The relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression on offspring growth and body composition.

Background and objective: Imprinted genes are important for the offspring development. To assess the relationship between obesity-related H19DMR methylation and H19 and IGF2 gene expression and offspring growth and body composition. Methods: Thirty-nine overweight/obese and 25 normal weight pregnant women were selected from the "Araraquara Cohort Study" according to their pre-pregnancy BMI. Fetal growth and body composition and newborn growth were assessed, respectively, by ultrasound and anthropometry. The methylation of H19DMR in maternal blood, cord blood, maternal decidua and placental villi tissues was evaluated by methylation-sensitive restriction endonuclease qPCR, and H19 and IGF2 expression by relative real-time PCR quantification. Multiple linear regression models explored the associations of DNA methylation and gene expression with maternal, fetal, and newborn parameters. Results: H19DMR was less methylated in maternal blood of the overweight/obese group. There were associations of H19DMR methylation in cord blood with centiles of fetal biparietal diameter (BPD) and abdominal subcutaneous fat thickness and newborn head circumference (HC); H19DMR methylation in maternal decidua with fetal occipitofrontal diameter (OFD), HC, and length; H19DMR methylation in placental villi with fetal OFD, HC and abdominal subcutaneous fat thickness and with newborn HC. H19 expression in maternal decidua was associated with fetal BPD and femur length centiles and in placental villi with fetal OFD and subcutaneous arm fat. IGF2 expression in maternal decidua was associated with fetal BPD and in placental villi with fetal OFD. Conclusion: To our knowledge, this is the first study to demonstrate associations of imprinted genes variations at the maternal-fetal interface of the placenta and in cord blood with fetal body composition, supporting the involvement of epigenetic mechanisms in offspring growth and body composition.

Autocuidado e assistência à saúde na atenção básica a pacientes hospitalizados por úlcera do pé diabético / Self-care and health assistance in primary care for patients hospitalized for diabetic foot ulcers

Estudo de delineamento transversal que teve como objetivo descrever o cuidado pré-hospitalar a pacientes hospitalizados com úlcera do pé diabético. Entre junho e dezembro de 2019, 159 pacientes adultos e idosos internados em hospital geral do interior do nordeste1 responderam a um formulário aplicado pela equipe de pesquisa. Questões referentes aos cuidados pré-hospitalares e ao autocuidado, bem como informações sociodemográficas foram coletadas. Medidas de associação foram calculadas através da determinação da razão de chances. As estimativas da associação foram calculadas por pontos e por intervalos com 95% de confiança. Apesar de a maioria dos pacientes relatarem acesso adequado aos itens pesquisados, ficou evidente que o acompanhamento prévio à hospitalização carece de melhoria1. Houve associação positiva entre frequentar regularmente os serviços de saúde (RC 4,2; IC 2,1 ­ 8,5), hospitalização anterior (RC 7,1; IC 2,6 ­ 19,2), hospitalização anterior pelo diabetes (RC 2,3; IC 1,2 ­ 4,5) e ter realizado exames dos pés nos últimos seis meses (RC 2,7; IC 1,4 ­ 5,2) com ter recebido orientações em relação aos cuidados com os pés. Conclui-se que a maior parte dos hospitalizados por úlcera do pé diabético não foi corretamente acompanhada antes da sua hospitalização. Sugere-se que uma qualificação da assistência ao paciente diabético na atenção básica contribua para a redução das hospitalizações por complicações da doença.

Cross-sectional study that aimed to describe pre-hospital care for hospitalized patients with diabetic foot ulcers. From June to December 2019, 159 adult and elderly patients admitted in a general hospital in the northeastern interior were interviewed. Questions regarding pre-hospital care, self-care, as well as sociodemographic information were collected. Even though most patients report adequate access to the researched items, it was evident that the pre-hospitalization follow-up needs improvement. There was a positive association between regularly attending health services (OR 4,2; CI 2,1 ­ 8,5), previous hospitalizations (OR 7,1; CI 2,6 ­ 19,2), previous hospitalization for diabetes (OR 2,3; CI 1,2 ­ 4,5) and performing foot examinations in the last six months meses (OR 2,7; CI 1,4 ­ 5,2) with receiving guidance regarding foot care. It is concluded that most of those hospitalized for diabetic foot ulcers were not properly followed up before their hospitalization. It is suggested that a qualification of assistance to diabetic patients in primary care contributes to the reduction of hospitalizations due to complications of the disease.

Maternal plasma transforming growth factor-β1 (TGF-β1) and newborn size: the Araraquara Cohort Study

Abstract Objective To investigate associations of maternal and cord blood cytokine patterns with newborn size and body composition. Methods This cross-sectional study involved 70 pregnant women and their healthy newborns selected from the "Araraquara Cohort Study". Newborn anthropometric measurements were recorded at birth. Body composition was evaluated by air displacement plethysmography. Maternal blood samples were collected from pregnant women between 30 and 36 weeks of gestation, and umbilical cord blood samples were collected immediately after placenta discharge. The concentrations of the cytokines were determined in plasma by ELISA. Multiple linear regression models were used to assess associations between maternal and cord blood cytokine concentrations and newborn anthropometry and body composition measurements. Results Maternal plasma TGF-β1 concentration was inversely associated with newborn weight (β= -43.0; p= 0.012), length (β= -0.16, p= 0.028), head circumference (β= -0.13, p= 0.004), ponderal index (β= -0.32, p= 0.011) and fat-free mass (β= -0.05, p= 0.005). However, the association persisted just for head circumference (β= -0.26; p= 0.030) and ponderal index (β= - 0.28; p= 0.028), after adjusting for pre-gestational BMI, gestational weight gain, gestational age, hours after delivery, newborn sex, smoking and alcohol consumption. Conclusions Maternal plasma TGF-β1 concentration may be involved in the regulation of newborn size, mainly head circumference and ponderal index. Further cohort studies are necessary to investigate the role of TGF-β1 in different trimesters of pregnancy and its effect during the early stages of fetal development.

Maternal plasma transforming growth factor-ß1 (TGF-ß1) and newborn size: the Araraquara Cohort Study.

OBJECTIVE: To investigate associations of maternal and cord blood cytokine patterns with newborn size and body composition. METHODS: This cross-sectional study involved 70 pregnant women and their healthy newborns selected from the "Araraquara Cohort Study". Newborn anthropometric measurements were recorded at birth. Body composition was evaluated by air displacement plethysmography. Maternal blood samples were collected from pregnant women between 30 and 36 weeks of gestation, and umbilical cord blood samples were collected immediately after placenta discharge. The concentrations of the cytokines were determined in plasma by ELISA. Multiple linear regression models were used to assess associations between maternal and cord blood cytokine concentrations and newborn anthropometry and body composition measurements. RESULTS: Maternal plasma TGF-ß1 concentration was inversely associated with newborn weight (ß = -43.0; p = 0.012), length (ß = -0.16, p = 0.028), head circumference (ß = -0.13, p = 0.004), ponderal index (ß = -0.32, p = 0.011) and fat-free mass (ß = -0.05, p = 0.005). However, the association persisted just for head circumference (ß = -0.26; p = 0.030) and ponderal index (ß = - 0.28; p = 0.028), after adjusting for pre-gestational BMI, gestational weight gain, gestational age, hours after delivery, newborn sex, smoking and alcohol consumption. CONCLUSIONS: Maternal plasma TGF-ß1 concentration may be involved in the regulation of newborn size, mainly head circumference and ponderal index. Further cohort studies are necessary to investigate the role of TGF-ß1 in different trimesters of pregnancy and its effect during the early stages of fetal development.

Podemos falar de segurança do paciente durante uma pandemia? Uma experiência portuguesa / Can we talk about patient safety during a pandemia? A portuguese experience / ¿Podemos hablar sobre seguridad del paciente durante una pandemia? Una experiencia portuguesa

Objetivo: enumerar medidas governativas e de saúde pública implementadas em Portugal decorrentes da pandemia pelo vírus SARS-CoV-2 e descrever a atuação do Gabinete de Segurança do Paciente do Centro Hospitalar Universitário de Lisboa Central (CHULC), referência nacional na resposta à situação de emergência de saúde pública. Métodos: utilizou-se como método a análise normativa, documental, além de relato de caso por pesquisa-ação. Resultados: em Portugal, documentaram-se os primeiros casos de infeção por SARS-CoV-2 a 2 de março de 2020. Os processos assistenciais são geridos pelo Ministério da Saúde e Direção Geral da Saúde, abrangendo o Sistema Nacional de Saúde (universal) e o sector privado. O Gabinete de Segurança do Doente do CHULC, participou na redefinição dos processos, criação de vias alternativas de informação entre as várias estruturas, implementação de inovações no uso de tecnologias e vigilância clínica, gestão dos equipamentos de proteção, motivação e suporte emocional dos profissionais e na consolidação das principais metas de segurança do doente (ex. identificação do doente, medicação e cirurgia segura). A aprendizagem feita com os erros contribui para a melhoria contínua dos processos. Conclusão: em Portugal e no mundo a pandemia por COVID-19 não terminou. Compreendemos que é tempo de refletir e voltar aos princípios básicos da segurança, como a higiene das mãos, a etiqueta respiratória e o controlo ambiental. Na gestão do risco e segurança do paciente em situação de crise, é necessário, mais do que nunca, inovar e aprender com os erros.

Objective: to enumerate governmental and public health measures implemented in Portugal resulting from the SARS-CoV-2 virus pandemic and describe the work of the Patient Safety Office of the Centro Hospitalar Universitário de Lisboa Central (CHULC), a national reference in the response to the situation of public health emergency. Methods: normative, documentary analysis was used as a method, in addition to case reports by action research. Results: in Portugal, the first cases of SARS-CoV-2 infection were documented on March 2, 2020. Assistance processes are managed by the Ministry of Health and the General Directorate of Health, covering the National Health System (universal) and the private sector. The CHULC Patient Safety Office, participated in the redefinition of processes, creation of alternative information routes between the various structures, implementation of innovations in the use of technologies and clinical surveillance, management of protective equipment, motivation and emotional support from professionals and consolidating the main patient safety goals (eg patient identification, medication and safe surgery). Learning from mistakes contributes to the continuous improvement of processes. Conclusion: In Portugal and in the world, the COVID-19 pandemic has not ended. We understand that it is time to reflect and return to the basic principles of safety, such as hand hygiene, respiratory etiquette and environmental control. In the management of risk and safety of patients in crisis situations, it is necessary, more than ever, to innovate and learn from mistakes.

Objetivo: enumerar las medidas gubernamentales y de salud pública implementadas en Portugal como resultado de la pandemia del virus SARS-CoV-2 y describir el trabajo de la Oficina de Seguridad del Paciente del Centro Hospitalar Universitário de Lisboa Central (CHULC), una referencia nacional en la respuesta a la situación de emergencia de salud pública. Métodos: se utilizó como método el análisis documental, normativo, además de los reportes de casos por investigación-acción. Resultados: en Portugal se documentaron los primeros casos de infección por SARS-CoV-2 el 2 de marzo de 2020. Los procesos de atención son gestionados por el Ministerio de Salud y la Dirección General de Salud, abarcando el Sistema Nacional de Salud (universal) y el privado. sector. La Oficina de Seguridad del Paciente del CHULC, participó en la redefinición de procesos, creación de rutas alternativas de información entre las distintas estructuras, implementación de innovaciones en el uso de tecnologías y vigilancia clínica, manejo de equipos de protección, motivación y apoyo emocional de los profesionales y consolidando las principales objetivos de seguridad del paciente (por ejemplo, identificación del paciente, medicación y cirugía segura). Aprender de los errores contribuye a la mejora continua de los procesos. Conclusión: En Portugal y en el mundo, la pandemia de COVID-19 no ha terminado. Entendemos que es hora de reflexionar y volver a los principios básicos de seguridad, como la higiene de manos, la etiqueta respiratoria y el control ambiental. En la gestión del riesgo y la seguridad de los pacientes en situaciones de crisis, es necesario, más que nunca, innovar y aprender de los errores.

Ginástica rítmica: experiência baseada nos esportes unificados, da Special Olympics / Rhythmic gymnastics: experience based on unified sports, Special Olympics / Gimnasia rítmica: experiencia basada en los deportes unificados de las Olimpiadas Especial

O programa de Esporte Unificado, da Special Olympics, possibilita práticas esportivas para pessoas com e sem deficiência intelectual conjuntamente, visando a promoção da inclusão social. Fundamentado neste programa, foi realizada uma pesquisa-ação objetivando analisar a relação entre atletas com e sem deficiência intelectual em aulas de ginástica rítmica fundamentadas no Esporte Unificado. Para isso, 18 meninas, 12 com deficiência intelectual e 6 sem essa condição, realizaram aulas de ginástica rítmica, conjuntamente, por 12 semanas, com 2 sessões semanais de 2 horas cada, em uma quadra de esportes de Guaratinguetá, São Paulo, Brasil. Ao final do programa, foi empregada uma entrevista semiestruturada com as meninas sem deficiência, apreciando os dados por análise de conteúdo. Os resultados apontaram que a interação entre atletas com e sem deficiência promoveu melhoras na performance das atletas e possibilitou a construção de conhecimento sobre as diversidades, alcançando atitudes de aceitação e respeito pelas diferenças.

The Special Olympics Unified Sport program enables sports practices for people with and without intellectual disabilities to work together to promote social inclusion. Based on this program, an action research was carried out aiming to verify possible implications achieved through the implementation of a rhythmic gymnastics project based on the Unified Sport, from the perspective of non-disabled participants. To that end, 18 girls, 12 with intellectual disabilities and 6 without this condition, performed rhythmic gymnastics classes together for 12 weeks, with 2 weekly sessions of 2 hours each, in a sports court in Guaratinguetá, São Paulo, Brazil. At the end of the program, a semi-structured interview with non-disabled girls was used, assessing the data by content analysis. The results showed improvements in the performance of athletes, stimulation of the interactions between athletes with and without disabilities and the construction of knowledge about the diversities, reaching attitudes of acceptance and respect for differences.

El programa de deportes unificados de Olimpiadas Especiales permite prácticas deportivas para personas con y sin discapacidad intelectual conjuntamente, con vistas a la promoción de la inclusión social. Fundamentado en este programa, se realizó una investigación-acción objetivando verificar posibles implicaciones alcanzadas por medio de la implantación de un proyecto de gimnasia rítmica fundamentado en el Deporte Unificado, desde la perspectiva de los partícipes sin discapacidad. Para ello, 18 niñas, 12 con discapacidad intelectual y 6 sin esa condición, realizaron clases de gimnasia rítmica, conjuntamente, por 12 semanas, con 2 sesiones semanales de 2 horas cada una, en una cuadra de deportes de Guaratinguetá, São Paulo, Brasil. Al final del programa, se empleó una entrevista semiestructurada con las niñas sin discapacidad, apreciando los datos por análisis de contenido. Los resultados apuntaron mejoras en el desempeño de las atletas, estímulo a las interacciones entre atletas con y sin discapacidad ya la construcción de conocimiento sobre las diversidades, alcanzando actitudes de aceptación y respeto por las diferencias.

Provimento médico na atenção primária à saúde no estado da Paraíba por meio do Programa Mais Médicos / Provision of physicians in primary health care in the state of Paraíba, Brazil, according to the More Doctors Program / Proveimiento de médicos en la atención primaria de salud en el estado de Paraíba, Brasil, según el Programa Más Médicos

Resumo A provisão médica tem sido fruto de debates internacionais há décadas, inclusive no Brasil, onde há um cenário de déficit e má distribuição de médicos. Esta pesquisa objetivou descrever o perfil dos médicos inseridos no Programa Mais Médicos a fim de avaliar a qualidade do provimento médico. Trata-se de um estudo quantitativo do tipo transversal, descritivo, seguido de estudo de caso baseado em informações de 272 questionários, no período de 2015 e 2016.Os dados foram analisados com o programa estatístico IBM SPSS v.22.0. A idade média dos entrevistados foi de 38,2 anos, sendo 50,7% do sexo feminino, 11% estavam no primeiro emprego, 51,1% tinham entre 1 e 5 anos de formado e 85% disseram ter experiência de trabalho na Atenção Primária à Saúde. Observou-se que, com a implantação do Programa na Paraíba, houve uma mudança não apenas no quantitativo de médicos, como também no número de postos de trabalho, na interiorização e redistribuição desses profissionais. Todavia, há 22 municípios paraibanos sem médico, e 85,3% dos médicos inseridos no Programa sem título de especialista. Denota-se que as condições de acesso e a qualidade dos serviços prestados constituem um grande desafio a ser superado, com fundamental participação reguladora do Estado.

Abstract The provision of physicians has been the object of international discussions for decades, and the same is true for Brazil, where there is a situation of shortage and bad distribution of physicians. The present research had the aim of describing the profile of the physicians included in the 'More Doctors' Program (Programa Mais Médicos, in Portuguese). It is a quantitative, cross-sectional, descriptive study, followed by a case study with information from 272 questionnaires. The data were analyzed using the SPSS statistical software, version 22.0. The average age of the interviewees was 38.2 years, and 50.7% of them were female, 11% were in their first jobs, 51.1% had graduated between 1 and 5 years prior to the study, and 85% reported having experience working in primary health care. We observed that, with the implementation of the 'More Doctors' Program in the state of Paraíba, Northeastern Brazil, there was a change not only in the amount of doctors, but also in the number of job posts, in the number of physicians who go work on the countryside, and in the redistribution of these professionals. However, the results indicate that there still are 22 municipalities in Paraíba without physicians, and that 85.3% of the physicians included in the Program still did not have a specialist title. The conditions of access and the quality of the services provided still constitute a great challenge yet to be overcome.

Resumen Hace décadas que se discute internacionalmente el proveimiento de médicos, y la situación no es distinta en Brasil, donde hay un escenario de déficit y mala distribución de médicos. Esta investigación tuvo el objetivo de describir el perfil de los médicos integrantes del Programa "Más Médicos". Se trata de un estudio cuantitativo del tipo transversal, descriptivo, seguido de estudio de caso con informaciones de 272 cuestionarios. Los datos fueron analizados con el programa estadístico SPSS, versión 22.0. La edad media de los entrevistados fue de 38,2 años, y 50,7% era del sexo femenino, 11% estaban en su primer empleo, 51,1% tenían entre 1 y 5 años de egresados, y 85% afirmaron tener experiencia de trabajo en la atención primaria. Se observó que, con la implantación del Programa en Paraíba, hubo un cambio no sólo en la cantidad de médicos, sino que también en el número de puestos de trabajo, en la interiorización, y en la redistribución de estos profesionales. Sin embargo, los resultados indican que todavía hay 22 municipios de Paraíba sin médico, y 85,3% de los médicos integrantes del Programa aún no tenían el título de especialista. Las condiciones de acceso y la calidad de los servicios prestados aún son un gran reto por superar.

Reduced Expression of IL-1ß and IL-18 Proinflammatory Interleukins Increases the Risk of Developing Cervical Cancer.

Background: The objective of this study was to analyze the gene expression profile of the proinflammatory interleukins, (IL-1ß and IL-18) in patients with premalignant lesions and cervical cancer. Methods: Total IL-1ß and IL-18 mRNA was quantified by qPCR to obtain the expression data in cervical tissues. A total of 74 cervical biopsies were obtained from women undergoing a colposcopy. The samples were divided into: normal (19), low level lesions (LSIL) or NIC I (17), high level lesions (HSIL) or CIN II and CIN III (29) and cancer (9). The normal cervical tissue samples were included as controls. The OR and 95% CI were calculated for the determination of the risk of progression between each type of lesion and cancer using logistic regression. Results: The results showed that an increase in the risk of progression of pre-neoplastic lesions to cancer was between 2.5 and 2.08 times higher in women with lower IL-1ß and IL-18 expression, respectively. Conclusions: This study provided evidence that IL-1ß and IL-18 are potential biomarkers that can be explored in further studies for monitoring the evolution of pre-neoplastic lesions and avoiding overtreatment or undertreatment of the patients.

Care technologies to prevent and control hemorrhage in the third stage of labor: a systematic review. / Tecnologias de cuidado para prevenção e controle da hemorragia no terceiro estágio do parto: revisão sistemática.

OBJECTIVE: to identify evidence concerning the contribution of health technologies used to prevent and control hemorrhaging in the third stage of labor. METHOD: systematic review with database searches. First, two researchers independently selected the papers and, at a second point in time, held a reconciliation meeting. The Kappa coefficient was used to assess agreement, while the Grading of Recommendations, Assessment, Development and Evaluation was adopted to assess risk of bias and classify level of evidence. RESULTS: in this review, 42 papers were included, 34 of which addressed product technologies, most referred to pharmacological products, while two papers addressed the use of blood transparent plastic bags collector and the contribution of birth spacing and prenatal care. The eight papers addressing process technologies included the active management of the third stage of labor, controlled cord traction, uterine massage, and educational interventions. CONCLUSION: product and process technologies presented high and moderate evidence confirmed in 61.90% of the papers. The levels of evidence confirm the contribution of technologies to prevent and control hemorrhaging. Clinical nurses should provide scientific-based care and develop protocols addressing nursing care actions.

Prevalence of school violence and use of alcohol and other drugs in adolescents.

OBJECTIVE: to analyze the school violence suffered and practiced and its association with the use of alcohol and other drugs in adolescents between 12 and 18 years old. METHOD: the study sample consisted of 643 adolescents enrolled in six schools, who answered two self-administered questionnaires: "Global School-based Student Health Survey" and "Violence in School". Statistical analysis was performed using the chi-square test and the degree of association between the variables was analyzed using the prevalence ratio. RESULTS: the prevalence of school violence suffered and practiced was 62.2% and 51.9%, respectively. About 44.6% of the aggressors said they did not want to change their behavior. There was an expressive prevalence of alcohol use (16.5%), tobacco (15.7%) and illicit drugs (6.8%), and drunkenness (12.6%). There was a significant association between the violence suffered and the age group of 12 to 14 years old (p=0.001); (p=0.011) and education level in elementary school (p<0.001). In mothers with less than eight years of studies, the association was significant for the violence practiced (p=0.002). CONCLUSION: the study contributes to the aspects involved in school violence, which can subsidize actions and policies in this area.

Prevalence of school violence and use of alcohol and other drugs in adolescents / Prevalência de violência na escola e uso de álcool e outras drogas entre adolescentes / Prevalencia de violencia en la escuela y uso de alcohol y otras drogas entre adolescentes

ABSTRACT Objective: to analyze the school violence suffered and practiced and its association with the use of alcohol and other drugs in adolescents between 12 and 18 years old. Method: the study sample consisted of 643 adolescents enrolled in six schools, who answered two self-administered questionnaires: "Global School-based Student Health Survey" and "Violence in School". Statistical analysis was performed using the chi-square test and the degree of association between the variables was analyzed using the prevalence ratio. Results: the prevalence of school violence suffered and practiced was 62.2% and 51.9%, respectively. About 44.6% of the aggressors said they did not want to change their behavior. There was an expressive prevalence of alcohol use (16.5%), tobacco (15.7%) and illicit drugs (6.8%), and drunkenness (12.6%). There was a significant association between the violence suffered and the age group of 12 to 14 years old (p=0.001); (p=0.011) and education level in elementary school (p<0.001). In mothers with less than eight years of studies, the association was significant for the violence practiced (p=0.002). Conclusion: the study contributes to the aspects involved in school violence, which can subsidize actions and policies in this area.

RESUMO Objetivo: analisar a violência escolar sofrida e praticada e a sua associação com o uso de álcool e outras drogas entre adolescentes com 12 a 18 anos de idade. Método: a amostra do estudo foi composta por 643 adolescentes matriculados em seis escolas, que responderam a dois questionários autoaplicáveis: "Global School-based Student Health Survey" e "Violência na Escola". A análise estatística foi realizada utilizando-se o teste Qui-quadrado e o grau de associação entre as variáveis analisado por meio da razão de prevalência. Resultados: as prevalências de violência escolar sofrida e praticada foram de 62,2% e 51,9%, respectivamente. Cerca de 44,6% dos agressores afirmaram não querer mudar seu comportamento. Houve prevalência expressiva do uso de álcool (16,5%), tabaco (15,7%), drogas ilícitas (6,8%) e de embriaguez (12,6%). Houve associação significativa entre a violência sofrida e a faixa etária de 12 a 14 anos (p=0,001), sexo masculino (p=0,011) e grau de escolaridade em ensino fundamental (p<0,001). Em mães com menos de oito anos de estudo, a associação foi significativa para a violência praticada (p=0,002). Conclusão: o estudo traz contribuições para os aspectos envolvidos na violência escolar, que podem subsidiar ações e políticas nesse âmbito.

RESUMEN Objetivo: analizar la violencia escolar sufrida y practicada y su asociación con el uso de alcohol y otras drogas entre adolescentes de 12 a 18 años de edad. Método: la muestra del estudio fue compuesta por 643 adolescentes matriculados en seis escuelas, que respondieron a dos cuestionarios autoaplicables: "Global School-based Student Health Survey" y "Violencia en la Escuela". El análisis estadístico fue realizado utilizando el test Chi-cuadrado y el grado de asociación entre las variables fue analizado por medio de la razón de prevalencia. Resultados: las prevalencias de violencia escolar sufrida y practicada fueron de 62,2% y 51,9% respectivamente. Alrededor del 44,6% de los agresores afirmaron no querer cambiar su comportamiento. Se observó una prevalencia expresiva del uso de alcohol (16,5%), tabaco (15,7%) y drogas ilícitas (6,8%), y de embriaguez (12,6%). Se observó una asociación significativa entre la violencia sufrida y el grupo de edad de 12 a 14 años (p=0,001); sexo masculino (p=0,011) y grado de escolaridad en enseñanza primaria (p<0,001). En madres con menos de ocho años de estudio, la asociación fue significativa para la violencia practicada (p=0,002). Conclusión: el estudio aporta contribuciones a los aspectos envueltos en la violencia escolar, que pueden subsidiar acciones y políticas en este ámbito.

A relação entre fatores psicológicos e perfil glicêmico maternos e adiposidade nos períodos fetal e neonatal / The relationship between psychological factors and maternal glycemic profile and adiposity in the fetal and neonatal periods

Introdução: As alterações hormonais, sobretudo resistência a glicocorticoides, que ocorrem no período gestacional, podem estar envolvidas na adiposidade do concepto, mediante mecanismos inflamatórios desencadeados pelo estresse e distresse (depressão e ansiedade) que envolvem hiperatividade do eixo hipotálamo-pituitária-adrenal (HPA). Objetivo: Avaliar a relação entre fatores psicológicos e perfil glicêmico maternos em 3 períodos da gestação (<= 19, 20-29 e 30-39 semanas) e adiposidade do concepto nos períodos fetal e neonatal. Métodos: Trata-se de estudo epidemiológico, coorte prospectivo, desenvolvido em Unidades de Saúde da Rede de Atenção Básica de Araraquara, São Paulo, e de outros 7 municípios da região, o Serviço Especial de Saúde de Araraquara e Maternidade Municipal "Gota de Leite", que incluiu respectivamente 768, 745 e 681 mulheres nos 3 períodos da gestação, até nascimento dos conceptos. O estresse e distresse maternos foram avaliados pelos seguintes instrumentos: General Health Questionnaire - Edinburgh Postnatal Depression Scale - State-Trait Anxiety Inventory - Perceived Stress Scale. O perfil glicêmico foi avaliado por glicemia, insulina e hemoglobina glicada, respectivamente, pelos métodos ensaio UV enzimático de referência com hexoquinase, método de quimioluminescência e cromatografia líquida de alta eficiência, calculando-se o índice HOMA-IR. A adiposidade do feto foi avaliada por ultrassonografia e a do neonato por pletismografia. A análise estatística envolveu regressão linear múltipla de efeitos mistos, considerando o aspecto longitudinal do estudo. O nível de significância adotado em todos os testes foi p <= 0,05. Resultados: Houve associação da hemoglobina glicada materna com o tecido adiposo subcutâneo da coxa do feto no período de 30-39 semanas da gestação. Para cada 1 mg/dL de hemoglobina glicada houve aumento de 12,91 cm2 no tecido adiposo da coxa (p < 0,001). A glicemia materna foi associada com o percentual de massa gorda do neonato. Para cada 1 mg/dL na glicemia houve aumento de 0,23% na massa gorda do neonato (p< 0,003). Conclusão: O perfil glicêmico materno foi importante preditor para o aumento de adiposidade do feto e neonato. No entanto, os resultados deste estudo não permitiram apoiar a hipótese de que o estresse e distresse maternos durante a gestação se relacionam a adiposidade da criança nas fases fetal e neonatal. Pode ser que a associação exista para outro tecido adiposo - o visceral - mais comumente envolvido nos distúrbios metabólicos do adulto.

Introduction: Hormonal changes, especially resistance to glucocorticoids, which occur during pregnancy, may be involved in the conceptus adiposity through inflammatory mechanisms triggered by stress and distress (depression and anxiety) involving hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA). Objective: To evaluate the relationship between maternal psychological factors and glycemic profile in 3 gestational periods (<= 19, 20-29 and 30-39 weeks) and concept adiposity in the fetal and neonatal periods. Methods: This is an epidemiological study, prospective cohort, developed in Health Units of the Primary Care Network of Araraquara, São Paulo, and in 7 other municipalities in the region, the Special Health Service of Araraquara and Municipal Maternity "Gota de Leite". Which included 768, 745 and 681 women respectively in the 3 gestational periods, until the birth of the child. Maternal stress and distress were assessed by the following instruments: General Health Questionnaire - Edinburgh Postnatal Depression Scale - State-Trait Anxiety Inventory - Perceived Stress Scale. The glycemic profile was evaluated by glycemia, insulin and glycated hemoglobin, respectively, by the reference enzymatic UV assay with hexokinase assay, chemiluminescence method and high performance liquid chromatography, calculating the HOMA-IR index. The adiposity of the fetus was evaluated by ultrasound and that of the newborn by plethysmography. Statistical analysis involved multiple linear mixed effects regression considering the longitudinal aspect of the study. The significance level adopted in all tests was p <= 0.05. Results: There was an association of maternal glycated hemoglobin with subcutaneous adipose tissue of the thigh of the fetus within 30-39 weeks of gestation. For each 1 mg/dL glycated hemoglobin there was an increase of 12.91cm2 in the thigh adipose tissue (p<0.001). Maternal glycemia was associated with the newborn's fat mass percentage. For each 1 mg/dL in blood glucose there was a 0.23% increase in neonate fat mass (p<0.003). Conclusion: The maternal glycemic profile was an important predictor for increased adiposity of the fetus and neonate. However, the results of this study did not support the hypothesis that maternal stress and distress during pregnancy are related to the child's adiposity in the fetal and neonatal phases. It may be that the association exists for another adipose tissue - visceral tissue - most commonly involved in adult metabolic disorders.

Tecnologias de cuidado para prevenção e controle da hemorragia no terceiro estágio do parto: revisão sistemática / Care technologies to prevent and control hemorrhage in the third stage of labor: a systematic review / Tecnologías de cuidado para prevención y control de la hemorragia en la tercera etapa del parto: revisión sistemática

Objetivo identificar evidências acerca das contribuições das tecnologias de cuidado usadas para prevenção e controle da hemorragia no terceiro estágio do parto. Método revisão sistemática com busca em bases de dados. Dois investigadores selecionaram os textos de forma independente na primeira etapa e, na segunda, em reunião de conciliação. Para avaliação da concordância, aplicou-se o coeficiente Kappa; para avaliação do risco de viés e classificação dos níveis de evidência, adotou-se o Grading of Recommendations, Assessment, Development and Evaluation. Resultados incluíram-se 42 artigos; desses, 34 classificados como tecnologias de produto, sendo a maioria produtos farmacológicos; dois referentes ao uso do saco plástico transparente para a coleta de sangue e contribuição do intervalo de nascimento e dos cuidados pré-natais. Os oito artigos classificados como tecnologias de processo se referiam a manejo ativo do terceiro estágio do parto, tração controlada de cordão, massagem uterina e intervenções educacionais. Conclusão as tecnologias de produto e de processo apresentaram evidência alta e moderada confirmada em 61,90% dos artigos. Os níveis de evidência demonstram contribuições das tecnologias para prevenção e controle da hemorragia. Na prática clínica, o enfermeiro deve oferecer cuidados à mulher fundamentados em evidências científicas e construir protocolos sobre as ações de cuidado da enfermagem.

Objective to identify evidence concerning the contribution of health technologies used to prevent and control hemorrhaging in the third stage of labor. Method systematic review with database searches. First, two researchers independently selected the papers and, at a second point in time, held a reconciliation meeting. The Kappa coefficient was used to assess agreement, while the Grading of Recommendations, Assessment, Development and Evaluation was adopted to assess risk of bias and classify level of evidence. Results in this review, 42 papers were included, 34 of which addressed product technologies, most referred to pharmacological products, while two papers addressed the use of blood transparent plastic bags collector and the contribution of birth spacing and prenatal care. The eight papers addressing process technologies included the active management of the third stage of labor, controlled cord traction, uterine massage, and educational interventions. Conclusion product and process technologies presented high and moderate evidence confirmed in 61.90% of the papers. The levels of evidence confirm the contribution of technologies to prevent and control hemorrhaging. Clinical nurses should provide scientific-based care and develop protocols addressing nursing care actions.

Objetivo identificar las evidencias acerca de las contribuciones de las tecnologías de cuidado usadas para la prevención y el control de la hemorragia en la tercera etapa del parto. Método revisión sistemática con búsqueda en bases de datos. Dos investigadores seleccionaron los textos, de forma independiente, en la primera etapa; y, en la segunda en reunión de conciliación. Para evaluación de la concordancia fue aplicado el coeficiente Kappa; para evaluación del riesgo de sesgo y clasificación de los niveles de evidencia, se adoptó el Grading of Recommendations, Assessment, Development and Evaluation. Resultados fueron incluidos 42 artículos; de estos, 34 fueron clasificados como: tecnologías de producto (siendo la mayoría productos farmacológicos), dos referentes a la contribución del saco plástico transparente recolector de sangre y del intervalo de nacimiento y de los cuidados prenatales. Los ocho artículos clasificados como tecnologías de proceso se referían al manejo activo de la tercera etapa del parto, a la tracción controlada del cordón, al masaje uterino y a intervenciones educacionales. Conclusión las tecnologías de producto y de proceso presentaron evidencia alta y moderada, lo que fue confirmado en 61,90% de los artículos. Los niveles de evidencia demuestran las contribuciones de las tecnologías para la prevención y el control de la hemorragia. En la práctica clínica, el enfermero debe ofrecer cuidados a la mujer fundamentados en evidencias científicas y construir protocolos sobre las acciones de cuidado de la enfermería.

Critical path of women in situations of intimate partner violence.

OBJECTIVE: To know and analyze the critical path followed by women subjected to intimate partner violence until reaching a Reference Center of a Brazilian city, from the perspective of these women. METHOD: Qualitative research, based on the concept of critical path. Participant observations of the support group of the Reference Center and interviews with ten women in situations of violence who were followed up in this service. RESULTS: the motivating factors for women to seek help were the increase in the severity of the aggressions, the impact of the violence on their children and support from their family. They go to several sectors and services before reaching the Reference Center, such as the police and legal counsel, health and social services. They find little effective responses from the services, and care is indicated as the most relevant response factor to face the situation. CONCLUSION: the assistance is fragmented and dependent on the posture of the professional. The Reference Center is recognized as an important place of support for women. In addition to governmental efforts to maintain the network structured, the permanent education of the working professionals is also fundamental.

Educação popular como orientadora de grupos de promoção à saúde de pessoas com hipertensão e diabetes na atenção básica: caminhos e aprendizados com base em uma experiência / Popular education as a guideline of health promotion groups for persons with hypertension and diabetes in basic attention: pathways

A Hipertensão Arterial Sistêmica (HAS) e o Diabetes Mellitus (DM) destacam-se entre as patologias responsáveis pela maior parte da morbimortalidade decorrente de doenças crônicas não transmissíveis, constituindo linha de cuidado estratégica na Atenção Básica (AB). Este trabalho sistematiza a experiência de um grupo comunitário com foco na promoção da saúde de pessoas que convivem com HAS e DM, desenvolvido no contexto da AB pela abordagem da Educação Popular (EP). Contextualizaremos o grupo, trazendo à tona suas experiências e uma análise crítica. O estudo resultou de pesquisa qualitativa com metodologia da sistematização de experiências, envolvendo três frentes: observação participante; entrevistas individuais; e grupo de discussão. Observou-se reorientação do tradicional grupo HiperDia, de momento de distribuição de medicamentos, aferição de pressão arterial e de glicemia, para seu estabelecimento como espaço de encontro e convivência comunitária, focado em conversas acerca de conhecimentos, apoio social e estratégias para a qualidade de vida e a realização de projetos de felicidade. Nesses espaços, a EP pode compor uma aplicação edificante e compartilhada do cuidado, na perspectiva da integralidade e do bem viver, tendo como abordagens diálogo cotidiano, valorização das histórias de vida e inclusão das iniciativas dos usuários na pauta do serviço.

Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM) are among the pathologies responsible for most of the morbidity and mortality resulting from nontransmissible chronic diseases, constituting a strategic care line in Primary Health Care (PHC). This work systematizes the experience of a community group focused on the health promotion of people living with SAH and DM, developed in the context of PHC by the Popular Education (PE) approach. We will contextualize the group, bringing their experiences and a critical analysis to the surface. The study resulted from a qualitative research with methodology of the systematization of experiences, involving three fronts: participant observation; individual interviews; and discussion group. It was observed a reorientation of the traditional SAH/DM group, at the moment of drug distribution, blood pressure and glucose measurement, for its establishment as a meeting place and community coexistence focused on conversations about knowledge, social support and strategies for quality of life and the realization of projects of happiness. In these spaces, the PE can compose an uplifting and shared application of care, in the perspective of integrality and well-being, having as daily dialogue approaches, valuing life histories and inclusion of users' initiatives in the service agenda.

Critical path of women in situations of intimate partner violence / Rota crítica de mulheres em situação de violência por parceiro íntimo / Ruta crítica de mujeres en situación de violencia perpetrada por su pareja

ABSTRACT Objective: To know and analyze the critical path followed by women subjected to intimate partner violence until reaching a Reference Center of a Brazilian city, from the perspective of these women. Method: Qualitative research, based on the concept of critical path. Participant observations of the support group of the Reference Center and interviews with ten women in situations of violence who were followed up in this service. Results: the motivating factors for women to seek help were the increase in the severity of the aggressions, the impact of the violence on their children and support from their family. They go to several sectors and services before reaching the Reference Center, such as the police and legal counsel, health and social services. They find little effective responses from the services, and care is indicated as the most relevant response factor to face the situation. Conclusion: the assistance is fragmented and dependent on the posture of the professional. The Reference Center is recognized as an important place of support for women. In addition to governmental efforts to maintain the network structured, the permanent education of the working professionals is also fundamental.

RESUMO Objetivo: Conhecer e analisar a rota crítica de mulheres em situação de violência, na perspectiva das mesmas, perpetrada por parceiro íntimo até um Centro de Referência de um município brasileiro. Método: Pesquisa qualitativa, ancorada pelo conceito de rota crítica. Foram realizadas observações participantes do grupo de apoio do Centro de Referência e entrevistas com dez mulheres em situação de violência, acompanhadas por esse serviço. Resultados: os fatores motivadores para as mulheres buscarem ajuda foram o aumento da gravidade das agressões, o impacto da violência nos filhos e o apoio familiar. Passando por diversos setores e serviços antes do acesso ao Centro de Referência, tais como policial, jurídico, saúde e social. Tais mulheres encontram pouca resposta efetiva dos serviços, sendo que o acolhimento é apontado como fator de resposta mais relevante para enfrentamento da situação. Conclusão: O atendimento é fragmentado e dependente da postura do profissional que as atende. O Centro de Referência é reconhecido como importante local de apoio pelas mulheres. Além dos esforços governamentais para manter a rede estruturada, é fundamental a educação permanente dos profissionais atuantes.

RESUMEN Objetivo: Conocer y analizar la ruta crítica de mujeres en situación de violencia perpetrada por su pareja hasta un Centro de Referencia de un municipio brasileño, según la perspectiva de las mismas. Método: se trata de una investigación cualitativa, fundamentada bajo el concepto de ruta crítica. Se realizaron observaciones participativas del grupo de apoyo del Centro de Referencia y se entrevistaron diez mujeres en situación de violencia, acompañadas por este servicio. Resultados: los factores motivadores para que las mujeres buscaran ayuda fueron el aumento de la gravedad de las agresiones, el impacto de la violencia en los hijos y el apoyo familiar. Las mujeres pasan por diversos sectores y servicios antes de acceder al Centro de Referencia, tales como el policial, el jurídico, el de salud y el social. Encuentran poca respuesta efectiva de los servicios, siendo que la acogida es el factor de respuesta principal para enfrentar la situación. Conclusión: La atención está dividida y depende de la postura del profesional que las asiste. El Centro de Referencia es reconocido como importante lugar de apoyo para las mujeres. Además de los esfuerzos gubernamentales para mantener la red estructurada, es fundamental educar continuamente a los profesionales actuantes.

Domestic violence against children and adolescents: social support network perspectives. / Violência doméstica contra crianças e adolescentes: olhares sobre a rede de apoio.

OBJECTIVE: To identify and analyze the social support network of families involved in violence against children and adolescents, from the perspective of health professionals and families in a municipality of the state of São Paulo, Brazil. METHODS: This was a qualitative strategic social study, anchored in the paradigm of complexity. Data were collected from 41 health professionals and 15 families using institutional or personal network maps, and semi-structured interviews. Analysis was conducted by organizing the data, constructing theoretical frameworks, and categorizing resulting information. RESULTS: The category "weaving the network" was unveiled, with family experiences and professionals focused on a logic of fragmentation of care. FINAL CONSIDERATIONS: The creation and implementation of public policy are urgently needed to address the needs of this population, by empowering families and communities and developing research that respects the multidimensional nature of the phenomenon.

The care network of the families involved in violence against children and adolescents: the Primary Health Care perspective.

AIMS AND OBJECTIVES: To contribute the understanding of the network care provided to families involved in family violence against children and adolescents (FVACA), from the Primary Health Care (PHC) perspective. BACKGROUND: Children and adolescents figure among the main victims of violence around the world, which occurs predominantly in the family context. PHC-guided network care has emerged as a new process that contrasts with traditional approaches, which rely on fragmented, punctual and compensatory actions and produce simplified and segmented interventions in response to complex phenomena like violence. The Paradigm of Complexity interacts with the network care approach and, by articulating the multiple dimensions of the research phenomenon, contributes to its understanding. DESIGN: Qualitative research, based on the Paradigm of Complexity. METHODS: Data were collected through minimal maps of the external institutional social network, focus groups and semi-structured interviews held with 41 PHC professionals in Brazil. The notions of comprehension and contextualisation as well as dialogical, recursive and holographic principles from complexity theory guided the data analysis. RESULTS: The two thematic categories that emerged revealed reduced institutional networks, with low-density and homogeneous bonds, which resulted in fragmented care in all stages of the care process. CONCLUSIONS: Although the network organisation of care for the families involved in FVACA is fundamental, the construction of these networks still represents a great challenge, as it requires the joint work of a multiprofessional team. RELEVANCE TO CLINICAL PRACTICE: For nursing to respond to the contemporary care demands in a contemplative and pertinent manner, a perspective and a reference framework need to be developed, leading to broader and more contextualised actions, with a multidimensional approach to the families and communities of which child and adolescent victims of violence are a part.

Intraoperative Analysis of Flow Dynamics in Arteriovenous Composite Y Grafts.

Objective: Composite graft of left internal thoracic artery and great saphenous vein in revascularization of the left coronary system is a technique well described in literature. The aim of this study is to analyze blood flow dynamics in this configuration of composite graft especially in what concerns left internal thoracic artery's adaptability and influence of great saphenous vein segment on left internal thoracic artery's flow. Methods: Revascularization of left coronary system with composite graft, with left internal thoracic artery revascularizing the anterior interventricular artery and a great saphenous vein segment, anastomosed to the left internal thoracic artery, revascularizing another branch of the left coronary system, was performed in 23 patients. Blood flow was evaluated by transit time flowmetry in all segments of the composite graft (left internal thoracic artery proximal segment, left internal thoracic artery distal segment and great saphenous vein segment). Measures were performed in baseline condition and after dobutamine-induced stress, without and with non-traumatic temporary clamping of the distal segments of the composite graft. Results: Pharmacological stress resulted in increase of blood flow values in the analyzed segments (P<0.05). Non-traumatic temporary clamping of great saphenous vein segment did not result in statistically significant changes in the flow of left internal thoracic artery distal segment, both in baseline condition and under pharmacological stress. Similarly, non-traumatic temporary clamping of left internal thoracic artery distal segment did not result in statistically significant changes in great saphenous vein segment flow. Conclusion: Composite grafts with left internal thoracic artery and great saphenous vein for revascularization of left coronary system, resulted in blood flow dynamics with physiological adaptability, both at rest and after pharmacological stress, according to demand. Presence of great saphenous vein segment did not alter physiological blood flow dynamics in distal segment of left internal thoracic artery.

Intraoperative analysis of flow dynamics in arteriovenous composite y grafts

Abstract Objective: Composite graft of left internal thoracic artery and great saphenous vein in revascularization of the left coronary system is a technique well described in literature. The aim of this study is to analyze blood flow dynamics in this configuration of composite graft especially in what concerns left internal thoracic artery's adaptability and influence of great saphenous vein segment on left internal thoracic artery's flow. Methods: Revascularization of left coronary system with composite graft, with left internal thoracic artery revascularizing the anterior interventricular artery and a great saphenous vein segment, anastomosed to the left internal thoracic artery, revascularizing another branch of the left coronary system, was performed in 23 patients. Blood flow was evaluated by transit time flowmetry in all segments of the composite graft (left internal thoracic artery proximal segment, left internal thoracic artery distal segment and great saphenous vein segment). Measures were performed in baseline condition and after dobutamine-induced stress, without and with non-traumatic temporary clamping of the distal segments of the composite graft. Results: Pharmacological stress resulted in increase of blood flow values in the analyzed segments (P<0.05). Non-traumatic temporary clamping of great saphenous vein segment did not result in statistically significant changes in the flow of left internal thoracic artery distal segment, both in baseline condition and under pharmacological stress. Similarly, non-traumatic temporary clamping of left internal thoracic artery distal segment did not result in statistically significant changes in great saphenous vein segment flow. Conclusion: Composite grafts with left internal thoracic artery and great saphenous vein for revascularization of left coronary system, resulted in blood flow dynamics with physiological adaptability, both at rest and after pharmacological stress, according to demand. Presence of great saphenous vein segment did not alter physiological blood flow dynamics in distal segment of left internal thoracic artery.