Inequalities in health care and access to health services among adults with self-reported arterial hypertension: Brazilian National Health Survey.

This study compared indicators of care and access to health services by adults who self-reported hypertension in 2013 and 2019, analyzing those indicators according to gender, age group, schooling level, and race/color. This is an analytic study with data from the Brazilian National Health Survey (PNS), conducted in 2013 and 2019 in Brazil. The indicators to care and access to health services by individuals with arterial hypertension in both surveys were compared. For 2019, those indicators were analyzed according to sociodemographic characteristics. This study estimated the proportions, prevalence ratio (PR), and their respective 95% confidence intervals (95%CI). In total, 60,202 individuals were evaluated in 2013 and 88,531 in 2019, of these 24.4% reported arterial hypertension in 2013 and 23.9% in 2019. Women received more medical care for hypertension within the last year (PR = 1.07; 95%CI: 1.04; 1.11), had the last physician appointment at an basic health unit (PR = 1.11; 95%CI: 1.05; 1.17) than men. About race/color, black people had more hospitalization for hypertension or some complication (PR = 1.2; 95%CI: 1.05; 1.38) and intense or very intense degree of limitation in performing daily activities (PR = 1.37; 95%CI: 1.06; 1.76). In 2019, inequalities were evidenced and worse indicators were observed for males, black, with low education and young age. Therefore, investments in the Brazilian Unified National Health System, as well as public policies and strategic actions are essential to reduce inequalities, promote health care.

Inequalities in health care and access to health services among adults with self-reported arterial hypertension: Brazilian National Health Survey / Desigualdades na assistência à saúde e no acesso aos serviços de saúde em adultos brasileiros com autorrelato de hipertensão arterial: Pesquisa Nacional de Saúde / Inequidades en la atención de salud y acceso a servicios de salud entre adultos con hipertensión arterial autoinformada: Encuesta Nacional de Salud

This study compared indicators of care and access to health services by adults who self-reported hypertension in 2013 and 2019, analyzing those indicators according to gender, age group, schooling level, and race/color. This is an analytic study with data from the Brazilian National Health Survey (PNS), conducted in 2013 and 2019 in Brazil. The indicators to care and access to health services by individuals with arterial hypertension in both surveys were compared. For 2019, those indicators were analyzed according to sociodemographic characteristics. This study estimated the proportions, prevalence ratio (PR), and their respective 95% confidence intervals (95%CI). In total, 60,202 individuals were evaluated in 2013 and 88,531 in 2019, of these 24.4% reported arterial hypertension in 2013 and 23.9% in 2019. Women received more medical care for hypertension within the last year (PR = 1.07; 95%CI: 1.04; 1.11), had the last physician appointment at an basic health unit (PR = 1.11; 95%CI: 1.05; 1.17) than men. About race/color, black people had more hospitalization for hypertension or some complication (PR = 1.2; 95%CI: 1.05; 1.38) and intense or very intense degree of limitation in performing daily activities (PR = 1.37; 95%CI: 1.06; 1.76). In 2019, inequalities were evidenced and worse indicators were observed for males, black, with low education and young age. Therefore, investments in the Brazilian Unified National Health System, as well as public policies and strategic actions are essential to reduce inequalities, promote health care.

Este estudo comparou indicadores de cuidados e acesso aos serviços de saúde por adultos que se autodeclararam hipertensos em 2013 e 2019, analisando esses indicadores de acordo com o sexo, grupo etário, nível de escolaridade, e rala/cor. Estudo analítico com dados da Pesquisa Nacional de Saúde (PNS), realizado em 2013 e 2019 no Brasil. Os indicadores de cuidados e acesso aos serviços de saúde por indivíduos com hipertensão arterial em ambos os inquéritos foram comparados. Para 2019, esses indicadores foram analisados de acordo com características sociodemográficas. Este estudo estimou as proporções, as razões de prevalência (RP), e os respectivos intervalos de 95% de confiança (IC95%). No total, 60.202 indivíduos foram avaliados em 2013 e 88.531 em 2019, destes 24,4% referiram hipertensão arterial em 2013 e 23,9% em 2019. As mulheres receberam mais cuidados médicos para hipertensão no último ano (RP = 1,07; IC95%: 1,04; 1,11) e a última consulta médica na unidade básica de saúde (RP = 1,11; IC95%: 1,05; 1,17) que homens. Sobre raça/cor, os negros tiveram mais hospitalização por hipertensão ou alguma complicação (RP = 1,2; IC95%: 1,05; 1,38) e grau de limitação intenso ou muito intenso na realização de atividades diárias (RP = 1,37; IC95%: 1,06; 1,76). Em 2019, foram evidenciadas desigualdades e piores indicadores foram observados em homens, negros, com baixa escolaridade e idade jovem. Investimentos no Sistema Único de Saúde brasileiro, bem como políticas públicas e ações são essenciais para reduzir as desigualdades, promover os cuidados de saúde.

Este estudio comparó indicadores de atención y acceso a servicios de salud por parte de los adultos que se autodeclararon hipertensos en 2013 y 2019, analizando estos indicadores según género, grupo de edad, nivel de educación y raza/color. Estudio analítico con datos de la Encuesta Nacional de Salud (PNS) realizada en 2013 y 2019 en Brasil. Se compararon indicadores de atención y acceso a los servicios sanitarios de los individuos con hipertensión en ambas encuestas. Para 2019, estos indicadores se analizaron según características sociodemográficas. Este estudio estimó las proporciones, la razón de prevalencia (RP) y los respectivos intervalos de 95% de confianza (IC95%). En total, 60.202 individuos fueron evaluados en 2013 y 88.531 en 2019, de los cuales 24,4% declaró ser hipertenso en 2013 y 23,9% en 2019. Las mujeres recibieron mas atención médica por hipertensión en el último año (RP = 1,07; IC95%: 1,04; 1,11) y la última consulta médica en unidad básica de salud (RP = 1,11; IC95%: 1,05; 1,17) que los hombres. En cuanto raza/color, los negros tuvieron más hospitalizaciones por hipertensión o alguna complicación (RP = 1,2; IC95%: 1,05; 1,38) y un grado intenso o muy intenso de limitación para realizar actividades diarias (RP = 1,37; IC95%: 1,06; 1,76). En 2019, se evidenciaron desigualdades y se observaron peores indicadores en hombres, los negros, con baja educación y la edad joven. Las inversiones en el Sistema Único de Salud brasileño, así como políticas públicas y acciones son esenciales para reducir las desigualdades, promover la atención sanitaria.

In Vitro and In Vivo Characterization of PLLA-316L Stainless Steel Electromechanical Devices for Bone Tissue Engineering-A Preliminary Study.

Bone injuries represent a major social and financial impairment, commonly requiring surgical intervention due to a limited healing capacity of the tissue, particularly regarding critical-sized defects and non-union fractures. Regenerative medicine with the application of bone implants has been developing in the past decades towards the manufacturing of appropriate devices. This work intended to evaluate medical 316L stainless steel (SS)-based devices covered by a polymer poly (L-lactic acid) (PLLA) coating for bone lesion mechanical and functional support. SS316L devices were subjected to a previously described silanization process, following a three-layer PLLA film coating. Devices were further characterized and evaluated towards their cytocompatibility and osteogenic potential using human dental pulp stem cells, and biocompatibility via subcutaneous implantation in a rat animal model. Results demonstrated PLLA-SS316L devices to present superior in vitro and in vivo outcomes and suggested the PLLA coating to provide osteo-inductive properties to the device. Overall, this work represents a preliminary study on PLLA-SS316L devices' potential towards bone tissue regenerative techniques, showing promising outcomes for bone lesion support.

First record of Scybalocanthon nigriceps (Harold, 1868) (Coleoptera: Scarabaeidae: Scarabaeinae) in Rio Grande do Sul state, southern Brazil

ABSTRACT The dung beetle, Scybalocanthon nigriceps (Harold, 1868), is recorded in Rio Grande do Sul state, Brazil, for the first time, at the Moreno Fortes Biological Reserve, municipality of Dois Irmãos das Missões, northwest region of the state, expanding the area of occurrence and distribution of this species in the country.

First record of Scybalocanthon nigriceps (Harold, 1868) (Coleoptera: Scarabaeidae: Scarabaeinae) in Rio Grande do Sul state, southern Brazil.

The dung beetle, Scybalocanthon nigriceps (Harold, 1868), is recorded in Rio Grande do Sul state, Brazil, for the first time, at the Moreno Fortes Biological Reserve, municipality of Dois Irmãos das Missões, northwest region of the state, expanding the area of occurrence and distribution of this species in the country.

Plataforma EAD: uma ferramenta queaproxima as pessoas / EAD platform: a tool that brings people closer

Neste artigo, descreve-se a experiência de utilização de uma plataforma virtual para potencializar o processo de formulação e implantação da Política Nacional de Atenção Integral à Saúde da Criança. Pretende-se narrar como uma ferramenta considerada ‘dura’pode ser transformada para manter vivo o vínculo entre os participantes de um coletivo. Nele,apresenta-se a metodologia de trabalho criada, as modificações realizadas ao longo do tempo,as dificuldades encontradas e relatos de experiência das pessoas que utilizam a plataforma.Demonstra-se que, apesar de o Brasil possuir dimensão continental, foi possível moldar uma ferramenta para a aproximação de uma equipe de trabalho, unindo comprometimento,capacidade técnica e afetividade. Nesse sentido, propõe-se uma nova maneira de fazer e dar suporte para os desafios das ações nos territórios...

In this paper, we describe the experience of using a virtual platform to potentialize the process of formulation and implementation of the Política Nacional de Atenção Integral à Saúde da Criança (National Policy for Comprehensive Child Health Care – PNAISC). We intend to narrate how a tool that is considered ‘stiff ’ can be transformed to keep alive the bond between the participants of a collective. In it, we present the methodology of work created, the modifications performed throughout the time, the difficulties found, and reports of experience of the people who use the platform. It is shown that, although Brazil has a continental dimension, it was possible to forge a tool for approximating a work team, uniting compromise, technical skill,and affectionateness. In that sense, we propose a new way of doing and supporting the challenges of the actions in the territories...

Posterior Reversible Encephalopathy Syndrome Associated with FOLFOX Chemotherapy.

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity characterized by headaches, altered mental status, seizures, visual loss, and characteristic imaging pattern in brain MRI. The cause of PRES is not yet understood. We report a case of a 27-year-old woman that developed PRES after the use of FOLFOX 5 (oxaliplatin/5-Fluoracil/Leucovorin) chemotherapy for a colorectal cancer.

Synchronous gastrointestinal stromal tumors (GIST) and other primary cancers: case series of a single institution experience.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasm affecting the gastrointestinal tract. The incidental occurrence of mesenchymal tumors and other primary tumors has not been well described in literature. OBJECTIVE: The aim of this study was to evaluate the clinical and pathologic features of GIST occurring synchronously with other primary tumors. METHODS: Forty-three patients with diagnosis of GIST treated surgically with curative intent at our institution from 1998 to 2006 were included. The patient clinical data and pathological reports were reviewed. RESULTS: Of the 43 patients, there were 6 (14%) cases of synchronous GIST and other primary tumors discovered as coincidental findings. The synchronous GISTs analyzed were located in the stomach (50%) and small intestine (50%), size ranging from 0.7 to 7.6 cm (median 3.35 cm). Five (83%) of the concurrent primary tumors were from gastrointestinal origin and only one (17%) patient presented with concurrent breast cancer and GIST. The synchronous GISTs immunofenotype shows positivity for CD117 and CD34 (100%), smooth-muscle actin (SMA) (67%), S100 (50%) and desmin (33%). Whereas staining for cytokeratin AE1/AE3 and PDGF were all negative. According to GIST risk category for aggressive behavior three were classified as very low, one intermediate and two high. CONCLUSIONS: The synchronous occurrence of GISTs and other primary neoplasm is not an uncommon entity and usually they are discovery incidentally. Epithelial tumors of the gastrointestinal tract are the most associated with concomitant GISTs. Further studies are required to clarify the molecular and genetic mechanisms of carcinogenesis and progression associating GIST and synchronous tumors.

Alterações eletrocardiográficas durante e após tratamento com benzonidazol em fase aguda de doença de Chagas autóctone da Amazônia brasileira / Electrocardiographic changes during and after benznidazole treatment against acute-stage Chagas disease indigenous to the Brazilian Amazon

Avaliar o comprometimento cardíaco associado às infecções agudas por Tripanosomas considerando os distúrbios de condução elétrica e ritmo cardíacos apresentados durante a fase aguda e após tratamento, em uma casuística de doença de Chagas autóctone da Amazônia. Foram analisadas duas coortes de indivíduos: uma em fase aguda (coorte I) e outra (coorte II) feita nos mesmos pacientes reavaliados em período médio da primeira coorte, de 3,9 anos após tratamento. Entre os indivíduos da coorte I, a análise eletrocardiográfica foi realizada em eletrocardiogramas recuperados e submetidos à nova leitura e em eletrocardiogramas realizados prospectivamente. Todos foram submetidos a tratamentos regulares com benzonidazol. Foram estudados 179 indivíduos que tiveram doença de Chagas aguda no período entre 1992 e 2005. Na fase aguda, 47,7 por cento dos traçados eletrocardiográficos apresentaram-se normais e em 52,3 por cento registraram-se anormalidades. As alterações difusas de repolarização ventricular e baixa voltagem de QRS foram as principais anormalidades. Em 39,1 por cento dos pacientes houve comprometimento cardíaco caracterizado por miopericardite, sendo que 24,3 por cento (17/70) dos casos foram considerados graves. Foi demonstrada maior frequência de alterações eletrocardiográficas após tratamento em pacientes que manifestaram alteração eletrocardiográfica durante a fase aguda, comparativamente àqueles que não apresentaram. Outros cinco indivíduos que apresentaram diagnósticos tardios e manifestaram miocardite difusa durante o período agudo evoluíram insatisfatoriamente, uma vez que desenvolveram forma cardíaca com lesões de cardiopatia crônica...

This article aims to assess the cardiac impairment associated with acute infections by Trypanosoma considering abnormalities in electrical conduction and heart rate during the acute phase and after treatment in a case-study of Chagas' disease indigenous to the Amazon. The individuals assessed were grouped into two cohorts: cohort I had patients during the acute phase of the disease; and cohort II included the same patients re-evaluated at the average period of the first cohort, 3.9 years after treatment. The electrocardiographic analysis of the individuals in cohort I was based both on restored electrocardiograms that underwent a new reading and on electrocardiograms performed prospectively. All patients were treated with benznidazole on a regular basis. A total of 179 individuals that had acute Chagas disease in the period between 1992 and 2005 were assessed. During the acute phase, 47.7 per cent of the electrocardiographic tracings were normal, and 52.3 per cent reported abnormalities. The diffuse changes in ventricular repolarization and low QRS voltage were the main abnormalities reported. Cardiac impairment characterized by myopericarditis was observed in 39.1 per cent of the patients, and 24.3 per cent (17/70) of the cases were considered severe. The electrocardiographic changes were more frequent after treatment of patients who had shown electrocardiographic abnormalities during the acute phase, when compared to those who had not. Five other individuals who were diagnosed late and presented with diffuse myocarditis during the acute phase evolved poorly because they developed a clinical picture with lesions of chronic cardiopathy...

Asthma as a clinical presentation of cor triatriatum sinister in a Brazilian Amazon child: a case report.

Cor triatriatum sinister (CTS) is an extremely rare congenital cardiac malformation characterized by the presence of a fibromuscular membrane subdividing the left atrium into two chambers. Although respiratory symptoms are often observed in patients with this anomaly, wheezing is an unusual clinical presentation. We report on a child, born and resident in the Brazilian Amazonia, with a history of recurrent episodes of 'asthma' who was subsequently found to have CTS. After successful surgical correction of the cardiac congenital malformation, the child became symptom free. This case highlights the importance of investigating by cardiologic assessment children with worsening wheezing that do not respond well to appropriate medical management.

New species and records of Paliphora from the Brazilian semi-arid region.

In the course of studies about conidial fungi that grow on plant debris in the semi-arid region of Brazil, four species of Paliphora were found on unidentified dicotyledonous plants. Paliphora intermedia and P. porosa are recorded for the first time for South America and the neotropics respectively. Paliphora inflata and P. multiseptata are proposed as new species. A key and synoptic table of characters of the five known species of Paliphora are provided.

As dificuldades no aleitamento materno de bebês de risco na área de abrangência da UBS Planalto do Município de Marília, SP / Difficulties in breastfeeding risk babies in the Planalto Health Center area, Marília, SP

Este estudo objetivou caracterizar as dificuldades observadas e referidas pelas mães no aleitamento materno de bebês de risco, analisar a técnica de aleitamento e caracterizar as causas destacadas para o desmame precoce desses bebês. Foi realizado no período de maio de 2003 a agosto de 2004, na área de abrangência da UBS Planalto, Município de Marília, SP. Trata-se de estudo descritivo, identificando bebês de zero a doze meses cadastrados no Programa de Vigilância ao Bebê de Risco da área de abrangência da UBS Planalto. Foram contatadas 17 mães de bebês de risco. Entre as dificuldades mais mencionadas pelas mães estavam mamadas longas e ingurgitamento mamário. Nenhuma mãe citou a falta de orientação como causa do desmame; a indicação médica foi uma das causas mais referidas. Em relação aos aspectos adequados do aleitamento, todos foram contemplados pela maioria das mães, exceto os itens “mãe segura o peito em forma de pinça” e “sinais de ejeção do leite”. Em relação aos aspectos inadequados, os mais prevalentes foram: “bebê não busca o peito”, “ausência de sinais de ejeção do leite” e “seios ingurgitados”. Tendo em vista que a OMS preconiza o aleitamento materno exclusivo até os seis meses de idade, a partir dos dados na presente pesquisa, questiona-se a qualidade da educação em saúde para gestantes de risco e puérperas com dificuldades no aleitamento materno, tornando necessária orientação mais adequada tanto no pré-natal como no puerpério.

To characterize mothers’ difficulties in breastfeeding risk babies and to analyze the technique for this procedure were the main goals of this investigation carried out from May 2003 to August 2004 in the Planalto Health Center area, Marília, SP. For this descriptive study, babies from zero to twelve months registered in the Baby Risk Attention Program in the Planalto Health Center area were identified, and 17 mothers of risky babies were contacted. Among the difficulties pointed by these mothers long and eager sucking periods were the most frequent. No mother said that weaning was due to lack of guidance. They stated that weaning was due to medical advice. They mentioned that milking was adequate except in the items “assertive mother”, “breast compression” and “signs of milk ejection”. Prevalent inadequate aspects were “baby does not look for breast”, “absence of milk ejection signs” and “swollen breasts”. Exclusive breastfeeding advised by WHO presents problems related to the quality in health education for risky pregnant women and for women with difficulty in breastfeeding. A better guidance is necessary in the prenatal and puerperal periods.

Tumores de estroma gastrointestinal: uma nova visão no tratamento oncológico / Gastrointestinal stromal tumors: a new vision in the oncological treatment

Tumores de estroma gastrointestinal (GIST) são neoplasia que por muitos anos foram definidas como leiomiomas e leiomiossarcomas. Com a melhor caracterização da microscopia eletrônica, imunohistoquímica e biologia molecular o diagnóstico adequado deste grupo de tumores e o desenvolvimento de terapias alvo permitiu um grande avanço para a clínica médica. Compreende menos de 3% de todos os tumores malignos do trato gastrointestinal, mas o correto diagnóstico revolucionou a abordagem terapêutica a ser instituída. No presente trabalho, os avanços no diagnóstico, caracterização e conduta para os GISTs serão revisados.

Interferências do acesso às distintas modalidades linguísticas no processo de escrita espontânea do surdo inserido no contexto de educaçäo especial / Interferences in access distinctive linguistic modalities in the process of spontaneous writing of deaf people in special educational context

O acesso real a uma língua torna-se extremamente difícil para crianças surdas. Como a maioria dessa populaçäo nasce em lares de pais ouvintes, o desenvolvimento de uma base linguística adequada tanto em língua oral quanto em língua de sinais fica limitado, prejudicando o desenvolvimento linguístico, cognitivo e social dessas crianças. A aquisiçäo da língua escrita, que poderia ser um instrumento para auxiliar a integraçäo do surdo, é percebida como fator de discriminaçäo e rejeiçäo. Com a finalidade de esclarecer um pouco mais aspectos relacionados com a escrita de surdos, neste artigo pretende-se analisar e discutir a produçäo escrita de 18 adolescentes à 4ª série do 1§ grau de três escolas de diferentes regiöes de Säo Paulo. Analisou-se também a interaçäo entre alunos e professores e a metodologia utilizada. Os resultados demonstaram que os professores têm papel fundamental enquanto mediadores na avaliaçäo da produçäo escrita dos surdos, uma vez que houve uma relaçäo direta entre o comportamento dos sujeitos, influenciando o desempenho dos mesmos nesta área. A utilizaçä de coesäo textual foi fator determinante na produçäo escrita adequada, contudo, nem sempre garantiu a inteligibilidade do texto.

Semilunar valvar stenosis associated with congenital rubella syndrome

We studied four children who were born with congenital rubella syndrome, in whom cardiac malformations including semilunar valvar stenosis were present. These children attended the pediatric cardiology unit of Hospital Fundacao Santa Casa de Misericordiórdia do Pará. The diagnosis was made clinically and by laboratory results. Specific anti-rubella antibodies IgM and IgG were measured using a capture-antibody enzyme immunoassay. Three patients presented with aortic stenosis associated with patient ductus arteriosus, and 1 patient had isolated pulmonary valvar stenosis. Rubella-specific IgM antibodies were detected in 3 of the 4 children and IgG antibodies in 1. We review the role of rubella virus as a teratogenic agent implicated in a pathogenesis of aortic and pulmonary valvar stenosis. These pathologic lesion are part of the diffuse ateriopathy that affects the fetus with rubella virus infection.

Emergências oncológicas mais frequentes na prática clínica / Oncologic emergencies frequency in clinical practice

Os autores fazem uma revisäo bibliográfica, sintetizando de forma clara e concisa os principais aspectos etiológicos e terapêuticos das emergências oncológicas mais frequentemente encontradas na prática clínica diária: hipercalcemia, síndrome da veia cava superior e compressäo medular