Prediction of metabolic syndrome: A machine learning approach to help primary prevention.

AIMS: To describe the performance of machine learning (ML) applied to predict future metabolic syndrome (MS), and to estimate lifestyle changes effects in MS predictions. METHODS: We analyzed data from 17,182 adults attending a checkup program sequentially (37,999 visit pairs) over 17 years. Variables on sociodemographic attributes, clinical, laboratory, and lifestyle characteristics were used to develop ML models to predict MS [logistic regression, linear discriminant analysis, k-nearest neighbors, decision trees, Light Gradient Boosting Machine (LGBM), Extreme Gradient Boosting]. We have tested the effects of changes in lifestyle in MS prediction at individual levels. RESULTS: All models showed adequate calibration and good discrimination, but the LGBM showed better performance (Sensitivity = 87.8 %, Specificity = 70.2 %, AUC-ROC = 0.86). Causal inference analysis showed that increasing physical activity level and reducing BMI by at least 2 % had an effect of reducing the predicted probability of MS by 3.8 % (95 % CI = -4.8 %; -2.7 %). CONCLUSION: ML models based on data from a checkup program showed good performance to predict MS and allowed testing for effects of lifestyle changes in this prediction. External validation is recommended to verify models' ability to identify at-risk individuals, and potentially increase their engagement in preventive measures.

Internal construct validity of the Brazilian version of a tool for assessing the population's knowledge of human papillomavirus.

OBJECTIVE: To verify the internal construct validity of the Brazilian Portuguese version of a tool for measuring the general population's knowledge of human papillomavirus (HPV). MATERIALS AND METHODS: A cross-culturally adapted Brazilian Portuguese version of a measurement tool originally designed for English speaking populations was administered to 330 adults in Tubarão, Santa Catarina, Southern Brazil. After examining the overall suitability of the method, we performed investigations based on the item response theory and exploratory factor analysis. RESULTS: Ten of the 29 items presented a low contribution to the construct and were excluded from subsequent analysis. The factor analysis yielded three factors, which explained approximately 51% of the variance variability. A different arrangement from the original measurement tool was found: general HPV knowledge, with six items; HPV vaccination knowledge, with five items; HPV transmission and testing knowledge, with eight items. CONCLUSION: The Brazilian Portuguese version under study presented a different behavior from the original measurement tool, but proved to be a reliable and valid instrument in assessing the Brazilian population's knowledge about HPV.

Internal construct validity of the Brazilian version of a tool for assessing the population's knowledge of human papillomavirus / Validade interna do construto da versão brasileira de um instrumento para aferição do conhecimento sobre o papilomavírus humano

ABSTRACT: Objective: To verify the internal construct validity of the Brazilian Portuguese version of a tool for measuring the general population's knowledge of human papillomavirus (HPV). Materials and methods: A cross-culturally adapted Brazilian Portuguese version of a measurement tool originally designed for English speaking populations was administered to 330 adults in Tubarão, Santa Catarina, Southern Brazil. After examining the overall suitability of the method, we performed investigations based on the item response theory and exploratory factor analysis. Results: Ten of the 29 items presented a low contribution to the construct and were excluded from subsequent analysis. The factor analysis yielded three factors, which explained approximately 51% of the variance variability. A different arrangement from the original measurement tool was found: general HPV knowledge, with six items; HPV vaccination knowledge, with five items; HPV transmission and testing knowledge, with eight items. Conclusion: The Brazilian Portuguese version under study presented a different behavior from the original measurement tool, but proved to be a reliable and valid instrument in assessing the Brazilian population's knowledge about HPV.

RESUMO: Objetivo: Verificar a validade interna do construto da versão em português de uma ferramenta para aferir o conhecimento da população sobre o papilomavírus humano (HPV). Materiais e métodos: Uma versão brasileira transculturalmente adaptada de uma ferramenta de aferição de conhecimento sobre HPV originalmente projetada para ser utilizada em populações de língua inglesa foi aplicada a 330 adultos em Tubarão/SC, Brasil. Após examinar a adequação geral do método, foram realizadas análises baseadas na Teoria de Resposta ao Item e na Análise Fatorial Exploratória. Resultados: Dez dos 29 itens apresentaram baixa contribuição para o construto e foram excluídos das análises subsequentes. Três fatores foram gerados pela análise fatorial e explicaram aproximadamente 51% da variabilidade da variância. Um arranjo diferente em relação ao instrumento de medida original foi encontrado, baseado em: conhecimento geral do HPV, com seis perguntas; conhecimento sobre vacinação contra o HPV, com cinco perguntas; e conhecimento sobre transmissão e teste de HPV com oito perguntas. Conclusão: A versão brasileira em estudo apresentou um comportamento diferente da ferramenta de aferição original, mas demonstrou ser um instrumento confiável e válido para acessar o conhecimento da população brasileira sobre o HPV.

Isolation and Identification of the Five Novel Flavonoids from Genipa americana Leaves.

Genipa americana is a medicinal plant popularly known as "jenipapo", which occurs in Brazil and belongs to the Rubiaceae family. It is a species widely distributed in the tropical Central and South America, especially in the Cerrado biome. Their leaves and fruits are used as food and popularly in folk medicine to treat anemias, as an antidiarrheal, and anti-syphilitic. Iridoids are the main secondary metabolites described from G. americana, but few studies have been conducted with their leaves. In this study, the aim was to chemical approach for identify the main compounds present at the extract of G. americana leaves. The powdered leaves were extracted by maceration with EtOH: water (70:30, v/v), following liquid-liquid partition with petroleum ether, chloroform, ethyl acetate and n-butanol. A total of 13 compounds were identified. In addition three flavonoids were isolated from the ethyl acetate fraction: quercetin-3-O-robinoside (GAF 1), kaempferol-3-O-robinoside (GAF 2) and isorhamnetin-3-O-robinoside (GAF 3) and, from n-butanol fraction more two flavonoids were isolated, kaempferol-3-O-robinoside-7-O-rhamnoside (robinin) (GAF 4) and isorhamnetin-3-O-robinoside-7-rhamnoside (GAF 5). Chemical structures of these five flavonoids were elucidated using spectroscopic methods (MS, ¹H and 13C-NMR 1D and 2D). These flavonoids glycosides were described for the first time in G. americana.

Crude extract and fractions from Eugenia uniflora Linn leaves showed anti-inflammatory, antioxidant, and antibacterial activities.

BACKGROUND: This study showed phytochemical composition and evaluates the anti-inflammatory, and analgesic activities of crude extract (CE) and fractions from E. uniflora Linn leaves. METHODS: Polyphenols present in crude extract (CE), in aqueous fraction (AqF), and ethyl acetate (EAF) treated fractions from E. uniflora Linn leaves were shown by chromatographic analysis in order to conduct a phytochemical characterization. Antibacterial activity was evaluated based on minimum inhibitory concentrations (MICs) determined using the agar dilution method. Doses of 50, 100, and 200 mg/kg of the CE and fractions were applied for conducting in vivo models (male Swiss mice, 8-10 weeks old). The peritonitis experimental model was induced by carrageenan following of Myeloperoxidase activity (MPO), Total glutathione and malondialdehyde (MDA), IL-1ß and TNF-α levels by spectroscopic UV/VIS analysis. Antinociceptive activity was evaluated based on an abdominal writhing model and hot plate test. The results were statistically evaluated using one-way analysis of variance (ANOVA), followed by Bonferroni's post-hoc test. The level of statistical significance was p < 0.05. RESULTS: High-performance liquid chromatography with photodiode array detection (HPLC-DAD) detected varying concentrations of gallic acid, ellagic acid, and myricitrin in the CE and fractions obtained from E. uniflora Linn leaves (0.05-0.87%w/w, 0.20-0.32%w/w, and 1.71-6.56%w/w, respectively). In general, the CE had lower MIC values than the fractions, including the lowest MIC against the MRSA strain. The CE and AqF also significantly reduced leukocyte migration and MPO activity (p < 0.05). In addition, AqF significantly reduced IL-1ß and TNF-α levels (p < 0.05). Furthermore, the CE and fractions exhibited an antioxidant effect (p < 0.05) and peripheral analgesic activity (p < 0.05). CONCLUSIONS: The CE and fractions from the studied E. uniflora Linn leaves exhibited antibacterial, anti-inflammatory, antioxidant, and analgesic activity in the performed assays.

Comportamento sexual de estudantes de medicina do Brasil: um estudo multicêntrico / Sexual behavior of students of medicine of Brazil: a multicenter study

A sexualidade abrange fatores psicológicos, emocionais e culturais. Objetivo: Determinar o comportamento sexual de estudantes de Medicina do Brasil. Métodos: Estudo transversal multicêntrico com coleta de dados por meio de questionário eletrônico. Resultados: Foram entrevistados 459 universitários. Destes, 76,4% já tiveram a sexarca, tendo ocorrido em 25,2% dos indivíduos com idade ≥19 anos. Entre os sexualmente ativos, 60,0% perderam a virgindade com o(a) namorado(a), e 54,9% utilizaram preservativo nesta primeira relação sexual; os que não o utilizaram atribuíram o fato à confiança no parceiro. A mediana do número de parceiros sexuais na vida foi 2, e 12,4% já tiveram relações homossexuais. Com relação ao consumo de álcool/drogas, 6,2% costumam utilizá-los antes do sexo e 18,9% já deixaram de utilizar preservativo por esse motivo. Conclusão: Apesar de a amostra ter maior conhecimento sobre vulnerabilidade a doenças sexualmente transmissíveis, apresentou fatores de risco para a ocorrência destas.

Sexuality involves psychological, emotional and cultural factors. Objective: Identify sexual habits of Brazilian medical students. Methods: A multicenter cross-sectional study was conducted and an electronic questionnaire was used. Results: They were interviewed 459 university students. About their sexarche, 76.4% had already had it, 25.2% before 19 years old. From those who have sexual life, 60.0% lost their virginity with their boyfriend or girlfriend, and 54.9% used a condom in this first intercourse; those who did not use it said they trusted in their partners. The median of sexual partners in lifetime was 2, and 12.4% have ever had homosexual intercourses. About alcohol and drugs, 6.2% generally use them before having sex and 18.9% have not used condom because of these substances. Conclusion: Even though the sample have more knowledge about vulnerability to sexually transmitted diseases, they show risk factors for having it.

Avaliação do conhecimento sobre o vírus do papiloma humano (HPV) e sua vacinação entre agentes comunitários de saúde na cidade de Tubarão, Santa Catarina, em 2014 / Evaluación del conocimiento acerca del papiloma vírus humano (HPV) y su vacuna, en agentes comunitarios de salud en la ciudad de Tubarão, Santa Catarina, Brasil, in 2014 / Evaluation of knowledge about the Human Papilloma Virus (HPV) and its vaccination among Community Health Agents in the municipality of Tubarão, Santa Catarina, Brazil, in 2014

Resumo OBJETIVO: avaliar o conhecimento de agentes comunitários de saúde (ACS) acerca do vírus do papiloma humano (HPV) e sua vacinação. MÉTODOS: foi realizado inquérito com ACS atuantes no município de Tubarão-SC, Brasil, em 2014; os dados foram coletados por um instrumento de avaliação do conhecimento sobre HPV e sua vacinação, validado para o idioma inglês e adaptado - transculturalmente - para o português. RESULTADOS: participaram do estudo 124 ACS; todos já haviam ouvido falar do HPV mas apenas 25,0% sobre o teste para o HPV; 72,6% acertaram menos de 70,0% das respostas do instrumento de avaliação; os ACS que acertaram mais de 70,0% dos questionamentos apresentavam, em conjunto, menor média de idade (p=0,010). CONCLUSÃO: há pouco conhecimento dos ACS sobre o HPV, o que pode repercutir em sua atuação como agentes multiplicadores de (i) prevenção de doenças e agravos, e de (ii) educação em saúde.

Resumen OBJETIVO: ese trabajo tuvo como objetivo evaluar el conocimiento de los Agentes Comunitarios de Salud (ACS) acerca del Papiloma Virus Humano (HPV) y su vacuna. MÉTODOS: realizamos un estudio transversal con ACS activos en la ciudad de Tubarão-SC, Brasil, en 2014; los datos fueron colectados a través de un instrumento de evaluación sobre el conocimiento acerca del HPV y su vacuna, validado para el inglés y adaptado para el portugués. RESULTADOS: participaron del estudio 124 ACS; todos ya tenían escuchado del HPV, pero solamente 25,0% del teste para el virus; del total de preguntas, 72,6% de los ACS respondieron menos de 70,0% de forma correcta; los que acertaron más que 70,0% tenían, en promedio, una edad más baja (p=0,010). CONCLUSIÓN: el conocimiento de los ACS acerca del HPV está debajo de lo esperado, eso puede repercutir en su actuación como agentes multiplicadores de prevención y educación en salud.

Abstract OBJECTIVE: to evaluate the knowledge of Community Health Agents (CHA) about the Human Papilloma Virus (HPV) and its vaccination. METHODS: this is a cross-sectional study with CHA who worked in Tubarão-SC, Brazil, in 2014; data were collected through an evaluation tool about HPV and its vaccination, validated for English language and translated and adapted into Portuguese. RESULTS: 124 CHA participated in this study; all of them had already heard about HPV, but only 25.0% had heard about HPV testing; 72.6% answered correctly less than 70.0% of the questions; those who answered correctly more than 70.0% were, in general, younger than the other CHA (p=0.010). CONCLUSION: CHA demonstrated little knowledge on HPV, which may affect their work as multipliers in the prevention of diseases and in education in health.

Evaluation of knowledge about the Human Papilloma Virus (HPV) and its vaccination among Community Health Agents in the municipality of Tubarão, Santa Catarina, Brazil, in 2014. / Avaliação do conhecimento sobre o vírus do papiloma humano (HPV) e sua vacinação entre agentes comunitários de saúde na cidade de Tubarão, Santa Catarina, em 2014.

OBJECTIVE: to evaluate the knowledge of Community Health Agents (CHA) about the Human Papilloma Virus (HPV) and its vaccination. METHODS: this is a cross-sectional study with CHA who worked in Tubarão-SC, Brazil, in 2014; data were collected through an evaluation tool about HPV and its vaccination, validated for English language and translated and adapted into Portuguese. RESULTS: 124 CHA participated in this study; all of them had already heard about HPV, but only 25.0% had heard about HPV testing; 72.6% answered correctly less than 70.0% of the questions; those who answered correctly more than 70.0% were, in general, younger than the other CHA (p=0.010). CONCLUSION: CHA demonstrated little knowledge on HPV, which may affect their work as multipliers in the prevention of diseases and in education in health.

Prevalência de hiperglicemia em idosos: um estudo de base populacional / Prevalence of hyperglycemia in the elderly: a population-based study

OBJETIVOS: Avaliar a prevalência de hiperglicemia e fatores associados, na população idosa residente de um município do sul do Brasil. MÉTODOS: Estudo transversal, de base populacional, realizado com idosos (≥60 anos) residentes na cidade de Tubarão, estado de Santa Catarina, no período de setembro de 2010 a maio de 2011. Os idosos foram cadastrados pelos Agentes Comunitários de Saúde do Programa Estratégia Saúde da Família. Foram registrados dados sociodemográficos (idade, gênero, cor da pele, situação conjugal, situação de trabalho e escolaridade), dados comportamentais (atividade física, uso de álcool e tabagismo) e dados clínicos (obesidade, uso de medicamentos e história familiar de diabetes). Após responderem estas questões, os participantes eram agendados para comparecerem à unidade de saúde para coleta de sangue e medidas antropométricas. A prevalência de hiperglicemia foi avaliada a partir de exames de glicemia de jejum e foram considerados hiperglicêmicos os indivíduos com valores ≥126 mg/dL ou em uso de medicamentos hipoglicemiantes. Os participantes foram selecionados por amostragem aleatória simples. Para verificar associação entre as variáveis de interesse, foi aplicado o teste do qui-quadrado. O intervalo de confiança pré-estabelecido foi de 95% e o erro α de 5%. RESULTADOS: Foram incluídos 833 idosos, e 220 foram considerados hiperglicêmicos conforme os critérios da metodologia (prevalência de 26,4%). Dos pacientes inclusos no grupo hiperglicemia, 190 estavam em uso de hipoglicemiantes orais, e destes, 112 ainda apresentavam glicemia de jejum ≥126 mg/dL, enquanto 78 apresentavam glicemia de jejum <126 mg/dL. Ainda no grupo hiperglicemia, 30 pacientes apresentavam glicemia de jejum ≥126 mg/dL e não estavam em uso de hipoglicemiantes. Possuir pais com diagnóstico prévio de diabetes mellitus e ser obeso foram fatores associados à presença de hiperglicemia. CONCLUSÕES: Este estudo sugere que uma grande parcela da população idosa tem hiperglicemia de jejum, necessitando de uma avaliação mais ampla para pesquisa do diabetes mellitus.

AIMS: To evaluate the prevalence of hyperglycemia and associated factors in the elderly population of a municipality in southern Brazil. METHODS: Cross-sectional population-based study, carried out with the elderly (≥60 years) living in the city of Tubarão, state of Santa Catarina, Brazil, from September 2010 to May 2011. Participants were selected by simple random sampling. The elderly were registered by the Community Health Agents of the Family's Health Strategy Program. Sociodemographic data (age, gender, skin color, marital status, employment status and education), behavioral data (physical activity, alcohol use and smoking) and clinical data (obesity, drug use and family history of diabetes) were recorded. After answering these questions the participants were scheduled to attend the clinic for blood collection and anthropometric measurements. The prevalence of hyperglycemia was assessed from fasting blood glucose tests, and individuals with values ≥126 mg/dL or use of hypoglycemic drugs were considered hyperglycemic. To assess the association between the variables of interest, the chi-square test was applied. The pre-determined confidence interval was of 95% and the error α of 5%. RESULTS: Eight hundred thirty-three elderly patients were included, and 220 were considered hyperglycemic according to the methodology criteria (prevalence of 26.4%). Of the patients included in the hyperglycemia group, 190 were using oral hypoglycemic drugs, and of these, 112 had also fasting glucose ≥126 mg/dL, while in 78 fasting glucose was <126 mg/dL. Also in the hyperglycemia group, 30 patients had fasting glucose ≥126 mg/dL and were not on hypoglycemic treatment. Having parents diagnosed with diabetes and being obese were associated with the presence of hyperglycemia. CONCLUSIONS: This study suggests that a large portion of the elderly population has fasting hyperglycemia, requiring a wider evaluation for diabetes mellitus.

Preliminary stages of a cross-cultural Brazilian Portuguese adaptation of a measurement tool for assessing public understanding of human papillomavirus.

The objective of this study was to conduct the initial stages of the cross-cultural adaptation to Brazilian Portuguese of a scale to measure the level of knowledge about HPV. The stages included: translation from English into the Portuguese spoken in Brazil; synthesis of the translated version; back-translation; analysis by an expert committee; and reliability analysis based on internal consistency and reproducibility. Cronbach's α coefficient for the instrument was 0.985. Subset analysis produced only minor variations. The correlation coefficients between the individual items and the overall result showed strong positive correlations, except for three items. Reproducibility analysis showed kappa values with substantial or moderate agreement for the majority of the items. A preliminary Brazilian version was obtained with satisfactory results, but other stages are necessary in the process of validation of the Brazilian version.

Alterações laríngeas em professores do ensino fundamental: prevalência, fatores de risco e achados da videolaringoscopia / Laryngeal disorders in elementary school teachers: prevalence, risk factors and videolaryngoscopic findings

Introdução: Os professores apresentam um dos mais altos índices de sintomas vocais dentre as classes profissionais. Estão constantemente expostos aos fatores de risco e, por vezes, necessitam de afastamento do local de trabalho. Portanto, o objetivo deste estudo foi determinar e caracterizar a presença de sintomas laríngeos em professores do Ensino Fundamental da cidade de Tubarão/SC. Métodos: Tratou-se de uma pesquisa observacional e descritiva. Aplicou-se um questionário em 263 professores, dos quais 51 foram submetidos ao exame de videolaringoscopia, sendo esta a amostra do estudo. Resultados: Entre os 51 indivíduos, 49 (96,1%) eram mulheres, a média de idade foi de 38,69 anos (DP ±9,60) e a de tempo de trabalho, 14,61 anos (DP±120,62). Toda a amostra apresentava sintomas que tiveram a maior duração relatada por até 7 dias, sendo os mais comuns fadiga vocal, garganta seca e rouquidão. Na videolaringoscopia, nódulo, fenda e refluxo foram as lesões encontradas. Conclusão: Ausência de significância entre a queixa de sintomas e presença de lesão na videolaringoscopia. Não houve valor estatístico entre tempo de exposição em sala de aula, queixa de sintomas e presença de dano em videolaringoscopia(AU)

Introduction: Teachers have one of the highest rates of vocal symptoms across the professional classes. They are constantly exposed to risk factors and sometimes require removal from the workplace. Therefore, the aim of this study was to determine and characterize the presence of laryngeal symptoms in elementary school teachers in the city of Tubarão, SC. Methods: This was an observational and descriptive study. A questionnaire was administered to 263 teachers, of whom 51 were submitted to videolaryngoscopy, who thus comprised the study sample. Results: Of the 51 subjects, 49 (96.1%) were women, the mean age was 38.69 years (SD ± 9.60), and mean working time 14.61 years (SD ± 120.62). The entire sample had symptoms that had the longest duration reported for up to seven days, the most common being vocal fatigue, dry throat, and hoarseness. On videolaryngoscopy, nodule, crack and reflux were the injuries found. Conclusion: Lack of significance between symptoms complaints and presence of lesions on laryngoscopy. There was no statistical value of exposure time in the classroom, complaining of symptoms, and presence of damage on videolaryngoscopy(AU)

Preliminary stages of a cross-cultural Brazilian Portuguese adaptation of a measurement tool for assessing public understanding of human papillomavirus / Etapas preliminares da adaptação transcultural para o Português de um intrumento de aferição do conhecimento sobre o papilomavírus humano / Etapas preliminares de una adaptación cultural al portugués de una herramienta de medición para evaluar la comprensión pública de virus del papiloma humano

Abstract: The objective of this study was to conduct the initial stages of the cross-cultural adaptation to Brazilian Portuguese of a scale to measure the level of knowledge about HPV. The stages included: translation from English into the Portuguese spoken in Brazil; synthesis of the translated version; back-translation; analysis by an expert committee; and reliability analysis based on internal consistency and reproducibility. Cronbach's α coefficient for the instrument was 0.985. Subset analysis produced only minor variations. The correlation coefficients between the individual items and the overall result showed strong positive correlations, except for three items. Reproducibility analysis showed kappa values with substantial or moderate agreement for the majority of the items. A preliminary Brazilian version was obtained with satisfactory results, but other stages are necessary in the process of validation of the Brazilian version.

Resumo: O objetivo deste artigo foi proceder às primeiras etapas de adaptação transcultural de um instrumento que mede o conhecimento sobre HPV para a língua portuguesa falada no Brasil. Foram realizadas a tradução inicial para o português brasileiro; síntese das versões traduzidas; retrotradução; análise por comitê de especialistas e análise de confiabilidade por intermédio da análise de consistência interna e de reprodutibilidade. O coeficiente α-Cronbach do instrumento foi estimado em 0,985. A análise por blocos implicou em pequenas variações. Os coeficientes de correlação entre cada questão e o resultado geral do instrumento mostraram correlações positivas fortes, com exceção de três questões. A análise de reprodutibilidade mostrou valores de kappa que evidenciaram concordâncias substanciais ou moderadas para a maioria das questões. Foi obtida uma primeira versão brasileira com resultados satisfatórios, mas outras etapas são necessárias ao processo de validação.

Resumen: El objetivo de este trabajo fue realizar las primeras etapas de la adaptación cultural un instrumento que mide los conocimientos sobre el VPH para el idioma portugués hablado en Brasil. Se realizó la traducción inicial para el portugués brasileño; síntesis de las versiones traducidas; retrotraducción; análisis por un Comité de Expertos y análisis de confiabilidad a través de la consistencia interna y reproducibilidad. El coeficiente α-Cronbach del instrumento se estimó en 0,985. El análisis por bloques resultó en variaciones menores. Los coeficientes de correlación entre cada ítem y el resultado general del instrumento mostraron fuertes correlaciones positivas, a excepción de tres ítems. El análisis de la reproducibilidad mostró valores del kappa con concordancias sustanciales o moderadas para la mayoría de los ítems. Fue obtenida una primera versión brasileña con resultados satisfactorios, pero otros pasos son necesarios para el proceso de validación.

Prevalência e perfil dos pacientes que utilizam antipsicóticos em um hospital do sul do Brasil / Prevalence and profile of patients on antipsychotics in a hospital in southern Brazil

OBJETIVOS: Avaliar a prevalência e o perfil de pacientes hospitalizados que receberam prescrição de medicamentos antipsicóticos. MÉTODOS: Este foi um estudo de delineamento transversal que avaliou pacientes atendidos durante o ano de 2013 no Hospital Nossa Senhora da Conceição, em Tubarão, estado de Santa Catarina e que fizeram uso de medicamentos antipsicóticos. A coleta de dados aconteceu integralmente nos prontuários eletrônicos. Os pacientes foram avaliados de acordo com suas características sociodemográficas, tipo de antipsicótico utilizado e diagnóstico clínico pelo Código Internacional de Doenças (CID 10). RESULTADOS: De 125.670 pacientes atendidos no HNSC em 2013, 1.559 receberam algum medicamento antipsicótico. A média de idade desses pacientes foi de 50,34 anos (DP=22,89). Não houve variação na prevalência de prescrição de antipsicóticos de acordo com o gênero e notou-se aumento nesta frequência de acordo com a idade dos pacientes. Os antipsicóticos mais prescritos foram os típicos; entre estes o haloperidol foi o mais utilizado, em 852 (54,7%) pacientes. Entre os diagnósticos principais, os transtornos ansiosos foram os mais prevalentes, estando presentes em 131 (6,3%) pacientes. Considerando somente diagnósticos de transtornos mentais ou comportamentais e incluindo os diagnósticos secundários, os transtornos ansiosos estiveram presentes em 233 (14,9%) pacientes. Apenas 470 (30,1%) pacientes que utilizaram antipsicóticos tinham, pelo menos, um diagnóstico de transtorno mental ou comportamental registrado. CONCLUSÕES: Houve uma taxa de prevalência de 1,24% de uso de antipsicóticos nos pacientes do Hospital Nossa Senhora da Conceição, sendo haloperidol o antipsicótico mais prescrito. O diagnóstico de transtornos ansiosos foi o mais frequente entre os principais, porém grande parte dos pacientes que receberam antipsicóticos não tinham nenhum diagnóstico psiquiátrico, recebendo-os por outras causas.

AIMS: To evaluate the prevalence and the profile of inpatients prescribed antipsychotics. METHODS: This was a cross-sectional study which evaluated patients admitted to Hospital Nossa Senhora da Conceição (HNSC), in Tubarão, State of Santa Catarina, Brazil, in 2013, who were prescribed antipsychotic drugs. All the data were collected from electronic medical records. Patients were evaluated according to their sociodemographic characteristics, type of antipsychotic drug prescribed, and clinical diagnosis (ICD 10). RESULTS: Out of 125,670 patients admitted to HNSC in 2013, 1,559 received some kind of antipsychotic. The mean age of the patients was 50.34 years (SD=22.89). There was no variation in the prevalence of antipsychotic drug prescription between male and female patients, but the frequency of these prescriptions increased with age. Conventional antipsychotics were the most commonly prescribed ones, among which haloperidol was prescribed to 852 (54.7%) patients. Among the major diagnoses, anxiety disorders were the most prevalent ones, detected in 131 (6.3%) patients. Considering only the diagnoses of mental or behavioral disorders and including secondary diagnoses, anxiety disorders were observed in 233 (14.9%) patients. A total of 470 (30.1%) patients on antipsychotics had been diagnosed at least once with mental or behavioral disorders. CONCLUSIONS: The prevalence of antipsychotic drug use was 1.24% among the inpatients, and haloperidol was the most widely prescribed drug. The diagnosis of anxiety disorders was the most frequent one, but most patients who received antipsychotics had not been diagnosed with any psychiatric disorder, and eventually received them for other reasons.

[The position of the Brazilian Federal Board of Medicine on incentives for reimbursement of childbirth care and the impact on cesarean rates]. / O parecer do Conselho Federal de Medicina, o incentivo à remuneração ao parto e as taxas de cesariana no Brasil.

This study analyzed incentives for reimbursement of childbirth care advocated by the Brazilian Federal Board of Medicine (CFM) and their impact on cesarean rates. A consecutive sample of 600 postpartum women was surveyed. The overall cesarean rate was 59.2%, as compared to 92.3% among women that had the same physician for their prenatal care and childbirth. Cesarean rates were significantly greater in the groups of women with higher prevalence of the same physician during prenatal care and delivery, that is, higher rates were associated with older maternal age (PR = 1.65), more schooling (PR = 1.25), prenatal care in the private sector (PR = 1.39) or through private health plans (PR = 1.43), previous cesarean section (PR = 2.78), and admission earlier in labor (PR = 1.93). The results challenge the position by the CFM that financial incentives for women to have the same obstetrician during prenatal care and labor would encourage normal childbirth, when these women are precisely the ones with the highest cesarean rates.

Hipertensão arterial sistêmica em idosos do município de Tubarão, SC – Brasil: estudo populacional / Hypertension in elderly individuals from a city of Santa Catarina: a population-based study

Fundamentos: O envelhecimento é um fenômeno de realidade mundial. Com a senilidade da população, háaumento da prevalência de doenças crônicas não transmissíveis e, entre elas, a hipertensão arterial sistêmica(HAS) é a mais prevalente.Objetivo: Estimar a prevalência de hipertensão arterial sistêmica e os fatores associados em idosos residentes nomunicípio de Tubarão, SC, Brasil.Métodos: Estudo transversal, de base populacional, realizado com idosos (≥60 anos) residentes na cidade deTubarão, SC, Brasil, no período de setembro de 2010 a maio de 2011. Realizada entrevista e posterior aferição dapressão arterial (PA), peso e altura. As variáveis analisadas foram: sexo, faixa etária, escolaridade, etnia, alcoolismo, tabagismo, obesidade, atividade física e história familiar. Foi considerado hipertenso o idoso com níveis pressóricos≥140/90mmHg ou aquele em uso de medicação anti-hipertensiva. Resultados: Foram entrevistados 805 idosos dos quais 699 (86,8%) considerados hipertensos. Destes, 56,2% apresentaram hipertensão arterial sistólica isolada. Todos os idosos com faixa etária ≥80 anos apresentavam hipertensão. As variáveis estatisticamente significativas foram idade, etnia, obesidade e história familiar de HAS. Conclusão: A prevalência da hipertensão arterial em idosos foi superior à encontrada em pesquisas realizadas anteriormente na cidade de Tubarão, SC. Os fatores associados à HAS foram: idade avançada, etnia não branca,presença de obesidade e história familiar positiva.

Background: Aging is a global phenomenon. With population aging, there is an increase in the prevalence of non-transmissible chronic diseases, among which systemic arterial hypertension (SAH) is the most prevalent one. Objective: To estimate the prevalence of systemic arterial hypertension and associated factors in elderly individuals from the city of Tubarão, Santa Catarina, Brazil.Methods: Population-based cross-sectional study conducted with elderly individuals (≥ 60 years old) living in the city of Tubarão, Santa Catarina, Brazil, from September 2010 to May 2011. The individuals were interviewed and had their blood pressure (BP), weight and height checked. The variables analyzed were sex, age group, education level, ethnicity, alcoholism, smoking, obesity, physical activity and family history. Elderly individuals with blood pressure levels ≥140/90 mmHg or those using anti-hypertensive medication were considered hypertensive. Results: A total of 805 elderly individuals were interviewed, of which 699 (86.8%) were considered hypertensive. Of these, 56.2%had isolated systolic hypertension. All elderly individuals aged ≥ 80 had hypertension. The statistically significant variables were age, ethnicity, obesity and family history of hypertension. Conclusion: The prevalence of hypertension in elderly individuals was higher than that reported in research studies carried out inthe city of Tubarão, Santa Catarina. The factors associated with hypertension were older age, non white ethnicity, presence of obesity and positive family history.

O parecer do Conselho Federal de Medicina, o incentivo à remuneração ao parto e as taxas de cesariana no Brasil / The position of the Brazilian Federal Board of Medicine on incentives for reimbursement of childbirth care and the impact on cesarean rates / La opinión del Consejo Federal de Medicina, remuneración por nacimiento y tasas de cesárea en Brasil

O estudo buscou investigar como o incentivo à remuneração ao parto, preconizado pelo Conselho Federal de Medicina (CFM) do Brasil, influencia as taxas de cesariana. Foi investigada uma amostra consecutiva de 600 puérperas. A proporção de cesarianas na amostra foi de 59,2%, sendo 92,3% entre as mulheres tendo parto e pré-natal com o mesmo profissional. As taxas de cesariana foram significativamente mais elevadas exatamente naqueles grupos com maior prevalência do mesmo profissional, ou seja, idade mais avançada (RP = 1,65), maior escolaridade (RP = 1,25), pré-natal privado (RP = 1,39) ou por convênio (RP = 1,43), cesariana prévia (RP = 2,78) e admitidas precocemente (RP = 1,93). O entendimento do CFM de que o incentivo ao acompanhamento presencial do trabalho de parto, pago à parte, para o mesmo obstetra que realizou o pré-natal, funcionará como incentivo ao parto normal, está exatamente na contramão de nossos resultados, mostrando que as mulheres atendidas pelo mesmo profissional no pré-natal e parto são exatamente aquelas que apresentam as taxas de cesariana mais elevadas.

This study analyzed incentives for reimbursement of childbirth care advocated by the Brazilian Federal Board of Medicine (CFM) and their impact on cesarean rates. A consecutive sample of 600 postpartum women was surveyed. The overall cesarean rate was 59.2%, as compared to 92.3% among women that had the same physician for their prenatal care and childbirth. Cesarean rates were significantly greater in the groups of women with higher prevalence of the same physician during prenatal care and delivery, that is, higher rates were associated with older maternal age (PR = 1.65), more schooling (PR = 1.25), prenatal care in the private sector (PR = 1.39) or through private health plans (PR = 1.43), previous cesarean section (PR = 2.78), and admission earlier in labor (PR = 1.93). The results challenge the position by the CFM that financial incentives for women to have the same obstetrician during prenatal care and labor would encourage normal childbirth, when these women are precisely the ones with the highest cesarean rates.

El estudio investiga cómo el pago por parto, recomendado por el Consejo Federal de Medicina de Brasil (CFM), influye en las tasas de cesárea. Se investigó una muestra consecutiva de 600 mujeres embarazadas. La tasa de cesárea en la muestra fue de un 59,2% y un 92,3% entre las mujeres con parto y atención prenatal con el mismo profesional. Las tasas de cesáreas fueron significativamente mayores en los grupos exactamente con mayor prevalencia del mismo profesional, es decir, edad avanzada (RP = 1,65), educación superior (RP = 1,25), atención prenatal privada (RP = 1,39) o por acuerdo (RP = 1,43), cesárea anterior (RP = 2,78) y admisión precoz (RP = 1,93). La recomendación del CFM que incentiva la atención del parto por el mismo profesional que realizó la atención prenatal, es exactamente la contraria a la nuestra, debido a nuestros resultados, ya que demuestra que las mujeres atendidas por el mismo profesional en la atención prenatal y el parto son exactamente las que presentan las tasas más altas de cesárea.

Depressive Symptoms and Associated Factors among People Living with HIV/AIDS.

The purpose of this study was to evaluate the prevalence of depressive symptoms and associated variables among people living with HIV/AIDS (PLWHA) in a specialized treatment center in a city located in southern Brazil. A cross-sectional study was conducted using the Beck Depression Inventory to assess the presence of depressive symptoms. The prevalence of depressive symptoms was 53.5% among the surveyed population, which supports the idea that depressive symptoms are more common among PLWHA, mainly if compared with the general population. It was observed that 57.7% of the study participants were with depressive symptoms and did not take any psychiatric medication and 100% did not undergo psychotherapy, which indicates undertreatment. There was no statistically significant difference in the mean CD4 count between patients with depressive symptoms (484.1  ±  353) and patients without depressive symptoms (528.4  ±  263). Further actions should be taken to improve the care for PLWHA. The interface between psychology, psychiatry, and internal medicine is of utmost importance to provide a more humanized care, in which the psychosocial, psychological, and psychiatric aspects are not neglected.

Quantification of polyphenols and evaluation of antimicrobial, analgesic and anti-inflammatory activities of aqueous and acetone-water extracts of Libidibia ferrea, Parapiptadenia rigida and Psidium guajava.

ETHNOPHARMACOLOGICAL RELEVANCE: Vast numbers of plant species from northeastern Brazil have not yet been phytochemically or biologically evaluated. AIM OF THE STUDY: The goal of this work was to obtain, characterize and show the antimicrobial, analgesic and anti-inflammatory activities of aqueous and acetone-water extracts of Libidibia ferrea, Parapiptadenia rigida and Psidium guajava. MATERIALS AND METHODS: The plant material (100g) was dried, and the crude extracts were obtained by using turbo-extraction (10%; w/v) with water or acetone:water (7:3, v/v) as the extraction solvent. High-performance liquid chromatography (HPLC) methods were used to screen the crude extracts for hydrolysable tannins (gallic acid) and condensed tannins (catechins). The antibacterial activity was evaluated by agar-diffusion and microdilution methods against Gram-positive strains (Staphylococcus aureus ATCC 25923, Staphylococcus epidermidis INCQS 00016, Enterococcus faecalis ATCC 29212 and a clinical isolate of methicillin-resistant Staphylococcus aureus) as well as Gram-negative strains (Escherichia coli ATCC 25922, Salmonella enteritidis INCQS 00258, Shigella flexneri and Klebsiella pneumoniae). To evaluate the anti-inflammatory activity, a leukocyte migration model was used. Analgesic activity was determined by the hot plate test and the acetic acid-induced abdominal writhing test. Data were analyzed by analysis of variance (ANOVA) at a significance level of 5%. RESULTS: Parapiptadenia rigida presented the highest amount of total polyphenols (35.82 ± 0.20%), while the greatest catechin content was found in the acetone-water extract of Psidium guajava (EAWPg; 1.04 µg/g). The largest amounts of catechins were found in the aqueous extract of Libidibia ferrea (EALf; 1.07 µg/g) and the acetone-water extract of Parapiptadenia rigida (EAWPr; 1.0 µg/g). All extracts showed activity against Gram-positive bacteria. The aqueous and acetone-water extracts of Psidium guajava showed the greatest inhibition zones in the agar diffusion tests. In the evaluation of the minimum inhibitory concentration (MIC), the most susceptible Gram-positive bacterium was Staphylococcus epidermidis and the most susceptible Gram-negative bacterium was Shigella flexneri. EAPg and EAWPg showed the greatest MIC values. All extracts were significant inhibitors of leukocyte migration (p<0.05). Using the writhing test, significant analgesic activity was found for EAPr (50 mg/kg), EAWPr (100 mg/kg and 200 mg/kg) and EAWPg (50 mg/kg) (p<0.05). CONCLUSIONS: Thus, the appropriate extraction procedure preserves the chemical components such as gallic acid and catechin, and showed antimicrobial, anti-inflammatory and analgesic properties.