[Percutaneous revascularization in non-ST-elevation acute coronary syndromes: complete or incomplete?] / Rivascolarizzazione percutanea nelle sindromi coronariche acute senza sopraslivellamento del tratto ST: completa o incompleta?

Non-ST-elevation myocardial infarction with multivessel coronary disease is increasing in patients presenting with acute coronary syndrome (ACS) and it is associated with a high rate of mortality. Complete revascularization may reduce major adverse cardiac events in patients with ACS. However, the preferred revascularization strategies (complete vs incomplete) of non-culprit lesions in this setting, as well as the correct timing of revascularization are still matters of debate. This is mostly related to the heterogeneity of patients with this clinical presentation, who are often older and affected by multiple comorbidities. The present review aims to evaluate this topic highlighting the pros and cons of complete revascularization according to anatomical or functional and imaging evaluation and based on timing and patient's clinical phenotype.

Future of invasive and non-invasive hemodynamic assessment for coronary artery disease management.

Coronary artery disease represents a global health challenge. Accurate diagnosis and evaluation of hemodynamic parameters are crucial for optimizing patient management and outcomes. Nowadays a wide range of both non-invasive and invasive methods are available to assess the hemodynamic impact of both epicardial coronary stenosis and vasomotor disorders. In fact, over the years, important developments have reshaped the nature of both invasive and non-invasive diagnostic techniques, and the future holds promises for further innovation and integration. Non-invasive techniques have progressively evolved and currently a broad spectrum of methods are available, from cardiac magnetic resonance imaging with pharmacological stress and coronary computed tomography (CT) to the newer application of FFR-CT and perfusion CT. Invasive methods, on the contrary, have developed to a full-physiology approach, able not only to identify functionally significant lesions but also to evaluate microcirculation and vasospastic disease. The aim of this review is to summarize the current state-of-the-art of invasive and non-invasive hemodynamic assessment for CAD management.

Coronary Physiology Guidance vs Conventional Angiography for Optimization of Percutaneous Coronary Intervention: The AQVA-II Trial.

BACKGROUND: The debate surrounding the efficacy of coronary physiological guidance compared with conventional angiography in achieving optimal post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) values persists. OBJECTIVES: The primary aim of this study was to demonstrate the superiority of physiology-guided PCI, using either angiography or microcatheter-derived FFR, over conventional angiography-based PCI in complex high-risk indicated procedures (CHIPs). The secondary aim was to establish the noninferiority of angiography-derived FFR guidance compared with microcatheter-derived FFR guidance. METHODS: Patients with obstructive coronary lesions and meeting CHIP criteria were randomized 2:1 to receive undergo physiology- or angiography-based PCI. Those assigned to the former were randomly allocated to angiography- or microcatheter-derived FFR guidance. CHIP criteria were long lesion (>28 mm), tandem lesions, severe calcifications, severe tortuosity, true bifurcation, in-stent restenosis, and left main stem disease. The primary outcome was invasive post-PCI FFR value. The optimal post-PCI FFR value was defined as >0.86. RESULTS: A total of 305 patients (331 study vessels) were enrolled in the study (101 undergoing conventional angiography-based PCI and 204 physiology-based PCI). Optimal post-PCI FFR values were more frequent in the physiology-based PCI group compared with the conventional angiography-based PCI group (77% vs 54%; absolute difference 23%, relative difference 30%; P < 0.0001). The occurrence of the primary outcome did not differ between the 2 physiology-based PCI subgroups, demonstrating the noninferiority of angiography- vs microcatheter-derived FFR (P < 0.01). CONCLUSIONS: In CHIP patients, procedural planning and guidance on the basis of physiology (through either angiography- or microcatheter-derived FFR) are superior to conventional angiography for achieving optimal post-PCI FFR values. (Physiology Optimized Versus Angio-Guided PCI [AQVA-II]; NCT05658952).

Coronary Sinus Narrowing Improves Coronary Microcirculation Function in Patients With Refractory Angina: A Multicenter Prospective INROAD Study.

BACKGROUND: The underlying mechanisms responsible for the clinical benefits following coronary sinus narrowing and pressure elevation remain unclear. The present study aims to investigate whether coronary sinus narrowing improves the indexes of coronary microcirculatory function. METHODS: Patients with refractory angina who had a clinical indication for reducer implantation underwent invasive physiological assessments before and 4 months after the procedure. The primary outcome was the change in the values of the index of microcirculatory resistance. Secondary end points included changes in coronary flow reserve and the resistive resistance ratio values. Angina status was assessed with the Canadian Cardiology Society class and the Seattle Angina Questionnaire. RESULTS: Twenty-four patients with a history of obstructive coronary artery disease and prior coronary revascularization (surgical and percutaneous) treated with reducer implantation were enrolled, and 21 of them (87%) underwent repeated invasive coronary physiological assessment after 4 months. The index of microcirculatory resistance values decreased from 33.35±19.88 at baseline to 15.42±11.36 at 4-month follow-up (P<0.001; mean difference, -17.90 [95% CI, -26.16 to -9.64]). A significant (≥20% from baseline) reduction of the index of microcirculatory resistance was observed in 15 (71.4% [95% CI, 47.8%-88.7%]) patients. The number of patients with abnormal index of microcirculatory resistance (≥25) decreased from 12 (57%) to 4 (19%; P=0.016). Coronary flow reserve increased from 2.46±1.52 to 4.20±2.52 (mean difference, 1.73 [95% CI, 0.51-2.96]). Similar findings were observed for resistive resistance ratio values. Overall, 16 patients (76.1%) had an improvement of 1 Canadian Cardiology Society class. Seattle Angina Questionnaire summary score increase of around 3 points (3.01 [95% CI, 1.39-4.61]). CONCLUSIONS: Coronary sinus reduction implantation is associated with a significant improvement in the parameters of coronary microcirculatory function. These findings provide insights into the improvement of angina symptoms and may have implications for the treatment of coronary microvascular dysfunction. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05174572.

QFR for the Revascularization of Nonculprit Vessels in MI Patients: Insights From the FIRE Trial.

BACKGROUND: The role of quantitative flow ratio (QFR) in the treatment of nonculprit vessels of patients with myocardial infarction (MI) is a topic of ongoing discussion. OBJECTIVES: This study aimed to investigate the predictive capability of QFR for adverse events and its noninferiority compared to wire-based functional assessment in nonculprit vessels of MI patients. METHODS: The FIRE (Functional Assessment in Elderly MI Patients With Multivessel Disease) trial randomized 1,445 older MI patients to culprit-only (n = 725) or physiology-guided complete revascularization (n = 720). In the culprit-only arm, angiographic projections of nonculprit vessels were prospectively collected, centrally reviewed for QFR computation, and associated with endpoints. In the complete revascularization arm, endpoints were compared between nonculprit vessels investigated with QFR or wire-based functional assessment. The primary endpoint was the vessel-oriented composite endpoint (VOCE) at 1 year. RESULTS: QFR was measured on 903 nonculprit vessels from 685 patients in the culprit-only arm. Overall, 366 (40.5%) nonculprit vessels showed a QFR value ≤0.80, with a significantly higher incidence of VOCEs (22.1% vs 7.1%; P < 0.001). QFR ≤0.80 emerged as an independent predictor of VOCEs (HR: 2.79; 95% CI: 1.64-4.75). In the complete arm, QFR was used in 320 (35.2%) nonculprit vessels to guide revascularization. When compared with propensity-matched nonculprit vessels in which treatment was guided by wire-based functional assessment, no significant difference was observed (HR: 0.57; 95% CI: 0.28-1.15) in VOCEs. CONCLUSIONS: This prespecified subanalysis of the FIRE trial provides evidence supporting the safety and efficacy of QFR-guided interventions for the treatment of nonculprit vessels in MI patients. (Functional Assessment in Elderly MI Patients With Multivessel Disease [FIRE]; NCT03772743).

Coronary Computed Tomography Angiography: Beyond Obstructive Coronary Artery Disease.

Nowadays, coronary computed tomography angiography (CCTA) has a role of paramount importance in the diagnostic algorithm of ischemic heart disease (IHD), both in stable coronary artery disease (CAD) and acute chest pain. Alongside the quantification of obstructive coronary artery disease, the recent technologic developments in CCTA provide additional relevant information that can be considered as "novel markers" for risk stratification in different settings, including ischemic heart disease, atrial fibrillation, and myocardial inflammation. These markers include: (i) epicardial adipose tissue (EAT), associated with plaque development and the occurrence of arrhythmias; (ii) late iodine enhancement (LIE), which allows the identification of myocardial fibrosis; and (iii) plaque characterization, which provides data about plaque vulnerability. In the precision medicine era, these emerging markers should be integrated into CCTA evaluation to allow for the bespoke interventional and pharmacological management of each patient.

[Epicardial adipose tissue: a novel cardiovascular risk factor]. / Tessuto adiposo epicardico quale nuovo fattore di rischio cardiovascolare.

Epicardial adipose tissue (EAT) has various metabolic functions aiming at heart protection. When abnormal, it is related to atherosclerotic plaque development and adverse cardiovascular outcome. Additionally, in recent years, several studies have demonstrated its role in other settings such as atrial fibrillation and heart failure with preserved ejection fraction. Future studies should aim to assess diagnostic role of EAT and the effect of medical therapy on EAT volume and attenuation.

Structural Abnormalities in Brugada Syndrome and Non-Invasive Cardiac Imaging: A Systematic Review.

The aim of this review is to identify possible structural abnormalities of BrS and their potential association with symptoms, risk stratification, and prognosis. (1) Background: BrS has always been considered a purely electrical disease and imaging techniques do not currently play a specific role in the diagnosis of this arrhythmic syndrome. Some authors have recently hypothesized the presence of structural and functional abnormalities. Therefore, several studies investigated the presence of pathological features in echocardiography and cardiac magnetic resonance imaging (MRI) in patients with BrS, but results were controversial. (2) Methods: We performed a systematic review of the literature on the spectrum of features detected by echocardiography and cardiac MRI. Articles were searched in Pubmed, Cochrane Library, and Biomed Central. Only papers published in English and in peer-reviewed journals up to November 2021 were selected. After an initial evaluation, 596 records were screened; the literature search identified 19 relevant articles. (3) Results: The imaging findings associated with BrS were as follows: right ventricular dilation, right ventricular wall motion abnormalities, delayed right ventricular contraction, speckle and feature tracking abnormalities, late gadolinium enhancement, and fat infiltration in the right ventricle. Furthermore, these features emerged more frequently in patients carrying the genetic mutation on the sodium voltage-gated channel α-subunit 5 (SCN5A) gene. (4) Conclusions: Specific imaging features detected by echocardiography and cardiac magnetic resonance are associated with BrS. However, this population appears to be heterogeneous and imaging anomalies emerged to be more frequent in patients carrying genetic mutations of SCN5A. Future studies with an evaluation of BrS patients are needed to identify the specific association linking the Brugada pattern, imaging abnormalities and their possible correlation with prognosis.

[Mitral valve prolapse and mitral annulus disjunction: be aware of a potential arrhythmogenic substrate]. / Prolasso valvolare mitralico e disgiunzione mitro-anulare. La consapevolezza di un possibile substrato aritmico.

Mitral valve prolapse is a relatively common disease with a good overall prognosis. However, in specific clinical and instrumental contexts, patients at high risk of ventricular arrhythmias and sudden cardiac death can be identified. Female sex, history of palpitations or syncope, bi-leaflet myxomatous valve, ECG repolarization abnormalities in the inferior leads, complex ventricular arrhythmias, left ventricular fibrosis detected by cardiac magnetic resonance correlate with a higher risk clinical profile. Additionally, morpho-functional abnormalities of the mitral valve annulus, particularly mitral annulus disjunction, may cause a mechanical stretch at the inferior basal ventricular wall and posterior papillary muscles, predisposing to myocardial fibrosis and arrhythmias. A risk stratification strategy is needed to identify patients with mitral valve prolapse and/or mitral annulus disjunction at high risk of arrhythmias; however, few data are available. Further prospective multicenter studies are warranted, focusing on medical therapy, the role of implantable cardioverter-defibrillators for primary prevention, efficacy of targeted catheter ablation or mitral valve surgery.

Coronary Computed Tomography Angiography for the Assessment of Sirolimus-Eluting Resorbable Magnesium Scaffold.

BACKGROUND: Little evidence to date has described the feasibility and diagnostic accuracy of coronary computed tomography angiography (CCTA) with noninvasive fractional flow reserve (CT-FFR) in coronary vessels with resorbable magnesium scaffold (RMS). METHODS: The SHERPA-MAGIC is a prospective study enrolling patients receiving RMS. The present analysis considered patients undergoing CCTA 18 months after the index procedure. CCTA images were employed to investigate reabsorption status, luminal measurements, and noninvasive FFR. Three-year follow-up was available for all patients. RESULTS: Overall, 26 patients with a total of 29 coronary arteries treated with 35 RMS were considered. The most frequently involved vessel was left anterior descendent (LAD). Median stent length was 25 (20-25) mm, with a median diameter of 3 (3-3.5) mm. At 18-month CCTA, all scaffolded segments were patent. Complete RMS reabsorption was observed in 27 (93%, 95% CI 77-99%) cases. Median minimal lumen diameter (MLD) and area (MLA) of the scaffolded segments were 2.5 [2.1-2.8] mm and 6.4 [4.4-8.4] mm2, respectively. Median CT-FFR was 0.88 [0.81-0.91]. Only one (3.5%) vessel showed a flow-limiting CT-FFR value ≤0.80. During the 3-year follow-up, only one (4%) adverse event was observed. Conclusions: In patients undergoing RMS implantation, CCTA including noninvasive CT-FFR evaluation is feasible and allows investigation of long-term RMS performance.

[Violence among youngsters: social dynamics and situations of vulnerability]. / Violência entre jovens: dinânicas sociais e situações de vulnerabilidade.

The purpose of this study is to analyze the social dynamics implied in the life of youngsters, victims of violence, by (re) constructing the day-to-day relations and, therefore, discussing vulnerability situations. It is a descriptive and exploratory study that uses the genogram and the ecomap as instruments for data collection. Interview was carried out with 23 young victims of these events in Porto Alegre, Rio Grande do Sul, Brazil. Content analysis of the thematic type was adopted. From the social interactions of the surveyed youngsters, we observed the fragility of their relationship networks. Regarding the family environment, evidence shows that most of the youngsters come from families with precarious social and economic background. School education is recognized as a guarantee of social inclusion; however for some, the problems with state education and violence in and out of school collaborate for the decharacterization of the school as a protected and learning space. Learning the social dynamics implied in situations of vulnerability helps to understand this phenomenon and can influence prevention and promotion actions from health services.

Fatores de risco associados a anemia ferropriva em crianças de 0 a 5 anos, em um municipio da região noroeste do Rio Grande do Sul / Risk factors associated with iron deficiency anaemia in children from 0 to 5year old inamunicipality tothe northeast region of Rio Grande do Sul / Factores de riesgo asociados a la anemia por deficiencia de hierro en ninos de 0 a 5 anos de una ciudad de la region noroeste del estado de Rio Grande do Sul

Com este estudo, objetivou-se identificar os fatores de risco associados à anemia ferropriva em crianças de 2 meses a 5 anos, usuárias da Estratégia de Saúde da Família (ESF) no município de Panambi-RS. Optou-se por desenvolver pesquisa descritiva, com abordagem quantitativa. A população do estudo constituiu-se de crianças usuárias dos serviços de saúde da ESF, sendo a amostra composta por 41 crianças. Para a identificação dos fatores de risco, construiu-se um questionário fechado e para avaliar a anemia adotou-se o hemograma. Os dados foram analisados por meio da Estatística Descritiva no Programa Excel 2003, apresentados em forma de tabelas e discutidos à luz da literatura. Os resultados revelam que os fatores de risco mais prevalentes foram idade, classe econômica, realização do pré-natal, aleitamento materno e peso ao nascer. Diante dos achados, faz-se necessário fortalecer ações relacionadas ao serviço de pré-natal que integrem em sua rotina uma assistência mais eficaz a gestantes e crianças. Sugere-se que as equipes de ESF realizem um acompanhamento nutricional ao grupo de gestantes e crianças com intervenções, tais como visita domiciliar ao grupo de gestantes e puericultura, acolhimento, busca ativa, consultas e realização de exames. O diálogo deve ser utilizado em cada um desses momentos como ferramenta da educação em saúde para o autocuidado, fomentando nas gestantes a adoção de hábitos de vida que promovam sua saúde e a de seus filhos, contribuindo para a redução dos fatores de risco associados à anemia.

This study aimed to identify the risk factors associated with iron deficiency anaemia in 0 to 5 year old children participating in the Family Health Strategy (FHS) program in the municipality of Panambi-RS. A descriptive researchwith quantitative approach was adopted for the study development and the study subject comprised of 41 children attended at a FHS service unit. Risk factors were identified via a closed ended questionnaire. Anemia was identified and evaluated through a blood test. The data were analyzed by Descriptive Statistics using Excel 2003, presented intables, and discussed in the light of the related literature. The results reveal that the prevalent risk factors were age, socio-economic class, antenatal examination, breast-feeding and birth weight. The results demonstrate the need for a more effective antenatal health and care service. FHS teams should perform a nutritional follow-up on the pregnant women group and children through actions such as home visit to pregnant women and childcare advice, active searchfor and reception of pregnant women at risk, medical examinations and tests. Dialogue should be employed as an educational tool to promote amongst pregnant women the adoption of a healthy lifestyle for the mand for their children and consequently reduce the incidence of the risk factors associated with iron deficiency anaemia.

El presente estudio buscó identificar los factores de riesgo asociados a la anemia por deficiencia de hierro en niños de cero a cinco años, usuarios de servicios de la Estrategia de Salud de la Familia (ESF) en Panambi - RS. Para realizar el estudios e efectuó una investigación descriptiva con enfoque cuantitativo. Los sujetos del estudio fueron niños atendidos en la ESF que constituyeron un muestreo de 41 niños. Para identificar los factores de riesgo se elaboró un cuestionario cerrado y para evaluar la anemia se adoptó el hemograma. Los datos fueron analizados a través de la Estadística Descriptiva en el Programa Computacional Excel 2003, presentados en forma de tablas y discutidos a la luz de la literatura. Los resultados revelan que los factores de riesgo más prevalentes fueron edad, clase económica, realización del examen pre-natal, lactancia materna y peso al nascer. Frente a los hallazgos, es necesario fortalecer acciones relacionadas al Servicio de Pre-natal que integren en su rutina una asistencia más eficaz a las mujeres embarazadas y a los niños. Se sugiere que los equipos de ESF realicen el seguimiento nutricional del grupo de mujeres embarazadas y de los niños con acciones tales como: visita domiciliaria al estas mujeres y procedimientos de puericultura, acogida, búsquedaactiva, consultas y realización de exámenes. El diálogo en estos momentos sirve como herramienta de educación ensalud para el auto-cuidado, fomentando en las mujeres embarazadas a que adopten costumbres que promuevan su salud y la de sus hijos, contribuyendo a la reducción de los factores de riesgo asociados a la anemia.

Violência entre jovens: dinâmicas sociais e situações de vulnerabilidade / Violencia entre jóvenes: dinámicas sociales y situaciones vulnerabilidad / Violence among youngsters: social dynamics and situations of vulnerability

Esse estudo busca analisar as dinâmicas sociais implicadas na vida de jovens vítimas de violências por meio da (re)construção das relações cotidianas discutindo situações de vulnerabilidade. Trata-se de um estudo descritivo-exploratório, utilizando o genograma e ecomapa como instrumentos de coleta de dados. Entrevistou-se 23 jovens vítimas desse evento, no município de Porto Alegre, Rio Grande do Sul. Adotou-se análise de conteúdo do tipo temático. Nas interações sociais dos jovens, observou-se fragilização das redes de relações. A maioria desses jovens são oriundos de famílias com precária inserção social e econômica. A formação escolar é reconhecida enquanto garantia de inclusão social, no entanto para alguns os problemas do ensino público e a violência intra e extramuros, colaboram para a descaracterização da escola como espaço protegido e de aprendizagem. Conhecer as dinâmicas sociais implicadas nas situações de vulnerabilidade, auxilia na compreensão desse fenômeno e pode influenciar ações de prevenção e promoção a partir dos serviços de saúde.

Este estudio busca analizar dinámicas sociales implicadas en la vida de jóvenes víctimas de violencias por medio de la (re)construcción de las relaciones cotidianas discutiendo situaciones de vulnerabilidad. Se trata de un estudio descriptivo-exploratorio, utilizando el genogramo y el ecomapa como instrumentos de recolección de datos. Fueron entrevistados 23 jóvenes víctimas de estos eventos, en la municipalidad de Porto Alegre, Rio Grande do Sul, Brasil. Se adoptó el análisis de contenido del tipo temático. En las interacciones sociales de los jóvenes, se observó la fragilidad de las redes de relaciones. La mayoría de estos jóvenes son oriundos de familias con precaria inserción social yeconómica. La formación escolar es reconocida como garantía de inclusión social. Sin embargo para algunos, los problemas de la enseñanza pública y la violencia intra y extramuros colaboran para la descaracterización de la escuela como espacio protegido y de aprendizaje. Conocer las dinámicas sociales implicadas en las situaciones de vulnerabilidad y protección auxilia la comprensión de este fenómeno y, puede influenciar acciones de prevención y promoción a partir de los servicios de salud.

The purpose of this study is to analyze the social dynamics implied in the life of youngsters, victims of violence, by (re)constructing the day-to-day relations and, therefore, discussing vulnerability situations. It is a descriptive and exploratory study that uses the genogram and the ecomap as instruments for data collection. Interview was carried out with 23 young victims of these events in Porto Alegre, Rio Grande do Sul, Brazil. Content analysis of the thematic type was adopted. From the social interactions of the surveyed youngsters, we observed the fragility of their relationship networks. Regarding the family environment, evidence shows that most of the youngsters come from families with precarious social and economic background. School education is recognized as a guarantee of social inclusion; however, for some, the problems with state education and violence in and out of school collaborate for the decharacterization of the school as a protected and learning space. Learning the social dynamics implied in situations of vulnerability helps to understand this phenomenon and can influence prevention and promotion actions from health services.

Violência contra crianças e adolescentes: estratégias decuidado adotadas por profissionais de saúde / Violence against children and adolescents: care strategies adoptedby health professionals / Violencia contra niños y adolescentes: estrategias de cuidadoadoptadas por profesionales de salud

O estudo buscou caracterizar os profissionais de saúde e analisar suas estratégias de cuidados adotadas comcrianças e adolescentes vítimas de violência. Trata-se de um estudo exploratório-descritivo de abordagemquantitativa. Os sujeitos foram profissionais da equipe de saúde que atuavam nas unidades de prontoatendimentoe de pediatria nas instituições hospitalares da cidade de Cruz Alta/RS. Para coleta dos dados foiutilizado um instrumento com perguntas fechadas. Os dados foram analisados pela estatística descritiva. Foramentrevistados 34 profissionais de saúde, dos quais 19 eram do sexo feminino. Os profissionais e as estratégiasde cuidado mais evidenciados, conforme a categoria profissional, foram: o médico, com atendimento clínico epsicológico e encaminhamento ao especialista e ao Conselho Tutelar; os enfermeiros, que promovem assistênciaclínica e psicológica, fazem o histórico de enfermagem e o encaminham para avaliação do plantonista; e ostécnicos de enfermagem, que acalmam as vítimas, conversam com elas e realizam procedimentos técnicos. Oestudo em questão contribui para a visibilidade do fenômeno da violência contra crianças e adolescentes e paraa formulação de práticas assistenciais em saúde. Especificamente, para os profissionais de saúde, buscaram-seelementos de compreensão das práticas de cuidado nos serviços, considerando esse evento como real problemade saúde.

The study had the purpose to characterize the health professionals and analyze care strategies adopted withchildren and adolescents victims of violence. This is an exploratory-descriptive study with a quantitative approach.The subjects were professionals from the health team that acted in Emergency and Pediatrics units in hospitals ofCruz Alta/RS. For data collection an instrument with closed questions was used. Data were analyzed bydescriptive statistics. Thirty-four health professionals were interviewed, 19 of them were female. The moreevidenced care strategies, according to professional category, were: clinical care, medical, psychological support,routing to specialist and to the Tutelary Council; the nurses promote clinical and psychological assistance, carryout nursing records and direct the victim to the emergency room physician. Nursing technicians calm down, talk tothe victims, and carry out technical procedures. The study in question contributes to the visibility of thephenomenon of violence against children and adolescents, as well as to the formulation of care practices inhealth. Specifically, for the health professionals, it was sought elements of understanding of the care practices,considering this event a real problem on the health assistance.

El estudio buscó caracterizar los profesionales de salud y analizar las estrategias de cuidados adoptados conniños y adolescentes víctimas de la violencia. Se trata de un estudio exploratorio-descriptivo de abordajecuantitativo. Los sujetos fueron profesionales del equipo de salud que trabajaban en un Hospital de Urgencias yde pediatría en las instituciones hospitalarias de la ciudad de Cruz Alta/Rio Grande do Sul. Para la recolección dedatos, se utilizó un instrumento con preguntas cerradas. Los datos fueron analizados por la estadísticadescriptiva. Fueron entrevistados 34 profesionales de salud, siendo 19 del sexo femenino. Los profesionales ylas estrategias de cuidado más evidenciados, conforme la categoría profesional, fueron: los médicos, conatención clínica y psicológico y encaminamiento al especialista y al Consejo Tutelar; los enfermeros, quepromueven asistencia clínica y psicológica, realizan histórico de enfermería y lo encaminan para la evaluacióndel médico que está de guardia; y los técnicos de enfermería que calman a las víctimas, hablan con ellas yrealizan procedimientos técnicos. El estudio contribuye para la visibilidad del fenómeno de la violencia contraniños y adolescentes y para la formulación de prácticas asistenciales en salud. Específicamente, para losprofesionales de salud, se buscaron elementos de comprensión de las prácticas de cuidado en los servicios,considerando ese evento como un real problema de salud.

Abordagem dos profissionais de saúde em instituições hospitalares a crianças e adolescentes vítimas de violência / Approach of health professionals in hospitals to children and adolescents victims of violence / Abordaje de los profesionales de salud en instituciones hospitalarias a niños y adolescentes víctimas de violencia

O estudo busca analisar o fluxo da assistência em instituições hospitalares a crianças e adolescentes, vítimas desse agravo, e o sentimento despertado nos profissionais diante do fenômeno. Trata-se de estudo descritivo-exploratório, com abordagem quantitativa. Participaram do mesmo, profissionais de saúde que atuavam em instituições hospitalares da região norte do estado do Rio Grande do Sul, num total de 34 profissionais. A coleta de dados foi realizada no período de maio a julho de 2008. Para a realização do estudo, estruturou-se instrumento com perguntas fechadas, analisado pela estatística descritiva. Os resultados mostram que, quanto à composição da equipe, 72% dos profissionais eram do sexo feminino e 38%, na faixa etária de 23-30 anos. Quanto à categoria profissional, 59% eram técnicos de enfermagem. Em relação ao fluxo do atendimento dos casos de violência, 31% acionam o Ministério Público; 25% comunicam o Conselho Tutelar e 12% preenchem a ficha de notificação compulsória, comunicam o Conselho Tutelar e prestam assistência. Em relação aos sentimentos diante do atendimento, evidenciou-se revolta, indignação, medo e impotência. O estudo possibilitou visibilizar a realidade em que as crianças e os adolescentes vítimas de violência são atendidos, discutindo as intervenções locais e apontando elementos para a ações mais eficazes.

The study aims at analyzing the flow of care in hospitals rendered for children and adolescents who are victims of such offence and the feeling it arises in the professionals who face this phenomenon. It is a descriptive and exploratory study with quantitative approach. It counted on the participation of 34 health professionals who perform their job in hospitals from the northern region of the state of Rio Grande do Sul. The data collection was carried out from May to July 2008. In order to make the study, an instrument was elaborated with closed questions and analyzed by descriptive statistics. The results show that as to the composition of the team, 72% of the professionals belonged to the feminine sex and 38% to the age frame of 23-30 years old. As to the professional category, 59% were nursing technicians. Regarding the flow of attendance regarding violence cases, 31% call the Justice Department, 25% communicate the Guardianship Court and 12% fill out the compulsory notice form, communicate the Guardianship Court and render assistance. Regarding the feelings that arise in view of the attendance, the evidence shows commotion, indignation, fear and impotence.The study made it possible to render visible the reality where children and adolescents who are victims of violence are attended and to discuss the local interventions and to point out the elements for the more effective actions.

El estudio intenta analizar el flujo de la asistencia en instituciones hospitalarias a niños y adolescentes víctimas de este agravio y el sentimiento despertado en los profesionales delante del fenómeno. Se trata de un estudio descriptivo-exploratorio, con abordaje cuantitativo. Participaron de lo mismo 34 profesionales de salud que actuaban en instituciones hospitalarias de la región norte de la provincia de Rio Grande do Sul. La recolección de datos fue realizada en el período de mayo hasta julio de 2008. Para la realización del estudio, se estructuró un instrumento con preguntas cerradas, analizado por la estadística descriptiva.Los resultados muestran que en cuanto a la composición del equipo, 72% de los profesionales eran del sexo femenino y 38% de edad entre 23 y 30 años. En cuanto a la categoría profesional, 59% eran técnicos de enfermería. En relación al flujo do atendimiento de los casos de violencia, 31% accionan el Ministerio Público; 25% comunican el Consejo Tutelar y 12% llenan la ficha de notificación compulsoria, comunican el Consejo Tutelar y prestan asistencia. En relación a los sentimientos delante del atendimiento, se evidenciaron revuelta, indignación, miedo e impotencia. El estudio posibilitó visibilizar la realidad en que los niños y adolescentes víctimas de violencia son atendidos, discutiendo posibilidades y límites de las intervenciones locales, apuntando elementos para acciones más eficaces.

Violência contra crianças: dimensões apreendidas nas falas de professoras de educação infantil e a articulação com o setor saúde / Violencia contra ninos: dimensiones captadas en las palabras de profesores de educacion infantil y la articulacion con el sector de salud / Violence against children: aspects apprehended via the elementary school teachers discourse and the coordination with the health care sector

A violência contra crianças acompanha o desenvolvimento da humanidade, afetando a qualidade de vida, dadasas lesões físicas, psíquicas e morais. Apesar do crescente reconhecimento das formas de violência praticadas contraas crianças e as ações realizadas pelos setores de saúde e educação, há, ainda, uma invisibilidade desse problema.É nesse contexto que se busca, neste estudo, conhecer e analisar as concepções e ações de professoras diante daviolência contra crianças em escola de Educação Infantil do município de Palmeira das Missões-RS. Trata-se de estudoexploratório-descritivo, com abordagem qualitativa, sendo sujeitos 11 professoras. Para a coleta dos dados, os quaisforam analisados pela modalidade temática, utilizou-se entrevista semiestruturada. A visão da violência contra criançasé resultante de diversos fatores e o seu reconhecimento baseia-se nas marcas físicas, o que impede, muitas vezes, avisualização das diversas formas de violência e reforça sua naturalização. Outros elementos centram-se na omissão ena concepção de que a violência contra as crianças é um problema de família e a responsabilização da denúncia é dadireção da escola, tornando-se entraves que dificultam o enfrentamento desse agravo. Constatou-se, também, queos profissionais de educação não reconhecem o setor saúde como integrante da rede de proteção. Nesse sentido, acriação de uma rede e o desenvolvimento de ações intersetoriais, principalmente entre o setor saúde e o da educação,são estratégias fundamentais para o enfrentamento desse grave problema contra as crianças.

A violência contra crianças acompanha o desenvolvimento da humanidade, afetando a qualidade de vida, dadasas lesões físicas, psíquicas e morais. Apesar do crescente reconhecimento das formas de violência praticadas contraas crianças e as ações realizadas pelos setores de saúde e educação, há, ainda, uma invisibilidade desse problema.É nesse contexto que se busca, neste estudo, conhecer e analisar as concepções e ações de professoras diante daviolência contra crianças em escola de Educação Infantil do município de Palmeira das Missões-RS. Trata-se de estudoexploratório-descritivo, com abordagem qualitativa, sendo sujeitos 11 professoras. Para a coleta dos dados, os quaisforam analisados pela modalidade temática, utilizou-se entrevista semiestruturada. A visão da violência contra criançasé resultante de diversos fatores e o seu reconhecimento baseia-se nas marcas físicas, o que impede, muitas vezes, avisualização das diversas formas de violência e reforça sua naturalização. Outros elementos centram-se na omissão ena concepção de que a violência contra as crianças é um problema de família e a responsabilização da denúncia é dadireção da escola, tornando-se entraves que dificultam o enfrentamento desse agravo. Constatou-se, também, queos profissionais de educação não reconhecem o setor saúde como integrante da rede de proteção. Nesse sentido, acriação de uma rede e o desenvolvimento de ações intersetoriais, principalmente entre o setor saúde e o da educação,são estratégias fundamentais para o enfrentamento desse grave problema contra as crianças.

La violencia contra los niños sigue el camino del desarrollo de la humanidad, afectando la calidad de vida debido alas lesiones físicas, psíquicas y morales. A pesar del creciente reconocimiento de las formas de violencia contra losniños y las acciones por parte de los sectores de salud y educación, aún se trata de un problema bastante invisible.Dentro de dicho contexto este estudio ha buscado conocer y analizar las concepciones y acciones de los profesores ante la violencia contra los niños en escuelas de educación infantil del municipio de Palmeira das Missões/RS. Se tratade un estudio descriptivo exploratorio con enfoque cualitativo y 11 profesores como sujetos. La recogida de datos,analizados por tema, se realizó mediante una entrevista semiestructurada. La visión de violencia contra los niños resulta de varios factores y se reconoce por las marcas físicas lo que muchas veces impide vislumbrar otras formas de violenciay refuerza su tolerancia. Otros elementos se centran en la omisión y en el concepto de que la violencia contra los niños es un problema familiar y que la dirección de la escuela tiene la responsabilidad de hacer la denuncia, lo cual torna más difícil enfrentar el problema. Se constata también que los educadores no reconocen al sector de la salud como parte de la red de protección. En ese sentido, la creación de una red y el desarrollo de acciones intersectoriales, principalmente entre los sectores salud y educación, son estrategias fundamentales para combatir esta grave ofensa a los niños.