Tendência da mortalidade por neoplasias malignas em idosos brasileiros com mais de 80 anos entre 2000 e 2017 / Cancer mortality trends in Brazilian adults aged 80 and over from 2000 to 2017

INTRODUÇÃO: Idosos com 80 anos ou mais representam o segmento populacional com o maior crescimento proporcional em países emergentes. Investigações abordando a tendência de mortalidade por neoplasias malignas na população muito idosa no Brasil são escassas e incomuns. OBJETIVO: Descrever a tendência de óbitos por câncer na população muito idosa, por sexo e tipo, entre 2000 e 2017 no Brasil. METODOLOGIA: Estudo descritivo, tipo tendência, com uso de dados secundários do Sistema de Informações sobre Mortalidade (do Departamento de Informática do Sistema Único de Saúde). As variáveis foram ano de óbito, sexo e sítio da neoplasia. Os cinco principais tipos de neoplasia foram determinados, e foram calculadas as taxas de mortalidade e tendência específicas. A tendência foi determinada por modelo de regressão joinpoint Nos casos em que se identificaram um ou mais joinpoints, calculou-se a variação percentual anual média, do inglês average annual percent change (AAPC), por meio da média geométrica ponderada das variações percentuais anuais (APCs, do inglês annual percent change) na qual os pesos foram equivalentes aos comprimentos dos segmentos. Estimou-se a significância estatística a da APC/AAPC pelo cálculo dos seus respectivos intervalos de confiança de 95% (IC95%), considerando alfa de 0,05. RESULTADOS: Foi observada uma tendência crescente da taxa de mortalidade (AAPC = 1,50; IC95% 1,20 - 1,70), no sexo masculino (AAPC = 1,90; IC95% 1,70 - 2,10) e feminino (AAPC = 1,30; IC95% 1,00 - 1,50). Maiores taxas de mortalidade concentraram-se em homens. Os sítios de câncer que mais causaram mortes foram próstata (AAPC = 1,70; IC95% 1,10 - 2,30), em homens, e mama (AAPC = 1,90; IC95% 1,50 - 2,20), em mulheres, seguidos por bronquios e pulmões, estômago e cólon, todos com taxas crescentes ­ exceto estômago. CONCLUSÕES: Observaram-se taxas crescentes de neoplasias rastreáveis e/ou preveníveis, alertando sobre necessidade de medidas preventivas.

INTRODUCTION: Adults aged 80 and over represent the fastest growing segment of the population in emerging countries. Studies of cancer mortality trends in the oldest old population are scarce in Brazil. OBJECTIVE: To describe trends in cancer mortality in the Brazilian oldest old, by gender and cancer type, from 2000 to 2017. METHODS: This was a descriptive study with a time trend design, based on data from the Mortality Information System (of the Informatics Department of the Unified Health System). The variables analyzed were year of death, sex and cancer site. The five most common types of cancer were identified, and mortality rates and trends were calculated for each one. Trends were determined using joinpoint regression. In all cases where one or more joinpoints were statistically significant the average annual percent change (AAPC) was calculated based on the arithmetic mean of the annual percent change (APC), weighted by the length of each segment. The statistical significance of the APC and AAPC was estimated by calculating 95% confidence intervals (CI) with an alpha level of 0.05. RESULTS: Mortality rates increased over time (AAPC = 1.50; 95%CI, 1.20 - 1.70) in both males (AAPC = 1.90; 95%CI, 1.70 - 2.10) and females (AAPC = 1.30; 95%CI, 1.00 - 1.50). Men had higher mortality rates than women. The most common causes of cancer-related death were prostate cancer (AAPC = 1.70; 95%CI, 1.10 - 2.30) in men, and breast cancer (AAPC = 1.90; 95%CI, 1.50 - 2.20) in women, followed by cancers of the lung and bronchus, stomach and colon. All rates increased over time, except in the case of stomach cancer. CONCLUSION: The study revealed increasing mortality rates for screenable and/or preventable cancers, alerting to the need for preventive measures.

Vivências de mulheres sobre o processo de parturição e pós-parto em um hospital escola / Women's experiences about the process of parturition and postpartum in a school hospital

Trata-se de uma pesquisa qualitativa que objetivou compreender a percepção das mulheres sobre o atendimento ofertado em um Hospital-Escola Público, assim como apreender as representações sociais sobre maternidade que perpassam este contexto, considerando de que forma a amamentação tem sido vivenciada pelas mulheres e incorporada na assistência em saúde. A coleta de dados ocorreu através de entrevistas presenciais semiestruturadas com oito mulheres hospitalizadas. A escolha pela entrevista semiestruturada se deu para que o foco da pesquisa pudesse ser investigado e não corrêssemos o risco de obter falas aleatórias e não relacionadas ao tema. Foi utilizada a Análise de Conteúdo de Bardin, resultando em quatro categorias de análise elaboradas pela pesquisadora após análise do conteúdo das falas obtidas, são elas: a) As representações sobre ser mãe; b) Vivências do trabalho de pré-parto, parto e pós-parto imediato; c) A institucionalização do corpo; d) Atendimento ofertado às mulheres e relação profissional-paciente. Como resultados, elucidou-se que as representações sociais sobre a maternidade estavam presentes nas experiências das mulheres entrevistadas, interferindo em sua maternagem e na percepção da amamentação, bem como na assistência em saúde. A institucionalização do corpo e partos disciplinadores entre cuidado/prevenção também agravam a regulação da mulher. Relatos de práticas de acolhimento, interdisciplinaridade e integralidade no cuidado estiveram presentes, porém a vivência de limitações nos processos comunicacionais, a organização do serviço de saúde, a relação de saber/poder transformada em hierarquização no encontro paciente-profissional e a objetificação da mulher no processo de parto, denotaram a necessidade de importantes modificações na forma de cuidar e assistir mulheres durante este processo, afim de possibilitar o protagonismo das mulheres e humanização hospitalar. Percebeu-se a importância desta pesquisa como forma de efetivação de um lugar de fala para as mulheres-pacientes e suas realidades, fato que justifica sua execução e publicação, uma vez que os dados obtidos podem contribuir para a melhora dos cuidados ofertados pela equipe multiprofissional, que pode também atuar objetivando a construção de um espaço de troca entre essas pacientes e os profissionais que as atendem.

This is a qualitative research that aimed to understand women's perception of the care offered in a Public School Hospital, as well as to apprehend the social representations about maternity that pervade this context, considering how breastfeeding has been experienced by women and incorporated into health care. Data collection occurred through semi-structured face-to-face interviews with eight hospitalized women. The choice for the semi-structured interview was made so that the research focus could be investigated and we did not run the risk of obtaining random and unrelated statements. Bardin Content Analysis was used, resulting in four categories of analysis elaborated by the researcher after analysis of the content of the speeches obtained: a) Representations about being a mother; b) Experiences of pre-partum, delivery and immediate post-partum work; c) The institutionalization of the body; d) Attendance offered to women and professional-patient relationship. As results, it was elucidated that the social representations about maternity were present in the experiences of the interviewed women, interfering in their maternity and in the perception of breastfeeding, as well as in health assistance. The institutionalization of the body and disciplinary births between care/ prevention also aggravate women's regulation. Reports of reception practices, interdisciplinarity and integrality in the care were present, however the experience of limitations in the communicational processes, the organization of the health service, the relation of knowledge/power transformed in hierarquization in the patient-professional relation and the objectification of the woman in the childbirth process, denounced the necessity of important modifications in the way of caring and assisting women during this process, in order to make possible the protagonism of the women and hospital humanization. It was perceived the importance of this research as a form of accomplishment of a place of speech for the women-patients and their realities, fact that justifies its execution and publication, once the obtained data can contribute for the improvement of the cares offered by the multiprofessional team, that can also act aiming at the construction of a space of exchange between these patients and the professionals that attend them.

Essential oil of the leaves of Eugenia sulcata preserve myocardial contractility and does not present immunotoxicity

The essential oil of the leaves of Eugenia sulcata, in the Myrtaceae family, has a demonstrated antihypertensive effect, but its effects on heart muscle and its toxicity have not yet been elucidated. Little chemical or biological data are available for E. sulcata, whether emphasizing the beneficial effects or the pharmacological security of this species. This study aims to evaluate myocardial contractility and to analyze angiotensin converting enzyme (ACE) and myosin ATPase activities associated with use of this essential oil. In addition, we evaluated the immunotoxicity of E. sulcata essential oil. Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR) were treated daily for 30 days (10 mg/kg of oil) to evaluate the isometric force of the papillary muscle, ACE measured by fluorimetry, and myosin ATPase activities by inorganic phosphate. Lymphocyte cultures were used to evaluate cytotoxicity, DNA damage, and mutagenicity of the essential oil. The results demonstrate that the treatment did not change the cardiac contraction force and did not alter the functioning of the sarcoplasmic reticulum, extrusion of the membrane calcium, or modify the membrane calcium channels or ß-adrenergic receptor activity. Tetanic contractions were potentiated in the SHR animals. Myosin ATPase activity was also increased in the SHR animals. Cardiac ACE activity was reduced in both animal strains, and the serum ACE was reduced only in the SHR animals. The essential oil did not cause cytotoxicity or mutagenicity and presented low DNA damage. Our results demonstrated that the essential oil does not change myocardial contractility and does not present relevant immunotoxicity

Comparison of vesical pressure values achieved by Valsalva maneuvers: A standardization proposal.

AIMS: To perform a comparative evaluation of Valsalva maneuver techniques, in an attempt to identify the most suitable one for achieving leak point pressure (LPP) during the cystometric phase of the urodynamic study (UDS), in order to propose a method for technical standardization. METHODS: Urodynamic data from women with stress urinary incontinence at three urogynecological medical centers were randomly selected and prospectively analyzed. Valsalva maneuver was executed through forceful attempted exhalation against the dorsal surface of the hand (Group 1), through abdominal strain (Group 2), or through low-elasticity latex balloon-blowing (Group 3). Patients were classified based on age and higher vesical pressure value, as well as time to perform Valsalva maneuver. RESULTS: Initially, 1358 urodynamic studies were identified as eligible for analysis. Among these, 340 belonged to Group 1, 318 to Group 2, and 700 to Group 3. Valsalva maneuver accomplished through abdominal straining was more effective, inducing increased vesical pressure, across age groups. The same maneuver may be sustained for longer than the other two techniques. CONCLUSION: When performed through abdominal strain, the Valsalva maneuver was more effective for stress urinary incontinence urodynamic's investigation.

Polycyclic aromatic hydrocarbons in commercial brands of dry whole soybeans for direct human consumption.

A total of 13 polycyclic aromatic hydrocarbons (PAHs) were surveyed in dry whole soybeans (Glycine max L.) sold for human consumption. The analysed samples were commercialised in vegetarian shops and food stores in Southern Brazil regions. The determination of PAHs levels was carried out by high performance liquid chromatography (HPLC)with fluorescence detection. PAHs were present in 89.7% of the samples. Chrysene (Chy) and 5 methyl chrysene (5MeChy) were the main PAHs detected (76.9% and 71.8%, respectively) followed by dibenzo(ai)pyrene (DaiP), however in a much less percentage of samples (23.1%). Apart from those PAHs, also benzo(a)antracene (BaA), benzo(b)fluoranthene (BbF), benzo(k)fluoranthene (BkF) and benzo(a)pyrene(BaP) were found. The ΣPAH levels in the positive samples ranged from 0.80 to 38.78 µg kg-1, with exception of one sample that reached 204.46 µg kg-1 (ΣPAHs of six compounds). Despite the present contamination there are no maximum limits set for PAHs in soybeans.

Fumonisins and fungi in dry soybeans (Glycine Max L.) for human consumption.

This survey reports the occurrence of fumonisins (FBs) and fungi in dry soybeans sold for human consumption. The variation levels were 138-1495 µg kg(-1) and 178-552 µg kg(-1) for FB1 and FB2, respectively. In addition, potentially toxigenic fungi as Fusarium, Aspergillus and Penicillium genera were isolated in the samples. These can be considered as indicator-toxin and can produce considerable amounts of mycotoxins. Despite FB presence in the soybeans for human consumption, there is no legal regulation. Therefore, it is important to emphasise the need for frequent monitoring of these contaminants in soybeans.

Laboratory evaluation of the effects of essential oil of Myrciaria floribunda leaves on the development of Dysdercus peruvianus and Oncopeltus fasciatus

Myrciaria floribunda (H. West ex Willd.) O. Berg, Myrtaceae, is popularly known as "camboim-amarelo" and was collected at Restinga de Jurubatiba (RJ, Brazil). Leaves from this species were submitted to hydrodistillation to extract its essential oil. Monoterpenes were the main compounds found (53.9%), and 1,8-cineole was the major constituent (38.4%). Studies were carried out to evaluate the effects of this essential oil on the development of two species of agricultural pests (Oncopeltus fasciatus and Dysdercus peruvianus). The essential oil was considered effective against D. peruvianus and O. fasciatus, causing mortality in both insects. The LD50 values (µg/insect) observed were 112.44 µg/insect (O. fasciatus) and 309.64 µg/insect (D. peruvianus) after one day of treatment, and 72.18 µg/insect (O. fasciatus) and 94.42 µg/insect (D. peruvianus) after 22 days of treatment. The present study reports for the first time the bioinsecticidal activity of essential oil of Myrciaria floribunda leaves, and provides important data regarding the use of essential oils in complementary programs for pest control.

Ele ou ela? quando é necessário conceber, ressignificar e renascer no imaginario dos pais - intervenções psicológicas / He or She? when it is necessary to conceive, ressignificate and reborn in imagery parents contents - psychological interventions

O presente trabalho pretende ilustrar, através de um olhar psicológico, o relato de experiência de profissionais da psicologia hospitalar numa intervenção interdisciplinar em dois casos que relatam a experiência vivida por pais de crianças com diagnóstico de Desordem do Desenvolvimento Sexual (DDS). A Hiperplasia Adrenal Congênita (HAC), que resulta numa DDS, consiste numa doença que se manifesta através da mutação no gene CYP21A2, que acaba por ser responsável pelo surgimento, ao nascimento, de um quadro clínico denominado genitália externa ambígua, com variados graus de virilização nas meninas e macrogenitossomia nos meninos, que podem ser acompanhadas por desidratação, arritmias cardíacas, choque e mesmo morte. Esta é uma doença cuja incidência é de 1:10.325 nascimentos na população brasileira. A partir de dois casos de bebês atendidos no Hospital Universitário de Maringá (HUM), que tiveram diagnóstico de genitália ambígua, a equipe da psicologia realizou atendimentos aos pais voltados para a escuta das questões surgidas a partir do diagnóstico de seus filhos. Neste sentido, houve uma preocupação em trabalhar com o conteúdo imaginário de cada casal em relação a gestação e como isso se dava em relação ao bebê real, buscando uma ressignificação de todo esse processo. A experiência em ambas as situações demonstrou que, além das relações familiares, estão imbricados no resultado desse trabalho a concepção do bebê, o desejo dos pais e o luto em relação ao bebê real, mostrando que não são casos simples e que seus desenvolvimentos irão depender da relação do casal parental e de suas próprias histórias de vida.(AU)

This paper aims to illustrate, through a psychological view, an experience of professionals in health psychology in interdisciplinary intervention in two cases that report the experiences of parents of children diagnosed with disorder of sex development (DSD). Congenital adrenal hyperplasia (CAH), which results in a DSD, is a disease that manifests itself through mutation in the CYP21A2 gene, that is responsible for the appearance, at birth, of a clinical condition called ambiguous genitalia, with various degrees of virilization in girls and macrogenitossomia in boys, which may be accompanied by dehydration, cardiac arrhythmia, shock and even death. This is a disease with a incidence of 1:10.325 births in our population. From two cases of infants treated at Hospital Universitário de Maringá (HUM), who had a diagnosis of ambiguous genitalia, the psychology team performed consultations with the parents seaking to listen to the questions arising from diagnosis of their children. In this sense, there was a concern in working with imagery content of each couple in relation to pregnancy and how this happened in relation to the real baby, looking for a resignification of this whole process. Experience in both situations has shown that, in addition to family relationships the desire of parents and the grief over the real baby are intertwined in the outcome of this work to conceive the baby, showing that cases are not simple and that its development will depend on the relationship of the parents and their own life stories.(AU)