Findings on dietary characteristics among Haitian immigrants and the threat of food insecurity: A scoping review.

Objectives: This study aimed to map and describe the available evidence on dietary characteristics and diet-related health conditions among Haitian immigrants across the globe. Study design: Scoping review. Methods: This review was based on the international guide Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The searches were conducted in several electronic databases in July 2023. Reports focusing on diet, nutrition, and diet-related health conditions among international Haitian immigrants published in English, Portuguese, French, or Spanish with no year limit were included. The data extracted was tabulated and presented in a narrative summary. Results: Database search retrieved 502 records, of which 30 met the inclusion criteria. The categories that emerged from the analysis were: food consumption patterns and trends, food and nutrition insecurity, cultural identity, and diet-related health conditions. Findings suggest: available evidence underrepresents Latin America and the Caribbean context; research gaps related to adolescents and the elderly and also to noncommunicable diseases except obesity; changes in food consumption after immigration towards less healthy eating; the Haitian immigrant's preference for healthy and traditional eating patterns; many experiences of food insecurity related to poverty, unemployment, and lack of social support, especially in host countries in Latin America and the Caribbean; and a high prevalence of obesity, especially among women. Conclusions: Further research is required in countries in Latin America, mainly. Diet-related chronic diseases, adolescents, and the elderly should be targeted for further research. We recommend: longitudinal and qualitative research; field action reports describing local and global strategies to manage Haitian migration-related food and nutrition issues; culturally appropriate dietary interventions; and policies to protect and support the most vulnerable Haitian immigrants to have their fundamental right to adequate food guaranteed, reducing health inequalities.

Sérgio Arouca na Faculdade de Ciências Médicas da Unicamp / Sérgio Arouca at the UNICAMP School of Medical Sciences

RESUMO Este trabalho resgatou a passagem do médico sanitarista e professor universitário Antônio Sérgio da Silva Arouca pela Universidade Estadual de Campinas (Unicamp), entre 1967 e 1975, mediante estudo de três documentos importantes conservados nessa instituição, a saber, seu Processo de Vida Funcional, a Revista Comemorativa dos 25 anos do Departamento de Medicina Preventiva e Social da Faculdade de Ciências Médicas, onde consta depoimento seu, e o Relatório Final da Comissão da Verdade e Memória "Octávio Ianni". No Departamento de Medicina Preventiva e Social da Unicamp, encontrou ambiente propício para atuar conforme suas convicções. Integrou-se à disciplina de Ciências Sociais Aplicadas à Medicina, cujo conteúdo teórico dialogava com ações extramuros desenvolvidas pelos alunos em bairro pobre da cidade, com o intuito de lhes propiciar a oportunidade de reconhecer a importância e a influência dos fatores sociais sobre o estado de saúde dos indivíduos e das populações. Tal experiência, muito provavelmente, influenciou sobremaneira o jovem docente que, anos depois, produziria uma tese de extrema relevância para formulação e consolidação da saúde coletiva brasileira e presidiria a VIII Conferência Nacional de Saúde, que estabeleceu as bases do Sistema Único de Saúde.

ABSTRACT This work recovers the passage of the public health physician and university professor Antônio Sérgio da Silva Arouca through the State University of Campinas (UNICAMP), between 1967 and 1975, through the study of three important documents kept in this institution, namely, his Functional Life File, the Commemorative Magazine of the 25th anniversary of the Department of Preventive and Social Medicine of the Faculty of Medical Sciences, where his statement is included, and the Final Report of the "Octávio Ianni" Truth and Memory Commission. At the UNICAMP's Department of Preventive and Social Medicine, he found a favorable environment to act according to his convictions. He joined the discipline of Social Sciences Applied to Medicine, whose theoretical content dialogued with extramural actions developed by students in poor neighborhoods of the city, in order to give them the opportunity to recognize the importance and influence of social factors on the health status of individuals and populations. This experience probably had a great influence on the young professor who, years later, would produce a thesis of extreme relevance for the formulation and consolidation of Brazilian Public Health, and preside over the 8th National Health Conference, which established the bases for the Unified Health System.

[The suffering of women living in an informal settlement in São Paulo, Brazil: a challenge to the work of Primary Health Care]. / Sufrimiento de mujeres en una ocupación urbana de São Paulo, Brasil: un desafío para el trabajo en atención primaria de la salud.

Among the social effects of the COVID-19 pandemic, increased poverty, unemployment, and social inequality in Brazil have led to worsening health problems, especially in the poorest citizens. The purpose of this research was to discuss the potentialities and limitations of the work process in primary health care based on the Family Health Strategy. In order to do so, we conducted semi-structured interviews with four women living in an informal settlement in the interior of the state of São Paulo, Brazil, between January and February 2020. We found that the women experienced suffering in relation to issues such as housing precariousness, transience, social isolation, and silencing. The way in which primary health care is organized and professionals' work processes make it difficult for this population to access health services and for professionals to perceive their suffering. The findings of this research point to the need to reevaluate and improve the Family Health Strategy.

Entre los efectos sociales de la pandemia de COVID-19, el aumento de la pobreza, el desempleo y la desigualdad social en el país agravaron los problemas de salud, principalmente, de la población más pobre. Esta investigación buscó discutir potencialidades y limitaciones del proceso de trabajo en atención primaria de la salud, basado en la Estrategia de Salud Familiar. Para ello, entre enero y febrero de 2020, se realizaron entrevistas semiestructuradas a cuatro mujeres residentes de una ocupación urbana del interior del estado de São Paulo, Brasil. Se encontró que presentan sufrimiento relacionado con la precariedad de las viviendas, la provisoriedad, el aislamiento social y el silenciamiento. El modo en que se organiza la atención primaria de la salud y el proceso de trabajo de las y los profesionales dificulta tanto el acceso de una parte de la población a los servicios de salud, como la percepción de las y los profesionales sobre el sufrimiento de la población. Los resultados de la investigación indican la necesidad de una nueva evaluación y perfeccionamiento de la Estrategia de Salud Familiar.

Sufrimiento de mujeres en una ocupación urbana de São Paulo, Brasil: un desafío para el trabajo en atención primaria de la salud / The suffering of women living in an informal settlement in São Paulo, Brazil: a challenge to the work of Primary Health Care

RESUMEN Entre los efectos sociales de la pandemia de COVID-19, el aumento de la pobreza, el desempleo y la desigualdad social en el país agravaron los problemas de salud, principalmente, de la población más pobre. Esta investigación buscó discutir potencialidades y limitaciones del proceso de trabajo en atención primaria de la salud, basado en la Estrategia de Salud Familiar. Para ello, entre enero y febrero de 2020, se realizaron entrevistas semiestructuradas a cuatro mujeres residentes de una ocupación urbana del interior del estado de São Paulo, Brasil. Se encontró que presentan sufrimiento relacionado con la precariedad de las viviendas, la provisoriedad, el aislamiento social y el silenciamiento. El modo en que se organiza la atención primaria de la salud y el proceso de trabajo de las y los profesionales dificulta tanto el acceso de una parte de la población a los servicios de salud, como la percepción de las y los profesionales sobre el sufrimiento de la población. Los resultados de la investigación indican la necesidad de una nueva evaluación y perfeccionamiento de la Estrategia de Salud Familiar.

ABSTRACT Among the social effects of the COVID-19 pandemic, increased poverty, unemployment, and social inequality in Brazil have led to worsening health problems, especially in the poorest citizens. The purpose of this research was to discuss the potentialities and limitations of the work process in primary health care based on the Family Health Strategy. In order to do so, we conducted semi-structured interviews with four women living in an informal settlement in the interior of the state of São Paulo, Brazil, between January and February 2020. We found that the women experienced suffering in relation to issues such as housing precariousness, transience, social isolation, and silencing. The way in which primary health care is organized and professionals' work processes make it difficult for this population to access health services and for professionals to perceive their suffering. The findings of this research point to the need to reevaluate and improve the Family Health Strategy.

Eutanásia sob a perspectiva da bioética e clínica ampliada / Euthanasia from the perspective of extended bioethics and clinics / La eutanasia desde la perspectiva de la bioética y la clínica ampliada

Resumo "Eutanásia" significa causar óbito rápido e indolor ou não o evitar, visando aliviar o sofrimento do paciente quando a morte é entendida como melhor bem ou menor mal. "Clínica ampliada" diz respeito à expansão do objeto de interesse clínico, ocupando-se não apenas da doença, mas também e sobretudo do sujeito singular. O objetivo deste trabalho é analisar a eutanásia a partir da bioética ampliada. Para isso, utilizou-se trecho do romance Anne Prédaille , do escritor francês Henri Troyat, no qual a personagem principal provoca a morte da mãe aplicando dose elevada de morfina. O fragmento mostra a eutanásia como questão de sujeitos com histórias de vida singulares que se inter-relacionam, e não como a passagem asséptica da vida para a morte. Concluiu-se que a bioética deve considerar a história das pessoas envolvidas no processo da eutanásia.

Abstract Euthanasia is the act of intentionally ending a life quickly and painlessly, or omitting to prevent it, to alleviate suffering when death is understood as the greater good or the lesser evil. An extended clinical approach refers to the expansion of the object of clinical interest, which is concerned not only with the disease, but also and above all with the individual. This study analyzes euthanasia from the perspective of extended bioethics. To this end, we used an excerpt from the novel Anne Prédaille by French writer Henri Troyat, in which the main character causes the death of her mother, who suffers from a terminal illness, by applying a high dose of morphine. The literary fragment was intended to show euthanasia as a matter of subjects with unique interrelated life stories, and not as the aseptic passage from life to death. We concluded that bioethics must consider the life history of people involved in the process of euthanasia.

Resumen "Eutanasia" es hacer que una persona muera rápidamente y sin dolor, o no evitarlo, con el fin de aliviar el sufrimiento, cuando la muerte se entiende como el mejor bien o el menor mal. "Clínica ampliada" se refiere a la expansión del objeto de interés de la clínica, que se ocupa no solo de la enfermedad, sino también y sobre todo del individuo. El objetivo de este trabajo es analizar la eutanasia desde una bioética ampliada. Para ello, se utilizó un extracto de la novela Anne Prédaille del escritor francés Henri Troyat, en la que el personaje principal provoca la muerte de la madre por la aplicación de una alta dosis de morfina. El fragmento muestra la eutanasia como una cuestión de sujetos con historias de vida únicas que se interrelacionan, y no como la transición aséptica de la vida a la muerte. Se llegó a la conclusión de que la bioética debe considerar la historia de la vida de las personas que participan en el proceso de eutanasia.

Projetos de extensão do Curso de Bacharelado em Enfermagem de uma universidade pública brasileira / Extension projects of Nursing Graduation Course in a Brazilian public university

O tripé da universidade pública ensino, pesquisa e extensão, tem a extensão como principal instrumento de inter-relação da Universidade com a sociedade. Segundo as Diretrizes Curriculares Nacionais da Enfermagem (DCNs), o projeto pedagógico deve prever atividades complementares e mecanismos de aproveitamento de conhecimentos, como os programas de extensão. Esta pesquisa analisou projetos de extensão desenvolvidos no Curso de Bacharelado em Enfermagem de um campus da Universidade do Estado da Bahia. Objetivou traçar os perfis dos projetos de extensão, identificar as estratégias de Educação utilizadas nesses projetos e conhecer a opinião dos coordenadores acerca da extensão universitária. Metodologia qualitativa mediante análise do conteúdo do Sistema Integrado de planejamento, e de entrevistas semiestruturadas realizadas com os coordenadores. Predominou o perfil social/acadêmico, priorizando a busca de solução para problemas sociais e a construção de sujeitos que participam de sua própria história e da sociedade em que estão inseridos, com resquícios do modelo assistencialista; temas vinculados aos interesses dos coordenadores ou as suas linhas de pesquisa; contribuição relevante de discentes na execução; uso de metodologias participativas, oficinas, rodas de conversa, ações educativas e de promoção; limitação imposta pela carga horária de atividades curriculares; dificuldade de deslocamento por falta de transporte; empenho pessoal de docentes coordenadores inclusive de aporte de recursos financeiros próprios, para garantir a continuidade dos projetos e participação de discentes voluntários; subutilização do Sistema Integrado de Planejamento; necessidade de maior articulação com as atividades de ensino intramuros e os projetos político - pedagógicos da instituição; e fragilidade do processo de avaliação formal dos projetos.

The three pillars of public university are teaching, research and extension. The latter pillar became the main instrument of relationship between the University and society. According to National Curricular Guidelines for Nursing Graduate Courses, the pedagogical project must provide complementary activities for the use of acquired knowledge. This study examined extension projects developed in the Nursing Bachelor Course of a campus of the State University of Bahia. The objective of this study was to evaluate the profiles of these extension projects, to identify the educational strategies and to know the project coordinators' opinion regarding University extension. Qualitative methodology by means of analysis of the content of the Integrated System of Planning's report, filled in by the project coordinators, and of semi ­structured interviews conducted with project coordinators. The study found predominance of social/academic profile, with priority on the search for solutions that minimize the impact of social issues, with some remnants of the assistentialist model; topics linked to coordinators' interest or their research line; students's relevant contributions at the execution phase; use of participative methodologies, workshops, rounds of conversation, educational and health promotion activities; limitations imposed by large curricular academic load; displacement difficulties; personal commitment of teachers in order to keep the projects going; under utilization of the Integrated System of Planning; the need for better interaction between teaching activities inside and outside the university walls and the political- pedagogic project of the University; and fragility of the formal evaluation process of the University extension program.

Na ausência de endereço, onde mora a saúde? Determinantes sociais e populações de ocupações / In the absence of an address, where does health live? Social determinants and occupation populations

RESUMO Pesquisa qualitativa cujo objetivo foi analisar a influência dos Determinantes Sociais da Saúde no processo saúde-doença de população residente em área de ocupação de Campinas, com enfoque no acesso aos serviços de saúde, habitação (condições de moradia, água e esgoto) e trabalho (emprego e renda). Utilizaram-se entrevistas semiestruturadas com moradores e dados secundários oriundos de censo comunitário elaborado por lideranças locais para traçar o perfil sociodemográfico da população em estudo. Os resultados encontrados indicam desigualdades regionais reveladas nessa ocupação, onde a condição de pobreza, a miséria, a violência, o desemprego e a falta de acesso a direitos básicos de cidadania determinam a piora das condições de saúde de seus moradores. Conhecer e compreender como Determinantes Sociais da Saúde atuam no processo saúde-doença da população pode contribuir para que governos, profissionais de saúde e outros atores sociais, incluindo universidades públicas, intervenham, principalmente, com políticas públicas que busquem reduzir o impacto desses fatores e promover a melhoria das condições de vida e saúde dessas populações, vivendo na invisibilidade social, sujeitas a preconceitos e discriminação de diversas naturezas por parte da sociedade.

ABSTRACT Qualitative research in which the objective was to analyze the influence of the Social Determinants of Health on the health-disease process of the population living in the urban slum/occupation area of Campinas, focusing on access to health services, housing (housing, water, and sewage conditions) and work (employment and income). Semi-structured interviews with residents and secondary data from a community census prepared by local leaders were used to trace the sociodemographic profile of the population under study. The results found indicate regional inequalities revealed in the occupation, where the condition of poverty, misery, violence, unemployment, and lack of access to basic citizenship rights determine the worsening of the health conditions of its residents. Knowing and understanding how Social Determinants of Health work in the health-disease process of the population can contribute so that governments, health professionals, and other social actors, including public universities, can intervene, mainly with public policies that seek to reduce the impact of these factors and promote the improvement of living conditions and health of these populations, living in social invisibility, subject to prejudice and discrimination of various kinds by society in general.

A visão ramazziniana e os discriminados / Ramazzini's views on discriminate-against people

No seu livro Doenças dos trabalhadores, publicado em 1700, Bernardino Ramazzini dedicou um capítulo às doenças que acometiam os judeus. Nessa época, eles eram frequentemente perseguidos e proibidos de exercer a maioria das ocupações, restando-lhes como principal atividade permitida a recuperação e o comércio de roupas a partir de tecidos velhos e usados. Ramazzini observou que problemas respiratórios, cutâneos e oculares eram comuns para esse povo e estavam relacionados a sua atividade ocupacional típica. Concluindo, a fé religiosa foi fator relevante para determinar a morbidade desse grupo populacional.

In his book Diseases of workers, published in 1700, Bernardino Ramazzini devoted a chapter to the diseases affecting Jews. At that time, Jews were often persecuted and forbidden to engage in most occupations, except for recovering and selling clothes made of old and worn cloth. Ramazzini noticed that respiratory, skin and eye problems were common among Jews, and were related to their typical occupations. To conclude, religion has been a relevant determinant of the morbidity of this population group.

A clínica nos documentos para a Atenção Básica no Brasil / The clinic in documents for primary health care in Brazil

Esta pesquisa analisou documentos oficiais dirigidos à Atenção Básica no Brasil do ponto de vista do tipo de clínica presente: tradicional e/ou ampliada. Na maior parte dos documentos, a clínica da doença constitui a principal teoria presente. A clínica ampliada está presente de forma heterogênea: ausente em alguns documentos, apenas mencionada como estratégia para mudança de modelo em outros e mais amplamente explorada em outros. Ficou-se com a impressão que os documentos oficiais do Ministério da Saúde são elaborad os por grupos independentes, de forma fragmentada. Há um reconhecimento da necessidade de incluir o sujeito singular na clínica do profissional da atenção primária, mas os grupos que formularam os documentos não foram capazes, na sua maioria, de propor mudanças concretas na prática médica (AU).

This research analyzed official documents for primary health care in Brazil from the perspective of the type of clinic present: the traditional one and/or the extended one. For most documents, the main theory present is that of the traditional clinic. The extended clinic is heterogeneously present: absent in some documents, just mentioned as a strategy to change the health care model in others, and largely explored in others. The impression is that independent groups prepare the official documents of the Ministry of Health in a fragmentary way. There is an understanding of the need to include the unique subject in the primary care clinical activities, but most groups in charge of those documents failed to propose real changes in medical practice (AU).

Controle da dengue sob a ótica bioética / The dengue control from the Bioethic's perspective / El control del dengue desde la perspectiva de la Bioética

Esta pesquisa analisou ações, controle social e dilemas bioéticos relacionados ao controle da dengue. Utilizou-se metodologia qualitativa ­ grupo focal e entrevistas. Concluímos que as ações de saúde pública visando ao controle da dengue devem se pautar pela bioética sanitária. Gestores, trabalhadores e usuários devem agir no sentido de priorizar políticas que privilegiem o maior número de pessoas, por maior tempo possível, e que resultem em melhores consequências para toda a coletividade, não deixando que interesses particulares, corporativos ou partidários coloquem em risco seu compromisso ético. Entendemos ser necessário construir novos padrões de relação entre usuários e gestores, e também entre União, estados e municípios, baseados na bioética e na cogestão.

This research analyzed actions, social control and bioethical dilemmas concerning the dengue control. Qualitative methodology ­ focal groups and interviews ­ has been employed. We concluded that Public Health actions aimed at dengue control must follow sanitary bioethical principles. Public managers, workers and users must act to prioritize public policies that benefit as many people as possible, as long as possible, resulting in best consequences for the entire community, and not allow any private, corporate or party-political interests to put the ethics commitment in risk. We believe it's necessary to build new standards of relationship between users and public managers and between the Union, States and Municipalities, based on Bioethics and co-management.

En esta investigación se estudió acciones, el control social y los dilemas bioéticos relacionados al control del dengue. Se ha utilizado metodología cualitativa ­ grupo focal y entrevistas. Concluimos que las acciones de salud pública para controlar el dengue deben seguir la bioética sanitaria. Los gerentes, trabajadores y usuarios deben priorizar políticas para el mayor número de personas, por el mayor tiempo posible, y que resulten en las mejores consecuencias para todos, no permitiendo que intereses particulares, corporativos o partidarios pongan en riesgo su compromiso ético. Creemos necesario construir nuevas modalidades de relación entre usuarios y gerentes, y también entre la Unión, los estados y las municipalidades, basadas en la bioética y la cogestión.

[Clarifying the case of two people with the same name of Manoel de Abreu]. / Esclarecendo o caso dos homônimos Manoel de Abreu.

A curious episode in the history of Brazilian medicine is retold here, involving two physicians with the same name, between 1936 and 1937. The most important legacy left by Manoel Dias de Abreu was a method of radiography to diagnose tuberculosis - mass miniature radiography (abreugraphy). Manoel de Abreu Campanario wrote A medicina no interior (Medicine from the interior). The similarities between the two names created such confusion that some people believed that Campanario was a pseudonym. This case of mistaken identity led Manoel Dias de Abreu to send a consultation-statement to the Brazilian Society for Medicine and Surgery, which immediately created a commission to examine the case. The letter of clarification sent by Campanario resolved the issue.

Bernardo Bedrikow e a Medicina do Trabalho: o homem e a obra / Bernardo Bedrikow and the Occupational Health: the man and the work

Contexto: Este estudo consistiu na análise do conteúdo de trabalhos produzidos pelo Dr. Bedrikow, buscando significados e motivações. No início de sua carreira, dedicou-se à Clínica Geral e Doenças Sexualmente Transmissíveis (DST). Desde o início da década de 1950, passou a dedicar-se quase que exclusivamente à Medicina do Trabalho. Coordenou o ?Inquérito Preliminar de Higiene Industrial do Município de São Paulo?, pioneiro no país. Participou do estudo de silicose nas indústrias paulistas, cuja relevância foi reconhecida através do prêmio Alvarenga da Academia Nacional de Medicina de 1952. Tanto esse trabalho como a atividade em serviços de DST foram recuperados em textos escritos cerca de meio século depois. Produziu trabalhos sobre outras doenças ocupacionais, toxicologia ocupacional e história da Medicina do Trabalho, e reconheceu a presença da área em obras literárias de Euclides da Cunha e Gabriel Garcia Marques. Para não ficar apenas nas suas atividades acadêmicas e profissionais, considerou-se oportuno solicitar a um dos remanescentes do grupo de primeiros colegas associados da ANAMT que escrevesse algo sobre a convivência deles, ressaltando os momentos mais marcantes e pitorescos. Jorge da Rocha Gomes foi incumbido desta tarefa.

Context: This research analyzed contents of Dr. Bedrikow?s papers and texts in order to recognize meanings and motivations. At the beginning of his career, he practiced Internal Medicine and demonstrated special interest in sexually transmitted diseases. Since the first years of 1950s, his exclusive focus became the Occupational Health. He had been in charge of the ?Preliminar Investigation of Industrial Hygiene of the city of São Paulo?, the first study to investigate it in Brazil. He took part in a research about silicosis in industries of the city of São Paulo, recognized by the National Academy of Medicine with the Prize Alvarenga, in 1952. After half a century, he wrote about this experience and about his activities in other STD facilities. He prepared scientific publications about other occupational diseases, occupational toxicology, and the history of Occupational Medicine, and identified the presence of this specialty in literary compositions of Euclides da Cunha and Gabriel Garcia Marques. Not to mention only his academic and professional activities, it has been decided to ask one of his remaining first colleagues, associated to the ANAMT, to write a few words about their coexistence, high lightening the most significant and picturesque moments. Jorge da Rocha Gomes took on this assignment.

História da clínica e a atenção básica o desafio da ampliação

A clínica contemporânea é fruto de um processo histórico que combinou diferentes possibilidades epistemológicas com transformações sociais. A ampliação da clínica, especialmente pelo equilíbrio entre suas principais modalidades, da doença e do sujeito, constitui-se em potente ferramenta para profissionais da Atenção Básica.

[Accidental hypothermia cases in a tropical country]. / Hipotermia acidental em um país tropical.

OBJECTIVE: This paper has by objective to study the hypothermia's presence, presentation form and consequences in our environment. METHODS: A prospective study in hypothermic patients assisted in the Medical Clinic Emergency Service of Santa Casa of S o Paulo, with 212 patients with mild, moderate and serious hypothermia from 1987 to 2001, the most part of them constituted by chronic alcoholics and homeless. The results were analyzed in reference to sex, age group, central temperature, electrocardiogram, co-morbidity and mortality. RESULTS: The hypothermia prevailed in the male sex with 75.9%. As age group prevailed the age between 30 and 59 years. In 70.3% of the patients the central temperature went lower than 32 C, and in 26.4% of these, the temperature was lower than 28 C. The association with infectious processes happened in 76.8% of the cases. The patients with mild hypothermia answered better at therapeutics (96.8%) when compared with the moderate hypothermic (72.1%) and serious (87.5%) patients. The Osborn's wave was present in 42.6% of the patients. The general mortality was 38.2%. CONCLUSIONS: The accidental hypothermia in Emergency Services from Tropical Country is an undeniable fact. The paramedic and medics should be alert and trained to recognize this disease of high morbidity and mortality. The mortality increases with the presence of associated diseases, particularly infectious processes, malnutrition and chronic alcoholism.

Hipotermia acidental em um país tropical / Accidental hypothermia cases in a tropical country

OBJETIVOS: Estudar a presença, forma de apresentaçäo e as conseqüências da hipotermia em nosso meio. MÉTODOS: Estudo prospectivo em hipotérmicos atendidos no Serviço de Emergência de Clínica Médica da Santa Casa de São Paulo, com 212 pacientes com hipotermia leve, moderada e grave, entre 1987 a 2001, a maioria constituída por alcoólatras crônicos e moradores de rua. Foram analisados os resultados quanto ao sexo, faixa etária, temperatura central, eletrocardiograma, comorbidades e mortalidade. RESULTADOS: A hipotermia predominou no sexo masculino em 75,9 por cento. Quanto à faixa etária prevaleceu a idade entre 30 e 59 anos. Em 70,3 por cento dos pacientes a temperatura central foi inferior a 32ºC, sendo que em 26,4 por cento destes, a temperatura foi menor que 28ºC. A associaçäo com quadros infecciosos ocorreu em 76,8 por cento dos casos. Os pacientes com hipotermia leve responderam melhor à terapêutica (96,8 por cento) quando comparados com os hipotérmicos moderados (72,1 por cento) e graves (87,5 por cento). A onda de Osborn esteve presente em 42,6 por cento dos pacientes. A mortalidade geral foi de 38,2 por cento. CONCLUSÕES: A hipotermia acidental em serviços de emergência de país tropical é fato inegável. O socorrista deve estar atento e treinado para o reconhecimento desta doença de alta morbidade e mortalidade. A mortalidade aumenta com a presença de doenças associadas, particularmente processos infecciosos, desnutriçäo e alcoolismo crônico

Pulmonary thromboembolism: retrospective study of necropsies performed over 24 years in a university hospital in Brazil.

CONTEXT: Pulmonary thromboembolism is the third most frequent cause of morbidity and mortality among acute cardiovascular diseases. The incidence of pulmonary embolism in necropsies has remained unchanged over the last few decades. Cardiac diseases, neoplasia, trauma, recent surgery and systemic diseases are important predisposing clinical conditions. The relationship between male and female sexes is estimated at 1.24. Various studies have shown an increase in morbidity in spring and autumn. There is great difficulty in precise anatomopathological diagnosis in relation to the localization of the emboli in the pulmonary vessels, although they are preferentially located in the right lung and lower lobes. OBJECTIVE: To study the incidence of lethal and non-lethal pulmonary thromboembolism in relation to epidemiological and anatomical variables. DESIGN: Retrospective study performed via reports on the necropsy findings. SETTING: University hospital providing tertiary-level attendance. SAMPLE: 16,466 consecutive necropsies performed from January 1972 to December 1995. MAIN MEASUREMENTS: Frequency of lethal and non-lethal pulmonary thromboembolism, predisposing diseases, occurrence in relation to the seasons of the year, and location where the embolus is lodged. RESULTS: Pulmonary thromboembolism was found in 4.7% of all the necropsies performed. There was a predominance of lethal cases (68.2%). There was no difference in relation to sex or seasons of the year for the occurrence of this disease. Cardiovascular diseases were more frequently associated with thromboembolic phenomena. With regard to the location where the embolus was lodged, various lung segments showed greater incidence of being bilaterally compromised. CONCLUSION: Over the period of this study, it was observed that there was a reduction in the incidence of pulmonary thromboembolism, which was probably due to the increase in prophylactic measures over the last few decades. Nonetheless, lethal thromboembolism predominated in frequency, probably because of the abrupt onset of a condition of attack across a large area of the lung, lack of clinical suspicions and consequently a lack of early diagnosis, and delay in instituting fibrinolytic therapy in the cases with hemodynamic repercussions or a large number of lung segments affected.

Pulmonary thromboembolism: retrospective study of necropsies performed over 24 years in a university hospital in Brazil

CONTEXT: Pulmonary thromboembolism is the third most frequent cause of morbidity and mortality among acute cardiovascular diseases. The incidence of pulmonary embolism in necropsies has remained unchanged over the last few decades. Cardiac diseases, neoplasia, trauma, recent surgery and systemic diseases are important predisposing clinical conditions. The relationship between male and female sexes is estimated at 1.24. Various studies have shown an increase in morbidity in spring and autumn. There is great difficulty in precise anatomopathological diagnosis in relation to the localization of the emboli in the pulmonary vessels, although they are preferentially located in the right lung and lower lobes. OBJECTIVE: To study the incidence of lethal and non-lethal pulmonary thromboembolism in relation to epidemiological and anatomical variables. DESIGN: Retrospective study performed via reports on the necropsy findings. SETTING: University hospital providing tertiary-level attendance. SAMPLE: 16,466 consecutive necropsies performed from January 1972 to December 1995. MAIN MEASUREMENTS: Frequency of lethal and non-lethal pulmonary thromboembolism, predisposing diseases, occurrence in relation to the seasons of the year, and location where the embolus is lodged. RESULTS: Pulmonary thromboembolism was found in 4.7 percent of all the necropsies performed. There was a predominance of lethal cases (68.2 percent). There was no difference in relation to sex or seasons of the year for the occurrence of this disease. Cardiovascular diseases were more frequently associated with thromboembolic phenomena. With regard to the location where the embolus was lodged, various lung segments showed greater incidence of being bilaterally compromised. CONCLUSION: Over the period of this study, it was observed that there was a reduction in the incidence of pulmonary thromboembolism, which was probably due to the increase in prophylactic measures over the last few decades. Nonetheless, lethal thromboembolism predominated in frequency, probably because of the abrupt onset of a condition of attack across a large area of the lung, lack of clinical suspicions and consequently a lack of early diagnosis, and delay in instituting fibrinolytic therapy in the cases with hemodynamic repercussions or a large number of lung segments affected