Effect of Smoking on Longitudinal Interferon-ϒ Release Assay Results among Close Contacts of People with Pulmonary Tuberculosis.

Diagnosis of M. tuberculosis (Mtb) infection in close contacts is critical for TB control. Smoking is a risk factor for Mtb infection and TB disease but its effect on longitudinal interferon-gamma release assay (IGRA) results remains unknown. We conducted a multi-site prospective study in Brazil between 2015-2019, among close contacts of adults with culture-confirmed pulmonary TB. IGRA was performed at baseline, month 6 if negative at baseline, and month 24-30 after enrollment. IGRA results were categorized as IGRA-positive (maintained from baseline to last visit), IGRA-conversion (from negative to positive at any time), IGRA-reversion (from positive to negative at any time), and IGRA-negative (maintained from baseline to last visit). Associations between IGRA results and smoking status at baseline (current/former vs never) in contacts were evaluated using propensity score-adjusted logistic regression models. Estimated propensity score was used as a covariate in models, which regressed the outcome (IGRA-positive, IGRA-conversion, IGRA-reversion) on smoking status. Of 430 close contacts, 89 (21%) were IGRA-positive, 30 (7%) were converters, 30 (7%) were reverters and 22 were indeterminate. Smoking frequency was 26 (29%) among IGRA-positive contacts, 7 (23%) in converters, and 3 (10%) in reverters. Smoking in contacts was associated with lower odds of IGRA-reversion (adjusted odds ratio = 0.16; 95% confidence interval = [0.03-0.70]). We did not detect associations between smoking and IGRA-positive or IGRA-conversion. Our findings highlight the importance of smoking on longitudinal IGRA results. This has implications for clinical care and clinical trials in which IGRA status is monitored or used as an outcome.

Prediction Models for Adverse Drug Reactions During Tuberculosis Treatment in Brazil.

BACKGROUND: Tuberculosis (TB) treatment-related adverse drug reactions (TB-ADRs) can negatively affect adherence and treatment success rates. METHODS: We developed prediction models for TB-ADRs, considering participants with drug-susceptible pulmonary TB who initiated standard TB therapy. TB-ADRs were determined by the physician attending the participant, assessing causality to TB drugs, the affected organ system, and grade. Potential baseline predictors of TB-ADR included concomitant medication (CM) use, human immunodeficiency virus (HIV) status, glycated hemoglobin (HbA1c), age, body mass index (BMI), sex, substance use, and TB drug metabolism variables (NAT2 acetylator profiles). The models were developed through bootstrapped backward selection. Cox regression was used to evaluate TB-ADR risk. RESULTS: There were 156 TB-ADRs among 102 of the 945 (11%) participants included. Most TB-ADRs were hepatic (n = 82 [53%]), of moderate severity (grade 2; n = 121 [78%]), and occurred in NAT2 slow acetylators (n = 62 [61%]). The main prediction model included CM use, HbA1c, alcohol use, HIV seropositivity, BMI, and age, with robust performance (c-statistic = 0.79 [95% confidence interval {CI}, .74-.83) and fit (optimism-corrected slope and intercept of -0.09 and 0.94, respectively). An alternative model replacing BMI with NAT2 had similar performance. HIV seropositivity (hazard ratio [HR], 2.68 [95% CI, 1.75-4.09]) and CM use (HR, 5.26 [95% CI, 2.63-10.52]) increased TB-ADR risk. CONCLUSIONS: The models, with clinical variables and with NAT2, were highly predictive of TB-ADRs.

Transcriptomic signatures of progression to TB disease among close contacts in Brazil.

BACKGROUND: Approximately 5% of people infected with Mycobacterium tuberculosis progress to tuberculosis (TB) disease without preventive therapy. There is a need for a prognostic test to identify those at highest risk of incident TB, so that therapy can be targeted. We evaluated host blood transcriptomic signatures for progression to TB disease. METHODS: Close contacts (≥4 hours exposure per week) of adult patients with culture-confirmed pulmonary TB were enrolled in Brazil. Investigation for incident, microbiologically-confirmed or clinically-diagnosed pulmonary or extra-pulmonary TB disease through 24 months of follow-up was symptom-triggered. Twenty previously validated blood TB transcriptomic signatures were measured at baseline by real-time quantitative PCR. Prognostic performance for incident TB was tested using receiver operating characteristic curve (ROC) analysis at 6, 9, 12, and 24 months of follow-up. RESULTS: Between June 2015 and June 2019, 1,854 close contacts were enrolled; Twenty-five progressed to incident TB, of whom 13 had microbiologically-confirmed disease. Baseline transcriptomic signature scores were measured in 1,789 close contacts. Prognostic performance for all signatures was best within 6 months of diagnosis. Seven signatures (Gliddon4, Suliman4, Roe3, Roe1, Penn-Nicholson6, Francisco2, and Rajan5) met the minimum World Health Organization target product profile (TPP) for a prognostic test through 6 months; three (Gliddon4, Rajan5, and Duffy9) through 9 months. None met the TPP threshold through 12 or more months of follow-up. CONCLUSIONS: Blood transcriptomic signatures may be useful for predicting TB risk within 9 months of measurement among TB-exposed contacts, to target preventive therapy administration.

The Xpert® MTB/RIF cycle threshold value predicts M. tuberculosis transmission to close contacts in a Brazilian prospective multicenter cohort.

BACKGROUND: The Xpert® MTB/RIF rapid molecular test provides a quantitative measure of Mycobacterium tuberculosis (Mtb) DNA in the form of cycle threshold (Ct) values. This information can be translated into mycobacterial load and used as a potential risk measure of bacterial spread for tuberculosis cases, which can impact infection control. However, the role of Ct values in assessing Mtb transmission to close contacts has not yet been demonstrated. METHODS: A prospective study was performed to investigate the association between Xpert® MTB/RIF Ct values and Mtb transmission to close contacts of patients with culture-confirmed pulmonary TB in a multi-center Brazilian cohort. We evaluated clinical and laboratory data, such as age, sex, race, smoking habits, drug use, alcohol use, chest radiograph, Xpert® MTB/RIF results among pulmonary tuberculosis cases, and QuantiFERON(QFT)-Plus results at baseline and after six months for close contacts who had a negative result at baseline. RESULTS: A total of 1,055 close contacts of 382 pulmonary tuberculosis cases were included in the study. The median Ct values from pulmonary tuberculosis cases of QFT-Plus positive (at baseline or six months) close contacts were lower compared with those who were QFT-Plus negative. An adjusted logistic regression demonstrated that reduced Ct values from the index cases were independently associated with QFT-Plus conversion from negative to positive (OR: 1.61, 95% CI: 1.12-2.32) after adjusting for clinical characteristics. CONCLUSION: Close contacts of pulmonary TB index cases exhibiting low Xpert MTB/RIF Ct values displayed higher rates of TB infection, reflecting Mtb transmission.

An integrative multi-omics approach to characterize interactions between tuberculosis and diabetes mellitus.

Tuberculosis-diabetes mellitus (TB-DM) is linked to a distinct inflammatory profile, which can be assessed using multi-omics analyses. Here, a machine learning algorithm was applied to multi-platform data, including cytokines and gene expression in peripheral blood and eicosanoids in urine, in a Brazilian multi-center TB cohort. There were four clinical groups: TB-DM(n = 24), TB only(n = 28), DM(HbA1c ≥ 6.5%) only(n = 11), and a control group of close TB contacts who did not have TB or DM(n = 13). After cross-validation, baseline expression or abundance of MMP-28, LTE-4, 11-dTxB2, PGDM, FBXO6, SECTM1, and LINCO2009 differentiated the four patient groups. A distinct multi-omic-derived, dimensionally reduced, signature was associated with TB, regardless of glycemic status. SECTM1 and FBXO6 mRNA levels were positively correlated with sputum acid-fast bacilli grade in TB-DM. Values of the biomarkers decreased during the course of anti-TB therapy. Our study identified several markers associated with the pathophysiology of TB-DM that could be evaluated in future mechanistic investigations.

Isoniazid Monoresistance and Antituberculosis Treatment Outcome in Persons With Pulmonary Tuberculosis in Brazil.

Background: The high burden of drug-resistant tuberculosis (TB) is a problem to achieve the goals of the End TB Strategy by 2035. Whether isoniazid monoresistance (Hr) affects anti-TB treatment (ATT) outcomes remains unknown in high-burden countries. Methods: We evaluated determinants of ATT outcome among pulmonary TB cases reported to the National Notifiable Disease Information System (SINAN) between June 2015 and June 2019, according to drug sensitivity testing (DST) results. Binomial logistic regression models were employed to evaluate whether Hr was associated with an unfavorable ATT outcome: death or failure, compared to cure or treatment completion. Results: Among 60 804 TB cases reported in SINAN, 21 197 (34.9%) were included in the study. In this database, the frequency of unfavorable outcomes was significantly higher in those with Hr in contrast to isoniazid-sensitive persons with pulmonary TB (9.1% vs 3.05%; P < .001). Using a binomial logistic regression model, Hr was independently associated with unfavorable outcomes (odds ratio, 3.34 [95% confidence interval, 2.06-5.40]; P < .001). Conclusions: Hr detected prior to ATT was predictive of unfavorable outcomes at the national level in Brazil. Our data reinforce the need for high-TB-burden countries to prioritize DST to detect Hr. Effective treatment regimens for Hr-TB are needed to improve outcomes.

The effect of previous SARS-CoV-2 infection on systemic immune responses in individuals with tuberculosis.

Background: The impact of previous SARS-CoV-2 infection on the systemic immune response during tuberculosis (TB) disease has not been explored. Methods: An observational, cross-sectional cohort was established to evaluate the systemic immune response in persons with pulmonary tuberculosis with or without previous SARS-CoV-2 infection. Those participants were recruited in an outpatient referral clinic in Rio de Janeiro, Brazil. TB was defined as a positive Xpert-MTB/RIF Ultra and/or a positive culture of Mycobacterium tuberculosis from sputum. Stored plasma was used to perform specific serology to identify previous SARS-CoV-2 infection (TB/Prex-SCoV-2 group) and confirm the non- infection of the tuberculosis group (TB group). Plasmatic cytokine/chemokine/growth factor profiling was performed using Luminex technology. Tuberculosis severity was assessed by clinical and laboratory parameters. Participants from TB group (4.55%) and TB/Prex-SCoV-2 (0.00%) received the complete COVID-19 vaccination. Results: Among 35 participants with pulmonary TB, 22 were classified as TB/Prex-SCoV-2. The parameters associated with TB severity, together with hematologic and biochemical data were similar between the TB and TB/Prex-SCoV-2 groups. Among the signs and symptoms, fever and dyspnea were significantly more frequent in the TB group than the TB/Prex-SCoV-2 group (p < 0,05). A signature based on lower amount of plasma EGF, G-CSF, GM-CSF, IFN-α2, IL-12(p70), IL-13, IL-15, IL-17, IL-1ß, IL-5, IL-7, and TNF-ß was observed in the TB/Prex-SCoV-2 group. In contrast, MIP-1ß was significantly higher in the TB/Prex-SCoV-2 group than the TB group. Conclusion: TB patients previously infected with SARS-CoV-2 had an immunomodulation that was associated with lower plasma concentrations of soluble factors associated with systemic inflammation. This signature was associated with a lower frequency of symptoms such as fever and dyspnea but did not reflect significant differences in TB severity parameters observed at baseline.

The Tuberculosis Sentinel Research Network (TB-SRN) of the International epidemiology Databases to Evaluate AIDS (IeDEA): protocol for a prospective cohort study in Africa, Southeast Asia and Latin America.

INTRODUCTION: Tuberculosis (TB) is a leading infectious cause of death globally. It is the most common opportunistic infection in people living with HIV, and the most common cause of their morbidity and mortality. Following TB treatment, surviving individuals may be at risk for post-TB lung disease. The TB Sentinel Research Network (TB-SRN) provides a platform for coordinated observational TB research within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS AND ANALYSIS: This prospective, observational cohort study will assess treatment and post-treatment outcomes of pulmonary TB (microbiologically confirmed or clinically diagnosed) among 2600 people aged ≥15 years, with and without HIV coinfection, consecutively enrolled at 16 sites in 11 countries, across 6 of IeDEA's global regions. Data regarding clinical and sociodemographic factors, mental health, health-related quality of life, pulmonary function, and laboratory and radiographic findings will be collected using standardised questionnaires and data collection tools, beginning from the initiation of TB treatment and through 12 months after the end of treatment. Data will be aggregated for proposed analyses. ETHICS AND DISSEMINATION: Ethics approval was obtained at all implementing study sites, including the Vanderbilt University Medical Center Human Research Protections Programme. Participants will provide informed consent; for minors, this includes both adolescent assent and the consent of their parent or primary caregiver. Protections for vulnerable groups are included, in alignment with local standards and considerations at sites. Procedures for requesting use and analysis of TB-SRN data are publicly available. Findings from TB-SRN analyses will be shared with national TB programmes to inform TB programming and policy, and disseminated at regional and global conferences and other venues.

Developmental Dysplasia of the Hip - Part 1 / Displasia do desenvolvimento do quadril - Parte 1

Abstract Developmental dysplasia of the hip (DDH) is a condition characterized by changes in joint formation within the last months of intrauterine life or the first months after birth. Developmental dysplasia of the hip presentation ranges from femoroacetabular instability to several stages of dysplasia up to complete dislocation. Early diagnosis is essential for successful treatment. Clinical screening, including appropriate maneuvers, is critical in newborns and subsequent examinations during the growth of the child. Infants with suspected DDH must undergo an ultrasound screening, especially those with a breech presentation at delivery or a family history of the condition. A hip ultrasound within the first months, followed by pelvic radiograph at 4 or 6 months, determines the diagnosis and helps follow-up. Treatment consists of concentric reduction and hip maintenance and stabilization with joint remodeling. The initial choices are flexion/abduction orthoses; older children may require a spica cast after closed reduction, with or without tenotomy. An open reduction also can be indicated. After 18 months, the choices include pelvic osteotomies with capsuloplasty and, eventually, acetabular and femoral osteotomies. The follow-up of treated children must continue throughout their growth due to the potential risk of late dysplasia.

Resumo O termo displasia do desenvolvimento quadril (DDQ) refere-se à condição na qual a articulação sofre alterações na sua formação durante os últimos meses da vida intrauterina ou nos primeiros meses após o nascimento. No espectro de apresentação, varia desde a instabilidade femuroacetabular, passando por estádios de displasia até a completa luxação. O diagnóstico precoce é fundamental para o sucesso do tratamento. A triagem através do exame clínico incluindo manobras apropriadas é imprescindível nos recém-nascidos e nas avaliações subsequentes durante o crescimento da criança. O rastreamento ultrassonográfico é indicado nos bebês sob suspeita clínica e muito mais recomendável naqueles que tiveram apresentação pélvica para o parto ou que tenham antecedentes familiares. A ultrassonografia do quadril nos primeiros meses seguida da radiografia da bacia após o 4° ou 6° mês de vida são os exames que determinam o diagnóstico e auxiliam o seguimento. O tratamento está baseado na obtenção de uma redução concêntrica e na manutenção e estabilização do quadril, propiciando a remodelação articular. Inicialmente, as órteses de flexão/abdução são a escolha; em crianças maiores pode ser necessário o uso de gesso após redução incruenta com ou sem tenotomia; redução aberta pode ser indicada e após os 18 meses as osteotomias pélvicas associadas a capsuloplastia e eventuais osteotomias acetabular e femoral. Crianças tratadas devem ser acompanhadas durante todo o seu crescimento pelo eventual risco de displasias tardias.

Ciclo reprodutivo da ostra do mangue, Crassostrea rhizophorae (Bivalvia: Ostreidae) cultivada em uma zona de macromarés de alta salinidade na costa de manguezais da Amazônia do Brasil / Reproductive cycle of the mangrove oyster, Crassostrea rhizophorae (Bivalvia: Ostreidae) cultured in a macrotidal high-salinity zone on the Amazon mangrove coast of Brazil

Este estudo teve como objetivo estabelecer o ciclo reprodutivo da ostra do mangue, Crassostrea rhizophorae cultivada no estuário de macromarés do Rio Paciência, Maranhão, na costa nordeste do Brasil, e suas relações com fatores ambientais. As ostras foram coletadas mensalmente ao longo de 2013 para análise histológica da proporção sexual, desenvolvimento gonadal e índice de condição. A proporção sexual foi de 1:1,39 (M:F) e apenas 5 espécimes apresentaram hermafroditismo. A maturação foi contínua ao longo do ano e ostras maduras (estágio IIIA) e em desova (estágio IIIB) estiveram presentes em praticamente todos os meses. A baixa variação de temperatura parece ser o principal fator para a continuidade da gametogênese. Entretanto, além da temperatura, a relação entre precipitação, salinidade e produtividade primária afetou o estímulo e o tempo dos eventos reprodutivos. A estação chuvosa, com baixos valores de salinidade e altos valores de clorofila a e matéria orgânica particulada, pareceu ser o principal período reprodutivo, com liberação de gametas e produção e maturação de novas coortes de gametas em curto prazo. Nos trópicos, onde a maturação e liberação de gametas parecem ser contínuas e concomitantes, o índice de condição não se apresenta como o melhor método para avaliar os picos de acúmulo de reserva e desenvolvimento gonadal.(AU)

Sofrimento mental, desesperança e adesão a terapia antirretroviral de pessoas com hiv/aids / Sufrimiento mental, falta de esperanza y adherencia al tratamiento antirretroviral entre pacientes con hiv/ sida / Mental suffering, hopelessness, and adherence to antiretroviral therapy of people with hiv/aids

RESUMO Objetivo: analisar aassociação entre sofrimento mental, desesperança, idade e escolaridade na adesão à terapia antirretroviral de pessoas com HIV/AIDS. Método: Estudo transversal realizado de janeiro a julho de 2019, em Hospital referência para doenças infectocontagiosas no Nordeste, Brasil. Participaram 100 pessoas com HIV/AIDS que responderam às escalas de sofrimento mental, desesperança e adesão à terapia antirretroviral (CEAT-VIH). Análise estatística descritiva e testes Kruskal Wallis, teste t, qui quadrado e Mannv Whitney, considerando significância quando p≤0,05. Resultados: identificou-se que64% eram homens, 50% possuíam ensino fundamental completo, 58% apresentavam sofrimento mental, 48% desesperança leve, 60% tinham dificuldade no tratamento com terapia antirretroviral. Conclusão: os resultados revelaram que a desesperança está associada à adesão à terapia antirretroviral; o sofrimento mental está associado ao escore de desesperança; a idade está associada ao escore de sofrimento mental, desesperança e adesão à terapia antirretroviral.

RESUMEN Objetivo: analizar la asociación entre el sufrimiento mental, la falta de esperanza, la edad y la escolaridad en la adhesión al tratamiento antirretroviral de personas con HIV/SIDA. Método: estudio transversal realizado de enero a julio de 2019 en un hospital de referencia para enfermedades infectocontagiosas del noreste de Brasil. Participaron 100 personas con HIV/SIDA que respondieron a las escalas de sufrimiento mental, falta de esperanza y adherencia al tratamiento antirretroviral (CEAT-VIH). Análisis estadístico descriptivo y pruebas de Kruskal Wallis, prueba t, chi cuadrado yMannv Whitney, considerando significancia cuando p≤0,05. Resultados: se identificó que64% eran hombres, el 50% había terminado la escuela primaria, el 58% sufría de angustia mental, el 48% sentía ligera falta de esperanza, el 60% dificultad en el tratamiento antirretroviral. Conclusión: los resultados señalan que la falta de esperanza está asociada con la adherencia a la terapia antirretroviral; el sufrimiento mental está asociado con el escore de falta de esperanza; la edad está vinculada con el puntaje de sufrimiento mental, falta de esperanza y adherencia a la terapia antirretroviral.

ABSTRACT Objective: to analyze the association between mental suffering, hopelessness, age, and education when adhering to antiretroviral therapy for people with HIV/AIDS. Method: Cross-sectional study conducted from January to July 2019, at a reference hospital for infectious diseases in the Northeast, Brazil. Participated 100 people with HIV/AIDS who responded to the scales of mental suffering, hopelessness, and adherence to antiretroviral therapy (CEAT-HIV). Descriptive statistical analysis and Kruskal Wallis tests, t Test, chi-square, and MannWhitney, considering significance when p≤0.05. Results: it was identified that 64% were men, 50% had completed elementary school, 58% had mental distress, 48% mild hopelessness, 60% had difficulty in treatment with antiretroviral therapy. Conclusion: the results revealed that hopelessness is associated with adherence to antiretroviral therapy; mental suffering is associated with the hopelessness score; age is associated with the score of mental suffering, hopelessness, and adherence to antiretroviral therapy.

Condições de risco à saúde: pessoas em situação de rua / Health risk conditions: people on the streets / Condiciones de riesgo de salud: personas en la situación de la calle

Objetivo: analisar condições clínicas e comportamentos de risco à saúde de pessoas em situação de rua. Método: estudo transversal, realizado em duas instituições de referência para pessoas em situação de rua na região nordeste do Brasil. Aplicouse um roteiro de entrevista referente a variáveis sociodemográficas, clínicas e comportamentos vulneráveis ao adoecer para 100 participantes. Utilizou-se o teste Qui Quadrado e ANOVA. Resultados: o tipo de parceiro sexual influência na presença de sintomas de infecção sexualmente transmissível, a presença de sintomatologia relacionada à infecção sexualmente transmissível do parceiro influência na sintomatologia do próprio indivíduo, o etilismo influência na prática de sexo com usuário de drogas, a prática de sexo em troca de dinheiro apresenta correlação com a violência física, o sexo oral influência na presença de sintoma de infecção sexualmente transmissível. Conclusão: pessoas em situação de rua apresentam condições e comportamentos que potencializam o adoecimento.

Objective: to examine the clinical conditions and health risk behavior of homeless people. Method: this cross-sectional study was conducted at two referral centers for homeless people in northeast Brazil. Information on sociodemographic and clinical variables, and vulnerable behaviors when falling ill was elicited from 100 participants by scripted interviews. Chi-Square and Anova tests were used. Results: type of sexual partner influenced the presence of symptoms of sexually-transmitted infection; the presence of symptoms related to the partner's sexually-transmitted infections influenced the participant's symptomatology; alcoholism influenced the practice of sex with drug users; sex in exchange for money correlated with physical violence; and oral sex influenced the presence of a sexually-transmitted infection symptom. Conclusion: people on the street display conditions and behaviors that potentiate illness.

Objetivo: examinar las condiciones clínicas y el comportamiento de riesgo para la salud de las personas sin hogar. Método: este estudio transversal se realizó en dos centros de referencia para personas sin hogar en el noreste de Brasil. La información sobre las variables sociodemográficas y clínicas, y los comportamientos vulnerables cuando se enferma se obtuvo de 100 participantes mediante entrevistas con guión. Se utilizaron pruebas de Chi-Cuadrado y Anova. Resultados: el tipo de pareja sexual influyó en la presencia de síntomas de infección de transmisión sexual; la presencia de síntomas relacionados con las infecciones de transmisión sexual de la pareja influyó en la sintomatología del participante; el alcoholismo influyó en la práctica del sexo con consumidores de drogas; sexo a cambio de dinero correlacionado con violencia física; y el sexo oral influyó en la presencia de un síntoma de infección de transmisión sexual. Conclusión: las personas en la calle exhiben condiciones y comportamientos que potencian la enfermedad.

Urinary incontinence and quality of life in female patients with obesity / Incontinência urinária e qualidade de vida em pacientes femininas com obesidade

Abstract Objective To analyze the prevalence of urinary incontinence (UI) in female patients with an indication for bariatric surgery, to investigate the potential risk factors and the impact on quality of life. Methods A cross-sectional study with female patients with obesity. The evaluation consisted of a structured interview, a specific study form and quality of life questionnaires. The Poisson regression was performed to identify independent risk factors related to UI. Results A total of 221 patients were enrolled; 118 of the study participants (53.4%) reported UI episodes. Mixed UI (MUI), stress UI (SUI) only, and urgency UI (UUI) only were reported by 52.5% (62), 33.9% (40) , and 13.5% (16) of these patients respectively. The prevalence of UI was increased by 47% among the women who had given birth vaginally and by 34% of the women who had entered menopause. Vaginal delivery and menopause were identified as independent risk factors related to UI. The mean International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) score was 9.36 ± 4.9. The severity of symptoms was considered moderate in 53.3% (63) of the patients with UI. Conclusion Urinary incontinence impacts quality of life negatively, and the prevalence of UI is high among obese patients. In the present study, vaginal delivery and menopause were independently associated with UI.

Resumo Objetivo Analisar a prevalência de incontinência urinária (IU), os fatores de risco e o impacto na qualidade de vida em pacientes femininas comindicação para realização de cirurgia bariátrica. Métodos Estudo transversal com pacientes femininas obesas. A avaliação consistiu em entrevista estruturada, com questionários de estudo específico e de qualidade de vida. A regressão de Poisson foi utilizada para identificar os fatores de risco independentes para IU. Resultados Um total de 221 pacientes foram incluídos; 118 participantes (53.4%) relataram episódios de IU. Incontinência urinária mista, IU de esforço e IU de urgência foram relatadas por 52.5% (62), 33.9% (40) e 13.5%(16) das pacientes, respectivamente. A prevalência de IU foi 47%maior emmulheres que tiveramparto vaginal, e 34% maior em mulheres que já entraram no período da menopausa. Parto vaginal e menopausa foram identificados como fatores de risco independentes para IU. A média da pontuação do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) foi de 9.36 ± 4.9. A severidade dos sintomas foi considerada moderada em 53.3% (63) das pacientes com IU. Conclusão A IU impacta negativamente a qualidade de vida, e a prevalência de IU é maior empacientes obesas. Neste estudo, parto vaginal e menopausa foram fatores de risco independentes para a ocorrência de IU.

Associação entre o desempenho em leitura de palavras e a disponibilidade de recursos no ambiente familiar / Association between the performance in reading of words and the availability of home environment resources

RESUMO Objetivo: Investigar a associação do desempenho em leitura de palavras aos recursos do ambiente familiar de escolares do terceiro ano do primeiro ciclo de uma escola da rede pública municipal de ensino de Belo Horizonte. Métodos: Trata-se de um estudo com amostra não probabilística composta por escolares de ambos os sexos, com idades entre 9 e 11 anos, estudantes de uma escola da rede pública municipal de ensino de Belo Horizonte. Foram analisadas as configurações dos recursos do ambiente familiar de 41 escolares, por meio do Inventário de Recursos do Ambiente Familiar e seu desempenho em leitura, avaliado pelas Provas de Avaliação dos Processos de Leitura. Resultados: Foi encontrada significância estatística nas relações entre a disponibilidade de recursos materiais (lúdicos e linguísticos) e atividades sociais e a leitura de palavras. As práticas parentais se relacionaram positivamente à leitura de palavras não frequentes. Apenas o item "rotinas" não se associou significativamente ao desempenho de leitura dos escolares. Conclusão: Constatou-se associação proporcional dos recursos do ambiente familiar ao desempenho em leitura e escrita de escolares, evidenciando a necessidade de trabalhos junto às famílias no enfrentamento das adversidades e potencialização dos recursos familiares para o desenvolvimento infantil.

ABSTRACT Purpose: To investigate the association between word reading performance and the resources of the family environment of third-year elementary school children enrolled in a Belo Horizonte municipal school. Methods: This study involved a nonprobability sample comprising schoolchildren of both sexes aged between 9 and 11 years enrolled in a municipal school of Belo Horizonte. The status of the children's home environment resources was assessed using the inventory of the Home Environment Resources and their reading performance was measured through the Evaluation Tests of Reading Processes. Results: We found statistical significance in the relationship between the availability of material resources (ludic and linguistic) and social activities and the reading of words. Parental practices were positively correlated to the reading of infrequent words. Only the rubric "routines" was not significantly associated with the students' reading performance. Conclusion: It was observed a proportional association between the resources of the family environment and the reading and writing performance of the schoolchildren. These results demonstrate the need for actions to be developed with the families to assist them in coping with the adverse conditions and optimizing the home resources to enhance the children's development.

A habilidade incorporada enquanto dimensão política: a transmissão do saber-fazer artesanal em uma fábrica de doces / Embodied ability as political dimension: artisanal know-how transmission in a candy factory

Neste artigo, partimos da seguinte questão: se a técnica é passível de objetivação, como pode a habilidade ser tão dificilmente transmissível,mesmo em organizações artesanais? Para respondê-la, realizamos pesquisa etnográfica em uma fábrica de doces artesanais em Pelotas, RS, com o objetivo de compreender os modos de transmissão de um saber-fazer incorporado. A análise dos dados empíricos, à luz do paradigma do embodiment, demonstra que muito embora o produto artesanal em questão oriente um sistema produtivo relativamente simples, nem todos os envolvidos na produção alcançam o mesmo domínio técnico. Disso decorre que a manutenção e propagação de dado saber-fazer depende deinteresses que contribuem para restringi-lo por força de fatores sociais, econômicos e simbólicos.Constatamos que a habilidade incorporada através da prática apresenta uma dimensão política, que se manifesta à medida que determinado saber-fazer postula a distinção de uma pessoa ou grupo de pessoas em relação às demais

In this paper, we address the following question: if it is possible to objectify a technique, how can ability be so hard to transmit even in artisanal organizations? To answer it, we made anethnographical research in an artisanal candy shop in Pelotas, RS, in order to understand the ways of transmission of an embodied know-how. In the light of the embodiment paradigm empirical data shows that even though this handmade good may guide a relatively simple production system, it was not taken for granted that everyone involved in this production could reach the same technical domain. It follows that the maintenance and propagation of know-how is conditional to interests that can restrict it according to social,economic and symbolic factors. We found that embodied ability acquired through practice has a political dimension that manifests it self as certain know-how sett les the distinction of a personor a group over another

Slow movement: trabalho e experimentação do tempo na vida líquido-moderna / Slow movement: work and time experimentation in the liquid-modern life

O presente artigo coloca em pauta uma reflexão cujo objetivo é discorrer sobre os modos de trabalhar e de viver na vida líquido-moderna. Para tanto, apresenta o Slow Movement como referência de análise. Divulgado como movimento mundial em prol da desaceleração, sua proposta difundiu-se e firmou-se ao acolher a sensação generalizada de esgotamento promovida pela vida líquida, conforme preconizada por Bauman (2007). Objetiva-se compreender se e como o Slow Movement possibilita uma outra experimentação do tempo, bem como se interpõe enquanto expressão da resistência aos atuais modos de trabalhar e de viver. A análise empreendida permite perceber que o Slow Movement, apesar de se apresentar como um modo de expressão da resistência frente à aceleração, mantém-se subordinado à ideologia gerencialista (Gaulejac, 2007) que caracteriza os atuais modos de trabalhar. Desse modo, o movimento contribui para apaziguar os sofrimentos psíquicos causados pela pressão do tempo, mas não para a sua revolução.

The following paper aims at describing work and life in the liquid modern life. For that matter the Slow Movement is presented as an analysis reference. Advertised as a world movement towards a slower time, its proposition has spread and been recognized as it acknowledges the feeling of hopelessness brought up by the liquid life, as described by Bauman (2007). The objective is to understand if and how the Slow Movement leads to a different experimentation of time, as well as if it is an expression of resistance to the current ways of working and living. The analysis proposes that although the Slow Movement presents itself as a resistance to the current acceleration, it is still linked to a managerial ideology (Gaulejac, 2007). Thus, the movement contributes to peace the psychological damages caused by the pressures of time, although it doesn't operate as a revolution.

Pseudartrose congênita de clavícula / Congenital pseudarthrosis of the clavicle

A pseudartrose congênita de clavícula (PCC) é uma afecção rara, que representa um distúrbio na união dos núcleos de ossificação e que pode ser diagnosticada ao nascimento. É mais comum em meninas e do lado direito. Este trabalho tem por objetivo proceder a uma revisão bibliográfica sobre o tema, em pesquisa realizada nas bases de dados LILACS e MEDLINE. Foram encontrados 56 artigos publicados até a corrente data. Apesar de pouco frequente, a PCC não deve ser desconhecida ou mesmo esquecida, especialmente como diagnóstico diferencial com a fratura aguda da clavícula por distocia de parto e/ou tocotraumatismo. O diagnóstico é relativamente fácil e o tratamento pode ser apenas expectante ou até mesmo cirúrgico.

Congenital pseudarthrosis of the clavicle (PCC) is a rare affection, that can be diagnosed at birth and represent a disturbance of union of the ossification centers. It's more common in girls and in the right side. This study objectives to proceed a revision about the subject, that was searched in online database of LILACS and MEDLINE. We found 56 articles till present data. Besides be a bit infrequent, the PCC must not be missed or even forgotten, especially as differential diagnosis with acute fracture of the clavicle at birth by trauma in the childbirth. The diagnostic is relatively easy and the treatment can be just observation or even surgical.

Fatores de risco de úlceras por pressão no doente cirúrgico / Risk factors for pressure ulcers in the surgical patient

As UPPs são internacionalmente definidas como uma lesão localizada da pele e/ou tecido subjacente, geralmente sobre uma proeminência óssea, resultante de uma pressão ou combinação desta com forças de torção. São das complicações mais comuns experienciadas pelos doentes internados, os cirúrgicos são dos mais suscetíveis a desenvolver UPPs. Pretende-se com este estudo saber quais os fatores de risco de desenvolvimento de UPPs no doente cirúrgico, fim de obter respostas formularam-se os seguintes objetivos: Identificar os fatores de risco para o desenvolvimento de UPPs no doente cirúrgico; Identificar se existe influência entre os fatores identificados e o desenvolvimento de UPPs no doente cirúrgico; e Identificar a incidência de UPPs em doentes cirúrgicos. Consiste numa investigação quantitativa, de caracter descritivoexploratório. A colheita de dados foi realizada através da aplicação de um questionário, a uma amostra de 94 doentes, submetidos a cirurgias de média e longa duração. Os resultados obtidos permitiram identificar 3 doentes com UPPs de categoria I: uma no trocânter esquerdo e duas nas cristas ilíacas. Constatou-se que são vários os fatores de risco que terão influenciado o desenvolvimento das feridas: sexo, estado nutricional, comorbilidades, gravidade do doente segundo a classificação ASA, duração da cirurgia, tipo de cirurgia, posicionamento do doente, dispositivos de posicionamento, anestesia, utilização de manta de aquecimento, hipotensão e imobilidade do doente no pósoperatório. Identificou-se uma taxa de incidência de UPPs de 3,19%, inferior às descritas na literatura. Pretende-se com este estudo um melhoramento na prestação de cuidados de enfermagem com impacto na qualidade dos cuidados e consequentemente ganhos em saúde.

Epidemiologia das fraturas de face em crianças num pronto-socorro de uma metrópole tropical / Epidemiology of children's facial fractures in the emergency room of a tropical metropolis

OBJETIVO: Realizar um estudo epidemiológico das fraturas de face em crianças em um serviço de urgência. MÉTODOS: Estudo retrospectivo de quarenta e dois pacientes com idades variando entre zero a 17 anos, portadores de fraturas de face, tratados no Setor de Cirurgia Buco-Maxilo-Facial da Santa Casa de São Paulo, no período de janeiro de 2000 a dezembro de 2003. Os dados foram tabulados através das informações colhidas dos prontuários dos pacientes, tais como: idade, gênero, tipo de fratura, etiologia e sazonalidade. RESULTADOS: Entre os resultados encontrados, houve predominância do gênero masculino com 81 por cento da casuística, a fratura de mandíbula foi a mais prevalente, com mais de 70 por cento dos casos, os acidentes de trânsito e as quedas foram os agentes etiológicos que mais causaram fraturas. O verão foi a época do ano com mais casos de fratura e mais de 80 por cento destas necessitaram de intervenção cirúrgica para o seu tratamento. CONCLUSÃO: É necessária uma política de prevenção com uma atenção especial aos acidentes de trânsito e às quedas, que foram os agentes etiológicos que mais causaram fraturas faciais.

OBJECTIVE: To conduct an epidemiological study of facial fractures in children in an emergency room. METHODS: A retrospective study of forty-two patients, aged zero to 17 years, with facial fractures treated at the Department of Oral and Maxillofacial Surgery, Santa Casa de São Paulo, from January 2000 to December 2003. The data were tabulated from information retrieved from patient files, such as age, gender, type of fracture, etiology and season of occurrence. RESULTS: Among the results were a predominance of males, accounting for 81 percent of all cases; jaw fracture was the most prevalent, constituting more than 70 percent of cases; and traffic accidents and falls were the etiologic agents that caused the most fractures. Summer was the season with the greatest number of cases of fracture and more than 80 percent required surgical intervention for their treatment. CONCLUSION: A policy of prevention is necessary, with special attention to traffic accidents and falls, which were the etiologic agents that caused the most facial fractures.