Evaluation of the efficacy of labor induction with vaginal misoprostol in a low-risk pregnant women population.

OBJECTIVE: The aim of this study was to evaluate the success rate and predictors of labor induction using vaginal misoprostol in a low-risk pregnant women population. METHODS: A prospective cohort study was carried out with 196 pregnant women. Groups 2 and 4 of the Robson Classification admitted for induction of labor with vaginal misoprostol (25 µg tablets every 6 h, up to 4 tablets, for a maximum of 24 h). The success of labor induction was considered the achievement of vaginal delivery. Binary logistic regression was used to determine the best predictors of successful induction of labor with vaginal misoprostol. RESULTS: Of all the pregnant women analyzed, 140 (71.4%) were successful and 56 (28.6%) were unsuccessful. Pregnant women who achieved successful induction had a higher number of pregnancies (1.69 vs. 1.36, p=0.023), a higher number of deliveries (0.57 vs. 0.19, p<0.001), a higher Bishop score (2.0 vs. 1.38, p=0.002), and lower misoprostol 25 µg tablets (2.18 vs. 2.57, p=0.031). No previous deliveries [x2(1)=3.14, odds ratio (OR): 0.24, 95% confidence interval (CI): 0.10-0.57, R2 Nagelkerke: 0.91, p=0.001] and the presence of one previous delivery [x2(1)=6.0, OR: 3.40, 95% CI: 1.13-10.16, R2 Nagelkerke: 0.043, p=0.029] were significant predictors of successful induction of labor with vaginal misoprostol. CONCLUSION: A high rate of labor induction success using vaginal misoprostol in a low-risk population was observed, mainly in multiparous and with gestational age>41 weeks. No previous delivery decreased the success of labor induction, while one previous delivery increased the success of labor induction.

Evaluation of the efficacy of labor induction with vaginal misoprostol in a low-risk pregnant women population

SUMMARY OBJECTIVE: The aim of this study was to evaluate the success rate and predictors of labor induction using vaginal misoprostol in a low-risk pregnant women population. METHODS: A prospective cohort study was carried out with 196 pregnant women. Groups 2 and 4 of the Robson Classification admitted for induction of labor with vaginal misoprostol (25 μg tablets every 6 h, up to 4 tablets, for a maximum of 24 h). The success of labor induction was considered the achievement of vaginal delivery. Binary logistic regression was used to determine the best predictors of successful induction of labor with vaginal misoprostol. RESULTS: Of all the pregnant women analyzed, 140 (71.4%) were successful and 56 (28.6%) were unsuccessful. Pregnant women who achieved successful induction had a higher number of pregnancies (1.69 vs. 1.36, p=0.023), a higher number of deliveries (0.57 vs. 0.19, p<0.001), a higher Bishop score (2.0 vs. 1.38, p=0.002), and lower misoprostol 25 μg tablets (2.18 vs. 2.57, p=0.031). No previous deliveries [x2(1)=3.14, odds ratio (OR): 0.24, 95% confidence interval (CI): 0.10-0.57, R2 Nagelkerke: 0.91, p=0.001] and the presence of one previous delivery [x2(1)=6.0, OR: 3.40, 95% CI: 1.13-10.16, R2 Nagelkerke: 0.043, p=0.029] were significant predictors of successful induction of labor with vaginal misoprostol. CONCLUSION: A high rate of labor induction success using vaginal misoprostol in a low-risk population was observed, mainly in multiparous and with gestational age>41 weeks. No previous delivery decreased the success of labor induction, while one previous delivery increased the success of labor induction.

Validation of the Opening Minds Scale for Health Care Providers (OMS-HC): Factor Structure and Psychometric Properties of the Brazilian Version.

Stigma towards people with mental illness is also present among health professionals. The study validated and estimated the reliability, dimensionality and structure of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) scale in Brazil. In this methodological study, health professionals (n = 199) from Family Health Units in Brazil were recruited by convenience sampling. The EFA conducted with 16 items resulted in four factors. The Cronbach's Alpha for the OMS scale was 0.74, which is considered to reflect reasonable reliability. The data presented contribute to the use of the scale in studies that investigate the level of stigma among health professionals towards people with mental illness, as well as in the development of anti-stigma interventions in this context.

Gender Differences in Gambling Exposure and At-risk Gambling Behavior.

This study aimed to evaluate the differences in gambling exposure and onset of gambling problems among male and female gamblers by comparing their demographic and behavioral profiles. This study utilized data from the gambling section of the First Brazilian National Alcohol Survey and Related Behaviors. Interviews were conducted with 3007 participants who were recruited after screening for at-risk gambling behaviors. Individuals who tested positive for at-risk gambling behaviors completed the Gambling Progression Questionnaire comprising items on games of chance, and were evaluated using the DSM-IV pathological gambling criteria. The participants' "lifetime gambling exposure" was 12.5%, with 4% having experienced gambling problems during their lifetime. Majority of the male at-risk gamblers (78%) reported that they began gambling in their 20 s and took approximately 3 years to start experiencing gambling-related problems. Contrastingly, female at-risk gamblers started gambling in their 30 s and they took about 12 years to start experiencing gambling-related problems. The present results show that men were 2.3 times more at risk of gambling exposure and 3.6 times more likely to experience gambling-related problems. Male at-risk male gamblers seemed to be lonelier and to have a low socioeconomic status, while women seemed to have lower income and social insertion. Considering these significant differences, more studies evaluating gender differences in gambling behavior are necessary.

Geospatial, racial, and educational variation in firearm mortality in the USA, Mexico, Brazil, and Colombia, 1990-2015: a comparative analysis of vital statistics data.

BACKGROUND: Firearm mortality is a leading, and largely avoidable, cause of death in the USA, Mexico, Brazil, and Colombia. We aimed to assess the changes over time and demographic determinants of firearm deaths in these four countries between 1990 and 2015. METHODS: In this comparative analysis of firearm mortality, we examined national vital statistics data from 1990-2015 from four publicly available data repositories in the USA, Mexico, Brazil, and Colombia. We extracted medically-certified deaths and underlying population denominators to calculate the age-specific and sex-specific firearm deaths and the risk of firearm mortality at the national and subnational level, by education for all four countries, and by race or ethnicity for the USA and Brazil. Analyses were stratified by intent (homicide, suicide, unintentional, or undetermined). We quantified avoidable mortality for each country using the lowest number of subnational age-specific and period-specific death rates. FINDINGS: Between 1990 and 2015, 106·3 million medically-certified deaths were recorded, including 2 472 000 firearm deaths, of which 851 000 occurred in the USA, 272 000 in Mexico, 855 000 in Brazil, and 494 000 in Colombia. Homicides accounted for most of the firearm deaths in Mexico (225 000 [82·7%]), Colombia (463 000 [93·8%]), and Brazil (766 000 [89·5%]). Suicide accounted for more than half of all firearm deaths in the USA (479 000 [56·3%]). In each country, firearm mortality was highest among men aged 15-34 years, accounting for up to half of the total risk of death in that age group. During the study period, firearm mortality risks increased in Mexico and Brazil but decreased in the USA and Colombia, with marked national and subnational geographical variation. Young men with low educational attainment were at increased risk of firearm homicide in all four countries, and in the USA and Brazil, black and brown men, respectively, were at the highest risk. The risk of firearm homicide was 14 times higher in black men in the USA aged 25-34 years with low educational attainment than comparably-educated white men (1·52% [99% CI 1·50-1·54] vs 0·11% [0·10-0·12]), and up to four times higher than in comparably-educated men in Brazil, Colombia, and Mexico. In the USA, the risk of firearm homicide was more than 30 times higher in black men with post-secondary education than comparably educated white men. If countries could achieve the same firearm mortality rates nationally as in their lowest-burden states, 1 777 800 firearm deaths at all ages and in both sexes could be avoided, including 1 028 000 deaths in men aged 15-34 years. INTERPRETATION: Firearm mortality in the USA, Mexico, Brazil, and Colombia is highest among young adult men, and is strongly associated with race and ethnicity, and low education levels. Reductions in firearm deaths would improve life expectancy, particularly for black men in the USA, and would reduce racial and educational disparities in mortality. FUNDING: Canadian Institutes of Health Research and the University of Toronto Connaught Global Challenge.

Peritoneal washing in gynecological neoplasias / Lavado peritoneal em neoplasias ginecológicas

ABSTRACT Introduction and objective: Peritoneal washing cytology is part of pathological staging of adenocarcinomas of the endometrium and ovary. The objective of this study was to verify the prevalence of cytology positive for malignancy in patients diagnosed with adenocarcinoma of the endometrium or ovary, as well as to verify the association between the positive cytology and the variables age of the patient, histological type of the neoplasm and degree of tumor differentiation. Method: A retrospective and prospective cross-sectional study was carried out through the analysis of peritoneal washing cytology reports and the anatomopathological reports of 43 patients diagnosed with ovarian or endometrial adenocarcinoma, provided by the Pathology Center of Curitiba. Results: In relation to endometrial adenocarcinoma, the prevalence of positive cytologies was 7%. Neither the degree of tumor differentiation (p = 1) nor age (p = 0.233) demonstrated association with such positivity. In relation to ovarian adenocarcinoma, the prevalence of positive cytologies was 20%. The degree of tumor differentiation showed a significant positive association with this positivity (p = 0.044). Age did not show association (p = 0.804). It was not possible to verify association with the histological type of neoplasms due to non-applicability of the statistical test. Conclusion: The prevalence of peritoneal lavage cytology positive for malignancy was 7% in endometrial adenocarcinoma and 20% in ovarian adenocarcinoma. Only the degree of tumor differentiation of ovarian adenocarcinomas showed a significant association with peritoneal washing positivity.

RESUMEN Introducción y objetivo: La citología del lavadoperitoneal es parte de la estadificación de los adenocarcinomas de endometrio y ovario. El objetivo de este trabajo es estimar la prevalencia de citologías positivas para malignidad en pacientes con diagnóstico de adenocarcinoma de endometrio y/u ovario, así como la asociación entre positividadde la citologíay las variables edaddel paciente, tipo histológico de la neoplasiay grado de diferenciación tumoral. Método: Se realizó un estudio transversal retrospectivoy prospectivo mediante el análisis de los reportes citológicos de lavado peritoneal y hallazgos anatomopatológicos de 43 pacientes con diagnóstico de adenocarcinoma ovárico o endometrial, puestos a disposición por el Centro de Patologia de Curitiba. Resultados: En cuanto al adenocarcinoma de endometrio, la prevalencia de citologías positivas fue 7%. Ni el grado de diferenciación tumoral (p = 1) ni la edad (p = 0,233) mostraron asociación con la positividad. En cuanto al adenocarcinoma de ovario, la prevalencia de citologías positivas fue 20%. El grado de diferenciación tumoral mostró asociación positiva significativa con esa positividad (p = 0,044); la edad no mostró asociación (p = 0,804). No fue posible verificar la asociación con tipo histológico de las neoplasias por cuanto el test estadístico no sería aplicable. Conclusión: La prevalencia de citologías de lavado peritoneal positivas para malignidad fue 7% en el adenocarcinoma de endometrio y 20% en el adenocarcinoma de ovario. Solamente el grado de diferenciación tumoral de los adenocarcinomas ováricos demostró asociación significativa con la positividad del lavado peritoneal.

RESUMO Introdução e objetivo: A citologia de lavado peritoneal faz parte do estadiamento patológico dos adenocarcinomas de endométrio e ovário. O objetivo deste trabalho foi verificar a prevalência de citologias positivas para malignidade em pacientes com diagnóstico de adenocarcinoma de endométrio e/ou ovário, bem como a associação entre apositividade da citologia e as variáveis idade da paciente, tipo histológico da neoplasia e grau de diferenciação tumoral. Método: Foi realizado um estudo transversal retrospectivo e prospectivo por meio da análise dos laudos de citologia de lavado peritoneal e dos laudos anatomopatológicos de 43 pacientes com diagnóstico de adenocarcinoma ovariano ou endometrial, disponibilizados pelo Centro de Patologia de Curitiba. Resultados: Em relação ao adenocarcinoma de endométrio, a prevalência de citologias positivas foi de 7%. Nem o grau de diferenciação tumoral (p = 1) nem a idade (p = 0,233) demonstram associação com a positividade. Em relação ao adenocarcinoma de ovário, a prevalência de citologias positivas foi de 20%. O grau de diferenciação tumoral demonstrou associação positiva significativa com essa positividade (p = 0,044); a idade não demonstrou associação (p = 0,804). Não foi possível verificar a associação com o tipo histológico das neoplasias por não aplicabilidade do teste estatístico. Conclusão: A prevalência de citologias de lavado peritoneal positivas para malignidade foi de 7% no adenocarcinoma de endométrio e de 20% no adenocarcinoma de ovário. Somente o grau de diferenciação tumoral dos adenocarcinomas ovarianos demonstrou associação significativa com a positividade do lavado peritoneal.

Perfil das vítimas de acidentes de trânsito atendidas pelo serviço integrado de atendimento ao trauma em Curitiba e Região Metropolitana / Profile of the victims of transit accidents attended by the integrated service of trauma at Curitiba and metropolitan region

Objetivo: descrever características epidemiológicas das vítimas de acidentes de trânsito atendidas pelo SIATE no município de Curitiba e Região Metropolitana, no período de 2004 a 2013. Métodos: pesquisa descritiva retrospectiva, com utilização de dados obtidos de fonte secundária, compreendendo o período entre 01/01/2004 a 31/12/2013. Foram incluídos, dados referentes à solicitação de Atendimento Pré-Hospitalar do SIATE Curitiba e região metropolitana, que incluem situações de acidentes de trânsito. Resultados: O número total de ocorrências no período foi de 176.186, com 200.159 vítimas atendidas. O ano com maior proporção de acidentes de trânsito foi 2011 (64,17%), havendo uma tendência a queda no número de ocorrências, bem como de acidentes de trânsito, ao longo dos anos. Dentre os acidentes de trânsito, a grande maioria foi de baixa gravidade: 113.299 (98,34%).Conclusão: Traçou-se o perfil epidemiológico e, dentre outras informações, conclui-se que a mortalidade por acidentes de trânsito vem diminuindo ao longo dos anos

Objective: to describe the epidemiological characteristics of the victims of traffic accidents attended by SIATE in the city of Curitiba and Metropolitan Region, from 2004 to 2013. Methods: retrospective descriptive research, using data obtained from a secondary source, comprising the period between 01 / 01/2004 to 12/31/2013. Data concerning the request for Pre-hospital Care of SIATE Curitiba and metropolitan region were included, will all the situations of traffic accidents. Results: The total number of occurrences in the period was 176,186, with 200,159 victims attended. The year with the highest proportion of traffic accidents was in 2011 (64.17%), with a tendency to decrease in the number of occurrences, as well as traffic accidents, over the years. Among the traffic accidents, the majority were of low severity: 113,299 (98.34%). Conclusion: The epidemiological profile was drawn and, among other information, it is concluded that the mortality due to traffic accidents has been decreasing over the years

The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses.

BACKGROUND: Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has suggested that depression could be associated with excess all-cause mortality across different settings and populations, although the causality of these associations remains unclear. METHODS: We conducted an umbrella review of systematic reviews and meta-analyses of observational studies. PubMed, PsycINFO, and Embase electronic databases were searched through January 20, 2018. Systematic reviews and meta-analyses that investigated associations of depression and all-cause and cause-specific mortality were selected for the review. The evidence was graded as convincing, highly suggestive, suggestive, or weak based on quantitative criteria that included an assessment of heterogeneity, 95% prediction intervals, small-study effects, and excess significance bias. RESULTS: A total of 26 references providing 2 systematic reviews and data for 17 meta-analytic estimates met inclusion criteria (19 of them on all-cause mortality); data from 246 unique studies (N = 3,825,380) were synthesized. All 17 associations had P < 0.05 per random effects summary effects, but none of them met criteria for convincing evidence. Associations of depression and all-cause mortality in patients after acute myocardial infarction, in individuals with heart failure, in cancer patients as well as in samples from mixed settings met criteria for highly suggestive evidence. However, none of the associations remained supported by highly suggestive evidence in sensitivity analyses that considered studies employing structured diagnostic interviews. In addition, associations of depression and all-cause mortality in cancer and post-acute myocardial infarction samples were supported only by suggestive evidence when studies that tried to adjust for potential confounders were considered. CONCLUSIONS: Even though associations between depression and mortality have nominally significant results in all assessed settings and populations, the evidence becomes weaker when focusing on studies that used structured interviews and those that tried to adjust for potential confounders. A causal effect of depression on all-cause and cause-specific mortality remains unproven, and thus interventions targeting depression are not expected to result in lower mortality rates at least based on current evidence from observational studies.

Lesão Isolada de Ducto Hepático Esquerdo em Trauma Abdominal Contuso: um Relato de Caso / An Isolated Injury Of Left Hepatic Duct In A Blunt Abdominal Trauma: A Case Report

Introdução: O fígado e suas vias biliares, é o segundo órgão mais acometido pelos traumas abdominais contusos. Entretanto, injúrias que acometem exclusivamente vias biliares extra-hepáticas são extremamente raras. Objetivo: Relatar um caso de lesão de ducto hepático esquerdo como única lesão de um trauma abdominal contuso. Relato: Paciente ICF, masculino, 37, vítima de colisão auto-auto com trauma abdominal contuso, admitido ao pronto socorro, recebendo alta na manhã seguinte. Após dois dias, retornou ao serviço relatando dor abdominal intensa e constipação significativa. Exames de imagem demonstraram líquido livre peri-hepático e peri-esplênico. Foi realizada laparotomia exploratória, que demonstrou lesão isolada de ducto hepático esquerdo, sem outras alterações. Paciente não apresentou intercorrências pós-operatórias, sendo que no 5º dia PO, recebeu alta. Na consulta de reavaliação, foi constatada boa evolução. Paciente segue hígido. Conclusão: Conhecido o bom prognóstico dessas lesões, quando da conduta adequada, relatos como esse são muito importantes para a clínica cirúrgica

Introduction: The liver and its biliary tract is the second organ most affected by blunt abdominal traumas. However, injuries that exclusively involve extrahepatic bile ducts are extremely rare. Objective: To report a case of left hepatic duct injury as the sole lesion of blunt abdominal trauma. Report: Patient ICF, male, 37, victim of auto-auto collision with blunt abdominal trauma, admitted to the emergency room, discharged the following morning. After two days, he returned to the service reporting severe abdominal pain and significant constipation. Imaging studies demonstrated free perihepatic and peri-spleen fluid. An exploratory laparotomy was performed, which demonstrated an isolated lesion of the left hepatic duct, without other alterations. Patient did not present postoperative complications, and on the 5th postoperative day, he was discharged. In the revaluation consultation, a good evolution was observed. Patient remains healthy. Conclusion: The good prognosis of these lesions is known, when the appropriate conduct is established. Therefore, reports such as these are very important for the surgical clinic

Gambling onset and progression in a sample of at-risk gamblers from the general population.

The goal of this study was to investigate gambling-related behavior, onset and progression in a sample of at-risk gamblers from the community. A national household survey was conducted in Brazil, covering individuals 14 years old or older. Subjects were screened for at-risk gambling, those testing positive answered a questionnaire about gambling progression, preferred games and DSM-IV pathological gambling criteria. Out of 3007 respondents, 118 were considered at-risk gamblers according to the Lie/Bet Questionnaire. According to the DSM-IV, 32.7% and 24.9% of those were considered problem and pathological gamblers, respectively. Early at-risk gamblers (onset prior to 20 years of age), were more likely to be male, to prefer non-commercially structured games, and to chase losses while gambling. Young pathological gamblers (under 35 years of age) progressed faster from regular to problem gambling (roughly 2 years) than mature pathological gamblers (12 years). Such findings had not been described before because previous reports focused mostly on clinical samples that lack young, male, early-onset gamblers. Gambling programs have not satisfactorily covered this segment of gamblers. Outreach strategies and early interventions should be provided to prevent these individuals from rapidly evolving into pathological gambling.

Sequência laboratorial para a confecção de prótese parcial removível: parte I: do modelo de estudo à inclusão da escultura / Guide for making removable partial denture: part I: from study model to sculpture inclusion

Apesar do número crescente de reabilitações orais com implantes osseointegrados, a Prótese Parcial Removível (PPR) ainda representa um meio de reabilitação estética e funcional satisfatória para a realidade brasileira. Dentre outros fatores, ela ainda é uma opção viável por ser mais barata que a reabilitação com próteses implantossuportadas e por não necessitar de uma etapa cirúrgica. Para que a terapia com PPR tenha sucesso é necessário que exista conhecimento da técnica de confecção por parte do cirurgião dentista e do técnico em prótese dentária e que haja comunicação entre estes dois profissionais. Assim, o objetivo desta primeira parte do trabalho é apresentar a técnica de confecção de PPR, desde a obtenção do modelo de estudo até a inclusão para obtenção do molde para fundição, procurando orientar o técnico e visando alcançar sucesso com o tratamento reabilitador. Esta sequência laboratorial compreende os seguintes passos: Obtenção e análise do modelo de estudo; Modelo de trabalho; Delineamento; Planejamento; Alívio ou bloqueio dos ângulos mortos; Duplicação do modelo de trabalho em modelo de revestimento; Tratamento da superfície do modelo de revestimento; Escultura da estrutura metálica e Inclusão para obtenção do molde para fundição

Despite the growing number of oral rehabilitation with osseointegrated implants, the Removable Partial Denture (RPD) still represents a mean of satisfying aesthetic and functional rehabilitation for the Brazilian reality. Among other factors, it is still a viable option because it is aheaper than rehabilitation with implant supported prosthesis and not requires a surgical step. For therapy to be successful, it is necessary that the dentist and the dental technician have technical knowledge and communication. The purpose of this paper is to present the technique to make RPD, tryng to guide the technician to get rehabilitation treatment success. The laboratorial steps are: collect and analysis of the study model; working model; design; planning; model duplication in a coating model, surface treatment, steel structure sculpture and inclusion for obtaining mold for casting

Sequência laboratorial para a confecção de prótese parcial removível: parte II: da fundição ao polimento final / Guide for making removable partial denture

O sucesso do tratamento reabilitador com Próteses Parciais Removíveis (PPRs) depende de um correto planejamento e passos clínicos realizados pelo dentista e de um adequado processamento laboratorial das próteses pelo protético. Muitas desadaptações e, consequentemente, falhas, podem ser evitadas se etapas laboratoriais não forem negligenciadas. Deste modo, o objetivo desta segunda parte do trabalho é apresentar os passos técnicos compreendidos entre a fase de fundição e polimento final da PPR. Tal sequência laboratorial inclui os seguintes passos: Fundição; Injeção do metal no molde de revestimento; Desinclusão da estrutura metálica; Acabamento e polimento; Adaptação no modelo; Plano de orientação; Montagem dos dentes; Inclusão e acrilização; Acabamento e polimento da PPR

Despite the growing number of oral rehabilitation with osseointegrated implants, the removable partial denture (RPD) still represents a means of satisfying aesthetic and functional rehabilitation for the Brazilian reality. Among other factors, it is still a viable option because it is cheaper than rehabilitation with implant supported prosthesis and not requires a surgical step. For therapy to be successful RPD is necessary that the dentist and the dental technician have technical knowledge and communication. The purpose of this paper is to present the technique to make RPD, trying to guide the technician to get rehabilitation treatment success. The laboratorial steps are: Collect and analysis of the study model; Working model; Design; Planning; Model duplication in a coating model, surface treatment; Steel structure sculpture; Inclusion for obtaining mold for casting; Casting; Injection molding of metal in a coating; Divestment of the metallic structure, Finishing and polishing; Adaptation in the model; Plane guidance; Artificial teeth positioning; Inclusion and polymerization, Finishing and polishing RPD. Follow ing this sequence and performing the technique correctly, success of the rehabilitation treatment with RPD is obtained

Endocardite em valva aórtica bivalvular com extensão e perfuração da cúspide anterior mitral / Endocarditis in bicuspid aortic valve with extension and perforation of the anterior leaflet mitral / Endocarditis en Válvula Aórtica Bivalva con Extensión y Perforación de la Cúspide anterior Mitral

Paciente jovem, internado por endocardite em valva aórtica bivalvular, com extensão perianular da infecção (abscesso mitral com perfuração de cúspide), apresentando insuficiência aórtica e mitral importantes. Evoluiu com choque misto, baixo débito cardíaco efetivo, acidose metabólica, insuficiência respiratória e insuficiência renal aguda dialítica secundária a glomerulonefrite por deposição de imunocomplexos. Instituído tratamento para insuficiência cardíaca, antibioticoterapia de amplo espectro, suporte ventilatório não invasivo e hemodiálise, apresentando melhora do quadro clínico. Submetido à troca valvar aórtica por prótese biológica e plastia mitral, com bom resultado cirúrgico. Não havia relato de procedimento dentário prévio, outras portas de entrada para microrganismos nem uso de drogas ilícitas por via intravenosa. Bacteremias espontâneas podem ser implicadas, certamente, nesses casos. Parece não haver redução da incidência de infecções valvares com uso de profilaxia antibiótica em portadores de valvas nativas alteradas, segundo as atuais recomendações.

Young patient, hospitalized for infective endocarditis in bicuspid aortic valve with extension periannular infection (abscess with perforation of mitral leaflet) presenting significant aortic and mitral insufficiency. Evolved with mixed shock, low cardiac output effective, metabolic acidosis, respiratory failure and acute renal failure requiring dialysis secondary to glomerulonephritis by immune complex deposition. Established treatment for heart failure, broad-spectrum antibiotic therapy, noninvasive ventilatory support and hemodialysis, with clinical improvement. Underwent to aortic valve replacement and mitral valve bioprosthesis with good outcome. There was no report of previous dental procedure, other ports of entry for microorganisms and drug addiction. Spontaneous bacteremia can be certainly involved in these cases. There seems no reduction in the incidence of valvular infections with use of antibiotic prophylaxis in patients with native valves changed, according to current recommendations.

Paciente joven, internado por endocarditis en válvula aórtica bivalva, con extensión perianular de la infección (absceso mitral con perforación de cúspide), presentando insuficiencias aórtica y mitral importantes. Evolucionó con choque mixto, bajo débito cardíaco efectivo, acidosis metabólica, insuficiencia respiratoria e insuficiencia renal aguda dialítica secundaria a glomerulonefritis por deposición de inmunocomplejos. Establecido tratamiento para insuficiencia cardíaca, antibioticoterapia de amplio espectro, soporte ventilatorio no invasivo y hemodiálisis, presentando una mejora del cuadro clínico. Sometido a un trasplante de la válvula aórtica por una prótesis biológica y una plastia mitral, con buen resultado quirúrgico. No había antecedentes de procedimientos previos, otras puertas de entrada para microorganismos ni uso de drogas ilícitas por vía intravenosa. Las bacteriemias espontáneas pueden ser implicadas, ciertamente, en esos casos. Parece no haber reducción de la incidencia de infecciones valvulares con uso de profilaxis antibiótica en portadores de válvulas nativas alteradas, conforme a las actuales recomendaciones

Differences in drinking patterns between men and women in Brazil.

OBJECTIVE: To examine sex differences in alcohol consumption according to age groups, and to assess gender and age effects on several aspects of alcohol consumption patterns. METHOD: Based on a Brazilian nationwide representative sample (n = 3,007), we analysed the differences in drinking patterns between genders. We also assessed the effects of gender, age, and gender by age interaction for alcohol consumption dimensions (frequent drinking, usual intake, binge drinking, and frequent binge drinking), using logistic and negative binomial regression models. RESULTS: Gender, age, and gender by age interaction had significant effects on the predictive models for all studied drinking patterns, except for the 'usual' dosage. The effect of gender on drinking patterns varies with age. While gender has a greater effect in older age groups, the difference between men and women decreased in the younger age groups. CONCLUSIONS: Gender convergence regarding alcohol use is a trend that might be influenced by environmental factors and should be addressed in prevention and treatment programs, as well as in public health policies.

Differences in drinking patterns between men and women in Brazil / Diferenças nos padrões de consumo de álcool entre homens e mulheres no Brasil

OBJECTIVE: To examine sex differences in alcohol consumption according to age groups, and to assess gender and age effects on several aspects of alcohol consumption patterns. METHOD: Based on a Brazilian nationwide representative sample (n = 3,007), we analysed the differences in drinking patterns between genders. We also assessed the effects of gender, age, and gender by age interaction for alcohol consumption dimensions (frequent drinking, usual intake, binge drinking, and frequent binge drinking), using logistic and negative binomial regression models. RESULTS: Gender, age, and gender by age interaction had significant effects on the predictive models for all studied drinking patterns, except for the 'usual' dosage. The effect of gender on drinking patterns varies with age. While gender has a greater effect in older age groups, the difference between men and women decreased in the younger age groups. CONCLUSIONS: Gender convergence regarding alcohol use is a trend that might be influenced by environmental factors and should be addressed in prevention and treatment programs, as well as in public health policies.

OBJETIVO: Avaliar as diferenças nos padrões de consumo de álcool entre os gêneros de acordo com as faixas etárias e avaliar os efeitos do gênero e da idade em diversos aspectos do padrão de consumo de bebidas alcoólicas. MÉTODO: Com base em amostra representativa da população brasileira (n = 3.007), nós avaliamos as diferenças nos padrões de consumo de álcool entre os gêneros. Nós também avaliamos os efeitos do gênero, da idade e da interação entre gênero e idade nas dimensões do consumo de álcool (consumo frequente, dose usual, consumo em binge e consumo frequente em binge), com uso de modelos de regressão logística e regressão binomial negativa. RESULTADOS: O gênero, a idade e a interação entre gênero e idade tiveram efeitos significantes nos modelos preditivos para todos os padrões de consumo estudados, com exceção da dose usual. O efeito do gênero ao longo das faixas etárias varia com a idade. Enquanto o gênero teve um efeito maior nas faixas etárias mais velhas, a diferença entre homens e mulheres diminuiu nas faixas etárias mais novas. CONCLUSÕES: A convergência entre os gêneros no que se refere ao uso de álcool é uma tendência que pode ser influenciada por fatores ambientais e deveria ser focada nos programas de prevenção e tratamento assim como nas políticas públicas.

Patterns of alcohol use among Brazilian adolescents / Padrões de uso de álcool entre adolescentes brasileiros

OBJECTIVE: To describe patterns of alcohol consumption by adolescents in Brazil. METHOD: From November 2005 to April 2006, a sample composed of 661 subjects aged between 14 to 17 years was rigorously selected in Brazil using a multistage probabilistic method to represent the profile of the adolescent Brazilian population. RESULTS: 34 percent of Brazilian adolescents drink alcoholic beverages. The mean age of drinking initiation was 14 years of age. Older adolescents, as well as those living in the southern part of Brazil, those who are not attending school and those who are working, and black individuals and those with personal income reported a higher frequency of drinking. Socio-demographic factors such as gender, income bracket, family income and student status do increase the amount of alcohol consumed. Males report a higher frequency of binge drinking than females. Moreover, more than half of the males that had drunk in the previous year reported having engaged in binge drinking on at least one occasion. Beer represents approximately half of all the drinks consumed by adolescents. There was no significant difference between genders in the kind of alcohol consumed. DISCUSSION: Among adolescents who drink, the consumption of several drinks is frequent. Alcohol consumption varies from region to region, social economic status (including self-generated income) and age. These findings are discussed in light of their importance for the development of alcohol prevention policies in Brazil.

OBJETIVO: Apresentar um panorama nacional sobre o padrão de consumo de bebidas alcoólicas entre adolescentes no Brasil. MÉTODO: Amostra rigorosamente selecionada em procedimento probabilístico em múltiplos estágios em todo o território brasileiro, de novembro de 2005 a abril de 2006, representando um perfil da população adolescente brasileira, composta por 661 sujeitos entre 14-17 anos. RESULTADOS: 34 por cento dos adolescentes brasileiros bebem. A idade média de início da experimentação de bebidas alcoólicas foi de 14 anos. Adolescentes mais velhos, habitando a região Sul, que não estudam, que trabalham, de cor negra e que têm rendimento próprio apresentaram maior frequência de consumo. A quantidade usual consumida varia de acordo com sexo, classe social, renda familiar e o fato de estudar ou não. Os jovens do sexo masculino se destacam por apresentarem um percentual bem maior do beber em binge quando comparados com as jovens e mais da metade dos adolescentes do sexo masculino que bebem o fizeram em binge em pelo menos em uma ocasião. Aproximadamente metade das doses consumidas por adolescentes é de cerveja ou chope. Com relação aos gêneros, não foi detectada diferença significativa entre tipos de bebida. DISCUSSÃO: O consumo de altas doses é frequente entre os adolescentes. Os padrões de consumo dos adolescentes apresentam variações em relação a região, estrato social, rendimentos próprios e idade. Os achados têm importância para o estabelecimento de políticas nacionais.

Alcohol use patterns among Brazilian adults / Padrão de uso de álcool em brasileiros adultos

OBJECTIVE: To describe patterns of alcohol consumption in the adult Brazilian population. METHOD: Multicluster random sample of 2,346 subjects 18 years of age or older, selected nationwide. Interviews were conducted in respondents' homes between November 2005 and April 2006. RESULTS: About 48 percent of the sample had not drunk alcoholic beverages in the past year, with variations by gender, age, marital status, education, income and region of the country. Among drinkers, 29 percent reported drinking 5 or more drinks per occasion (men, 38 percent). Sociodemographic variables are associated with the frequency and amount of drinking, alcohol problems, and alcohol abuse and dependence. Among the whole sample (including drinkers and non drinkers), 28 percent reported binge drinking, 25 percent reported at least one kind of alcohol related problem, 3 percent were alcohol abusers and another 9 percent were alcohol dependent. DISCUSSION: Abstinence is high in the Brazilian population. However, elevated proportions of those who drink consume alcohol in a high risk pattern (binge-drinking), report a high level of alcohol problems, alcohol abuse and dependence. National public policies must consider these factors, as well as the regional Brazilian differences.

OBJETIVO: Apresentar os padrões de consumo de bebidas alcoólicas entre a população adulta brasileira. MÉTODO: Amostra de 2.346 indivíduos, cuidadosamente selecionada da população brasileira com 18 anos ou mais. Amostra selecionada em todo o território brasileiro, por meio de procedimento probabilístico em múltiplos estágios. As entrevistas, realizadas nas residências, ocorreram entre novembro de 2005 e abril de 2006. RESULTADOS: 48 por cento da amostra relataram não haver bebido no último ano e esse índice variou de acordo com sexo, idade, estado civil, nível educacional e de renda e região do país. Entre aqueles que bebiam, 29 por cento consumiam usualmente cinco ou mais doses por ocasião (38 por cento entre os homens). Fatores sociodemográficos foram relevantes em relação a todas as variáveis de consumo estudadas: frequência, quantidade, problemas, abuso e dependência. Na amostra total, incluindo os não-bebedores, 28 por cento beberam em binge, 25 por cento relataram ao menos um tipo de problema relacionado ao consumo, 3 por cento preencheram critério para abuso e 9 por cento para dependência. DISCUSSÃO: O grau de abstinência da população brasileira é alto. No entanto, os bebedores apresentam elevado nível de consumo de risco. A prevalência de problemas relacionados ao consumo, abuso e dependência de álcool também é significativa. Políticas públicas nacionais devem levar em conta esses fatores assim como as diferenças regionais.

Gambling in Brazil: lifetime prevalences and socio-demographic correlates.

Gambling has experienced world-wide growth. The current study is the first national survey into household gambling conducted in a developing country. The sample was a three-stage probabilistic one designed to cover individuals 14 years old or older, of both genders and from all regions of the national territory; 325 census sectors were visited, including rural areas. DSM-IV-based instruments were used to assess problem and pathological gambling; individuals were asked to estimate their monthly gambling expenditure. The lifetime prevalences were: pathological gambling 1.0%, and problem gambling 1.3%. Maximum gambling expenditure corresponded to 5.4% of the household income for social gamblers, 16.9% for problem gamblers and 20.0% for pathological gamblers. The male:female ratio among adults for pathological gambling was 3.2:1. The data suggest the existence of two subgroups of pathological gamblers, one younger (33.9±4.19) and severe (7 or more DSM-IV criteria), another older (47.8±6.01) and less severe (5-6 criteria). In a multinomial logistic regression, problematic gambling was associated with gender, age, education, employment, region of origin and living in metropolitan areas. The data suggest that feeling active and socially inserted protects against problematic gambling. Individuals who are young, male, unemployed or not currently pursuing further education may be at special risk for severe pathological gambling.

Patterns of alcohol use among Brazilian adolescents.

OBJECTIVE: To describe patterns of alcohol consumption by adolescents in Brazil. METHOD: From November 2005 to April 2006, a sample composed of 661 subjects aged between 14 to 17 years was rigorously selected in Brazil using a multistage probabilistic method to represent the profile of the adolescent Brazilian population. RESULTS: 34% of Brazilian adolescents drink alcoholic beverages. The mean age of drinking initiation was 14 years of age. Older adolescents, as well as those living in the southern part of Brazil, those who are not attending school and those who are working, and black individuals and those with personal income reported a higher frequency of drinking. Socio-demographic factors such as gender, income bracket, family income and student status do increase the amount of alcohol consumed. Males report a higher frequency of binge drinking than females. Moreover, more than half of the males that had drunk in the previous year reported having engaged in binge drinking on at least one occasion. Beer represents approximately half of all the drinks consumed by adolescents. There was no significant difference between genders in the kind of alcohol consumed. DISCUSSION: Among adolescents who drink, the consumption of several drinks is frequent. Alcohol consumption varies from region to region, social economic status (including self-generated income) and age. These findings are discussed in light of their importance for the development of alcohol prevention policies in Brazil.

Alcohol use patterns among Brazilian adults.

OBJECTIVE: To describe patterns of alcohol consumption in the adult Brazilian population. METHOD: Multicluster random sample of 2,346 subjects 18 years of age or older, selected nationwide. Interviews were conducted in respondents' homes between November 2005 and April 2006. RESULTS: About 48% of the sample had not drunk alcoholic beverages in the past year, with variations by gender, age, marital status, education, income and region of the country. Among drinkers, 29% reported drinking 5 or more drinks per occasion (men, 38%). Sociodemographic variables are associated with the frequency and amount of drinking, alcohol problems, and alcohol abuse and dependence. Among the whole sample (including drinkers and non drinkers), 28% reported binge drinking, 25% reported at least one kind of alcohol related problem, 3% were alcohol abusers and another 9% were alcohol dependent. DISCUSSION: Abstinence is high in the Brazilian population. However, elevated proportions of those who drink consume alcohol in a high risk pattern (binge-drinking), report a high level of alcohol problems, alcohol abuse and dependence. National public policies must consider these factors, as well as the regional Brazilian differences.