was 10% (34 patients). The use of disposable diapers was significantly associated with the development of PI, with a 6.077 increased chance of PI in such patients in the ICU setting. In this epidemiologic study of 341 hospitalized cancer patients, the prevalence of PI was 10%. The use of disposable diapers was the only factor associated with the presence of PI after logistic regression analysis. CONCLUSION: Knowing the risk factors of this specific population was essential to implement actions and optimize indications of disposable diaper use. There is an absence of epidemiologic records due to limited publications available on the subject; creating a program to prevent PI development within the inpatient, assisted population.

A new insight on the preparation of stabilized alpha-nickel hydroxide nanoparticles.

Nickel hydroxide can provide an outstanding cathode material in alkaline secondary batteries, however the progressive decrease of the charge capacity as a function of the number of oxidation/reduction cycles is a challenging problem to be solved. New improvements on the electrochemical properties of electrode materials can be achieved by exploiting the much better performance of alpha-nickel hydroxide. Such materials were obtained in a stable form by sol-gel method and characterized by thermogravimetric analyses, UV-Vis spectroscopy, X-ray diffractometry, scanning and transmission electron microscopy, cyclic voltammetry and electrochemical quartz crystal microbalance techniques. The results revealed not only the formation of the alpha-Ni(OH)2 phase, but also a much better electrochemical reversibility and stability as compared with similar materials obtained by electrochemical precipitation method.

Access to innovative medicines by pharma companies: Sustainable initiatives for global health or useful advertisement?

Research & Development on new medicines plays an important role in life and well-being, making pharmaceutical companies important players in global health. Accessibility and financing new medicines, however, poses challenges for governments and patients around the world. Due to pricing and aggressive patent policy issues, pharma companies started to adopt access to medicines as a strategy to not only improve their public image but also to increase their economic performance. More than a useful institutional advertisement to attract new business, initiatives to improve access to medicines must be socially responsible and sustainable. Using content analysis methodology from CSR reports, the present study evaluated how 44 global companies are positioning themselves regarding access, whether these initiatives are aligned to existing access programmes and whether the actions disclosed on behalf of access are sustainable. We have identified 13 major access to medicines approaches that were classified into intrinsic, potentially sustainable and robust actions. We concluded that companies overvalue the term access to medicine. This can generate initiatives focused on advertisements rather than long-term actions and highlights the need for clear global criteria for companies and programmes that want to effectively publicise access to medicines as a social responsibility strategy.

Coenzyme Q10 Cardioprotective Effects Against Doxorubicin-Induced Cardiotoxicity in Wistar Rat.

In the present study, we investigated the cardioprotective effects of coenzyme Q10 (Q10) against doxorubicin (DOXO) induced cardiomyopathy. Twenty adult rats were distributed in four experimental groups: group 1 received NaCl 0.9% at 1 ml/day for 14 days; group 2 received Q10 at 1 mg/kg/day for 14 days; group 3 received initial 7 days of treatment with NaCl 0.9% followed by a single dose of doxorubicin (12.5 mg/kg IP) and another 7 days of NaCl; and group 4 received initial 7 days of Q10 1 mg/kg/day, followed by a single dose of doxorubicin (12.5 mg/kg IP) and another 7 days of Q10. At the end of 14 days, systolic, diastolic and mean blood pressure, electrocardiogram (ECG), complete blood count, and serum biochemical profile were evaluated. We also analyzed heart histological and ultrastructure analysis, and estimated heart's oxidative stress and lipid peroxidation. DOXO administration altered ECG, with increase heart rate, P-wave duration, PR interval duration, and T-wave amplitude. All the parameters were significantly reduced following Q10 treatment. DOXO also caused increase in CK, CK-MB, LDH, and urea levels, which were not mitigated by Q10 treatment. However, Q10 reduced oxidative stress by interfering with superoxide dismutase, significantly decreasing lipid peroxidation in heart tissue. DOXO administration also leads to several histological and ultrastructure alterations including cardiomyocyte degeneration and intense intracelullar autophagosomes, all minimized by Q10 treatment. Q10 treatment prevented the ECG changes, minimized oxidative stress, lipid peroxidation, and DOXO-induced heart tissue alterations. Our findings suggest that pre- and post-treatment with Q10 exerts potential cardioprotective effect against the DOX-induced cardiotoxicity.

GLUT4 translocation is not impaired after acute exercise in skeletal muscle of women with obesity and polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to examine the effects of acute exercise on insulin signaling in skeletal muscle of women with polycystic ovary syndrome (PCOS) and controls (CTRL). METHODS: Fifteen women with obesity and PCOS and 12 body mass index-matched CTRL participated in this study. Subjects performed a 40-min single bout of exercise. Muscle biopsies were performed before and 60 min after exercise. Selected proteins were assessed by Western blotting. RESULTS: CTRL, but not PCOS, showed a significant increase in PI3-k p85 and AS160 Thr 642 after a single bout of exercise (P = 0.018 and P = 0.018, respectively). Only PCOS showed an increase in Akt Thr 308 and AMPK phosphorylation after exercise (P = 0.018 and P = 0.018, respectively). Total GLUT4 expression was comparable between groups (P > 0.05). GLUT4 translocation tended to be significantly higher in both groups after exercise (PCOS: P = 0.093; CTRL: P = 0.091), with no significant difference between them (P > 0.05). CONCLUSIONS: A single bout of exercise elicited similar GLUT4 translocation in skeletal muscle of PCOS and CTRL, despite a slightly differential pattern of protein phosphorylation. The absence of impairment in GLUT4 translocation suggests that PCOS patients with obesity and insulin resistance may benefit from exercise training.

Lessons learned while implementing an HIV/AIDS care and treatment program in rural Mozambique.

Mozambique has severe resource constraints, yet with international partnerships, the nation has placed over 145,000 HIV-infected persons on antiretroviral therapies (ART) through May-2009. HIV clinical services are provided at > 215 clinical venues in all 11 of Mozambique's provinces. Friends in Global Health (FGH), affiliated with Vanderbilt University in the United States (US), is a locally licensed non-governmental organization (NGO) working exclusively in small city and rural venues in Zambézia Province whose population reaches approximately 4 million persons. Our approach to clinical capacity building is based on: 1) technical assistance to national health system facilities to implement ART clinical services at the district level, 2) human capacity development, and 3) health system strengthening. Challenges in this setting are daunting, including: 1) human resource constraints, 2) infrastructure limitations, 3) centralized care for large populations spread out over large distances, 4) continued high social stigma related to HIV, 5) limited livelihood options in rural areas and 6) limited educational opportunities in rural areas. Sustainability in rural Mozambique will depend on transitioning services from emergency foreign partners to local authorities and continued funding. It will also require "wrap-around" programs that help build economic capacity with agricultural, educational, and commercial initiatives. Sustainability is undermined by serious health manpower and infrastructure limitations. Recent U.S. government pronouncements suggest that the U.S. President's Emergency Plan for AIDS Relief will support concurrent community and business development. FGH, with its Mozambican government counterparts, see the evolution of an emergency response to a sustainable chronic disease management program as an essential and logical step. We have presented six key challenges that are essential to address in rural Mozambique.

Incidência de úlcera venosa recidivada em pacientes atendidos em um ambulatório de estomaterapia / Incidence of venous ulcer recurrence in patients from a stomal therapy nursing outpatient clinic

Introdução: A úlcera de etiologia venosa ocorre como resultado da hipertensão venosa e insuficiência da bomba muscular em membros inferiores. Aproximadamente 70% das úlceras venosas (UV) recidivam após cicatrização. Objetivo: Analisar a incidência de UV recidivadas de pacientes atendidos em um Ambulatório de Estomaterapia e os fatores de risco para o seu desenvolvimento. Métodos: Trata-se de estudo epidemiológico, observacional, de coorte retrospectiva, com abordagem quantitativa. A coleta de dados foi realizada através do prontuário eletrônico de pacientes adultos com UV, atendidos em um ambulatório de estomaterapia de uma Operadora de Saúde do município de São Paulo, no período de 01 de abril de 2014 a 01 de abril de 2019. A coleta de dados foi feita por meio de instrumento com variáveis demográficas, clínicas e das UV recidivadas. Após a coleta, os dados foram transferidos para o software RedCap®, e posteriormente foram analisados no software R 3.6.1. Para cálculo da incidência de UV foram considerados todos os pacientes da amostra que tiveram UV recidivada dividido pelo total de pacientes que tiveram a UV cicatrizada vezes 100, para o qual foi considerada somente a primeira recidiva. Os dados foram analisados por meio de estatística descritiva, frequência absoluta e relativa para as variáveis categóricas e média, desvio padrão, valor mínimo e máximo para as vaiáveis numéricas. Para análise de associação entre a variável dependente (incidência de UV recidivada) com as demais variáveis foi realizada com os testes qui- quadrado, o teste de Fisher para as variáveis categóricas e Wilcoxcon-Mann-Whitney para as variáveis numéricas. Para a identificação das variáveis preditoras foi aplicado modelo de regressão logística. O projeto foi aprovado pelo Comitê de ética em pesquisa da instituição onde foi realizado o estudo. Resultados: a amostra foi composta de 134 pacientes que tiveram a UV cicatrizada e 65 (48,5%) apresentaram recidiva, levando a uma incidência de 48,5%, com tempo médio de aparecimento de 230,1 (DP 267) dias (aproximadamente 8 meses) após a cicatrização da UV. Os indivíduos com UV recidivada era na sua maioria mulheres (39/48,1%) com idade média de 64 (DP 15,4) anos, 57 (50,8%) dos pacientes com UV recidivada tinha alguma comorbidade, sendo a mais comum a hipertensão arterial sistêmica (47/51%). A obesidade (15/88,2%) teve associação estatisticamente significativa, elevando o risco de recidiva em 8,7 (OR 95% IC 2,1-60,8; p=0,009). Em relação à localização, as UV recidivadas localizavam-se principalmente no maléolo medial (28/43,0%). Conclusão: A incidência de recidiva de UV foi de 48,5%. Os fatores de risco para o seu desenvolvimento foram a presença de obesidade. Estudos com análise mais aprofundada da doença vascular, as características da ferida e o tratamento aplicado são necessários para maior entendimento dos fatores de risco para recidiva das UV, contribuindo para o estabelecimento de medidas mais eficazes de prevenção e cura das UV em ambientes ambulatoriais. Devido a necessidade de melhorias na tratativa dos pacientes com UV, houve a implementação de um robusto prontuário eletrônico, especifico para o ambulatório de estomaterapia, que através da complexidade das informações direciona os achados para as intervenções necessárias, objetivando a qualidade da assistência, prevenção e manejo das UV.

Background: Ulcers from venous etiology are the consequence of venous hypertension and muscular pump insufficiency in lower limbs. Approximately 70% of venous ulcers (VU) recur after healing. Objective: To analyze the incidence of recurred VU in patients attended in a stomal-therapy outpatient clinic and identify the risk factors for its development. Methods: Epidemiological, observational, retrospective and cohort study, with a quantitative approach. Data collection was performed by clinical records review of adult patients with VU, being attended in a health insurance company\'s stomal-therapy clinic, in São Paulo municipality, during the period of April 1st of 2014 and April 1st of 2019. Data collection was done using an instrument containing demographic, clinical and specific variables related to VU recurrence using REDCap® web-based data management software, and then, transferred to be analyzed in R 3.6.1 statistical software. For the incidence calculation were considered all the sample patients with a VU recurred, divided by the total of patients with healed VU in the period, times 100; for this purpose, just the first recurred VU was considered. Data were analyzed by descriptive analysis with absolute and relative frequency for categorical variables. Mean, standard deviation, minimum and maximum for numerical variables. For association analysis between the dependent variable (recurred VU incidence) and categorical variables, were applied the hypothesis tests Chi-square and Fisher exact; for numerical variables, was applied Wilcoxon-Mann-Whitney test. The identification of predictors was performed by a logistic regression model. This project was approved by the Health insurance institutional ethics committee in research, the place where the study was performed. Results: The sample consisted of 134 patients who had VU healed and 65 (48.5%) relapsed, leading to an incidence of 48.5%, with occurrence mean time of 230,1 (DP 267) days (approximately eight months) after the VU was healed. Individuals with a recurred VU were in majority women (39/48,1%), with a mean age of 64 (DP 15,4) years, 57 (50,8%) of the patients with recurred VU had some, having systemic arterial systemic hypertension the most common (47/51%). The presence of obesity (15/88,2%) had significant statistical association, rising the recurrence risk in 8,7 (OR 95% IC 2,1-60,8; p=0,009) times. Regarding location, recurred VU were located mainly in the medial malleolus (28/43%). Conclusions: VU recurrence incidence was 48,5%. Risk factors for its development include obesity presence. Studies with a deeper analysis of the vascular disease, wound and topical treatment characteristics are needed for a bigger understanding of the risk factors for VU recurrence, contributing to the establishment of effective interventions for VU prevention and treatment in an outpatient environment. Due to the need for improvements in the treatment of patients with VU, a robust electronic medical record, specifically for the stomatherapy outpatient clinic, was implemented, which through the complexity of the information directs the findings to the necessary interventions, aiming at the quality of care, prevention and VU treatment.

Adesão ao tratamento e satisfação com o serviço entre pessoas com diabetes mellitus atendidas no PSF em Blumenau, Santa Catarina / Adherence to trearment and health care satisfaction in persons with diabetes in health family program, Blumenau, Santa Catarina

Introdução: A satisfação dos pacientes pode influenciar sua adesão ao tratamento em doenças crônicas. Tem-se por objetivo estudar a associação entre satisfação com o serviço e não-adesão ao tratamento entre diabéticos atendidos no PSF em Blumenau, SC. Métodos: Estudaram-se características sóciodemográficas, da doença, do tratamento e satisfação numa amostra aleatória de usuários em 2006, mediante entrevistas estruturadas. A variável dependente foi não adesão ao tratamento. Mediu-se a glicemia capilar pósprandial. Calculou-se a prevalência de não-adesão, razão de prevalência (IC95%) e análise estratificada por possíveis variáveis de confusão. Utilizou-se teste de Quiquadrado de Pearson e ajustado de Mantel-Haenszel, sendo aceito um valor de p<0,05. Resultados: foram entrevistadas 341 pessoas, sendo 67,4% do sexo feminino, 79,5% brancas, 60,2% casadas e 73,9% católicas. A média de idade foi de 59,4 anos (±13.51) e mediana de 59,3 anos. 93,3% estão satisfeitas com o atendimento do pessoal de saúde, 92,9%, com o médico; 81,7% estão satisfeitas com a estrutura do serviço e acesso a consultas 73,1%. A prevalência de não-adesão ao tratamento foi de 71,0% (IC 95% 65,8 - 75,7) e 47,2 % apresentaram glicemia capilar acima de 180 mg/dl. A não-adesão ao tratamento se mostrou associada a idades mais jovens, cor preta/parda, religião não-católica, consumo de álcool, interrupção previa do tratamento, presença de transtorno mental comum e menor grau de satisfação (p<0,05). Esta última associação sofreu ajuste das variáveis consumo de álcool, transtorno mental e idade. Conclusões: A elevada prevalência de não-adesão deve servir de alerta sobre a qualidade dos serviços. Pessoas mais satisfeitas parecem apresentar maior adesão ao tratamento.

Background: The patients' satisfaction can influence its adherence to drug treatment in chronic diseases. Objective: It was stuied the association between satisfaction of with the health service and non-adherence to treatment among diabetic patients' assisted by PSFin Blumenau, SC. Methods: The socio-demographic characteristics of the illness, treatment and also of the satisfaction were studied in a random sample of users in 2006, through structured interviews. The dependent variable was nonadherence with treatment. The post-prandial glycemic capillary was measured. The prevalence of nonadherence and prevalence ratio (95% confidence interval)were calculated, with stratified analysis by confounding. It was used Pearson's an Mantel-Haenszel Chi-Square test, with an accepted 'p -value' < 0,05. Results: population study had 341 people with age means of 59,4 years (± 13.51) and median of 59,3 years. They are female (67,4%), white (79,5%), married(60,2%) and catholic (73,9%). 93,3% are satisfied with the attendance health service, 92,9% with the doctor, 81,7% are satisfied with the structure of the service and access to appointments 73,1%. The prevalence of nonadherence to treatment was 71,0% and 47,2% hadcapillary glycemia above 180 mg/dl. Non-adherence to treatment was associated with younger age, black color,non-Catholic religion, alcohol consumption, premature interruption of treatment, presence of common mentaldisorder and smaller degree of satisfaction (p < 0,05). This last association was adjusted by variables alcohol consumption, common mental disorder and age. Conclusions: The high prevalence of non-adherence should serve as a warning about the quality of services. People who seem more satisfied produce greater adherence to treatment.

Relato de caso: bebê arlequim – ictiose congênita / Case report: baby harlequin - congenital ichthyosis

Feto arlequim é uma variante grave da ictiose congenita, uma herança autossômica recessiva que causa alteração da queratinização da pele, que incide em cerca de 1/100.000 nascimentos e está geralmente associada a consaguinidade dos pais. Manifesta-se ao nascimento como uma pele espessada que evolui para rachaduras generalizadas, comprometendo as suas funções básicas e predispondo a infecções. Relata-se o caso de um RN do sexo feminino, cujos pais não referem nenhum grau de parentesco. A mesma foi mantida em isolamento em incubadora, mas feleceu no nono dia de vida por insuficiência respiratória restritiva.

Harlequin fetus is a variant of severe congenital ichthyosis, an autosomal recessive heredity make change in the keratinization of skin, which appear around 1/100.000 births and is usually associated with consaguineus parents. At birth it seems like a thicken skin that develops into widespread cracks, affecting its basics functions and predisposes to infections. We report the case of a female newborn, whose parents don’t mention any degree of kinship. The baby stood on isolation in incubator, but died at ninth day of life from restrictive respiratory failure.

Avaliação comparativa do teor de cloro ativo e oxigênio dos irrigantes utilizados na terapia endodôntica / Comparative evaluation of chlorine tenor and liberation by irrigants used in endodontic therapy

O presente estudo objetivou determinar os teores de cloro e oxigênio em ppm, quando empregado hipoclorito de sódio (NaOCl) nas concentrações de 0,5%; 1,0% e 5,0% associado com peróxido de hidrogênio (H2O2) 3%, ácido cítrico 10% e EDTA 17%. Avaliaram-se, também, as reações do creme Endo PTC com NaOCl 0,5% e 5%. A determinação do teor de cloro (Cl2) foi realizada no espectrofotômetro ultravioleta visível analógico pelo método alaranjado de metila. O teor de oxigênio (O2) foi analisado volumetricamente pelo método de Winkler. O tempo reacional para produzir cloro e oxigênio foi 3 minutos. Padronizou-se o volume em 10 ml para as soluções testadas. Para realizar a reação do creme Endo PTC, utilizou-se 0,2 g com 2 ml das soluções de NaOCl 0,5% e 5,0%, no mesmo período de tempo. Os resultados demonstraram que a produção de CL2 foi encontrada nas reações entre NaOCl com ácido cítrico (0,07; 0,11 e 0,15 ppm) e com EDTA (0,01; 0,05 e 0,08 ppm). A produção de O2 foi encontrada nas reações do NaOCl com H2O2 (0,03; 0,18 e 0,49 ppm). Na reação com Endo PTC e NaOCl a 0,5% e 5,0%, observou-se também a produção de O2 (0,08 e 0,43 ppm), porém o gás cloro Cl2 só foi constatado na reação com NaOCl 5,0% (0,06 ppm). Concluiu-se que formação de Cl2 foi maior quando NaOCl 5% reagiu com ácido cítrico. A maior formação de O2 foi encontrada na reação de NaOCl 5% com H2O2, assim como na reação do NaOCl 5% com Endo PTC.

Envelhecimento humano: depoimentos de quatro gerações de uma mesma família / Human Ageing: testimony of same family's fourgeneration

Conhecer o entendimento sobre envelhecimento humano na voz de quatro gerações de uma mesma família, foi o objetivo do presente trabalho. Trata-se de um estudo de natureza qualitiva, descritiva exploratória, desenvolvido em três minicípios da microrregião de Ijuí, interior do Estado do Rio Grande. Os participantes da pesquisa constituíram-se de 9 pessoas que integram a uma mesma família, envolvendo quatro distintas gerações. As informações foram coletadas por meio de entrevista aberta, gravada e transcrita na íntegra. Para análise dos dados procedeu-se da seguinte forma: organização das informações, classificação em categorias e discussão de dados. Após repetidas leituras, as informações foram agrupadas em três categorias de análise. A primeira trata das questões relacionadas ao entendimento do processo de envelhecimento, na qual ficou evidente que as pessoas possuem estigmas e na qual aceitam esta fase do viver; a segunda aborda os aspectos referentes às mudanças orgânicas e psicológicas, demonstrando que há declínio das condições física e mental; a terceira discorre sobre a importância da manutenção dos vínculos familiares. Foi possível apreender que o processo de envelhecer, comumente, não é percebidopelas pessoas, e que ocorrem alterações físicas e mentais, que são fisiológicas e quando a pessoa idosa está integrada à família sente-se valorizada e respeitada, sendo preservada sua cidadania.