Contracepção em situações especiais / Contraception in special situations

A decisão de escolha do método contraceptivo em situações clínicas especiais é desafiadora tanto para médicos quanto para pacientes. Em parte, isso se deve às contraindicações reais que alguns contraceptivos apresentam. Porém, há uma estreita relação com a falta de conhecimento e medo de muitos profissionais em prescrever métodos que, na realidade, são seguros. A má escolha do método contraceptivo para pacientes portadoras de condições específicas pode levar a diversos desfechos ruins, como piora da condição de base, ocorrência de eventos adversos indesejáveis e preveníveis e ocorrência de gravidez de alto risco indesejada. Dessa forma, foi realizada uma revisão na literatura com o objetivo de auxiliar profissionais médicos na decisão contraceptiva de pacientes portadoras de doenças reumatológicas e musculoesqueléticas, epilepsia, esclerose múltipla, transtornos alimentares, anemia falciforme e obesidade, e que já foram submetidas a cirurgia bariátrica.(AU)

The decision to choose the contraceptive method in special clinical situations is challenging for both physicians and patients. In part, this is due to the real contraindications that some contraceptives present. However, there is a close relationship with the lack of knowledge and fear of many professionals in prescribing methods that are actually safe. The poor choice of contraceptive method in patients with specific conditions can lead to several bad outcomes, such as worsening of the baseline condition, occurrence of undesirable and preventable adverse events and occurrence of an unwanted high-risk pregnancy. Thus, a literature review was carried out in order to assist medical professionals in the contraceptive decision of patients with rheumatological and musculoskeletal diseases, epilepsy, multiple sclerosis, eating disorders, sickle cell anemia, obesity and who have already undergone bariatric surgery.(AU)

Scalable and green formation of graphitic nanolayers produces highly conductive pyrolyzed paper toward sensitive electrochemical sensors.

While pyrolyzed paper (PP) is a green and abundant material that can provide functionalized electrodes with wide detection windows for a plethora of targets, it poses long-standing challenges against sensing assays such as poor electrical conductivity, with resistivities generally higher than 200.0 mΩ cm (e.g., gold and silver show resistivities 1000-fold lower, ∼0.2 mΩ cm). In this regard, the fundamental hypothesis that drives this work is whether a scalable, cost-effective, and eco-friendly strategy is capable of significantly reducing the resistivity of PP electrodes toward the development of sensitive electrochemical sensors, whether faradaic or capacitive. We address this hypothesis by simply annealing PP under an isopropanol atmosphere for 1 h, reaching resistivities as low as 7 mΩ cm. Specifically, the annealing of PP at 800 or 1000 °C under isopropanol vapor leads to the formation of a highly graphitic nanolayer (∼15 nm) on the PP surface, boosting conductivity as the delocalization of π electrons stemming from carbon sp2 is favored. The reduction of carbonyl groups and the deposition of dehydrated isopropanol during the annealing process are hypothesized herein as the dominant PP graphitization mechanisms. Electrochemical analyses demonstrated the capability of the annealed PP to increase the charge-transfer kinetics, with the optimum heterogeneous standard rate constant being roughly 3.6 × 10-3 cm s-1. This value is larger than the constants reported for other carbon electrodes and indium tin oxide. Furthermore, freestanding fingers of the annealed PP were prototyped using a knife plotter to fabricate impedimetric on-leaf electrodes. These wearable sensors ensured the real-time and in situ monitoring of the loss of water content from soy leaves, outperforming non-annealed electrodes in terms of reproducibility and sensitivity. Such an application is of pivotal importance for precision agriculture and development of agricultural inputs. This work addresses the foundations for the achievement of conductive PP in a scalable, low-cost, simple, and eco-friendly way, i.e. without producing any liquid chemical waste, providing new opportunities to translate PP-based sensitive electrochemical devices into practical use.

Machine learning toward high-performance electrochemical sensors.

The so-coined fourth paradigm in science has reached the sensing area, with the use of machine learning (ML) toward data-driven improvements in sensitivity, reproducibility, and accuracy, along with the determination of multiple targets from a single measurement using multi-output regression models. Particularly, the use of supervised ML models trained on large data sets produced by electrical and electrochemical bio/sensors has emerged as an impacting trend in the literature by allowing accurate analyses even in the presence of usual issues such as electrode fouling, poor signal-to-noise ratio, chemical interferences, and matrix effects. In this trend article, apart from an outlook for the coming years, we present examples from the literature that demonstrate how helpful ML algorithms can be for dispensing the adoption of experimental methods to address the aforesaid interfering issues, ultimately contributing to translate testing technologies into on-site, practical, and daily applications.

Biocompatible Wearable Electrodes on Leaves toward the On-Site Monitoring of Water Loss from Plants.

Impedimetric wearable sensors are a promising strategy for determining the loss of water content (LWC) from leaves because they can afford on-site and nondestructive quantification of cellular water from a single measurement. Because the water content is a key marker of leaf health, monitoring of the LWC can lend key insights into daily practice in precision agriculture, toxicity studies, and the development of agricultural inputs. Ongoing challenges with this monitoring are the on-leaf adhesion, compatibility, scalability, and reproducibility of the electrodes, especially when subjected to long-term measurements. This paper introduces a set of sensing material, technological, and data processing solutions that overwhelm such obstacles. Mass-production-suitable electrodes consisting of stand-alone Ni films obtained by well-established microfabrication methods or ecofriendly pyrolyzed paper enabled reproducible determination of the LWC from soy leaves with optimized sensibilities of 27.0 (Ni) and 17.5 kΩ %-1 (paper). The freestanding design of the Ni electrodes was further key to delivering high on-leaf adhesion and long-term compatibility. Their impedances remained unchanged under the action of wind at velocities of up to 2.00 m s-1, whereas X-ray nanoprobe fluorescence assays allowed us to confirm the Ni sensor compatibility by the monitoring of the soy leaf health in an electrode-exposed area. Both electrodes operated through direct transfer of the conductive materials on hairy soy leaves using an ordinary adhesive tape. We used a hand-held and low-power potentiostat with wireless connection to a smartphone to determine the LWC over 24 h. Impressively, a machine-learning model was able to convert the sensing responses into a simple mathematical equation that gauged the impairments on the water content at two temperatures (30 and 20 °C) with reduced root-mean-square errors (0.1% up to 0.3%). These data suggest broad applicability of the platform by enabling direct determination of the LWC from leaves even at variable temperatures. Overall, our findings may help to pave the way for translating "sense-act" technologies into practice toward the on-site and remote investigation of plant drought stress. These platforms can provide key information for aiding efficient data-driven management and guiding decision-making steps.

Removal of the pesticide thiamethoxam from sugarcane juice by magnetic nanomodified activated carbon.

The removal of the neonicotinoid and systemic pesticide thiamethoxam (TMX) from water and sugarcane juice by magnetic nanomodified activated carbon (AC-NP) is proposed. This adsorbent was synthesized and characterized by FTIR, XRD, and SEM, and TMX was quantified by high-performance liquid chromatography coupled to a diode array detector (HPLC-DAD). The AC-NP was efficiently synthesized using a co-precipitation method and the impregnation of magnetite (NP) in the activated carbon (AC) was assessed by the crystalline planes found in the AC-NP structure shown in the XRD diffractograms. The AC-NP FTIR analysis also indicated predominant bands of Fe-O stretching of the magnetite at 610-570 cm-1. Functional groups in AC and AC-NP were identified by absorption bands at 3550 and 1603 cm-1, characteristic of O-H and C = C, respectively. The TMX adsorption kinetics in sugarcane juice was the pseudo-second-order type with r2 = 0.9999, indicating a chemical adsorption process. The experimental sorption capacity (SCexp) for both TMX (standard) and TMX-I (insecticide) by AC-NP were 13.44 and 42.44 mg/g, respectively. Seven non-linear isotherm models (Langmuir, Freundlich, Dubinin-Radushkevich, Toth, Hill, Sips, and Redlich-Peterson) were fitted to the experimental adsorption data of TMX and TMX-I by AC-NP. Considering the standard error (SE), Freundlich, Langmuir, and Sips were the most appropriate models to describe the TMX adsorption, and Hill's best adjusted to TMX-I experimental data. The chromatographic method was highly satisfactory due to its high selectivity and recovery (91-103%). The efficiency of AC-NP in the sorption of TMX was confirmed by the excellent values of SCexp and sorption kinetics.

Association between periodontitis and type 2 diabetes mellitus: study in a population attended by the Brazilian Health System / Associação entre periodontite e diabetes mellitus tipo 2: estudo em uma população atendida pelo Sistema Único de Saúde Brasileiro

Introduction: Periodontitis control helps to prevent and control diabetes mellitus and understanding of this relationship can lead to changes in health policy. Objective: The purpose of this study was to investigate the association between periodontitis, knowledge, and glycemic control. Material and method: This is a cross-sectional analytical epidemiological survey with 216 Type 2 diabetic patients, non-smokers, who had current blood screenings with glycated hemoglobin (HbA1c). Result: Overall, 93.51% of the patients reported brushing their teeth at least twice a day, 62.5% visited the dentist last year, 81.58% have already undergone treatment for periodontal disease, 43.52% reported having periodontitis and 59.72% had controlled diabetes. No significant (p=0.603) association between HbA1c control and the presence of periodontitis was found. Among the patients with periodontitis, no association between HbA1c control and information on the periodontal disease was found (p=0.996), and know/believe in its relationship with diabetes (p=0.659; p=0.973). Conclusion: No relationship between periodontitis and diabetes was found in the sample, as well as in patients with periodontitis, those with knowledge on periodontal disease and knowledge/belief in its relationship with diabetes, which could be justified by the care by a multi-professional health team.

Introdução: O controle da doença periodontal auxilia na prevenção e no controle do diabetes mellitus. A compreensão dessa relação pode desencadear mudanças nas políticas públicas de saúde. Objetivo: O objetivo deste estudo foi investigar a associação entre a doença periodontal, o controle glicêmico e o conhecimento dessa relação. Material e método: Trata-se de um inquérito epidemiológico analítico transversal com 216 pacientes com diabetes mellitus tipo 2, não fumantes, que realizaram exames de sangue atuais com hemoglobina glicada (HbA1c). Resultado: No geral, 93,51% dos pacientes relataram escovar os dentes pelo menos duas vezes ao dia, 62,5% visitaram o dentista no último ano, 81,58% já fizeram tratamento para doença periodontal, 43,52% relataram ter periodontite e 59,72% tinham diabetes controlado. Não foi encontrada associação significativa (p=0,603) entre o controle da HbA1c e a presença de periodontite. Entre os pacientes com periodontite, não foi encontrada associação entre o controle da HbA1c e informações sobre a doença periodontal (p=0,996), e conhecer/acreditar na sua relação com o diabetes (p=0,659; p=0,973). Conclusão: Não foi encontrada relação entre a doença periodontal e diabetes na amostra, o que poderia ser justificado pelo atendimento por uma equipe multiprofissional de saúde no Sistema Único de Saúde Brasileiro.

Odontologia hospitalar em tempos de COVID-19 / Hospital Dentistry in COVID-19 times

A pandemia da COVID-19 levou a população mundial a repensar todas as formas de relacionamento humano. Assim como as demais áreas da saúde, a Odontologia Hospitalar também passou por adaptações frente a atual situação. Objetivo: Apresentar as principais mudanças que ocorreram na atuação do Cirurgião-dentista no ambiente hospitalar em decorrência da COVID-19. Revisão de literatura: A prática odontológica baseia-se no uso de instrumentos que promovem a emissão de aerossóis. Diante da ampliação do risco o de disseminação do SARS-CoV-2 durante os procedimentos odontológicos hospitalares, profissionais de saúde bucal devem estar devidamente paramentados e respeitar todos os protocolos estabelecidos para este período. Discussão: Após redução da saliva residual, recomenda-se utilizar o peróxido de hidrogênio 1,0%, previamente a clorexidina 0,12% ou 0,2%, sem álcool, e proceder com a lubrificação oral. A realização da higiene oral em pacientes traqueostomizados para prevenção de PAVM no ambiente hospitalar deve ser mantida a fim de evitar novos casos por infecção de microrganismos diversos ao SARS-CoV-2. Conclusão: A biossegurança durante as práticas odontológicas nunca deve ser negligenciada, principalmente no atual cenário de pandemia.

The COVID-19 pandemic led the world's population to rethink all forms of human relationships. Like other areas of health, Hospital Dentistry has also undergone adaptations to the current situation. Aim: To present the main changes that have occurred in the role of dentists in the hospital environment as a result of COVID-19. Literature review: Dental practice is based on the use of instruments that promote the emission of aerosols. In view of the increased risk or dissemination of SAR-S-CoV-2 during hospital dental procedures, oral health professionals must be properly dressed and respect all the protocols established for this period. Discussion: After reducing residual saliva, it is recommended to use 1.0% hydrogen peroxide, before 0.12% or 0.2% chlorhexidine, without alcohol, and proceed with oral lubrication. The performance of oral hygiene in tracheostomized patients to prevent VAP in the hospital environment should be maintained in order to avoid new cases of infection by microorganisms other than SARS-CoV-2. Conclusion:Biosafety during dental practices should never be ne-glected, especially in the current pandemic scenario.

Corneal crosslinking efficacy in patients with keratoconus under 18 years of age / Eficácia do crosslinking corneano em portadores de ceratocone com idade inferior a 18 anos

ABSTRACT Purpose: Keratoconus presents certain specificities in pediatric patients compared with adults. The greatest challenge is because the disease is typically more severe and progresses faster in children. This retrospective study aimed to report crosslinking procedure in patients under 18 years of age and their follow-up for at least 24 months after the procedure. Methods: Overall, 12 eyes from 10 patients were studied and data, such as visual acuity with and without correction, maximum keratometry, corneal thickness, foveal thickness, and endothelial microscopy, were assessed at both preoperative and postoperative visits. Corneal crosslinking was performed in all patients. Results: A tendency toward reduced Kmax and improved Corrected Distance Visual Acuity at all postoperative moments. Only one of the 12 eyes exhibited increased Kmax of more than 1 D during a time frame longer than 12 months. Regarding pachymetry, a tendency for corneal thinning was observed in the first four months after surgery. Conclusion: Encouraging results were obtained regarding the stabilization of the disease, progression, and procedural safety, corroborating to other authors' findings. The significance of early diagnosis and short-term follow-up were highlighted.

RESUMO Objetivo: O ceratocone na população pediátrica apresenta algumas particularidades em relação à população adulta. O maior desafio é devido à doença ser geralmente mais severa e rapidamente progressiva em crianças. Métodos: Este artigo utiliza uma análise retrospectiva para relatar o uso do crosslinking em jovens menores de 18 anos e sua evolução pelo menos 24 meses após o procedimento. Foram estudados 12 olhos de 10 pacientes, e dados como acuidade visual com e sem correção, ceratometria máxima, espessura corneana, espessura foveal e microscopia endotelial avaliados no pré e pós-operatórios. O crosslinking corneano foi realizado em todos os pacientes pelo mesmo cirurgião. Resultados: Observou-se uma tendência de redução do valor do Kmax e melhora da acuidade visual corrigida em todos os momentos de pós operatório. Com relação à paquimetria, observou-se afinamento corneano do ponto mais fino, nos primeiros quatro meses de pós-operatório. Conclusão: Resultados encorajadores foram obtidos com relação à estabilização da doença, progressão e segurança do procedimento, corroborando com as conclusões de outros autores. A importância do diagnóstico precoce e do acompanhamento a curto prazo do paciente deve ser destacada.

Corneal crosslinking efficacy in patients with keratoconus under 18 years of age.

PURPOSE: Keratoconus presents certain specificities in pediatric patients compared with adults. The greatest challenge is because the disease is typically more severe and progresses faster in children. This retrospective study aimed to report crosslinking procedure in patients under 18 years of age and their follow-up for at least 24 months after the procedure. METHODS: Overall, 12 eyes from 10 patients were studied and data, such as visual acuity with and without correction, maximum keratometry, corneal thickness, foveal thickness, and endothelial microscopy, were assessed at both preoperative and postoperative visits. Corneal crosslinking was performed in all patients. RESULTS: A tendency toward reduced Kmax and improved Corrected Distance Visual Acuity at all postoperative moments. Only one of the 12 eyes exhibited increased Kmax of more than 1 D during a time frame longer than 12 months. Regarding pachymetry, a tendency for corneal thinning was observed in the first four months after surgery. CONCLUSION: Encouraging results were obtained regarding the stabilization of the disease, progression, and procedural safety, corroborating to other authors' findings. The significance of early diagnosis and short-term follow-up were highlighted.

The Action of JAK/STAT3 and BMP/HJV/SMAD Signaling Pathways on Hepcidin Suppression by Tucum-do-Cerrado in a Normal and Iron-Enriched Diets.

The Brazilian savanna fruit, tucum-do-cerrado (Bactris setosa Mart.) reduces hepatic hepcidin levels. Therefore, we investigated the effect of tucum-do-cerrado on the TfR/HFE and/or BMP/HJV/SMAD and JAK/STAT pathways, in normal and excess iron conditions. Rats were treated with: control diet (CT); control diet +15% tucum-do-cerrado (Tuc); iron-enriched diet (+Fe); or iron-enriched diet +15% tucum-do-cerrado (Tuc+Fe). Tucum-do-cerrado (Tuc) decreased hepatic Hamp and Hjv mRNA levels but did not alter Bmp6, Smad7, Tfr1, and Hfe mRNA levels; pSMAD1/5/8 and pSTAT3 protein levels; labile iron pool (LIP); and inflammatory biomarkers, compared to the CT group. The iron-enriched diet increased Hamp mRNA levels, as well as pSMAD1/5/8 and pSTAT3 protein levels, while no difference was observed in Hjv, Bmp6, Smad7, Tfr1, and Hfe mRNA levels and LIP compared to the CT group. The association of tucum-do-cerrado with the iron-enriched diet (Tuc+Fe) decreased Hamp, Hjv, Bmp6, and Hfe mRNA levels and pSTAT3 protein content compared to the +Fe group, while increased Hamp and decreased Hfe mRNA levels compared to the Tuc group. Therefore, the inhibition of hepatic hepcidin by tucum-do-cerrado consumption may involve the downregulation of intestinal Dmt1 and hepatic Hjv expression and deacetylation mediated by SIRT1 by a mechanism that is independent of tissue iron content. However, in excess iron conditions, the modulation of hepatic hepcidin expression by tucum-do-cerrado seems to be partially mediated by the inflammatory signaling pathway, as well as involves the chelating activity of tucum-do-cerrado.

Reversal of cupping em glaucoma juvenil tratado com análogo de prostaglandina tópica / Reversal of cupping in juvenile glaucoma treated with topical prostaglandin analogue

Resumo A reversão da escavação é uma entidade rara que se refere à redução da escavação do disco óptico em resposta à diminuição sustentada dos níveis de pressão intra-ocular (PIO), em cerca de 25% da PIO basal. A ocorrência deste fenômeno apenas com o tratamento clínico é pouco relatada na literatura, Este estudo relata um caso de um paciente com glaucoma juvenil, que apresentou à gonioscopia ângulo aberto e tomografia de coerência óptica (OCT) com uma diminuição significativa na camada de fibras nervosas retinianas em ambos os olhos. Após um ano utilizando análogos de prostaglandina tópica e manutenção de níveis baixos de PIO, ocorreu diminuição da escavação do nervo óptico, que foi confirmada pelos padrões topográficos da OCT. O "reversal of cupping" é um sinal da diminuição da tensão ao nível da lâmina crivosa e está provavelmente associada a uma redução do risco para a progressão do glaucoma a longo prazo, sem melhora da função visual.

Abstract Reversal of cupping is a rare entity, characterized by the reduction of optical disc cupping in response to sustained decrease in intraocular pressure (IOP) levels by 25% of the basal IOP. The occurrence of this phenomenon with clinical treatment is rarely reported in the literature. This study reports a case of a patient with juvenile glaucoma with augmented cupping, significant decrease in the retinal nerve fiber layer in both eyes and altered topografic measures in optical coherence tomography (OCT). After one year using topical prostaglandin analog and keeping low IOP levels, a decrease in optic nerve cupping was detected in rethinography, confirmed by the improvement of OCT topographic measures. Reversal of cupping is a sign of decreased tension at the level of the lamina cribosa and is probably associated with a reduced risk for long-term progression of glaucoma without improvement of visual function.

Cicatrização por segunda intenção como alternativa terapêutica para blebite grave / Second intention healing as a therapeutic alternative for blebitis serious

As infecções relacionadas à ampola filtrante da cirurgia de trabeculectomia podem ser divididas em dois subgrupos: formas localizadas de infiltrado mucopurulento limitadas a ela (blebite) ou uma infecção que envolve todo o olho (endoftalmite). Neste último caso, podemos observar hipópio e células no vítreo anterior. De etiologia ainda pouco definida, sabe-se que o uso de antimetabólitos como a mitomicina aumenta o risco de formação de bolha cística avascular mais susceptível à infecção. Embora não haja consenso sobre o manejo da blebite, sugere-se o início imediato da antibioticoterapia e o monitoramento diário. As intervenções cirúrgicas geralmente consistem na remoção do tecido não saudável, seguido de avanço conjuntival ou falha intencional da ampola seguida do implante de um tubo. O objetivo deste estudo é relatar uma abordagem cirúrgica incomum em um caso de blebite grave. Não foram encontrados dados na literatura de Oftalmologia que pudessem sugerir um manejo expectante mantendo uma esclera exposta, sem prejuízo do desfecho final da cirurgia fistulizante. (AU)

Infections related to the filtering ampoule of trabeculectomy surgery can be divided into two subgroups: localized forms of mucopurulent infiltrate limited to it (blebitis) or an infection involving the entire eye (endophthalmitis). In the second case we can observe hypopyon and cells in the anterior vitreous. Of a still poorly defined etiology, the use of antimetabolites, such as mitomycin, is known to increase the risk of creating an avascular cystic bleb more susceptible to infection. Although there is no consensus on blebitis management, it is suggested to start antibiotic therapy immediately and monitor it daily. Surgical interventions usually consist of removing the unhealthy tissue followed by conjunctival advancement or intentional failure of the ampulla followed by tube implantation. The aim of this study is to report an unusual surgical approach in a severe blebitis case. No data were found in the Ophthalmology literature that could suggest an expectant management maintaining an exposed sclera without any prejudice to the final outcome of the fistulizing surgery.

Educação Permanente em Saúde na atenção primária: uma revisão integrativa da literatura / Permanent Health Education in primary care: an integrative review of literature

RESUMO Este estudo objetivou compreender a apropriação da Educação Permanente em Saúde (EPS) pela Atenção Primária em Saúde (APS) no Brasil, por meio de uma revisão integrativa da literatura. Buscaram-se textos publicados em português, inglês e espanhol sobre a EPS na APS no Brasil, entre 2007 e 2017, que abordassem o conceito de EPS, iniciativas desenvolvidas na APS e/ou a percepção sobre mudanças na prática profissional. Foram selecionados 27 estudos. A análise de conteúdo temática identificou quatro categorias empíricas: concepções de EPS; iniciativas de EPS e suas características na APS; pontos positivos e facilitadores relacionados com as iniciativas de EPS na APS; e os pontos frágeis e dificultadores. Observou-se que a compreensão de EPS por profissionais de saúde e gestores aproxima-se do conceito de Educação Continuada (EC). Entre as iniciativas de EPS nos serviços, estavam: desenvolvimento de recursos tecnológicos; aproximação ensino-serviço; e formação de espaços coletivos de aprendizagem significativa no cotidiano do trabalho. No entanto, a desvalorização das iniciativas de EPS contribui para sua não efetivação na APS e na valorização de práticas de EC. Considera-se necessária a legitimação da EPS como movimento e política educativa no cenário da APS no Brasil, visando à melhoria da qualidade da gestão e da atenção.

ABSTRACT This study aimed to understand the appropriation of Permanent Health Education (PHE) by Primary Health Care (PHC) in Brazil, through an integrative review of the literature. There was a search for texts published in Portuguese, English and Spanish on PHE in PHC in Brazil, between 2007 and 2017, which addressed the concept of PHE, initiatives developed in PHC and/or perception about changes in professional practice. Twenty-seven studies were selected. The thematic content analysis identified four empirical categories: conceptions of PHE; PHE initiatives and their characteristics in the PHC; positive points and facilitators related to PHE initiatives in PHC; and fragile and difficult points. It was observed that the understanding of PHE by health professionals and managers is close to the concept of Continuing Education (CE). Among the PHE initiatives in the services were: development of technological resources; teaching-service approach; and the formation of collective spaces of meaningful learning in the daily work. However, the devaluation of PHE initiatives contributes to its non-effectiveness in PHC and the valuation of CE practices. It is considered necessary to legitimize PHE as a movement and educational policy in the scenario of PHC in Brazil, aiming at improving the quality of management and care.

Conhecimento dos pais sobre o processo de aleitamento materno em mães de uma maternidade pública em Belo Horizonte, MG / Fatherly knowledge of breastfeeding process in a public maternity in Belo Horizonte, MG

OBJETIVO: Analisar os graus de conhecimento e de participação dos pais acerca do processo de aleitamento materno. MÉTODOS: Estudo do tipo observacional e transversal realizado com 351 casais entrevistados na Maternidade Odete Valadares, em Belo Horizonte, com base em questionários semiestruturados. A coleta de dados foi feita com as entrevistas divididas em duas partes, primeiro respondida pela mãe e em seguida pelo pai. A análise dos dados foi feita por meio do software Epi-Info, versão 7.1.2.0. RESULTADOS: A maioria dos pais (92,02%) relatou não ter recebido dos profissionais de saúde qualquer informação sobre a amamentação. Apenas 4,27% dos pais souberam informar o período de aleitamento materno recomendado pela Organização Mundial da Saúde e o Ministério da Saúde do Brasil. Quando questionados se, em algum momento, conversaram com a mãe sobre alimentação infantil, 56,98% responderam que "não". CONCLUSÃO: O pai, apesar de reconhecer a importância do aleitamento materno, muitas vezes não conversa sobre esse assunto com a mãe. Um pai bem informado e participativo em relação à prática da amamentação poderá ser um elemento ativo de apoio para diminuir o desmame precoce. A assistência educativa sobre o aleitamento materno, por profissionais de saúde deve incluir e motivar o papel do pai a participar ativamente da amamentação.(AU)

Objectives: Analyse the degrees of involvement and knowledge of fathers on breastfeeding. Methods: Observational and transversal study undertaken with 351 interviewed couples at Odete Valadares Maternity Hospital, in Belo Horizonte, based on semi-structured questionnaires . Data was collected through a two-part interview, first answered by the mother and later by the father. Data analysis was run throughout the software Epi-Info, version 7.1.2.0. Results: Majority (92.0%) of fathers reported that they did not receive any information from health professionals about breastfeeding. Only 4.27% of fathers reported the correct breastfeeding timeline recommended by World Health Organisation and the Brazilian Ministry of Health. When argued if they, at any time, if they have spoken with the mother about the child's nurture, 56.98% answered "no". Conclusions: Despite the fact the father recognises the importance of breastfeeding, majority of the time do not talk with the mother about this subject. A well informed and engaged father on a child's nurture might be an active element in supporting precocious abclatation diminution. Educative assistance on breastfeeding undertaken by health professionals should include and motivate the role of the father to actively participate for breastfeeding. (AU)

Doenças cardiovasculares em mulheres / Cardiovascular diseases in women

Pesquisa com o objetivo de identificar os fatores de risco para Doenças Cardiovasculares (DCV), em mulheres comidade acima de 18 anos em uma cidade de médio porte do sudoeste goiano, no estado de Goiás. Estudo transversal com umaamostra calculada de 255 mulheres. Os dados referentes às doenças cardiovasculares foram compilados e submetidos a cálculo defrequência simples, relativa e de medidas de tendência central. Houve prevalência da pressão arterial (PA) em 27,9%, do sobrepesoem 36,1% e da obesidade em 25,9%. O sedentarismo, o hábito de ingerir bebida alcoólica e o tabagismo foram significantesentre as mulheres. Como resultado, foram identificados fatores de risco para Doenças Cardiovasculares nas mulheres.

Aiming to identify cardiovascular risk factors (CVD) in women over 18 years of age in a medium- sized city insouthwest goiano, in the state of Goiás. A cross-sectional study with a calculated sample of 255 women. Data on cardiovasculardiseases were compiled and subjected to simple, relative frequency and central trend measures. There was a prevalence ofblood pressure (BP) in 27.9%, overweight in 36.1% and obesity in 25.9%. Sedentary lifestyle, alcohol habit and smoking weresignificant among women. As a result, risk factors for cardiovascular disease in women were identified.

La investigación con el fin de identificar los factores de riesgo de enfermedad cardiovascular (ECV) en mujeresmayores de 18 años, una ciudad de tamaño medio de Goiás sudoeste, estado de Goiás. Estudio transversal con una muestracalculado de 255 mujeres. Los datos relativos a las enfermedades cardiovasculares fueron compilados y presentados al cálculo dela frecuencia y sencilla sobre las medidas de tendencia central. La prevalencia de hipertensión arterial (PA) en el 27,9%, el 36,1%de sobrepeso y obesidad en el 25,9%. Estilo de vida sedentario, el hábito de fumar y el alcohol fueron significativas entre lasmujeres. Los resultados se identificaron factores de riesgo para la enfermedad cardiovascular en las mujeres.

Nine years of a single referral center management of Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell's syndrome).

CONTEXT: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) corresponds to a rare and acute life-threatening mucocutaneous reactions characterized by extensive necrosis and epidermal detachment. There are no efficacious pharmaceutical interventions proven through large clinical trials. OBJECTIVE: We sought to study clinical cases admitted in our institution in order to determine which drugs and medical comorbidities or treatments impacted the mortality. MATERIAL AND METHODS: In a retrospective study over 9 years we evaluated all patients presenting biopsy-proven SJS or TEN for age, gender, total body surface area involved, causing agents, SCORTEN score, blood transfusion, steroid administration, intubation, length of intensive care stay and death rate. Statistical analysis was done using SPSS statistical software. RESULTS: The highest incidence of SJS and TEN was in age group of 71-80 years. Of the 30 patients, 30% died from SJS/TEN, mainly due sepsis. For each subgroup SJS/TEN overlap had the highest mortality. The highest mortality was from antibiotic treatment as causing agent. Step-wise regression analysis identified mechanical ventilation requirement and age over 65 years as mortality high-risk factors. DISCUSSION: The most crucial interventions are discontinuation of the offending drug and prompt referral to a burn unit, which helps in early diagnosis and decrease mortality in these diseases. CONCLUSION: When SJS/TEN is caused by antibiotics suspicion of developing fatal sepsis should be high, independently of patients' medical condition.

Análise do perfil socioeconômico e da prevalência de enteroparasitoses em crianças com idade escolar em um município de Minas Gerais / Analysis of the socioeconomic profile and prevalence of intestinal parasitic infections in school-age children in city of Minas Gerais State

As enteroparasitoses são causas relevantes de agravo à saúde, sendo frequentes principalmente em crianças com idade escolar. Saneamento básico, higiene e nível socioeconômico são fatores determinantes para a transmissão de parasitoses intestinais. O objetivo foi avaliar a prevalência das parasitoses intestinais em crianças em idade escolar, caracterizar o perfil socioeconômico e de moradia da população e analisar o perfil das parasitoses no município de Rio Preto/MG. O estudo descritivo e transversal analisou amostras de fezes de 79 crianças de 4 a 7 anos em uma escola municipal. A coleta das amostras fecais foi realizada pelo sistema parasitológico Paratest® Formalina 5 para pesquisa de ovos e larvas de helmintos e cistos de protozoários. O material foi avaliado conforme suas características morfológicas através da análise microscópica do sedimento, por quatro observadores. A média de idade foi de 5,6 anos (± 1,1), sendo 51,9% crianças do gênero feminino. A prevalência de parasitoses foi de 11,4% e os protozoários prevalentes foram Giardia lamblia, Endolimax nana e Entamoeba coli. Verificou-se que 69,6% das casas possuíam abastecimento de água tratada; 65,8% possuíam rede de esgoto; 85,0% consumiam água filtrada, mineral ou clorada em casa; e 92,5% declararam lavar as mãos antes das refeições e após usar o banheiro. A prevalência de parasitoses nas crianças participantes do estudo foi considerada baixa e os protozoários encontrados foram Giardia lamblia, Endolimax nana e Entamoeba coli. Apesar da baixa prevalência encontrada, estudos parasitológicos são considerados de extrema importância para o conhecimento das condições de saúde da população, visando a implementação de ações de educação, orientação em saúde e prevenção.

The enteroparasitoses are relevant causes of health damage, being frequent mainly in children of school age. Basic sanitation, hygiene and socioeconomic level are determining factors for the transmission of intestinal parasitoses. The aim was to evaluate the prevalence of intestinal parasitoses in school - age children, to characterize the socioeconomic and housing profile of the population and to analyze the profile of parasites in the municipality of Rio Preto/MG. Descriptive and cross - sectional study analyzed samples from 79 children aged 4 to 7 years old at a municipal school in Rio Preto/MG. Fecal samples were collected by Paratest ® Formalin 5 for egg and helminth larvae and protozoan cysts. The material was evaluated according to its morphological characteristics through the microscopic analysis of the sediment by four observers. The mean age was 5.6 years (± 1.1), of which 51.9% were female. The prevalence of parasitoses was 11.4% and the prevalent protozoa were Giardia lamblia, Endolimax nana and Entamoeba coli. It was verified that 69.6% of the houses had a supply of treated water; 65.8% had a sewage network; 85.0% consumed filtered, mineral or chlorinated water at home; and 92.5% reported washing hands before meals and after using the toilet. The prevalence of parasitoses in the children participating in the study was considered low and the protozoa found were Giardia lamblia, Endolimax nana and Entamoeba coli. Despite the low prevalence found, parasitological studies are considered of extreme importance for the knowledge of the health conditions of the population, aiming at the implementation of education, health guidance and prevention actions.

Prevalência de sobrepeso e obesidade em crianças de quatro escolas estaduais de Belo Horizonte, Minas Gerais / Prevalence of overweight and obesity in children of four State schools in Belo Horizonte, Minas Gerais

Introdução: a obesidade é um distúrbio do estado nutricional, de difícil tratamento, relacionado ao aumento do tecido adiposo, com consequente elevação do peso corporal. A população vem apresentando alta prevalência de excesso de peso e entre as causas para explicar esse aumento estão as mudanças no estilo de vida e nos hábitos alimentares. Objetivos: avaliar a prevalência de sobrepeso e obesidade em crianças dequatro escolas estaduais de Belo Horizonte, Minas Gerais. Métodos: estudo transversal e observacional, constituído por uma amostra de 194 estudantes, com idade entre sete e nove anos, de quatro escolas estaduais de Belo Horizonte. Foram obtidos os dados antropométricos (peso e altura) e alguns dados de hábitos de vida. Como referencial para a análise dos dados foram utilizados os indicadores propostos pela Organização Mundial da Saúde (OMS), a fim de se obter as prevalências de sobrepeso e obesidade. Resultados: houve certa homogeneidade na distribuição entre as faixas etárias e predominância do sexo feminino sobre o masculino. Das crianças analisadas, 20,1% estão na faixa de sobrepeso, sendo que 13,9% são meninas e 6,2% são meninos. Enquantoisso, 16,0% das crianças foram considerados obesos, sendo que 10,8% são meninas e 5,2% meninos. Conclusão: o número de crianças acima do peso é significativo e preocupante, o que indica a necessidade de ações direcionadas para a prevenção e tratamento desse importante problema de saúde pública.

Introduction: obesity is a disorder of nutritional status that is difficult to treat and related to increasing in adipose tissue with consequent elevation of body weight. The population has shown a high prevalence of overweight and among the causes to explain this weight increase are changes in lifestyle and eating habits. Objectives: to evaluate the prevalence of overweight and obesity in children of four State schools in Belo Horizonte, Minas Gerais. Methods: this was a cross-sectional and observational study consisting of 194 students, aged between seven and nine years, attending four State schools in Belo Horizonte. Anthropometric (height and weight) and some life habits data were obtained. Indicators proposed by the World Health Organization (WHO) were used as a reference for the data analysis to obtain the prevalence of overweight and obesity. Results: there was certain homogeneity in the distribution between age groups and female predominance over males. Out of the examined children, 20.1% are in the overweight range, 13.9% are girls and 6.2% are boys. Meanwhile,16.0% of children were considered obese; 10.8% are girls, and 5.2% are boys. Conclusion: the number of overweight children is significant and troubling, which indicates the need for targeted actions to prevent and treat this important public health problem.

The mental health of nursing students: an integrative review of literature / A saúde mental do aluno de Enfermagem: revisão integrativa da literatura / La salud mental del alumno de enfermería: revisión integrativa de la literatura

Study of integrative review type in order to examine the occurrence of scientific research on the mental health of undergraduate students in Nursing in Brazil in the last 21 years. 54 articles were included that from the content analysis were categorized into five thematic categories related to: quality of life, feelings during their academic formation, teacher-student relationship, student care and the consumption of alcohol and other drugs by the nursing student. The results portray the convergence of Brazilian publications that point critical moments experienced by students during the course, indicating the importance of initiatives to support them in their difficulties coping with a view to strengthening their mental health...

Estudo do tipo revisão integrativa com o objetivo de analisar a ocorrência da investigação científica sobre a saúde mental do aluno do curso de graduação em Enfermagem, no Brasil, nos últimos 21 anos. Foram incluídos 54 artigos que, a partir da análise de conteúdo, foram categorizados em cinco categorias temáticas relacionadas à qualidade de vida, aos sentimentos durante a formação acadêmica, relação professor/aluno, cuidados com o aluno, além do consumo de álcool e outras drogas pelo aluno de Enfermagem. Os resultados retratam a convergência das publicações brasileiras que apontam os momentos críticos vivenciados pelos alunos durante o curso, sinalizando a importância de iniciativas que venham a apoiá-lo no enfrentamento de suas dificuldades com vistas ao fortalecimento da sua saúde mental...

Estudio del tipo revisión integrativa con objetivo de que analizar la ocurrencia de la averiguación científica sobre la salud mental del alumno del curso de graduación en Enfermería, en Brasil, en los últimos 21 años. Fueron incluidos 54 artículos que el análisis de contenido fueron categorizados en cinco categorías temáticas relacionadas a la calidad de vida, a los sentimientos durante la formación académica, relación maestro-alumno, atenciones con el alumno, además del consumo de alcohol y otras drogas por el alumno de enfermería. Los resultados retractan la convergencia de las publicaciones brasileñas que apuntan los momentos críticos vividos por los alumnos durante el curso, señalizando la importancia de iniciativas que vengan a apoyarlo en el enfrentamiento de sus dificultades con vistas al fortalecimiento de su salud mental...

The mental health of nursing students: an integrative review of literature / A saúde mental do aluno de Enfermagem: revisão integrativa da literatura / La salud mental del alumno de enfermería: revisión integrativa de la literatura

Study of integrative review type in order to examine the occurrence of scientific research on the mental health of undergraduate students in Nursing in Brazil in the last 21 years. 54 articles were included that from the content analysis were categorized into five thematic categories related to: quality of life, feelings during their academic formation, teacher-student relationship, student care and the consumption of alcohol and other drugs by the nursing student. The results portray the convergence of Brazilian publications that point critical moments experienced by students during the course, indicating the importance of initiatives to support them in their difficulties coping with a view to strengthening their mental health.(AU)

Estudo do tipo revisão integrativa com o objetivo de analisar a ocorrência da investigação científica sobre a saúde mental do aluno do curso de graduação em Enfermagem, no Brasil, nos últimos 21 anos. Foram incluídos 54 artigos que, a partir da análise de conteúdo, foram categorizados em cinco categorias temáticas relacionadas à qualidade de vida, aos sentimentos durante a formação acadêmica, relação professor/aluno, cuidados com o aluno, além do consumo de álcool e outras drogas pelo aluno de Enfermagem. Os resultados retratam a convergência das publicações brasileiras que apontam os momentos críticos vivenciados pelos alunos durante o curso, sinalizando a importância de iniciativas que venham a apoiá-lo no enfrentamento de suas dificuldades com vistas ao fortalecimento da sua saúde mental.(AU)

Estudio del tipo revisión integrativa con objetivo de que analizar la ocurrencia de la averiguación científica sobre la salud mental del alumno del curso de graduación en Enfermería, en Brasil, en los últimos 21 años. Fueron incluidos 54 artículos que el análisis de contenido fueron categorizados en cinco categorías temáticas relacionadas a la calidad de vida, a los sentimientos durante la formación académica, relación maestro-alumno, atenciones con el alumno, además del consumo de alcohol y otras drogas por el alumno de enfermería. Los resultados retractan la convergencia de las publicaciones brasileñas que apuntan los momentos críticos vividos por los alumnos durante el curso, señalizando la importancia de iniciativas que vengan a apoyarlo en el enfrentamiento de sus dificultades con vistas al fortalecimiento de su salud mental.(AU)