Manual de acolhimento de Transexuais e Travestis (TT) à Atenção Primária à Saúde (APS)

O “Manual de acolhimento de Travestis e Transexuais (TT) à Atenção Primária à Saúde (APS)” é resultado de uma pesquisa de mestrado profissional realizada pela Escola de Enfermagem da Universidade de São Paulo (EEUSP) com a população TT na região central de São Paulo Neste trabalho foram entrevistados 20 usuários TT e investigados os motivos pelos quais estes usavam ou deixavam de usar suas Unidades Básica de Saúde (UBS). A parit daí foram identificadas barreiras que dificultam o acesso desta população à AP e propostas estratégias de superação. As barreiras identificadas estão associadas 1) às implicações da transfobia no acesso do serviço de saúde 2) aos paradigmas heteronormativo e de gênero como equivalência de sexo na APS; 3) à pouca oferta do cartão do sus com nome social e não uso do nome social; 4) à falta de uma escuta qualificada / comunicação não responsiva; 5) à falta de educação permanente: desconhecimento dos fluxos e conceitos da rede da pessoa trans e 6) à transfobia nos serviços da APS. “O Manual” tem como objetivo apresentar informações e propostas de abordagem ao usuário TT no contexto da APS que acredita-se, facilitará e poderá aprimorar o acesso desta população à este nível de atenção. Foi produzido com intenção de contemplar dúvidas de profissionais de saúde que já recebem e, receberão, cada vez mais, essa população. Os fluxos e protocolos aqui descritos são referentes a data de publicação deste material e, diante das constantes mudanças políticas e legislativas que a luta por direitos civis vem passando, faz-se necessária constantes revisões das informações aqui contidas.

Primary Soft-Tissue Lymphomas: MRI Features Help Discriminate From Other Soft-Tissue Tumors.

OBJECTIVES: MRI presentation of extra-nodal soft-tissue lymphomas (STLs) is scarcely reported and lacks of comparison with other soft-tissue tumors (STTs) including sarcomas (STS). Yet, suggesting this diagnosis on MRI would considerably reduce diagnostic intervals. Our aim was to investigate if conventional MRI could discriminate STLs from other STTs. METHODS: MRIs of STL patients were compared with those of patients addressed to a sarcoma reference center for the diagnosis of a STT. MRI characteristics depicting the tumor (size, signal, habitats, shape, surrounding tissues) were reported. Uni- and multivariate associations with STL diagnosis were evaluated in the entire cohort, and in the subgroups of benign and malignant STTs patients. Diagnostic performances of MRI features combinations were tested. RESULTS: We included 39 patients with STLs (median age: 69 years) and 368 patients with other STTs (122 benign STTs and 246 STS; median age: 58 years). Six MRI features were independent predictors of STL compared to all other STTs: intermediate SI on T1-WI, homogeneous enhancement (without necrotic areas), no blood signal, no fibrotic signal, no peritumoral enhancement and lack of abnormal intra- and peritumoral vasculature (p-value range: <0.0001-0.0163). Their simultaneous presence had a sensitivity of 0.88 (0.71-0.96) and a specificity of 0.88 (0.84-0.91). Other relevant MRI features were: no fat signal to discriminate against STS (p = 0.0409), the infiltrative growth pattern and the vessel and nerve encasement to discriminate against benign STTs (p = 0.0016 and 0.0011, respectively). CONCLUSION: Our research demonstrates that conventional MRI can help discriminating STLs from other STTs. Indeed, radiologists can help suggesting the possible diagnosis of STL, which could speed-up the subsequent proper histopathological analysis in light of MRI findings.

Maternal distress, DNA methylation, and fetal programing of stress physiology in Brazilian mother-infant pairs.

Maternal prenatal psychosocial stress is associated with adverse hypothalamic-pituitary-adrenal axis (HPAA) function among infants. Although the biological mechanisms influencing this process remain unknown, altered DNA methylation is considered to be one potential mechanism. We investigated associations between maternal prenatal psychological distress, infant salivary DNA methylation, and stress physiology at 12 months. Mother's distress was measured via depression and anxiety in early and late pregnancy in a cohort of 80 pregnant adolescents. Maternal hair cortisol was collected during pregnancy. Saliva samples were collected from infants at 12 months to quantify DNA methylation of three stress-related genes (FKBP5, NR3C1, OXTR) (n = 62) and diurnal cortisol (n = 29). Multivariable linear regression was used to test for associations between prenatal psychological distress, and infant DNA methylation and cortisol. Hair cortisol concentrations in late pregnancy were negatively associated with two sites of FKBP5 (site 1: B = -22.33, p = .003; site 2: B = -15.60, p = .012). Infants of mothers with elevated anxiety symptoms in late pregnancy had lower levels of OXTR2 CpG2 methylation (B = -2.17, p = .03) and higher evening salivary cortisol (B = 0.41, p = .03). Furthermore, OXTR2 methylation was inversely associated with evening cortisol (B = -0.14, p-value ≤ .001). Our results are, to our knowledge, the first evidence that the methylation of the oxytocin receptor may contribute to the regulation of HPAA during infancy.

Inattention symptoms in early pregnancy predict parenting skills and infant maltreatment during the first year of life

Objective: Maternal attention-deficit/hyperactivity disorder has not been investigated in relation to parenting skills in adolescent mothers. This study investigated whether maternal inattention and hyperactivity/impulsivity symptoms early in pregnancy predict poorer parenting skills and infant maltreatment during the first year of life in adolescent mothers living in adverse environmental conditions. Methods: The participants in this study were 80 adolescent mothers aged 14-19 years and their babies who were taking part in a randomized controlled trial on the effects of a home-visiting program on infant development. Symptoms of maternal attention-deficit/hyperactivity disorder were assessed in the first trimester of pregnancy. Parenting skills (maternal competence, attachment to the baby, home environment) and child maltreatment were assessed when the infants were aged 6 and 12 months. Multilevel linear regression models were constructed to test the extent to which prenatal maternal inattention and hyperactivity/impulsivity symptoms predicted these parenting variables during the first year of the infant's life. Results: Prenatal inattention symptoms significantly predicted lower maternal competence and attachment, a poorer home environment, and greater maltreatment during the first year of life. Hyperactivity did not significantly predict parenting skills or maltreatment. Conclusions: Our findings suggest that inattention symptoms may interfere with parenting abilities in adolescent mothers and should be considered in early intervention programs.

Inattention symptoms in early pregnancy predict parenting skills and infant maltreatment during the first year of life.

OBJECTIVE: Maternal attention-deficit/hyperactivity disorder has not been investigated in relation to parenting skills in adolescent mothers. This study investigated whether maternal inattention and hyperactivity/impulsivity symptoms early in pregnancy predict poorer parenting skills and infant maltreatment during the first year of life in adolescent mothers living in adverse environmental conditions. METHODS: The participants in this study were 80 adolescent mothers aged 14-19 years and their babies who were taking part in a randomized controlled trial on the effects of a home-visiting program on infant development. Symptoms of maternal attention-deficit/hyperactivity disorder were assessed in the first trimester of pregnancy. Parenting skills (maternal competence, attachment to the baby, home environment) and child maltreatment were assessed when the infants were aged 6 and 12 months. Multilevel linear regression models were constructed to test the extent to which prenatal maternal inattention and hyperactivity/impulsivity symptoms predicted these parenting variables during the first year of the infant's life. RESULTS: Prenatal inattention symptoms significantly predicted lower maternal competence and attachment, a poorer home environment, and greater maltreatment during the first year of life. Hyperactivity did not significantly predict parenting skills or maltreatment. CONCLUSIONS: Our findings suggest that inattention symptoms may interfere with parenting abilities in adolescent mothers and should be considered in early intervention programs.

Pyogenic and Non-pyogenic Spinal Infections: Diagnosis and Treatment.

Spinal Infection (SI) is an infection of vertebral bodies, intervening disc, and/or adjoining para-spinal tissue. It represents less than 10% of all skeletal infections. There are numerous factors that predispose to developing a SI. Due to the low specificity of signs, delayed diagnosis is common. Hence, SI may be associated with poor outcomes. Diagnosis of SI must be supported by clinicopathological and radiological findings. MRI is a reliable modality of choice. Treatment options vary according to the site of the infection, disease progression, neurology, presence of instability, and general condition of the subject. Conservative treatment (orthosis/ bed-rest + antibiotics) is recommended during the early course with no/ lesser degree of neurological involvement and to medically unfit patients. Nevertheless, when conservative measures alone fail, surgical interventions must be considered. The use of concomitant antimicrobial drugs intravenously during initial duration followed by oral administration is a necessity. Controversies exist regarding the optimal duration of antimicrobial therapy, yet never given less than six weeks. Heterogeneity in clinical picture and associated co-morbidities with a range of treatment modalities are available; however, a common applicable guideline for SI does not exist. Managing SI must be tailored on a case-to-case basis.

Apoio social e resiliência: um olhar sobre a maternidade na adolescência / Apoyo social y resiliencia: una mirada sobre la maternidad en la adolescencia / Social support and resilience: a look at adolescent motherhood

Resumo Objetivo Verificar a influência do apoio social no processo de resiliência de mães adolescentes. Métodos Estudo exploratório, descritivo, transversal, de abordagem quantitativa. Foram sujeitos da pesquisa 48 adolescentes atendidas em Unidades Básicas de Saúde, no estado de São Paulo, em 2016. Os dados foram coletados dos seguintes instrumentos: a) questionário sociodemográfico; b) Escala de Resiliência desenvolvida por Wagnild e Young (1993), adaptada por Pesce et al. (2005); c) Escala de Apoio Social utilizada no Medical Outcomes Study , adaptada por Griep et al. (2005). Resultados Os resultados mostraram alta pontuação nas Escalas de Resiliência e de Apoio Social das adolescentes. Destas 70,83% apresentaram atraso escolar significativo e 75% não trabalhavam. Foram encontradas associações significativas entre os fatores da Escala de Resiliência e as dimensões da Escala de Apoio Social. Foi identificada uma correlação inversa entre o fator "Independência e determinação", da Escala de Resiliência e a dimensão "Afetiva" da Escala de Apoio Social. Portanto, quanto maior o "apoio afetivo" percebido pelas mães adolescentes, menor a "independência e determinação" apresentada por elas. Conclusão O estudo aprofunda os conhecimentos sobre a influência do apoio social no processo de resiliência de mães adolescentes. Evidenciaram-se questões de gênero e a importância de políticas intersetoriais com foco em mães e pais adolescentes que fortaleçam o apoio social.

Resumen Objetivo Verificar la influencia del apoyo social en el proceso de resiliencia de madres adolescentes. Métodos Estudio exploratorio, descriptivo, transversal, de enfoque cuantitativo. Los sujetos de la investigación fueron 48 adolescentes atendidas en Unidades Básicas de Salud, en el estado de São Paulo, en 2016. Los datos fueron recopilados a través de los siguientes instrumentos: a) cuestionario sociodemográfico; b) Escala de Resiliencia, elaborada por Wagnild y Young (1993), adaptada por Pesce et al. (2005); c) Escala de Apoyo Social utilizada en el Medical Outcomes Study, adaptada por Griep et al. (2005). Resultados Los resultados reflejaron una puntuación elevada en la Escala de Resiliencia y de Apoyo Social de las adolescentes. De ellas, el 70,83 % presentó retraso escolar significativo y el 75 % no trabajaba. Se descubrieron relaciones significativas entre los factores de la Escala de Resiliencia y las dimensiones de la Escala de Apoyo Social. Se identificó una correlación inversa entre el factor "independencia y determinación" de la Escala de Resiliencia y la dimensión "afectiva" de la Escala de Apoyo Social. Por lo tanto, cuanto mayor era el "apoyo afectivo" percibido por las madres adolescentes, menor "independencia y determinación" presentaron. Conclusión El estudio profundiza los conocimientos sobre la influencia del apoyo social en el proceso de resiliencia de madres adolescentes. Se evidenciaron cuestiones de género y la importancia de políticas intersectoriales con foco en madres y padres adolescentes que fortalezcan el apoyo social.

Abstract Objective To verify the influence of social support on the resilience process of adolescent mothers. Methods Exploratory, descriptive, cross-sectional study with a quantitative approach. There were 48 adolescents research subjects, who attended Primary Care Centres, in the state of São Paulo, in 2016. Data were collected from the following instruments: a) sociodemographic questionnaire; b) Resilience Scale developed by Wagnild and Young (1993), adapted by Pesce et al. (2005); c) Social Support Scale used in the Medical Outcomes Study, adapted by Griep et al. (2005). Results The results showed high scores on the Resilience and Social Support Scales of the adolescents. Of these, 70.83% had significant school delays and 75% did not work. Significant associations were found between the factors of the Resilience Scale and the dimensions of the Social Support Scale. An inverse correlation was identified between the "Independence and determination" factor of the Resilience Scale and the "Affective" dimension of the Social Support Scale. Therefore, the greater the "affective support" perceived by teenage mothers, the less "independence and determination" they present. Conclusion The study deepens the knowledge about the influence of social support on the resilience process of teenage mothers. Gender issues and the importance of intersectoral policies focused on teenage mothers and fathers that strengthen social support were highlighted.

Craniofacial Osteomas: From Diagnosis to Therapy.

An osteoma is a benign bone lesion with no clear pathogenesis, almost exclusive to the craniofacial area. Osteomas show very slow continuous growth, even in adulthood, unlike other bony lesions. Since these lesions are frequently asymptomatic, the diagnosis is usually made by plain radiography or by a computed tomography (CT) scan performed for other reasons. Rarely, the extensive growth could determine aesthetic or functional problems that vary according to different locations. Radiographically, osteomas appear as radiopaque lesions similar to bone cortex, and may determine bone expansion. Cone beam CT is the optimal imaging modality for assessing the relationship between osteomas and adjacent structures, and for surgical planning. The differential diagnosis includes several inflammatory and tumoral pathologies, but the typical craniofacial location may aid in the diagnosis. Due to the benign nature of osteomas, surgical treatment is limited to symptomatic lesions. Radical surgical resection is the gold standard therapy; it is based on a minimally invasive surgical approach with the aim of achieving an optimal cosmetic result. Reconstructive surgery for an osteoma is quite infrequent and reserved for patients with large central osteomas, such as big mandibular or maxillary lesions. In this regard, computer-assisted surgery guarantees better outcomes, providing the possibility of preoperative simulation of demolitive and reconstructive surgery.

A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents.

To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40). Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child's age of 24 months. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child's age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen's d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Laços potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818).

Radiologic Assessment of Osteosarcoma Lung Metastases: State of the Art and Recent Advances.

The lung is the most frequent site of osteosarcoma (OS) metastases, which are a critical point in defining a patient's prognosis. Chest computed tomography (CT) represents the gold standard for the detection of lung metastases even if its sensitivity widely ranges in the literature since lung localizations are often atypical. ESMO guidelines represent one of the major references for the follow-up program of OS patients. The development of new reconstruction techniques, such as the iterative method and the deep learning-based image reconstruction (DLIR), has led to a significant reduction of the radiation dose with the low-dose CT. The improvement of these techniques has great importance considering the young-onset of the disease and the strict chest surveillance during follow-up programs. The use of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is still controversial, while volume doubling time (VDT) and computer-aided diagnosis (CAD) systems are recent diagnostic tools that could support radiologists for lung nodules evaluation. Their use, well-established for other malignancies, needs to be further evaluated, focusing on OS patients.

The implementation of a home visits program focused on parenting: an experience report. / A implementação de um programa de visitas domiciliárias com foco na parentalidade: um relato de experiência.

OBJECTIVE: To report the experience of implementing Home Visits as part of the Young Mothers Caregiver Program. METHOD: The program focuses on the mother-child relationship as an object of care for developing parenting using the attachment theory, the self-efficacy theory and the bioecological theory as references. The construction of this program was centered on materials of international visitation programs, based on the translation of the material, elaboration and validation of the theoretical content. RESULTS: The home visits performed by the nurses lasted an average of 1 hour, where issues related to health care, environmental health, life project, parenting, family and social network, in addition to the adolescents' demands were discussed. It was shown that nurses encountered difficulties in implementing the program. CONCLUSION: By adopting Home Visits as a care tool with a focus on parenting, the experience of implementing the program proved to be an innovative technology, with great potential and relevance for promoting adolescent care and child development.

Manual "Toda Hora é Hora de Cuidar" e e-book conceitual: promoção da saúde revisitada / Handbook "Toda Hora é Hora de Cuidar" and conceptual e-book: revisiting health promotion

Este estudo teve como objetivo analisar as dimensões de saúde e bem-estar contidas em materiais educativos impressos que enfatizam a promoção da saúde na primeira infância. Pesquisa qualitativa sobre a avaliação crítica de manual e e-book conceitual relacionado à promoção da saúde na primeira infância baseada no referencial de saúde e bem-estar de Ronald Labonte. Evidenciou-se por meio da frequência temática a ênfase da dimensão biológica nos documentos analisados, porém com a incorporação transversal das dimensões afetivas e sociais associadas a abordagens críticas para o cuidado de crianças, sem desconsiderar suas famílias e suas comunidades. O diagrama de Labonte permitiu avaliar de modo dialético os conteúdos de promoção da saúde em materiais instrucionais elaborados para a educação de profissionais que promovem a saúde e o bem-estar infantil.

Current paper analyzes health and well-being in educational printed materials which underscore health promotion in childhood. A qualitative research on the critical evaluation of the handbook and conceptual e-book related to health promotion in childhood based on Ronald Labonte´s health and well-being references. Through thematic frequency, results reveal emphasis on the biological dimension in the documents analyzed, with the transversal incorporation of affective and social dimensions, associated with critical stances for child care, without disregarding their families and communities. Labonte diagram evaluated dialectically the contents of health promotion in instructional material prepared for the education of professional who enhance health and well-being.

Validação de conteúdo do programa de visita domiciliar para a díade mãe-criança / Validación de contenido del programa de visita domiciliaria para la dupla madre-hijo / Content validation of a home visit program for mothers and children

RESUMO Objetivo: validar um programa de cuidado longitudinal para assistir adolescentes na sua primeira gravidez. Método: estudo metodológico de validação de aparência e de conteúdo. Os dados foram coletados pela técnica Delphi, por meio do envio das diretrizes do Programa Jovens Mães Cuidadoras via e-mail. Na análise dos dados, foi utilizado o índice de validade de conteúdo com valor estabelecido de 0,75. Resultados: a amostra foi composta de 11 profissionais, entre os quais sete eram experts de diversas áreas da saúde e quatro eram profissionais exclusivos da área de Enfermagem. No grupo 1, o índice de validade de conteúdo ocorreu dentro do esperado, mas o grupo 2 indicou que os valores descritivos da amostra no que diz respeito ao conteúdo de quatro itens obtiveram índice e concordância abaixo do número previamente estabelecido (75%). Conclusão: O programa de visita foi validado nos aspectos de conteúdo e de aparência. As sugestões feitas pelos juízes foram incorporadas em uma nova redação do Programa e estão disponibilizadas neste relatório.

RESUMEN Objetivo: Validar un programa de cuidado longitudinal para atención de adolescentes en su primer embarazo. Método: Estudio metodológico de validación de apariencia y contenido. Datos recolectados mediante técnica Delphi, habiéndose enviado las directrices del Programa Jóvenes Madres Cuidadoras vía e-mail. Análisis de datos realizado utilizando índice de validez de contenido, estableciéndose valor de 0,75. Resultados: Muestra compuesta por 11 profesionales; siete de ellos expertos en diversas áreas de la salud, y cuatro profesionales exclusivamente del área de Enfermería. En el grupo 1, el índice de validez de contenido entregó valores esperables. El grupo 2 indicó que los valores descriptivos de la muestra respecto del contenido de cuatro ítems obtuvieron índice y concordancia inferior al valor establecido del 75%. Conclusión: El programa de visitas fue validado en cuanto a contenido y apariencia. Las sugerencias realizadas por los evaluadores fueron incorporadas en una nueva versión del Programa, estando disponibles en este informe.

ABSTRACT Objective: To validate a longitudinal care program to assist adolescents in their first pregnancy. Methods: Methodological study for face and content validation of a home visit program. Data were collected using the Delphi technique, by sending the guidelines of Programa Jovens Mães Cuidadoras by e-mail. In data analysis, a content validity index with an established value of 0.75 was used. Results: The sample was 11 professionals, among whom seven were experts in several health areas and four were exclusive nursing professionals. In group 1, the obtained content validity index was compatible with the expected value, but group 2 indicated that the values descriptive of the sample regarding the content of four items resulted in an index and agreement level lower than the established number, that is, 0.75. Conclusion: The home visit program was validated as for its face and content aspects. The suggestions given by the referees were incorporated into a new version of the program and are available in the present paper.

Contribuições do pré-natal para o autocuidado de mulheres assistidas por equipes de saúde da família / Contribuciones del prenatal para el autocuidado de mujeres acompañadas por equipos de salud de la familia / Contributes of pre-natal to self-care of women assisted by family health teams

RESUMO A gravidez é uma fase que traz modificações físicas, psicológicas e sociais para a mulher e sua família Compreender o processo do autocuidado e como promovê-lo, repercutirá na saúde da mulher e nos cuidados à criança. Assim, objetivou-se analisar a contribuição do projeto "Nossas Crianças: Janelas de Oportunidades" no autocuidado da mulher assistida por equipes de saúde da família durante o pré-natal. Trata-se de estudo exploratório, descritivo, com abordagem quanti-qualitativa, realizado com 65 gestantes do município de São Paulo. Realizou-se entrevistas semiestruturadas, de dezembro de 2015 a fevereiro de 2016. As entrevistas foram digitadas em banco de dados e analisadas conforme o material do projeto, sendo agrupadas nas categorias: apoio no pré-natal e parto; família e rede social; e ambiente intrauterino adequado. As gestantes evitaram a automedicação, o consumo de álcool e reduziram o consumo do tabaco, porém tiveram pouca orientação quanto aos sinais de risco da gravidez e não foram estimuladas a envolverem um acompanhante nas consultas de pré-natal. Conclui-se que, os conceitos de cuidado do projeto estão presentes nas orientações oferecidas pelas equipes de saúde e vêm sendo incorporados pelas gestantes como atividades de autocuidado, contudo algumas ações não foram amplamente implementadas.

RESUMEN El embarazo es una fase que trae modificaciones físicas, psicológicas y sociales para la mujer y su familia. Comprender el proceso del autocuidado y cómo promoverlo afectará en la salud de la mujer y en los cuidados al niño. Así, el objetivo de este estudio fue analizar la contribución del proyecto "Nuestros Niños: Ventanas de Oportunidades" en el autocuidado de la mujer acompañada por equipos de salud de la familia durante el prenatal. Se trata de un estudio exploratorio, descriptivo, con abordaje cuanti-cualitativo, realizado con 65 gestantes del municipio de São Paulo-Brasil. Se realizaron entrevistas semiestructuradas, de diciembre de 2015 a febrero de 2016. Las entrevistas fueron digitadas en banco de datos; analizadas conforme el material del proyecto y agrupadas en las categorías: apoyo en el prenatal y parto; familia y red social; y ambiente intrauterino adecuado. Las gestantes evitaron la automedicación, el consumo de alcohol y redujeron el consumo del tabaco, pero tuvieron poca orientación en cuanto a las señales de riesgo del embarazo y no fueron estimuladas a involucrar a un compañero en las consultas de prenatal. Se concluye que los conceptos de cuidado del proyecto están presentes en las orientaciones ofrecidas por los equipos de salud y han sido incorporados por las gestantes como actividades de autocuidado, no obstante algunas acciones no fueron ampliamente implementadas.

ABSTRACT Pregnancy is a phase that brings the physical, psychological and social changes to the woman and her family. To understand the process of self-care and how to promote it, will affect the health of women and child care. The purpose of this study was to analyze the contribution of the project "Our Children: Windows of Opportunities" for the care of women assisted by family health teams during prenatal care. This is an exploratory, descriptive, quantitative-qualitative study conducted with 65 pregnant women from the city of São Paulo. The interviews were semi-structured, from December 2015 to February 2016. The interviews were typed in a database and analyzed according to project material, being grouped into categories: prenatal support and childbirth; family and social network; and adequate intrauterine environment. Pregnant women avoided self-medication and reduced alcohol and tobacco consumption, however, they received little guidelines for risk during pregnancy and were not encouraged to involve a companion in the consultation. It was concluded that the concepts of care are present in the guidelines given by the health teams are incorporated by the pregnant women, such as the management as self-care activities, but have not been implemented.

Práticas Ampliadas de Puericultura na Política São Paulo pela Primeiríssima Infância / Expanded Childcare Practices in São Paulo Early Childhood Policy

A formação em Puericultura: Práticas Ampliadas foi realizada no contexto do Programa São Paulo pela Primeiríssima Infância, em 41 municípios até 2017, junto a profissionais e representantes da sociedade civil que atendem crianças e suas famílias. Os conteúdos, as estratégias pedagógicas e as avaliações durante o processo visam a sensibilizar os participantes e mobilizá-los para atuar na promoção amoroso e responsivo, valorizando o patrimônio familiar e considerando a importância da intersetorialidade e da rede social de apoio à família. Profissionais dos setores da educação, da assistência social e da saúde avaliaram positivamente a Formação, com mudanças pessoais e atitudinais, além das institucionais. Destacam-se a Caderneta de Saúde da Criança, a Ficha de Acompanhamento dos cuidados para promoção do desenvolvimento infantil e a Proteção física e emocional da criança diante da realização de procedimentos como elementos para maior articulação intersetorial. Para cada setor, buscou-se avançar em ações de caráter universal e também focal. Identificaram-se ainda desafios para a incorporação permanente dos componentes da Formação, como superação dos atendimentos prescritivos, o reconhecimento da importância da Rede Social e da articulação intersetorial, a valorização da parentalidade e da fase da vida da criança e da divulgação desses princípios para o público em geral.

A implementação de um programa de visitas domiciliárias com foco na parentalidade: um relato de experiência / La implantación de un programa de visitas domiciliarias con enfoque en la parentalidad: un relato de experiencia / The implementation of a home visits program focused on parenting: an experience report

RESUMO Objetivo Relatar a experiência de implementação do Programa de visita domiciliar Jovens Mães Cuidadoras. Método O programa enfoca a relação mãe-criança como objeto do cuidado com vistas ao desenvolvimento da parentalidade e adota a teoria do apego, a teoria da autoeficácia e a teoria bioecológica como referenciais. A construção desse programa ocorreu a partir de materiais de programas de visitação internacionais, por meio da tradução do material, elaboração e validação do conteúdo teórico. Resultados As visitas realizadas pelas enfermeiras tiveram duração média de 1 hora, nas quais foram abordados junto às adolescentes assuntos referentes aos cuidados com saúde, saúde ambiental, projeto de vida, parentalidade, família e rede social, além das demandas das adolescentes. Evidenciou-se que as enfermeiras encontraram dificuldades na implementação do programa. Conclusão Ao adotar a visita domiciliar como ferramenta de cuidado com foco na parentalidade, a experiência de implementação do programa demonstrou ser uma tecnologia inovadora, com grande potencial e relevância para a promoção do cuidado à adolescente e ao desenvolvimento infantil.

RESUMEN Objetivo Relatar la experiencia de implantación del Programa de visita domiciliaria Jóvenes Madres Cuidadoras. Método El programa enfoca la relación madre-niño como objeto del cuidado con vistas al desarrollo de la parentalidad y adopta la teoría del apego, la teoría de la autoeficacia y la teoría bioecológica como marcos de referencia. La construcción de ese programa ocurrió a partir de materiales de programas de visitación internacionales, mediante la traducción del material, la elaboración y la validación del contenido teórico. Resultados Las visitas realizadas por las enfermeras tuvieron duración media de una hora, en las que fueron abordados con las adolescentes temas referentes a los cuidados con la salud, salud ambiental, proyecto de vida, parentalidad, familia y red social, además de las demandas de las adolescentes. Se evidenció que las enfermeras encontraron dificultades en la implantación del programa. Conclusión Al adoptar la visita domiciliaria como herramienta de cuidado con foco en la parentalidad, la experiencia de implantación del programa demostró ser una tecnología innovadora, con gran potencial y relevancia para la promoción del cuidado a la adolescente y al desarrollo infantil.

ABSTRACT Objective To report the experience of implementing Home Visits as part of the Young Mothers Caregiver Program. Method The program focuses on the mother-child relationship as an object of care for developing parenting using the attachment theory, the self-efficacy theory and the bioecological theory as references. The construction of this program was centered on materials of international visitation programs, based on the translation of the material, elaboration and validation of the theoretical content. Results The home visits performed by the nurses lasted an average of 1 hour, where issues related to health care, environmental health, life project, parenting, family and social network, in addition to the adolescents' demands were discussed. It was shown that nurses encountered difficulties in implementing the program. Conclusion By adopting Home Visits as a care tool with a focus on parenting, the experience of implementing the program proved to be an innovative technology, with great potential and relevance for promoting adolescent care and child development.

Integrated Use of Lung Ultrasound and Chest X-Ray in the Detection of Interstitial Lung Disease.

BACKGROUND: Current data have shown that lung ultrasound (LUS) may be useful in the detection of interstitial lung disease (ILD) by the evaluation of B-lines, the sonographic marker of pulmonary interstitial syndrome. Nevertheless, no prospective study has compared LUS to chest X-ray (CXR) for ILD assessment, and there is no general agreement on the specific echographic diagnostic criteria for defining ILD. OBJECTIVES: The aims of this study were (1) to compare the accuracy of LUS and CXR in the detection of ILD using high-resolution CT (HRCT) as the gold standard and (2) to compare the accuracy of different echographic diagnostic criteria for ILD diagnosis. METHODS: LUS was performed on 104 patients undergoing HRCT for suspected ILD. In 49 patients, a CXR scan performed within 3 months of HRCT was analyzed. ILD was defined as the presence of ≥5 B-lines in ≥3 chest areas. A total B-line score (TBLS) was also calculated, as in previous studies. The observers evaluating LUS and CXR were blinded to the HRCT results and clinical data. RESULTS: On HRCT, ILD was assessed in 50 patients. CXR was specific (91%; 95% CI 80-100) but not sensitive (48%; 95% CI 28-67). Conversely, LUS showed high sensitivity (92%; 95% CI 84-99) and low specificity (79%; 95% CI 69-90). Using a TBLS, sensitivity did not change, while specificity decreased. CONCLUSIONS: LUS could be a sensitive tool for ILD detection. CXR and LUS have different but complementary features, and their combined use could reduce the need for HRCT. The use of different diagnostic criteria for defining ILD does not affect sensitivity but influences specificity.

Incidental finding of bronchial diverticula in a non-smoker population: evaluation on thin-section CT.

Bronchial diverticula have been described as a common radiological finding in smoker patients with COPD, but the specificity of this sign should be further investigated. Thus, the aim of our study was to evaluate the prevalence of diverticula in a cohort of non-smoker subjects. Between February and July 2012, 2438 patients were admitted to our Radiology Unit to undergo a chest CT. Among them, we enrolled 121 non-smoking patients (78/121-64.5% females, 43/121-35.5% males), of different age (57.0±20.7 years-range: 12-88), without any respiratory symptoms, submitted to chest CT for several reasons (oncologic evaluation: 59/121-48.8%; follow up of lung nodules: 27/121-22.3%; screening in connectivitis: 12/121-9.9%; others: 23/121-19.0%). We considered thin-section CT scan on axial, coronal and sagittal plans to evaluate prevalence, numbers and level of bronchial diverticula. Diverticula were found in 41/121-33.9% patients, with a slight major prevalence in males (p=0.048), but no significant difference on age. In 31/41-75.6% the number was <3, whereof 17/31-54.8% with just one diverticulum assessed. Regarding the level, in 30/41-73.2% they were subcarinal, but they were also detected in mainstem (2/41-4.9%) and lobar bronchi (with the right upper lobe bronchus most frequently involved- 12/41-29.3%). Bronchial diverticula can be observed in non-smokers, as well as in smoker patients with COPD. However, their prevalence seems to be lower than in smokers and they tend to be isolated and subcarinal. The age of patients does not influence their finding. More studies should be proposed to better define a cut-off between smokers and healthy subjects.

Implications and issues related to familial pancreatic cancer: a cohort study of hospitalized patients.

BACKGROUND: The surveillance of subjects at risk of pancreatic cancer is restricted to clinical research; the incidence of familial pancreatic cancer needs to be better established. Thus, we aimed to evaluate the frequency of familial pancreatic cancer in a population of hospitalized patients with pancreatic cancer. METHODS: A retrospective study based on the hospital charts of patients discharged with a diagnosis of pancreatic cancer. One hundred and eighty-seven patients or their relatives were called for a phone interview. RESULTS: There were 97 males (51.9 %) and 90 (48.1 %) females. The overall mean ± SD age was 67.3 ± 11.8 years; the age of males was similar to that of females (P = 0140). The mean size of the tumors found was 36.3 ± 17.4 mm (range of 5-110 mm); it was related to gender but was not related to the site of the tumor or the age of the patient. Regarding genetic diseases, three females (1.6 %) had familial adenomatous polyposis; three patients (1 male and two females) (1.6 %) had at least one relative with pancreatic cancer whereas only one 80-year old male patient (0.5 %) had two relatives affected by pancreatic cancer (the mother had died at the 65 years of age and the brother had died at 75 years of age). CONCLUSIONS: The frequency of familial pancreatic ductal adenocarcinoma is small, but its importance, from the point of view of early diagnosis, is not negligible and patients with a risk of familial cancer merit an appropriate clinical follow-up.