Bioanalytical LC-QTOF/MS Method for a N-phenylpiperazine Derivate (LQFM05): An Anxiolytic- and Antidepressant-like Prototype Drug Applied to Pharmacokinetic and Biodistribution Studies.

The LQFM05 is a prototype drug designed for treatment of psychiatric disorders, such as schizophrenia, exhibiting anxiolytic- and antidepressant-like (12 or 24 µmol/kg) effects in classical behavioral tests. In order to evaluate its pharmacokinetic properties, a liquid chromatography method coupled to a quadrupole time of flight mass spectrometry system (LC-QTOF/MS) was developed and fully validated for LQFM05 analysis in rat plasma and tissue samples (brain, heart, liver, and kidneys). Liquid-liquid extraction, solid phase extraction and protein precipitation were assessed as clean-up procedures for biological samples and analyte enrichment. Plasma and tissue samples underwent protein precipitation as a preliminary step, using acetonitrile. Linearity was fully demonstrated for the dynamic range (10.0 to 900.0 ng/mL), with r2 values higher than 0.99 (RSDslope ≤ 2%, Fcal < Ftab, Ccal < Ctab). Biodistribution studies in rats revealed high brain tissue concentrations (12.4 µg/g), suggesting elevated drug affinity to the main therapeutic target tissue, showing a blood partition coefficient of 1.9. Kidneys also showed great exposure and tissue affinity, suggesting a potential extrahepatic clearance. Likewise, all examined tissues exhibited satisfactory LQFMF05 distribution. The mass fragmentation spectrum indicated the presence of its main metabolite, LQFM235, yielded by high hepatic hydroxylation route, an equally bioactive derivative. Lastly, the developed LC-QTOF/MS method was shown to be sensitive (LOQ = 10 ng/mL), precise and accurate for LQFM05 determination in tissue homogenates and plasma samples.

Factors Associated with Leg Ulcers in Adults with Sickle Cell Disease in Brazil.

OBJECTIVE: To define the prevalence of leg ulcers and identify the clinical and laboratory factors associated with leg ulcers in adult participants. METHODS: The authors conducted a cross-sectional study of 1,109 patients who were 18 years or older with SS or Sß0-thalassemia genotypes from a Brazilian cohort. Investigators assessed the prevalence of factors associated with leg ulcers from 2013 to 2017. RESULTS: The prevalence of leg ulcers was 21%. Increasing age (odds ratio [OR], 1.07; range, 1.06-1.09), male sex (OR, 2.03; range, 1.44-2.87), treatment with chronic transfusion therapy (OR, 1.88; range, 1.15-3.03), higher indirect bilirubin levels (OR, 1.48; range, 1.02-2.16), and low hemoglobin levels (OR, 2.17; range, 1.52-3.11) were associated with leg ulcers. Participants who self-reported as Black (OR, 6.75; range, 2.63-21.32), mixed (OR, 3.91; range, 1.55-12.20), and other/unknown (OR, 3.84; range, 1.04-15.24) were more likely to have leg ulcers compared with those who self-reported as White. CONCLUSIONS: The prevalence of leg ulcers in this Brazilian cohort was higher than the prevalence reported in developed countries. Known factors such as age and male sex were corroborated. The increased bilirubin level and decreased hemoglobin levels among participants with leg ulcers support the hypothesis that hemolysis is correlated with leg ulcer pathogenesis. Self-reported black skin color was an independent predictor of leg ulcers and warrants further study to understand the etiology and implications of this finding.

Correlation of endoscopic findings with suspected intestinal endometriosis in the distal sigmoid and rectum as observed on transrectal ultrasonography

Introduction: Colonoscopy enables detailed endoscopic evaluation of the interior of the colon. Changes observed via colonoscopy may be subtle or pronounced and can sometimes mimic those of other diseases, such as deep intestinal endometriosis. The diagnosis of endometriosis in the distal sigmoid and rectum by colonoscopy has been described in previous case reports. Objective: We aimed to correlate the endoscopic changes found in the distal sigmoid and rectum with the presence of endometrial deposits confirmed by transrectal ultrasound (TRUS). Methods: We included 50 female patients referred to the endoscopy department at our institution for colonoscopy, rectosigmoidoscopy, or TRUS, who exhibited one or more symptoms associated with endometriosis. Results: The colonoscopic findings were normal in 36 patients but showed alterations in 14 patients. Among the latter, TRUS revealed involvement of the sigmoid and/or rectal wall in 11 patients. Conclusions: The endoscopic changes in the distal sigmoid or rectum described in this study were strongly associated with endometrial deposits confirmed using TRUS. (AU)

Evaluation of the Diversity of Culicidae Vectors of the Sylvatic Yellow Fever Virus in Atlantic Forest Remnants with the Use of Ovitraps and Bamboo Traps.

Mosquitoes transmit several pathogens in tropical regions, especially in forest areas. The diseases caused by these pathogens include malaria and several arboviruses such as yellow fever. Brazil has the largest endemic area in the world for yellow fever. Many factors can affect the sylvatic cycle of the disease, shifting it into human-inhabited areas. This study aims to examine the oviposition behavior of mosquito species that are effective or potential vectors of the yellow fever virus and which colonize bamboo traps and ovitraps installed at different heights. The positions of the traps in the strata were changed every 15 days. The collection of immature stages (eggs, larvae, and pupae) was performed every 2 weeks for 12 months from August 2018 to July 2019 in the city of Nova Iguaçu, state of Rio de Janeiro, Brazil, in an area near the Tinguá Biological Reserve (REBIO) in the districts of Adrianópolis and Rio D'ouro. Statistical tests were used to compare oviposition at each stratum, and correlation tests showed the relationship between the presence of eggs and immature mosquitoes (larvae and pupae) and temperature, precipitation, and trap type. The diversity was calculated for each trap type and height, as well as the dry and rainy seasons. During the sampling period, 3929 eggs and 4953 larvae and pupae were collected. The traps installed in the high strata remained empty when traps on the ground were installed at the same time, although not when they were installed on their own. The results obtained with this new proposed methodology suggest that diversity is greatest in the rainy season and in bamboo traps for either stratum. Furthermore, this study suggests that mosquitoes begin searching for breeding sites at ground level. Higher levels may be occupied due to the absence or impermanence of other breeding sites.

HIV primary drug resistance and associated HIV risk factors among HIV positive blood donors in Brazil from 2007 to 2017.

BACKGROUND: Acquisition of HIV primary drug resistant (PDR) infection can lead to poor virologic and clinical outcomes in individuals and hampers public health efforts in epidemic control. Monitoring PDR in HIV-positive blood donors can be used to inform nationwide trends in the spread of drug-resistant HIV strains. METHODS: We conducted a cross-sectional study using genetic sequence analysis to assess HIV pol sequences, PDR, and risk factors for infection using audio computer-assisted structured interviews in four large blood centers in Brazil from 2007 to 2017. RESULTS: Of 716 HIV-positive blood donors, 504 (70.4%) were successfully sequenced. HIV clade B (73.2%) was the most prevalent subtype, followed by a mix of non-B (21.2%) sub-types. A twofold increase (from 4% to 8%) in recombinants prevalence was observed during the study period. Sixty-four (12.7%) presented PDR. Overall, HIV PDR prevalence remained stable during the study period. Drug resistance mutations for non-nucleoside reverse transcriptase inhibitors were found in 39 (7.7%) donors, while for nucleoside reverse transcriptase inhibitors were found in 26 (5.1%), and for protease inhibitors in 24 (4.8%) of HIV-infected donors. We did not find statistically significant differences in demographics, behavioural risk factors, or HIV genotypes when comparing volunteers with and without PDR. CONCLUSION: The HIV PDR rate among donors remained stable during the study period. HIV-positive blood donors can be an informative population to monitor primary HIV resistance and ultimately may help to increase the knowledge and awareness of HIV risk factors and PDR.

Decadal (2006-2018) dynamics of Southwestern Atlantic's largest turbid zone reefs.

Tropical reefs are declining rapidly due to climate changes and local stressors such as water quality deterioration and overfishing. The so-called marginal reefs sustain significant coral cover and growth but are dominated by fewer species adapted to suboptimal conditions to most coral species. However, the dynamics of marginal systems may diverge from that of the archetypical oligotrophic tropical reefs, and it is unclear whether they are more or less susceptible to anthropogenic stress. Here, we present the largest (100 fixed quadrats at five reefs) and longest time series (13 years) of benthic cover data for Southwestern Atlantic turbid zone reefs, covering sites under contrasting anthropogenic and oceanographic forcing. Specifically, we addressed how benthic cover changed among habitats and sites, and possible dominance-shift trends. We found less temporal variation in offshore pinnacles' tops than on nearshore ones and, conversely, higher temporal fluctuation on offshore pinnacles' walls than on nearshore ones. In general, the Abrolhos reefs sustained a stable coral cover and we did not record regional-level dominance shifts favoring other organisms. However, coral decline was evidenced in one reef near a dredging disposal site. Relative abundances of longer-lived reef builders showed a high level of synchrony, which indicates that their dynamics fluctuate under similar drivers. Therefore, changes on those drivers could threaten the stability of these reefs. With the intensification of thermal anomalies and land-based stressors, it is unclear whether the Abrolhos reefs will keep providing key ecosystem services. It is paramount to restrain local stressors that contributed to coral reef deterioration in the last decades, once reversal and restoration tend to become increasingly difficult as coral reefs degrade further and climate changes escalate.

Tropical rhodolith beds are a major and belittled reef fish habitat.

Understanding habitat-level variation in community structure provides an informed basis for natural resources' management. Reef fishes are a major component of tropical marine biodiversity, but their abundance and distribution are poorly assessed beyond conventional SCUBA diving depths. Based on a baited-video survey of fish assemblages in Southwestern Atlantic's most biodiverse region we show that species composition responded mainly to the two major hard-bottom megahabitats (reefs and rhodolith beds) and to the amount of light reaching the bottom. Both megahabitats encompassed typical reef fish assemblages but, unexpectedly, richness in rhodolith beds and reefs was equivalent. The dissimilar fish biomass and trophic structure in reefs and rhodolith beds indicates that these systems function based on contrasting energy pathways, such as the much lower herbivory recorded in the latter. Rhodolith beds, the dominant benthic megahabitat in the tropical Southwestern Atlantic shelf, play an underrated role as fish habitats, and it is critical that they are considered in conservation planning.

Quality of life in pre-adolescent children with sickle cell disease in Brazil.

Sickle cell disease (SCD) affects more than 13 million people and can have a significant impact on the quality of life (QoL) of those persons. We performed a cross-sectional study to evaluate the QoL in SCD children 8-12 years old enrolled from November 2014 to March 2016 in a large multicenter cohort study in Brazil. The PedsQL™ SCD Module was used to evaluate QoL in 412 children from six Brazilian health centers. The mean age of participants was 10.5 years and 193(46.7%) were women. The mean global score was 60.7, with a Cronbach´s alpha of 0.92. There were significant differences in socioeconomic demographics and treatments among participants at the six centers, but age, income, SCD genotype, and use of hydroxyurea did not significantly affect the QoL scores. After adjustment for all of these variables in a linear regression model, a significant difference was observed by site in global QoL score and the dimensions 'worry II'(ß0 = 20.7, p < .00), 'treatment´(ß0 = 66.8, p < .00) and communication II'(ß0 = 45.8, p < .00). These dimensions are affected by the capacity of health professionals to provide clinical and psychological support to patients. Our results suggest that QoL of this patient population varied according the health center even adjusted by sociodemographics characteristics. Additional training of health professionals in psychological and clinical support could directly reduce patient apprehension about the disease its clinical complications.

Clinical and genetic ancestry profile of a large multi-centre sickle cell disease cohort in Brazil.

Approximately 3500 children with sickle cell disease (SCD) are born in Brazil each year, but the burden of SCD morbidity is not fully characterised. A large, multi-centre cohort was established to characterise clinical outcomes in the Brazilian SCD population and create the infrastructure to perform genotype-phenotype association studies. Eligible patients were randomly selected from participating sites and recruited at routine visits. A biorepository of blood samples was created and comprehensive demographic and clinical outcome data were entered in a centralized electronic database. Peripheral blood genome-wide single nucleotide polymorphism (SNP) genotyping was performed using a customized Transfusion Medicine (TM) Array. A total of 2795 participants at six Brazilian sites were enrolled between 2013 and 2015. The cohort included slight predominance of children <18 years (55·9%) and females (53·0%). Haemoglobin (Hb) SS was the most common SCD genotype (70·7%), followed by HbSC (23%), Sß0 (3·0%) and Sß+ (2·9%). SNP data from the TM Array were analysed to evaluate the genetic ancestry of the cohort and revealed significant admixture among the population. Demographics and clinical complications, stratified by age and SCD genotype, are summarized and future studies in this cohort are discussed.

Factors associated with smoking initiation among school-aged adolescents. / Fatores associados à iniciação tabágica em adolescentes escolares.

OBJECTIVE: To identify factors associated with smoking initiation in adolescent secondary school students. METHOD: This is a cross-sectional study conducted in 2014 with 864 adolescents at a secondary school in southern Brazil. Data were collected using an instrument with sociodemographic questions, application of the Fagerström Nicotine Dependence Scale, and Beck Depression Inventory, and analysed using descriptive statistics, Fisher's Exact test, Chi-square test, Mann-Whitney's test, and the Poisson Regression test. RESULTS: Fifty-four of the adolescents started smoking, of which 35 continued smoking and exhibited high nicotine dependence. Smoking was associated with brown skin (p = 0.020), single-parent household (p = 0.006), a fair family relationship (p = 0.003), and drug users in the family (p = 0.04). A significantly higher prevalence ratio was detected for boys (p = 0.038), higher family income (p> 0.001), living with one family member (p> 0.001), and a fair family relationship (p> 0.001). CONCLUSIONS: We identified factors associated with smoking initiation, revealing the importance of supporting health education strategies to change this reality.

Usefulness of early colonoscopy in the diagnosis and treatment of moderate or severe lower gastrointestinal bleeding / Utilidade da colonoscopia precoce no diagnóstico e tratamento do sangramento gastrointestinal baixo moderado ou grave

ABSTRACT A total of 38,686 colonoscopies were performed between January 1985 and December 2012 at Hospital Sírio-Libanês, in São Paulo, Brazil. Two hundred thirty-four patients (0.6%) had acute lower gastrointestinal bleeding of moderate or severe intensity. A definitive diagnosis was possible in 151 cases, 64.5% of these patients.This study was approved by the Institutional Review Board. Medical charts were reviewed.All examinations were done under sedation by the same medical team.The predominant sources of bleeding were colonic diverticula (73 patients; 31%), ischemic or infectious colitis (18 patients; 7.7%) and radiation proctitis (18 patients; 7.7%).A specific therapeutic intervention was performed on 61 of the 151 patients who had the diagnosis confirmed (40.4%), according to the source of bleeding. Most patients with postpolypectomy bleeding were treated with injection of epinephrine (40%) and clipping (40%). Patients with angiodysplasia were treated predominantly with argon plasma coagulation (42%).Injection of epinephrine was the most frequent treatment, regardless of the source of bleeding (34.4%), followed by argon plasma coagulation (31.1%).Control of active hemorrhage was achieved endoscopically in 98.8% of the patients.Our data shows that early colonoscopy in the management of patients with suspected acute lower gastrointestinal bleeding is a useful tool for diagnosis and treatment.

RESUMO No total, 38.686 colonoscopias foram realizadas entre janeiro de 1985 e dezembro de 2012 no Hospital Sírio-Libanês, em São Paulo, Brasil. 234 pacientes (0,6%) sofriam de sangramento gastrointestinal baixo agudo (SGIBA) de intensidade moderada ou grave. Em 151 casos (64,5% desses pacientes) foi possível estabelecer um diagnóstico definitivo.O estudo foi aprovado pelo Comitê de Revisão Institucional. Os prontuários clínicos foram revisados.Todos os exames foram realizados com o paciente sedado e pela mesma equipe clínica.As origens predominantes de sangramento foram divertículos colônicos (73 pacientes; 31%), colite isquêmica ou infecciosa (18 pacientes; 7,7%) e proctite por radiação (18 pacientes; 7,7%).Uma intervenção terapêutica específica foi realizada em 61 dos 151 pacientes com diagnóstico confirmado (40,4%), de acordo com a origem do sangramento. Em sua maioria, os pacientes com sangramento pós-polipectomia foram tratados com injeção de adrenalina (40%) e por clipping (40%). Os pacientes com angiodisplasia foram tratados predominantemente com coagulação com plasma de argônio (42%).O tratamento mais frequentemente administrado foi a injeção de adrenalina, independentemente da origem do sangramento (34,4%), seguida pela coagulação com plasma de argônio (31,1%).O controle da hemorragia ativa foi obtido por via endoscópica em 98,8% dos pacientes. Nossos dados revelam que o uso precoce da colonoscopia no tratamento de pacientes com suspeita de SGIBA é instrumento útil para o diagnóstico e tratamento.

Fatores associados à iniciação tabágica em adolescentes escolares / Factores asociados con el inicio del tabaquismo en los adolescentes escuela / Factors associated with smoking initiation among school-aged adolescents

RESUMO Objetivo Identificar os fatores associados à iniciação tabágica em adolescentes escolares. Método Estudo transversal realizado em 2014 com 864 adolescentes do ensino médio do sul do Brasil. Os dados foram coletados por meio de instrumento com questões sociodemográficas, da aplicação da Escala de Fagerström e do Inventário de Depressão de Beck, sendo analisados por estatística descritiva, testes Exato de Fisher, Qui-quadrado, Mann-Whitney, T e Regressão de Poisson. Resultados Cinquenta e quatro adolescentes iniciaram o comportamento tabágico, desses 35 continuam fumando, com elevada dependência de nicotina. Estiveram associados ao tabagismo: cor parda (p=0,020), famílias monoparentais (p=0,006), regular relação familiar (p=0,003) e familiares usuários de drogas (p=0,04). Apresentaram razão de prevalência significativamente maior: masculino (p=0,038), maior renda familiar (p>0,001), morar com um membro da família (p>0,001), relação familiar regular (p>0,001). Conclusões Os fatores identificados como associados à iniciação tabágica, demonstram que existe a necessidade de construir apoio para estratégias de educação em saúde a fim de mudar esta realidade.

RESUMEN Objetivo Identificar los factores asociados con el inicio del tabaquismo en adolescentes estudiantes. Método Estudio transversal en 2014 con 864 adolescentes de la escuela secundaria en el Sur de Brasil. Recoge instrumento con preguntas sociodemográficas, aplicando el test de Fagerström Inventario de Depresión de Beck, analizados por estadística descriptiva, prueba exacta de Fisher, Chi-cuadrado, Mann-Whitney, T y de regresión de Poisson. Resultados Cincuenta y cuatro comenzaron el hábito de fumar, entre ellos, 35 permanecen fumando, con una alta dependencia de la nicotina. Se asociaron con el hábito de fumar personas pardas (p = 0,020), los padres solteros (p = 0,006), relación regular de la familia (p = 0,003) y los usuarios de drogas de la familia (p = 0,04). Ellos tenían significativamente más alta razón de prevalencia: masculino (p = 0,038), mayor ingreso familiar (p> 0,001), que viven con un miembro de la familia (p> 0,001), relación familiar normal (p> 0,001). Conclusiones Se identificaron como factores asociados con el inicio del tabaquismo mostrando que hay una necesidad de incrementar el apoyo a las estrategias de educación sanitaria para cambiar esta realidad.

ABSTRACT Objective To identify factors associated with smoking initiation in adolescent secondary school students. Method This is a cross-sectional study conducted in 2014 with 864 adolescents at a secondary school in southern Brazil. Data were collected using an instrument with sociodemographic questions, application of the Fagerström Nicotine Dependence Scale, and Beck Depression Inventory, and analysed using descriptive statistics, Fisher’s Exact test, Chi-square test, Mann-Whitney’s test, and the Poisson Regression test. Results Fifty-four of the adolescents started smoking, of which 35 continued smoking and exhibited high nicotine dependence. Smoking was associated with brown skin (p = 0.020), single-parent household (p = 0.006), a fair family relationship (p = 0.003), and drug users in the family (p = 0.04). A significantly higher prevalence ratio was detected for boys (p = 0.038), higher family income (p> 0.001), living with one family member (p> 0.001), and a fair family relationship (p> 0.001). Conclusions We identified factors associated with smoking initiation, revealing the importance of supporting health education strategies to change this reality.

Cultura do tabaco versus saúde dos fumicultores / La cultura del tabaco versus la salud de los fumicultores / Tobacco growing versus the health of tobacco growers

RESUMO Estudo com objetivo de identificar a associação entre a cultura de tabaco e a saúde de fumicultores. Estudo transversal, realizado em município do sul do Brasil. A coleta ocorreu em 2012 por inquérito domiciliar, por meio de entrevistas individuais e aplicação de dois instrumentos validados (Beck Depression Inventory e Escala de Fargerström). Procedeu-se análise estatística, utilizando-se regressão de Poisson para as associações. Participaram 100 fumicultores, 67,0% relataram sinais e sintomas relacionados à doença da folha verde do tabaco, 66,7% alterações na coluna, 25,0% doenças cardíacas, 25,0% respiratórias e 20,0% sintomas de depressão leve/moderada. Entre os fumantes, 64,7% declararam baixa dependência à nicotina. Houve associação estatisticamente significativa entre problemas de saúde e anos de cultura do tabaco (p=0,001). A produção do tabaco compromete a saúde dos fumicultores de diferentes formas. Existe a necessidade de medidas preventivas e educativas em saúde direcionadas aos fumicultores.

RESUMEN Estudio para identificar las asociaciones de cultivo de tabaco y la salud de los fumicultores. Estudio transversal, realizado en una ciudad en el sur de Brasil. Los datos fueron recolectados en 2012 a través de encuesta domiciliaria, entrevistas individuales y dos instrumentos validados (Inventario de Depresión de Beck y Escala de Fargerström). Después ocurrido el análisis estadístico, utilizando la regresión de Poisson para las asociaciones. Participaron 100 productores, 67,0% reportaron signos y síntomas relacionados con la hoja verde, 66,7% dolor de espalda, 25,0% la enfermedad cardíaca, 25,0% respiratoria y 20,0% síntomas de la depresión leve/moderada. Entre los fumadores, 64.7% reportaron baja dependencia a la nicotina. Se observó asociación estadísticamente significativa entre los problemas de salud y años de cultivo de tabaco (p=0,001). La producción de tabaco compromete la salud de los fumicultores de diferentes maneras, por consiguiente, hay necesidad de adoptar medidas preventivas y educativas de salud dirigidas a fumicultores.

ABSTRACT This study aimed to identify the association between tobacco growing and the health of tobacco growers. This was a cross-sectional study, performed in southern Brazil. Data collection occurred in 2012, through individual interviews at home, and administration of two validated instruments (Beck Depression Inventory and Fargerström Scale). For statistical analysis, the use of Poisson regression for associations was applied. Among the 100 tobacco growers included, 67.0% reported signs and symptoms related to green leaf sickness, 66.7% spinal problems, 25.0% heart disease, 25.0% respiratory disease, and 20.0% symptoms of mild/moderate depression. Among the smokers, 64.7% reported low dependence on nicotine. There was a statistically significant association between health problems and years of tobacco growing (p=0.001). Tobacco production compromises the health of tobacco growers in different ways; therefore, preventive and educational health measures directed at tobacco growers are necessary.

Recrutamento alveolar: em quem? como? quando? / Alveolar recruitment: who needs? how? when?

O advento da ventilação mecânica moderna trouxe inúmeros benefícios para o manejo anestésico e de pacientes críticos em unidades de cuidados intensivos. Acompanhando essa evolução vieram as complicações relacionadas ao controle ventilatório do paciente. A atelectasia é o principal evento complicador pulmonar dos pacientes submetidos à anestesia geral. As manobras de recrutamento alveolar são uma opção na tentativa de aumentar as unidades alveolares abertas, evitando, assim, a atelectasia pulmonar. Esse efeito pode ser mais ou menos duradouro, a depender da estratégia adotada para o recrutamento. O conhecimento das formas de recrutamento e suas peculiaridades, dos pacientes candidatos a essas manobras e do momento de realização das mesmas é extremamente importante, na tentativa de evitar as complicações per e pós-operatórias relacionadas ao colapso alveolar.

The advent of modern mechanical ventilation brought numerous benefits to the anesthetized and critically ill patients in intensive care management. Accompanying this evolution came the complications related to the patient?s ventilatory control. Atelectasis is the main event complicating pulmonary patients undergoing general anesthesia. The alveolar recruitment maneuvers are an option in an attempt to increase alveolar units open, thus preventing pulmonary atelectasis. This effect can be more or less permanent, depending on the strategy for recruitment. Knowledge of the methods of recruitment and its peculiarities, the eligible patients and the best time to perform these maneuvers, are extremely important in an attempt to avoid postoperative complications related to alveolar collapse.

Fatores que contribuem para a iniciação tabágica em adolescentes de quatro escolas de Porto Alegre e região metropolitana / Factors that contribute to smoking initiation among adolescents in four schools of Porto Alegre and metropolitan area

O número de jovens que inicia o comportamento tabágico é significativo, apesar do atual poder de alcance da globalização, do avanço conquistado pela área da saúde com o desenvolvimento de novos estudos sobre o tema, da ampla informação disponível sobre os malefícios causados pelo tabaco e da legislação vigente. Objetivo: A analisar os fatores que contribuem para iniciação tabágica em adolescentes de quatro escolas de Porto Alegre e região metropolitana. Método: Estudo misto composto de etapa quantitativa transversal com alunos do Ensino Médio de quatro escolas de Porto Alegre e região metropolitana por meio de instrumento com questões sociodemográficas, aplicação da Escala de Fagestrõm e o Inventário de Depressão de Beck. Uma segunda etapa, qualitativa, realizada com seleção aleatória por meio de sorteio com alunos tabagistas, os quais participaram de uma entrevista em grupo gravada em áudio. Os dados quantitativos foram digitados em banco de dados e analisados com auxílio do programa SPSS 18.0. Já os dados qualitativos foram transcritos e sofreram análise com auxílio do programa NVivo 10 por meio de técnica de Análise de Conteúdo. O projeto foi aprovado pelo Comitê de Ética da Universidade Federal do Rio Grande do Sul, sob número de CAEE 20816513.2.0000.5347. Resultados: Participaram 864 alunos na etapa quantitativa e onze na etapa qualitativa. Observou-se uma prevalência de 6,3% de adolescentes tabagistas, com nível elevado de dependência à nicotina. Diversos são os fatores associados à iniciação tabágica, entre eles destaca-se gênero masculino, cor parda, renda familiar mensal acima de nove salários mínimos, famílias monoparentais, regular relação familiar, familiares usuários de drogas lícitas e ilícitas...

Emergiram das entrevistas os temas: “Como tudo começou”, “O envolvimento da família” e “O despertar para os prejuízos do cigarro”. Esses temas abordaram a influência de pares, pais tabagistas, pouca presença dos pais e relações conflituosas, assim como os primeiros sintomas dos prejuízos do tabagismo e as percepções dos jovens acerca das propagandas anti-fumo. Considerações finais: Os resultados apontam para necessidade de se repensar uma estratégia de saúde que auxilie os adolescentes a enfrentarem seus problemas e dificuldades de forma construtiva e saudável, tornando-os capazes de se independentizar do cigarro para ocorrer uma verdadeira mudança na realidade da vida destes jovens. Conviver com os adolescentes e aprender a conhecê-los pode contribuir para instrumentalizar professores e profissionais da área da saúde que poderão, por meio do conhecimento científico, discutir com o jovem o que é saúde para o tabagista e planejar meios para promover sua saúde, reduzir os danos causados pelo uso indiscriminado do tabaco e a iniciação tabágica...

Impact of chronic kidney disease on quality of life, lung function, and functional capacity / Repercussão da doença renal crônica na qualidade de vida, função pulmonar e capacidade funcional

OBJECTIVES: To evaluate the impact of the chronic kidney disease (CKD) on quality of life, from the children's and their parents' perspective, respiratory muscle strength, lung function, and functional capacity in children and adolescents. METHOD: Cross-sectional study of children with CKD aged 8 to 17 years. Those incapable of taking the tests were excluded. After an interview, quality of life by Pediatric Quality of Life Inventory) (PedsQLTM), muscular strength, pulmonary function tests, and the 6-minute walking test (6MWT) were applied. Student's t-test, ANOVA (difference in means), and Pearson's coefficient of correlation were used. The level of significance was set at 5%. RESULTS: Of the 40 patients, the mean distance walked at the 6MWT was 396 meters, and the mean final score at the quality of life test as perceived by the children and parents was 50.9 and 51, respectively. From the children's perspective, the transplanted patients had a higher quality of life score when compared to those undergoing hemodialysis (p < 0.001); those who practiced physical activity had better quality of life when compared to the sedentary children (p < 0.001). From the children's and the parents' perspectives, the male gender had a higher quality of life score (p < 0.05). There was a positive correlation between the distance walked at the 6MWT and age, height, final PedsQLTM, forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), as well as a negative correlation between FEV1/FVC and the distance walked. CONCLUSION: A significant reduction in the quality of life and the functional capacity was observed in children with CKD, influenced by the type of treatment, gender, and sedentary life style. .

OBJETIVOS: Avaliar repercussões da doença renal crônica (DRC) sobre a qualidade de vida na percepção das crianças e dos pais, força muscular respiratória, função pulmonar e capacidade funcional em crianças e adolescentes. MÉTODO: Estudo transversal de crianças e adolescentes com DRC de oito a 17 anos. Excluídas as incapazes de realizar os testes. Após entrevista, aplicou-se questionário de qualidade de vida (PedsQLTM), testes de força muscular, função pulmonar e teste de caminhada de 6 minutos (TC6 min). Foi utilizado o teste t de Student e ANOVA (diferenças de médias) e o coeficiente de correlação de Pearson. Considerou-se nível de significância de 5%. RESULTADOS: Dentre os 40 pacientes, a média da distância percorrida no TC6 min foi de 396 ± 71 metros, e a média do escore final de qualidade de vida percebida pelas crianças e pelos pais de 50,9 e 51, respectivamente. Na percepção das crianças, os transplantados apresentaram maior escore de qualidade de vida, comparados aos em hemodiálise (p < 0,001), e aos com atividade física e melhor qualidade de vida, comparadas às sedentárias (p < 0,001). Na percepção das crianças e dos pais, o sexo masculino apresentou maior escore de qualidade de vida (p < 0,05). Houve correlação positiva entre a distância percorrida no TC6 min e as variáveis idade, altura, PedsQLTM final da criança, capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1) e negativa entre VEF1/CVF e a distância percorrida. CONCLUSÃO: Observou-se redução significativa na qualidade de vida e na capacidade funcional em crianças com DRC influenciadas pelo tipo de tratamento, sexo e sedentarismo. .