Teaching strategies to develop skills to address social inequalities in nursing education: A scoping review.

OBJECTIVES: to identify teaching strategies for developing skills to address social inequalities in nursing education. DESIGN: Following the Joanna Briggs Institute and PRISMA-ScR guidelines, a scoping review was performed to answer the following research question: "What are the teaching strategies employed to develop nurses' skills to address social inequalities?" DATA SOURCES: Bibliographical search was conducted seven electronic databases until December 29, 2020, and updated on March 25, 2022. Papers published in Portuguese, English, and Spanish on competence and professional practice, social inequality, education/training, and nursing were included. REVIEW METHODS: Seven reviewers screened the articles by reading titles and abstracts. Studies on teaching strategies used to develop nurses' skills to address social inequalities were included. Of the 1137 articles found, 61 were selected by the first screening, and 23 were included in the final sample. Data were analyzed and summarized as a narrative. RESULTS: The included papers were published between 2000 and 2020, predominantly in the United States. Curricular and learning strategies, including service, experience, and interactive, were the most common, followed by university programs and civil society initiatives. Courses, classes, debates, and practical activities predominated as teaching activities. Teaching techniques focus on resources such as posters, videos, workshops, and seminars. CONCLUSIONS: This review identified teaching strategies used to develop nurses' skills to address social inequalities. Curricular initiatives, learning strategies, university programs and civil society initiatives can expand students' understanding of social inequalities and be used to develop skills.

Evaluation of clinical, pathological and epidemiological profile of patients with breast cancer in the microregion of Lavras ­ MG

Breast cancer is associated with high frequency and mortality in Brazilian women. There have been limited studies portraying the characteristics of breast cancer cases in the countryside of the state of Minas Gerais for a long period of time, a fact that will allow us to better understand the epidemiology of these tumors. This descriptive study aims to analyze the epidemiology and clinical features of patients with breast cancer treated at a public health service facility in Lavras, MG. Methods: This is a transversal study with 299 women diagnosed with breast cancer between 2002 and 2022, based on data collection from medical records and subsequent descriptive analysis. Results: There were a total of 317 cases, and 299 were eligible for the study. The mean age at diagnosis was 54.2 years, and 36.1% of the patients were under 50 years old at diagnosis. Positive family history was found in 17.0% of the patients. The diagnosis was made by clinical alteration detected on physical examination in 71.5% of cases, and lump was the most frequent type of lesion (89.0%). Invasive carcinoma was 93.1% of the cases, and the mean tumor size was 28.6 mm. The average time between first medical appointment and diagnosis was 63.2 days, and between diagnosis and beginning of treatment was 39.6 days. Conclusions: This study showed that a significant number of cases occurred in women outside the recommended age for screening in Brazil. Diagnosis was predominantly performed by clinical examination, with delays in obtaining the histological diagnosis, and the stage at diagnosis was high, and these facts were associated with the health system limitations (AU)

Multi-omic based production strain improvement (MOBpsi) for bio-manufacturing of toxic chemicals.

Robust systematic approaches for the metabolic engineering of cell factories remain elusive. The available models for predicting phenotypical responses and mechanisms are incomplete, particularly within the context of compound toxicity that can be a significant impediment to achieving high yields of a target product. This study describes a Multi-Omic Based Production Strain Improvement (MOBpsi) strategy that is distinguished by integrated time-resolved systems analyses of fed-batch fermentations. As a case study, MOBpsi was applied to improve the performance of an Escherichia coli cell factory producing the commodity chemical styrene. Styrene can be bio-manufactured from phenylalanine via an engineered pathway comprised of the enzymes phenylalanine ammonia lyase and ferulic acid decarboxylase. The toxicity, hydrophobicity, and volatility of styrene combine to make bio-production challenging. Previous attempts to create styrene tolerant E. coli strains by targeted genetic interventions have met with modest success. Application of MOBpsi identified new potential targets for improving performance, resulting in two host strains (E. coli NST74ΔaaeA and NST74ΔaaeA cpxPo) with increased styrene production. The best performing re-engineered chassis, NST74ΔaaeA cpxPo, produced ∼3 × more styrene and exhibited increased viability in fed-batch fermentations. Thus, this case study demonstrates the utility of MOBpsi as a systematic tool for improving the bio-manufacturing of toxic chemicals.

[Professional practices in situations of violence in home care: an integrative review]. / Práticas profissionais em situações de violência na atenção domiciliar: revisão integrativa.

This article aims to describe the practices of health professionals in situations of violence in the provision of home care. It involved an integrative review of the literature conducted between December 2016 and December 2017 in the LILACS, BDENF and MEDLINE databases. The sample was composed of 15 articles, organized and characterized by author, publication journal, country, year, title, method, main idea, category and level of evidence. The violent situations found most often were abuse of elderly and children and domestic violence towards women and children. Different practices were adopted during violent situations against patients, like interventions, notifications, orientation, and professional qualification. Practices of health professionals in home care focuses on actions of patient care,seek to minimize the effects of violence.

Urban expansion and its impact on water security: The case of the Paraíba do Sul River Basin, São Paulo, Brazil.

Increasing demand for water is one of the most challenging problems that human societies face today and has encouraged new studies to examine water security and water management. Seeking to discuss this important issue in the Brazilian context, we analyzed the impacts of urban expansion on water security in a basin located in the most populated region of Brazil. To quantify increased water demand, we combined urban sprawl and regional population increase projections. In this context, our study contributes to discussions on water security by addressing the importance of integration between water and urban planning. Simulations indicate good performance in reproducing actual water system conditions. The finding demonstrates that urban expansion in the region is mainly driven by road proximity. Urban occupation is projected to increase in 170% by 2050, increasing water demands for domestic use in 38%. Results indicate the feasibility of including landscape and socioeconomic constrains in order to obtain potential domestic water demand scenarios by using land use and land cover change modelling to assess urban expansion and population growth. For the study region, our findings suggest that although urban sprawl increases water demand, urban supply will not be compromised given the large volume of available water in the basin. However, the indirect consequences of urban sprawl, such as industrialization and agricultural intensification, may compromise the quality of this resource and require better water use management in the region.

Práticas profissionais em situações de violência na atenção domiciliar: revisão integrativa / Professional practices in situations of violence in home care: an integrative review

Resumo O objetivo deste artigo é descrever as práticas de profissionais de saúde em situações de violência nos cuidados da Atenção domiciliar. Trata-se de uma revisão integrativa da literatura realizada entre dezembro de 2016 e dezembro de 2017 nas bases de dados LILACS, BDENF e MEDLINE. A amostra foi composta por 15 artigos, organizados e caracterizados de acordo com autor, periódico de publicação, país, ano, título, método, ideia central, categoria e nível de evidência. As situações de violência mais encontradas foram abuso em idosos e crianças e violência doméstica em mulheres e crianças. Práticas distintas foram adotadas nas situações de violência contra os pacientes, como intervenções, notificações, orientação, e capacitação profissional. As práticas dos profissionais na atenção domiciliar focalizam ações de cuidado dos pacientes, buscando minimizar os efeitos da violência.

Abstract This article aims to describe the practices of health professionals in situations of violence in the provision of home care. It involved an integrative review of the literature conducted between December 2016 and December 2017 in the LILACS, BDENF and MEDLINE databases. The sample was composed of 15 articles, organized and characterized by author, publication journal, country, year, title, method, main idea, category and level of evidence. The violent situations found most often were abuse of elderly and children and domestic violence towards women and children. Different practices were adopted during violent situations against patients, like interventions, notifications, orientation, and professional qualification. Practices of health professionals in home care focuses on actions of patient care,seek to minimize the effects of violence.

O cotidiano de trabalho na enfermagem: uma reflexão sobre práticas profissionais / The daily work in nursing: a reflection on professional practices

Objective: To reflect on the daily routineof nursing work practices, taking into account the daily ways of doing in which Certeau proposes, focusing on historical aspects and professional performance in health services. Methods: This is a reflection based on the studies on the daily life of Michel de Certeau. Results: The application of the arts of doing about the daily life of the profession proposes the need for discussions about the daily practices of nursing and critical reflection on the reality of health services. Strategies and tactics are used in the daily work of nursing, as a dimension of the real. Final considerations: Practices in health services include several ways of doing the work; and in the nursing routine these actions become multiple and intermittent. Nursing uses pre-established aspects of the work and a creative dimension of the professionals' work.

Objetivo: Refletir sobre o cotidiano das práticas de trabalho de enfermagem, levando em consideração as maneiras de fazer no cotidiano propostas por Certeau, focalizando aspectos históricos e de atuação profissional em serviços de saúde. Métodos: Trata-se de uma reflexão fundamentada nos estudos sobre o cotidiano de Michel de Certeau. Resultados: A aplicação das artes de fazer sobre o cotidiano da profissão propõe a necessidade de discussões sobre as práticas cotidianas da enfermagem e reflexão crítica sobre a realidade dos serviços de saúde. As estratégias e táticas são utilizadas no cotidiano de trabalho da enfermagem, como uma dimensão do real. Considerações finais: As práticas nos serviços de saúde contemplam diversas maneiras de fazer o trabalho; e no cotidiano da enfermagem essas ações se tornam múltiplas e intermitentes. A enfermagem utiliza aspectos preestabelecidos do trabalho e uma dimensão criativa do fazer dos profissionais.

Corrigendum: Contribution of the Alkylquinolone Quorum-Sensing System to the Interaction of Pseudomonas Aeruginosa With Bronchial Epithelial Cells.

[This corrects the article DOI: 10.3389/fmicb.2018.03018.].

Interrupções no trabalho do enfermeiro e suas interferências na segurança do paciente / Interruptions in nurses' work and their interference in patient safety

Objetivo: Trata-se de uma pesquisa quantitativa observacional de corte transversal, que teve como objetivo analisar as interrupções nas atividades primárias dos enfermeiros de uma unidade de Pronto Atendimento (PA) de um hospital universitário de Minas Gerais. Método: Os participantes foram 40 enfermeiros, dos turnos diurno e noturno, que atuavam na unidade. A coleta de dados foi realizada de 8 de junho a 23 de julho de 2018, por meio da observação direta não participante das interrupções nas atividades primárias dos enfermeiros, após aprovação do Comitê de Ética em Pesquisa e do hospital. A análise descritiva foi feita utilizando planilha eletrônica da plataforma Microsoft Excel e realizada distribuição de frequência absoluta e relativa. Resultados: Durante as 113,2 horas de coleta de dados, foram observadas 736 atividades primárias, sendo 277 (37,6%) de cuidado indireto ao paciente; 211 (28,7%) de cuidado direto; 144 (19,6%) de atividades administrativas; 99 (13,5%) de atividades pessoais; e 5 (0,7%) de atividades de ensino e pesquisa. Quanto ao tempo das interrupções, constatou-se que os enfermeiros gastaram mais tempo durante o cuidado indireto (34,9%). Das 736 atividades, 426 (57,9%) foram interrompidas, com média de 1,8 interrupções por atividade primária, totalizando 1.334 ocorrências (11,8 por hora). O cuidado indireto foi o mais interrompido (53,5%), seguido pelo cuidado direto (29,8%), atividade administrativa (13,2%) e atividade pessoal (3,5%). A atividade com maior número de interrupções foi registro de enfermagem (28,1%), seguida da avaliação do paciente (13,7%) e realização de procedimentos ou cuidado ao paciente (10,6%). As interrupções corresponderam a 41% do tempo de trabalho dos enfermeiros durante o período de observação. A mediana da duração das atividades primárias interrompidas foi de oito minutos e as não interrompidas foi de 2,5 minutos. O número de interrupções foi maior no turno da manhã (36%), mas a duração das interrupções foi maior no horário noturno (4,1%). As principais fontes de interrupções foram a equipe de enfermagem (40,6%) e a autointerrupção (13,3%), sendo as fontes que mais demandaram o tempo do enfermeiro, 41,2% e 12,3%, respectivamente. Os motivos de interrupções mais frequentes foram os relacionados ao paciente (31%), administrativo (24%), pessoal (18%), ajuda (17%), ambiente (8%) e ensino e pesquisa (2%). Os principais motivos foram fornecer e receber informações relacionadas ao paciente (18,1%), conversa paralela (12,5%) e alarmes (6,1%). O motivo que mais consumiu o tempo do enfermeiro foi conversa paralela (32,3%). Após as interrupções, os enfermeiros não retornaram à atividade primária em 1,8% dos casos, sendo necessário atender de uma a 30 interrupções antes de retornar à atividade inicial. Ao comparar a frequência das interrupções do PA Subunidades e PA Unidade de Terapia Intensiva, notou-se que o segundo correspondeu a 54% das interrupções, representando 61,5% do tempo total das interrupções. Conclusão: O conhecimento das interrupções no trabalho do enfermeiro pode contribuir para se elencar interrupções que propiciam a segurança do paciente e aquelas que geram problemas para a concentração e interferem na qualidade da assistência e na segurança do paciente. O profissional deve ater-se à atividade em execução e avaliar a pertinência da intervenção de acordo com a situação.(AU)

Objective: This is a cross-sectional, observational quantitative study, whose objective was to analyze the interruptions in the primary activities of nurses at an Emergency Care Unit at a university hospital in Minas Gerais. Method: There were 40 nurses participating in the study, from both day and night shifts, who worked in the unit. Data collection was performed from June 8th to July 23rd, 2018, through the direct non-participant observation of interruptions in nurses primary activities, after approval of the Research Ethics Committee and the hospital. The descriptive analysis was done using Microsoft Excel. In addition to that, it was performed absolute and relative frequency distribution. Results: During the 113.2 hours of data collection, 736 primary activities were observed, being: 277 (37.6%) of indirect care to the patient; 211 (28.7%) of direct care; 144 (19.6%) of administrative activities; 99 (13.5%) of personal activities; and 5 (0.7%) of teaching and research activities. Regarding the time of interruptions, it was found that nurses spent more time during indirect care (34.9%). Of the 736 activities, 426 (57.9%) were interrupted, with an average of 1.8 interruptions per primary activity, at a total of 1,334 occurrences (11.8 interruptions per hour). The indirect care was the most interrupted (53.5%), followed by direct care (29.8%), administrative activity (13.2%) and personal activity (3.5%). The activity with the highest number of interruptions was the nursing record (28.1%), followed by patient evaluation (13.7%), and procedures or patient care (10.6%). The interruptions corresponded to 41% of nurses' work time during the observation period. The median duration of interrupted primary activities was eight minutes and the non-interrupted was 2.5 minutes. The number of interruptions was higher in the morning shift (36%), but the duration of interruptions was higher at the night shift (34.1%). The main sources of interruptions were the nursing team (40.6%) and self-interruption (13.3%), being the sources that most demanded the nurses' time, 41.2% and 12.3%, respectively. Regarding the reasons for the interruptions, the most frequent were those related to the patient (31%), administrative (24%), personal (18%), help (17%), environment (8%) and teaching and research (2%). The main reasons were providing and receive information related to the patient (18.1%), parallel conversation (12.5%) and alarms (6.1%). The reason that most consumed the nurse's time was the parallel conversation (32.3%). After the occurrence of interruptions, the nurses did not return to primary activity in 1.8% of the cases, being necessary to attend from one to 30 interruptions before returning to the initial activity. When comparing the frequency of interruptions of the Emergency Care Subunits and the Intensive Care Unit of the Emergency Care Unit, it was observed that the second corresponded to 54% of the interruptions, besides representing 61.5% of the total time of the interruptions. Conclusion: The knowledge of the interruptions in the work of the nurse can contribute to list interruptions that promote patient safety and those that generate problems for concentration and interfere in the quality of care and in the patient safety. The professional should stick to the activity in execution and evaluate the pertinence of the intervention according to the situation.(AU)

Interrupções no trabalho do enfermeiro e na segurança do paciente / Interruptions in the nurse's work and patient safety

Objetivo: identificar os efeitos das interrupções na rotina de trabalho do enfermeiro e na segurança do paciente. Método: trata-se de estudo bibliográfico, descritivo, tipo revisão integrativa de literatura, com a coleta de dados nas bases de dados MEDLINE, CINAHL, Web of Science e LILACS, em artigos indexados de 2013 a 2017, analisando-os de forma descritva, após a apresentação em figuras. Resultados: encontraram-se 17 artigos e se percebeu que revelaram aspectos negativos em relação à interrupção na rotina de trabalho do enfermeiro e na segurança do paciente e 76,5% mostraram, também, pontos positivos. Salienta-se que os resultados analisados não apoiaram consistentemente a relação negativa entre as interrupções e as suas implicações na rotina de trabalho do enfermeiro e na segurança do paciente. Conclusão: evidenciaram-se aspectos que favorecem a ocorrência de interrupções na prática do enfermeiro, entretanto, há poucos estudos que descrevem o impacto das interrupções na prática e na segurança do paciente. Fazse necessária uma ampla compreensão dos fatores que ocasionam as interrupções e colocam em risco a segurança do paciente.(AU)

Objective: to identify the effects of disruptions on the nurse's work routine and patient safety. Method: this is a bibliographical, descriptive, type-integrative review of literature, with the collection of data in the MEDLINE, CINAHL, Web of Science and LILACS databases, in indexed articles from 2013 to 2017, analyzing them in a descriptive way, after the presentation in figures. Results: 17 articles were found and it was noticed that they revealed negative aspects regarding interruption in the nurse's work routine and patient safety, and 76.5% also showed positive points. It should be noted that the results analyzed did not consistently support the negative relationship between the interruptions and their implications in the nurse's work routine and patient safety. Conclusion: aspects that favor the occurrence of interruptions in nurses' practice were evidenced, however, there are few studies that describe the impact of interruptions on the practice and safety of the patient. There is a need for a broad understanding of the factors that cause disruption and jeopardize patient safety. (AU)

Objetivo: identificar los efectos de las interrupciones en la rutina de trabajo del enfermero y en la seguridad del paciente. Método: se trata de un estudio bibliográfico, descriptivo, tipo revisión integradora de literatura, con la recolección de datos en las bases de datos MEDLINE, CINAHL, Web of Science y LILACS, en artículos indexados de 2013 a 2017, analizándolos de manera descriptiva, después de la presentación en figuras. Resultados: se encontraron 17 artículos y se observó que revelaron aspectos negativos relacionados con la interrupción en la rutina de trabajo del enfermero y en la seguridad del paciente, y el 76.5% mostraron también puntos positivos. Cabe señalar que los resultados analizados no apoyaron de manera consistente la relación negativa entre las interrupciones y sus implicaciones en la rutina de trabajo del enfermero y en la seguridad del paciente. Conclusión: se evidenciaron aspectos que favorecen la ocurrencia de interrupciones en la práctica del enfermero, sin embargo, existen pocos estudios que describan el impacto de las interrupciones en la práctica y en la seguridad del paciente. Se hace necesaria una amplia comprensión de los factores que causan las interrupciones y ponen en riesgo la seguridad del paciente.(AU)

Obesidade Infantil: análises antropométricas, bioquímicas, alimentares e estilo de vida / Childhood Obesity: an anthropometric, biochemical, alimentary and lifestyle analysis / Obesidad Infantil: análisis antropométricos, bioquímicos, alimenticios y de estilo de vida

Resumo Introdução Hábitos alimentares inadequados na infância predispõem ao surgimento de doenças metabólicas na fase adulta, objetivando a identificar alterações de IMC em escolares no município de Poços de Caldas-MG-BR, com idades entre 6 a 12 anos, avaliar análises bioquímicas, dados antropométricos e padrão alimentar. Material e Métodos Estudo quantitativo de campo, desenvolvido em três escolas, uma de ensino público e duas de ensino privado, no período de 2015 a 2016, com amostragem de 104 crianças. As variáveis de interesse foram dados antropométricos, amostragem sanguínea para exames laboratoriais e formulário de padrão alimentar. Resultados: A idade média da amostra foi 9,5±0,2, sendo 53,9% meninos e 46,2% meninas. Entre as prevalências encontradas, 51,0% das crianças tiveram algum tipo de alteração no IMC, sendo 29,2% de obesidade e 25,0% de sobrepeso na escola particular frente a 6,3% obesidade e 15,6% sobrepeso na escola pública. Observou que 60,6% apresentam alteração para glicemia em jejum (113,1±1,4 mg/dl). Colesterol 51,9% de alteração (196,0±2,9 mg/dl), HDL 43,3% mostram alterados (40,5±0,4 mg/dl), LDL percebe 19,2% das crianças apresentam aumento do valor normal (143,6±4,0 mg/dl) e TG 20,2% acima do valor recomendado (158,8±10,7 mg/dl). Foi possível observar ainda uma alta significantemente estatística na ingesta alimentar dando prioridade ao grupo de açúcares. Discussão A amostra estudada apresenta alterações significativas para sobrepeso e obesidade, bem como para valores de porções alimentares, glicemia e dislipidemias. Conclusões Mostra-se importante estudo na área a fim de mapear e melhorar o perfil nutricional para diminuir os riscos aos quais as crianças estão expostas.

Abstract Introduction Inadequate eating habits in childhood predispose to the onset of metabolic diseases in adulthood, aiming to identify changes in BMI in schoolchildren in the municipality of Poços de Caldas, MG, Brazil, aged 6 to 12 years, and to evaluate biochemical analyzes, anthropometric data and food patterns. Materials and Methods A quantitative field study, developed in three schools, one public and two private schools, from 2015 to 2016, with a sample of 104 children. The variables of interest for the study were anthropometric data, blood sampling for laboratory tests and food patterns form. Results The average age of the sample was 9.5 ± 0.2, with 53.9% boys and 46.2% girls. Among the prevalence found, 51.0% of the children had some type of alteration in BMI, being 29.2% of obesity and 25,0% of overweight in private school, compared to 6.3% of obesity and 15.6% of overweight in public school. Observed that 60.6% presented alteration to fasting glycaemia (113.1±1.4 mg/dl). Alteration of 51,9% in Cholesterol (196,0±2,9 mg/dl), HDL 43,3% altered (40,5±0,4 mg/dl), the value of LDL indicate that 19,23% of the children increased of the normal value (143,6±4,0 mg/dl) and TG 20,2% is above the recommended value (158,8±10,7 mg/dl). It was also possible to observe a statistically significant increase in food intake giving priority to the sugar group. Discussion The sample studied, presented significant alterations for overweight and obesity, as well as for food portions, glycaemia and dyslipidemia. Conclusions It seems important studies in the area are necessary to map and improve the nutritional profile to reduce the risks to which children are exposed.

Resumen Introducción Los hábitos alimenticios inadecuados en la infancia predisponen al surgimiento de enfermedades metabólicas en la fase adulta, por ello, este estudio tiene por objeto identificar los cambios del IMC en alumnos del municipio de Poços de Caldas-MGBR, con edades de 6 a 12 años, así como evaluar análisis bioquímicos, datos antropométricos y patrones de alimentación. Materiales y Métodos: Estudio cuantitativo de campo, desarrollado en tres escuelas, una pública y dos privadas, en el período 2015- 2016, con un muestreo de 104 niños. Las variables de interés correspondieron a datos antropométricos, muestreo sanguíneo para exámenes de laboratorio y formulario de patrones alimenticios. Resultados La edad promedio de la amuestra fue de 9,5±0,2, con 53,9% de niños y 46,2% de niñas. Entre las prevalencias encontradas, 51 ,0% de los infantes tuvieron algún tipo de cambio en el IMC, de los cuales 29,2 correspondía a obesidad y 25,0% a sobrepeso en las escuelas privadas versus 6,3% de obesidad y 15,6% de sobrepeso en la escuela pública. Se observó que 60,6% presentan una alteración de la glicemia en ayunas (113,1±1,4 mg/dl). Colesterol 51,9% de alteración (196,0±2,9 mg/dl), HDL con 43,3% de resultados con alteraciones (40,5±0,4 mg/dl), LDL de 19,2% de los infantes que presentan aumento del valor normal (143,6±4,0 mg/dl) y TG 20,2% por encima del valor recomendado (158,8±10,7 mg/dl). Igualmente, se pudo observar un alza significativamente estadística en la ingesta de alimentos, con prioridad para el grupo de azúcares. Discusión La muestra estudiada presenta alteraciones significativas para sobrepeso y obesidad, así como valores de porciones alimenticias, glicemia y dislipidemias. Conclusiones El estudio en esta área resulta importante con el fin de mapear y mejorar el perfil nutricional para disminuir los riesgos a los que están expuestos los niños y niñas.

Increased Risk of Physical Punishment among Enuretic Children with Family History of Enuresis.

PURPOSE: Some parents blame their children for bedwetting and, therefore, punish them. This study aimed to assess the rate of punishment experienced by enuretic children and associated causative factors. MATERIALS AND METHODS: A total of 87 children 6 to 15 years old with monosymptomatic enuresis were assessed individually. Parents answered the questions in the tolerance scale. The forms of punishment were classified as verbal, chastisement and physical aggression. Family history of enuresis was considered only when 1 or both parents had experienced enuresis. RESULTS: Of the 35 girls and 52 boys with a mean ± SD age of 9.3 ± 2.3 years 67 had a family history of enuresis. Of the 67 parents 57 (85.0%) had a history of being punished due to enuresis. All children experienced some sort of verbal punishment. Children who had a family history of enuresis were more prone to being punished by physical aggression than those without such a family history (32 of 67 or 47.8% vs 4 of 20 or 20%, OR 3.7, 95% CI 1.1-12.1, p = 0.03). Punishment was found 3 times more frequently in girls than in boys (20 of 35 or 57.1% vs 16 of 52 or 30.8%, OR 3.0, 95% CI 1.2-7.3). Parents of 79 of the 87 children (90.8%) had high scores on the tolerance scale regardless of the history of enuresis. CONCLUSIONS: Enuretic children are at a high risk for experiencing some kind of punishment. Children whose parents had enuresis are at risk for being physically punished. Parents should be taught about the involuntary nature of enuresis and the fact that no punishment would help improve the condition.

CONSUMO DE ÁLCOOL E A INFLUÊNCIA DO EXERCÍCIO FÍSICO NA ATIVIDADE ENZIMÁTICA DE RATOS WISTAR / ALCOHOL CONSUMPTION AND THE INFLUENCE OF PHYSICAL EXERCISE ON ENZYME ACTIVITY OF WISTAR RATS / CONSUMO DE ALCOHOL Y LA INFLUENCIA DEL EJERCICIO FÍSICO EN LA ACTIVIDAD DE LA ENZIMA DE RATAS WISTAR

RESUMO Introdução: Biomarcadores vem sendo utilizados para monitorar o uso do álcool e, atualmente, os mais sensíveis e específicos são enzimas hepáticas, por exemplo, gama glutamiltransferase (GGT), alanina aminotransferase (ALT), aspartato aminotransferase (AST) e fosfatase alcalina (ALP). Objetivo: Verificar, a partir da experimentação animal, as alterações provocadas pelo uso de álcool e pela prática de atividade física nas enzimas hepáticas e pancreáticas. Métodos: Vinte e quatro ratos da linhagem Wistar foram distribuídos aleatoriamente em grupos experimentais, alojados em gaiolas com ambiente controlado, divididos de acordo com os tratamentos recebidos. No tratamento inicial, foi administrado álcool aos grupos álcool sedentário (AS) e álcool exercitado (AE) e, ao final da quarta semana, iniciou-se o programa de treinamento físico em esteira com os grupos AE e controle exercitado (CE). A coleta de sangue foi realizada por punção cardíaca ao final de cada experimento. Na análise estatística, utilizou-se teste de análise de variância (ANOVA) seguido de teste de Tukey e teste de Kruskal-Wallis. Resultados: O grupo AS apresentou valores significativamente mais elevados de ALT e ALP quando comparado aos grupos CE e AE, respectivamente. Não foram observadas diferenças significativas entre os quatro grupos estudados para os parâmetros AST, GGT e amilase. Conclusão: A associação entre consumo de álcool e sedentarismo aumentou a liberação das enzimas ALT e ALP em ratos Wistar; a prática de exercício físico aeróbico após abstinência alcoólica evitou o aumento da liberação de ALP no plasma desses animais.

ABSTRACT Introduction: Biomarkers have been used to monitor the use of alcohol and currently the most sensitive and specific are the liver enzymes, for example, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP). Objective: To determine through animal experiments the changes caused by alcohol and the physical activity in liver and pancreatic enzymes. Methods: Twenty-four Wistar rats were randomly assigned into experimental groups, housed in cages with controlled environment, divided according to the treatment received. In the initial treatment, alcohol was administered to sedentary alcohol (SA) and exercised alcohol (EA) groups and at the end of the fourth week the program of physical training on a treadmill began with the AE and control exercised (CE) groups. Blood collection was performed by cardiac puncture at the end of each experiment. For the statistical analysis we used analysis of variance (ANOVA) followed by Tukey test and Kruskal-Wallis test. Results: The AS group had significantly higher values of ALT and ALP when compared to CE and EA groups, respectively. No significant differences were observed between the four groups for the parameters AST, GGT and amylase. Conclusion: The association between alcohol consumption and physical inactivity increased the release of the enzymes ALT and ALP in Wistar rats; the practice of aerobic exercise after alcohol withdrawal prevented the increased release of ALP in the plasma of these animals.

RESUMEN Introducción: Los biomarcadores se han utilizado para controlar el consumo de alcohol y en la actualidad las enzimas hepáticas son las más sensibles y específicas, por ejemplo, gamma glutamil transferasa (GGT), alanina aminotransferasa (ALT), aspartato aminotransferasa (AST) y fosfatasa alcalina (ALP). Objetivo: Determinar, a partir de experimentos con animales, los cambios provocados por el alcohol y la actividad física en las enzimas hepáticas y pancreáticas. Métodos: Veinticuatro ratones Wistar fueron asignados al azar a los grupos experimentales, fueron alojados en jaulas con ambiente controlado, divididos de acuerdo a los tratamientos recibidos. En el tratamiento inicial, el alcohol se administró a los grupos alcohol sedentario (AS) y alcohol ejercicio (AE) y el final de la cuarta semana, se inició el programa de entrenamiento físico en una caminadora con los grupos AE y el control ejercitado (CE). La recogida de sangre se realizó mediante punción cardiaca al final de cada experimento. En el análisis estadístico se utilizó el análisis de varianza (ANOVA), seguido por la prueba de Tukey y la prueba de Kruskal-Wallis. Resultados: El grupo AS tuvo valores significativamente más elevados de ALT y ALP en comparación con los grupos CE y AE, respectivamente. No se observaron diferencias significativas entre los cuatro grupos para los parámetros de AST, GGT y amilasa. Conclusión: La asociación entre el consumo de alcohol y la falta de actividad física aumenta la liberación de las enzimas ALT y ALP en ratones Wistar; la práctica de ejercicio aeróbico después de la retirada del alcohol impidió el aumento de la liberación de ALP en el plasma de estos animales.

Correlação entre a curva de aprendizado e a dor referida pela paciente durante o procedimento histeroscópico ambulatorial sem anestesia / Correlation between the learning curve and the pain reported by the patient during outpatient hysteroscopy procedure without anesthesia

Introdução: a histeroscopia é considerada padrão-ouro na avaliação do útero e das doenças associadas a ele. Seu uso como técnica diagnóstica é uma prática ambulatorial, normalmente bem tolerado pelas pacientes, permitindo a retomada das atividades logo após o seu término. O ensino da técnica histeroscópica tende a ser demorado, apresentando lenta curva de aprendizado. Por isso, definir o impacto da curva de aprendizado da histeroscopia na intensidade da dor pode ajudar a melhorar a organização dos serviços de histeroscopia, maximizando o aprendizado e reduzindo o desconforto das pacientes. Objetivos: analisar, com a construção de uma curva de aprendizado a possível relação entre o número de procedimentos histeroscópicos realizados pelo médico e a intensidade da dor relatada pelo paciente no exame. Métodos: coorte prospectiva feita com 403 pacientes submetidas à histeroscopia no Hospital Universitário São José (HUSJ). Resultados: 72,45% dos pacientes classificaram a dor como leve e 5,95% como forte. Além disso, a curva de aprendizado construída apresentou tendência negativa. Discussão: a tendência negativa da curva mostra que quanto mais exames o aluno realiza, menos dor a paciente sente no progredir do aprendizado. Entretanto, nos quatro meses finais, foi identificada certa estabilização da curva, indicando que o processo de aprendizado foi mais intenso no início do curso. Conclusão: apesar das limitações encontradas na realização da pesquisa, é visível que estudos nessa área devem ser mantidos, visando à melhoria da técnica, à correção de falhas e ao bem-estar do paciente.

Introduction: Hysteroscopy is considered the gold standard in the evaluation of the uterus and its diseases. Its use as a diagnostic technique is an outpatient procedure, usually well tolerated by patients, allowing resumption of activities right after its completion. The teaching of the hysteroscopic technique tends to be time consuming, with a slow learning curve. Therefore, defining the impact of the histeroscopy's learning curve on the intensity of the pain felt by the patients can help improving the organization of hysteroscopy services, maximizing learning and reducing patient discomfort. Objectives: To analyze, with the construction of a learning curve, the possible relationship between the number of hysteroscopic procedures performed by the doctor and the intensity of pain reported by the patient during the exam. Methods: A prospective cohort study with 403 patients who underwent hysteroscopy in the Hospital Universitário São José (HUSJ). Results: 72.45% of the patients rated the pain as mild and 5.95% , as strong. Furthermore,the learning curve constructed presented a negative tendency. Discussion: The downward trend of the curve shows that the more procedures the trainee performs the less pain the patient feels along the learning process. However, in the final four months, a stabilization of the curve was identified, indicating that the process of learning was more intense at the beginning of the course. Conclusion: Despite the limitations encountered in conducting the survey, it is obvious that studies in this area should be maintained in order to improve technique, correct faults and upgrade patient welfare.

Principais profissões de saúde e fatores predisponentes da sí­ndrome do túnel do carpo: revisão da literatura. / Main health professions and factors related to professional activity developers of the carpal tunnel syndrome: a literature review.

OBJETIVO: identificar os principais profissionais da área de saúde suscetíveis ao desencadeamento da Sindrome do Túnel do Carpo (STC), bem como os fatores de risco associados com a atividade profissional. MÉTODO: revisão de literatura baseada em estudos de coorte e/ou de incidência, transversal e/ou prevalência da STC nos profissionais de saúde. Foram utilizados artigos do ano de 1997 a 2012, como fontes primárias da pesquisa. CONSIDERAÇÕES FINAIS: os resultados encontrados mostraram que dentistas e enfermeiros são os profissionais de saúde mais suscetíveis à doença, sendo obtida uma prevalência estimada na ordem de 25% a 75,6% nessas categorias. É necessária a realização de mais estudos específicos sobre a STC voltados a essas categorias profissionais, com a adoção de programas preventivos, a fim de minimizar os fatores de risco ocupacionais influenciadores no desempenho profissional e na qualidade de vida.

Carpal Tunnel Syndrome (CTS) is the most common neuropathy of the wrist and hand occurs due to compression of the median nerve within the inelastic retinaculum of the flexors muscles. The discussion about the disease has been increas-ing more and more, since occurs in several health professionals such as dentists, physiotherapists, nurses, doctors, and others, leading to radical changes in lifestyle. It is the main cause of the lost hours of working professionals in manually performing repetitive tasks or subjected to continuous vibration, causing numerous professional complications, causing the permanent absence of the work. Thus, this study reveals the need for an approach to the problem, aimed to identify the main health professionals susceptible to the development of this syndrome as well as the risk factors associated with the occupation. The methodology consists of a literature review based on cohort studies and / or incidence, cross-sectional and / or prevalence of CTS in healthcare professionals. Articles of year 1997 to 2012 were used as primary sources of search. The results showed that dentists and nurses are the professionals most susceptible to the CTS, so that estimated prevalence was in the range of 25% to 75.6% in these categories. Researches about the STC focused on these professional categories, with the adoption of preventive programs in order to minimize occupational risk factors influencers are needed to improve professional performance and quality of life

Asthma: Gln27Glu and Arg16Gly polymorphisms of the beta2-adrenergic receptor gene as risk factors.

BACKGROUND: Asthma is caused by both environmental and genetic factors. The ADRB2 gene, which encodes the beta 2-adrenergic receptor, is one of the most extensively studied genes with respect to asthma prevalence and severity. The Arg16Gly (+46A > G) and Gln27Glu (+79C > G) polymorphisms in the ADRB2 gene cause changes in the amino acids flanking the receptor ligand site, altering the response to bronchodilators and the risk of asthma through complex pathways. The ADRB2 polymorphisms affect beta-adrenergic bronchodilator action and are a tool to identify at-risk populations. OBJECTIVE: To determine the frequency of these two polymorphisms in allergic asthma patients and healthy subjects and to correlate these data with the occurrence and severity of asthma. METHODS: Eighty-eight allergic asthma patients and 141 healthy subjects were included in this study. The ADRB2 polymorphisms were analyzed using the amplification-refractory mutation system - polymerase chain reaction (ARMS-PCR) technique. The statistical analysis was performed with the SPSS 21.0 software using the Fisher's Exact and χ2 tests. RESULTS: The ADRB2 polymorphisms were associated with asthma occurrence. The Arg16Arg, Gln27Gln and Gln27Glu genotypes were risk factors; the odds ratios were 6.782 (CI = 3.07 to 16.03), 2.120 (CI = 1.22 to 3.71) and 8.096 (CI = 3.90 to 17.77), respectively. For the Gly16Gly and Glu27Glu genotypes, the odds ratios were 0.312 (CI = 0.17 to 0.56) and 0.084 (CI = 0.04 to 0.17), respectively. The haplotype analysis showed that there were associations between the following groups: Arg16Arg-Gln27Gln (OR = 5.108, CI = 1.82 to 16.37), Gly16Gly-Glu27Glu (OR = 2.816, CI = 1.25 to 6.54), Arg16Gly-Gln27Glu (OR = 0.048, CI = 0.01 to 0.14) and Gly16Gly-Gln27Glu (OR = 0.1036, CI = 0.02 to 0.39). The polymorphism Gln27Glu was associated with asthma severity, as the Gln27Gln genotype was a risk factor for severe asthma (OR = 2.798, CI = 1.099 to 6.674) and the Gln27Glu genotype was a protective factor for mild (OR = 3.063, CI = 1.037 to 9.041) and severe (OR = 0.182, CI = 0.048 to 0.691) asthma. CONCLUSIONS: The Arg16Gly and Gln27Glu polymorphisms in the ADRB2 gene are associated with asthma presence and severity.