Consistency of three different questionnaires for evaluating sexual function in healthy young women.

BACKGROUND: Most studies on female sexual dysfunction are performed in population inventories and under specific clinical conditions. These approaches are performed using validated psychometric scales. Different scales to assess sexual function use different numbers of questions to characterize their domains. They also may or may not include domains of interaction between sexual partners. The objective of this study was to compare the precision between scales to be able to analyze their accuracy for better diagnosis of sexual dysfunction. METHODS: Fifty (50) healthy young women were enrolled in this study. Three questionnaires (FSFI, SQ-F, and GRISS) were applied to assess sexual function (n = 44). The accuracy measured by the area under the ROC curve (AUC) for individual domains and to cross-validated pairwise comparison of the three analyzed instruments was used. Kruskall-Wallis test to analyze individual domains of the scales was also used.The P-value was established as 0.05. RESULTS: The results showed that all domains and total FSFI and GRISS scores were significantly different between normal and dysfunctional women, but not for SQ-F domains. Indeed, AUC accuracy varied from excellent-good domain discrimination for FSFI and GRISS, but fair-poor for SQ-F. For the paired comparison between the three questionnaires a fair accuracy was detected. The specificity percentage was around 84% whereas that for sensibility was low, around 30%. CONCLUSIONS: The best agreement was between FSFI and SQ-F, probably being related to high similar shared questions when compared to GRISS. The agreement between SQ-F and GRISS was low possible due to low number of questions in SQ-F to characterize similar domains. This study evidenced high agreement between scales to sensitivity and low agreement for specificity, thereby conferring fair accuracy between them. Thus, the limited grade for discriminatory capacity (AUC) for sexual response should be considered when comparing results from these three different questionnaires and also when comparing with other different scales. In addition, despite the diversity of scales, the high reliability and fit for their desire domain suggest that the FSFI scale has good accuracy for the current clinical assessment of women's sexual health. CLINICAL TRIAL REGISTRATION: NCT03241524 . Retrospectively registered on 08/02/2017.

[Blood regulation in Brazil: contextualization for improvement]. / Regulação de sangue no Brasil: contextualização para o aperfeiçoamento.

The use of blood products as essential medicines and the recognition of the high risk associated with blood transfusions require governments to take regulatory action with a focus on quality and safety. In this scenario, regulatory agencies play an essential role in socially advancing the guarantee that blood components will be produced according to current operating rules. Thus, in the effort to manage sanitary risks involved in the processing and use of blood, the Brazilian regulatory model, based on the construction of a national blood policy overseen by the State, has undergone conceptual improvement and review of the tools employed to achieve its goals. With the inclusion of good manufacturing practices as part of the Brazilian norms, as recommended by the World Health Organization, the country has moved forward in its view of blood facilities as manufacturing centers producing blood-derived biologics for therapeutic applications. It has also strengthened the need to develop safety mechanisms for blood donors and recipients. The development of a State-coordinated national blood policy and the institution of a national surveillance system with legitimate power of inspection are essential elements used in Brazil to guarantee the amount, quality, safety, and timeliness of blood supply to the population. The present article aims to discuss the present context of the blood regulatory model in Brazil so as to identify the challenges for improvement of this model.

The inhibitory effects of Curcuma longa L. essential oil and curcumin on Aspergillus flavus link growth and morphology.

The essential oil from Curcuma longa L. was analysed by GC/MS. The major components of the oil were ar-turmerone (33.2%), α -turmerone (23.5%) and ß -turmerone (22.7%). The antifungal activities of the oil were studied with regard to Aspergillus flavus growth inhibition and altered morphology, as preliminary studies indicated that the essential oil from C. longa inhibited Aspergillus flavus Link aflatoxin production. The concentration of essential oil in the culture media ranged from 0.01% to 5.0% v/v, and the concentration of curcumin was 0.01-0.5% v/v. The effects on sporulation, spore viability, and fungal morphology were determined. The essential oil exhibited stronger antifungal activity than curcumin on A. flavus. The essential oil reduced the fungal growth in a concentration-dependent manner. A. flavus growth rate was reduced by C. longa essential oil at 0.10%, and this inhibition effect was more efficient in concentrations above 0.50%. Germination and sporulation were 100% inhibited in 0.5% oil. Scanning electron microscopy (SEM) of A. flavus exposed to oil showed damage to hyphae membranes and conidiophores. Because the fungus is a plant pathogen and aflatoxin producer, C. longa essential oil may be used in the management of host plants.

Association between vascular calcification and osteoporosis in men with type 2 diabetes.

Atherosclerotic vascular disease is common in diabetes, and some data support a link with bone loss. This study evaluates the association between osteoporosis and clinical and metabolic factors and chronic complications of diabetes. We studied 59 diabetic men aged 50-80 yr who were assessed with bone densitometry (dual-energy X-ray absorptiometry). Of them, 10.2% of the patients were found to have osteoporosis in the lumbar spine and 45.8% osteopenia, whereas in the femoral neck, 11.8% had osteoporosis and 49% had osteopenia. There was a significant association of osteoporosis in the lumbar spine L1-L4 (p=0.004) and in the femoral neck (p=0.036) with iliac artery calcification. In addition, there was no association with any other metabolic factors, clinical factors, or chronic complications of diabetes evaluated, except for an association between a previous personal history of fractures (p=0.016) and low bone mineral density in the femoral neck. In conclusion, we found a positive association between the iliac artery calcification and osteoporosis in type 2 diabetic male patients.

The neem [Azadirachta indica a. juss (meliaceae)] oil reduction in the in vitro production of zearalenone by Fusarium graminearum.

Zearalenone, a mycotoxin produced by fungi of the genus Fusarium, including F. graminearum, triggers reproduction disorders in certain animals and hyperestrogen syndromes in humans. Current research investigates three concentrations of neem oil extract (0.1, 0.25 and 0.5%) in reducing the production of zearalenone. Neem oil extract decreased zearalenone amount in the three concentrations but highest inhibition (59.05%) occurred at 0.1%.

Chickenpox outbreak among Venezuelan immigrants housed in shelters and occupancies in the state of Roraima, Brazil, 2019: a descriptive study. / Surto de varicela entre imigrantes venezuelanos alojados em abrigos e ocupações no estado de Roraima, 2019: um estudo descritivo.

OBJECTIVE: To describe chickenpox outbreak among Venezuelan immigrants in shelters and occupancies in the municipalities of Pacaraima and Boa Vista, the state capital of Roraima, Brazil, and the control measures implemented. METHODS: This was a descriptive case series study, conducted between November 21 and December 13, 2019, based on secondary database obtained from the outbreak investigation made available by the General Coordination for the National Immunization Program. Descriptive analysis was performed using simple and relative frequency measurements, and measures of central tendency and dispersion were calculated. RESULTS: Of the 9,591 immigrants, 38 active cases and 1,459 susceptible to varicella were identified. With regard to active cases, 23 were female, and those aged under 9 years (17 cases) were the most affected. CONCLUSION: People susceptible to chickenpox were identified during the investigation. Immunization actions aimed at reducing transmission were adopted, thus preventing severe cases, deaths and overload in local health care system.

Production of recombinant human factor VIII in different cell lines and the effect of human XBP1 co-expression.

Recombinant factor VIII is one of the most complex mammalian proteins and a biotechnology venture required for the treatment of hemophilia A. The complexity of the protein, post-translational modifications and limitations of expression elements make the production of active recombinant FVIII a challenge. Here we report the production of biologically active Factor VIII in two different cell lines, CHO and HepG2, by transient transfection. Two expression vectors based on the CMV promoter were used: one harboring CMV Intron A (InA) and the other without it. To bypass difficulties in secretion, we also studied the influence of co-expression of the human splice isoform of the XBP1 gene. We report the production of recombinant FVIII possessing bioengineered FVIII heavy and light chains, linked by a minimal B domain. In our study, HepG2, a human hepatocyte cell line, expressed Factor VIII ten-fold more than a CHO cell line, and in HepG2 cells, the expression of XBP1 improved Factor VIII activity. For CHO cells, expression was improved by the presence of InA, but no further improvement was noted with XBP1 co-expression. These data suggest that the minimal B domain rFVIII preserves Factor VIII biological activity and that different expression elements can be used to improve its production.

Efficacy of gamification-based smartphone application for weight loss in overweight and obese adolescents: study protocol for a phase II randomized controlled trial.

BACKGROUND: Overweight and obesity are significant public health concerns that are prevalent in younger age cohorts. Preventive or therapeutic interventions are difficult to implement and maintain over time. On the other hand, the majority of adolescents in the United States have a smartphone, representing a huge potential for innovative digitized interventions, such as weight loss programs delivered via smartphone applications. Although the number of available smartphone applications is increasing, evidence for their effectiveness in weight loss is insufficient. Therefore, the proposed study aims to assess the efficacy of a gamification-based smartphone application for weight loss in overweight and obese adolescents. The trial is designed to be a phase II, single-centre, two-arm, triple-blinded, randomized controlled trial (RCT) with a duration of 6 months. METHOD: The intervention consists of a smartphone application that provides both tracking and gamification elements, while the control arm consists of an identically designed application solely with tracking features of health information. The proposed trial will be conducted in an urban primary care clinic of an academic centre in the United States of America, with expertise in the management of overweight and obese adolescents. Eligible adolescents will be followed for 6 months. Changes in body mass index z score from baseline to 6 months will be the primary outcome. Secondary objectives will explore the effects of the gamification-based application on adherence, as well as anthropometric, metabolic and behavioural changes. A required sample size of 108 participants (54 participants per group) was calculated. DISCUSSION: The benefits of the proposed study include mid-term effects in weight reduction for overweight and obese adolescents. The current proposal will contribute to fill a gap in the literature on the mid-term effects of gamification-based interventions to control weight in adolescents. This trial is a well-designed RCT that is in line with the Consolidated Standards of Reporting Trials statement.

Surto de varicela entre imigrantes venezuelanos alojados em abrigos e ocupações no estado de Roraima, 2019: um estudo descritivo / Brote de varicela entre inmigrantes venezolanos alojados en albergues y ocupaciones en el estado de Roraima, Brasil, 2019: estudio descriptivo / Chickenpox outbreak among Venezuelan immigrants housed in shelters and occupancies in the state of Roraima, Brazil, 2019: a descriptive study

Objetivo: Descrever o surto de varicela entre imigrantes venezuelanos em abrigos e ocupações nos municípios de Pacaraima e Boa Vista, Roraima, Brasil, e as medidas de controle implementadas. Métodos: Estudo descritivo do tipo 'série de casos', realizado entre 21 de novembro e 13 de dezembro de 2019, sobre banco de dados secundários da investigação do surto disponibilizado pela Coordenação-Geral do Programa Nacional de Imunizações. Na análise descritiva, utilizaram-se medidas de frequência simples e relativa e foram calculadas medidas de tendência central e dispersão. Resultados: Dos 9.591 imigrantes, detectaram-se 38 casos ativos e 1.459 suscetíveis à varicela. Dos casos ativos, 23 eram do sexo feminino e a faixa etária mais acometida foi a de menores de 9 anos (17 casos). Conclusão: Identificaram-se pessoas suscetíveis a varicela na investigação; foram adotadas ações de imunização que controlaram a transmissão, evitando casos graves, óbitos e sobrecarga da rede de assistência à saúde local.

Objetivo: Describir el brote de varicela entre inmigrantes venezolanos en albergues y ocupaciones en los municipios de Pacaraima y Boa Vista, Roraima, Brasil, y las medidas de control implementadas. Métodos: Estudio descriptivo del tipo "serie de casos", entre el 21 de noviembre y 13 de diciembre de 2019, utilizando datos secundarios de la investigación del brote, puesto a disposición por la Coordinación General del Programa Nacional de Inmunizaciones. En el análisis descriptivo, se utilizaron medidas de frecuencia simple y relativa y se calcularon medidas de tendencia central y dispersión. Resultados: Entre los 9.591 inmigrantes se detectaron 38 casos activos y 1.500 susceptibles a la varicela. Entre los casos activos, 23 fueron mujeres y el grupo de edad más afectado fue de menores de 9 años (17 casos). Conclusión: Se identificaron personas susceptibles a la varicela, lo que llevó a adopción de acciones de inmunización que controlaran la transmisión, previniendo casos graves, muertes y sobrecarga de la red local de atención.

Objective: To describe chickenpox outbreak among Venezuelan immigrants in shelters and occupancies in the municipalities of Pacaraima and Boa Vista, the state capital of Roraima, Brazil, and the control measures implemented. Methods: This was a descriptive case series study, conducted between November 21 and December 13, 2019, based on secondary database obtained from the outbreak investigation made available by the General Coordination for the National Immunization Program. Descriptive analysis was performed using simple and relative frequency measurements, and measures of central tendency and dispersion were calculated. Results: Of the 9,591 immigrants, 38 active cases and 1,459 susceptible to varicella were identified. With regard to active cases, 23 were female, and those aged under 9 years (17 cases) were the most affected. Conclusion: People susceptible to chickenpox were identified during the investigation. Immunization actions aimed at reducing transmission were adopted, thus preventing severe cases, deaths and overload in local health care system.

Pseudooutbreak of rapidly growing mycobacteria due to Mycobacterium abscessus subsp bolletii in a digestive and respiratory endoscopy unit caused by the same clone as that of a countrywide outbreak.

BACKGROUND: The nontuberculous mycobacteria (NTM) are widely spread. In Brazil, 2,520 cases of rapidly growing mycobacteria (RGM) infections after medical procedures were reported, with 5.4% of cases related to nonsurgical invasive procedures and with an occurrence of 1 clone (BRA100) of Mycobacterium abscessus subsp bolletii. OBJECTIVE: To describe a pseudooutbreak of M abscessus subsp bolletii in an endoscopy and bronchoscopy unit. METHODS: The alert for a pseudooutbreak was given when 3 patients, in the same week, had a positive bronchoalveolar lavage culture for M abscessus subsp bolletii. The patients had no symptoms/signs of mycobacterial infection; thus, contamination of bronchoscopes was suspected. Samples for culturing were collected from bronchoscopes, digestive endoscopes, automated disinfection machines, and the water supply. Clinical samples were identified by polymerase chain reaction restriction-enzyme analysis (PRA) of the hsp65 gene and their pulsed-field gel electrophoresis pattern was compared with environmental samples. RESULTS: The investigation demonstrated a contamination of bronchoscopes, digestive endoscopes, and disinfection machines. Molecular typing demonstrated that all strains belonged to the same clone (MAB01), identical to clone BRA100. DISCUSSION: Cross-transmission due to poor disinfection as well as resistance to glutaraldehyde may play roles in the spread of MAB01 M abscessus subsp bolletii, which may have a unique resistance to the environment and adaption to human hosts. However the water supply may have played a role. Attention is needed to ensure the quality of water used to rinse disinfected equipment.

Transporters in the Paracoccidioides brasiliensis transcriptome: insights on drug resistance.

In the struggle for life, the capacity of microorganisms to synthesize and secrete toxic compounds (inhibiting competitors) plays an important role in successful survival of these species. This ability must come together with the capability of being unaffected by these same compounds. Several mechanisms are thought to avoid the toxic effects. One of them is toxin extrusion from the intracellular environment to the outside vicinity, using special transmembrane proteins, referred to as transporters. These proteins are also important for other reasons, since most of them are involved in nutrient uptake and cellular excretion. In cancer cells and in pathogens, and particularly in fungi, some of these proteins have been pointed out as responsible for an important phenotype known as multidrug resistance (MDR). In the present study, we tried to identify in the Paracoccidioides brasiliensis transcriptome, transporter-ortholog genes from the two major classes: ATP binding cassette and major facilitator superfamily transporter. We found 22 groups with good similarity with other fungal ATP binding cassette transporters, and four Paracoccidioides brasilienses assembled expressed sequence tags that probably code for major facilitator superfamily proteins. We also focused on fungicide resistance orthologs already characterized in other pathogenic fungi. We were able to find homologs to C. albicans CDR1, CDR2, and MDR1, Saccharomyces cerevisiae PDR5 and Aspergillus AtrF genes, all of them related to azole resistance. As current treatment for paracoccidioidomycosis mainly uses azole derivatives, the presence of these genes can be postulated to play a similar role in P. brasiliensis, warning us for the possibility of resistant isolate emergence.

Educação Permanente em Saúde e atenção psicossocial: a experiência do Projeto Rede Sampa / Permanent Health Education and psychosocial care: the experience of the Projeto Rede Sampa

RESUMO Este artigo relata uma experiência de formação em saúde mental desenvolvida no município de São Paulo entre os anos de 2013 e 2016. Denominado Projeto Rede Sampa - Saúde Mental Paulistana, direcionou-se a trabalhadores de diversas categorias profissionais e diferentes pontos da Rede de Atenção Psicossocial, tendo sido elaborado e executado utilizando estratégias que garantiram a participação dos distintos atores na construção de conteúdos de aprendizagem, a abordagem da singularidade das redes territoriais e o registro do percurso formativo das turmas. A partir da metodologia construcionista social, procurou-se discutir a relevância das interações dialógicas para o fortalecimento do trabalho em rede e a importância do alinhamento com a atenção psicossocial como modelo ético de cuidado.

ABSTRACT This article reports on a training experience in mental health developed in the city of São Paulo between 2013 and 2016. Named Projeto Rede Sampa - Saúde Mental Paulistana, it was aimed at workers from different professional categories and different points of the Psychosocial Care Network, having been elaborated and executed using strategies that ensured the participation of the different actors in the construction of learning contents, the approach to the singularity of territorial networks and the registration of the training path of the classes. Based on the social constructionist methodology, we sought to discuss the relevance of dialogical interactions for the strengthening of networking and the importance of alignment with psychosocial care as an ethical model of care.

[Community vegetable gardens as a health promotion activity: an experience in Primary Healthcare Units]. / Hortas comunitárias como atividade promotora de saúde: uma experiência em Unidades Básicas de Saúde.

Urban and peri-urban agriculture (UPA) is being practiced in different settings, contributing to the improvement of health in communities and healthier environments. In order to identify the meanings and implications of the practice of UPA in Primary Healthcare Units (PHU) as an activity of health promotion (HP), and to what extent its therapeutic dimension characterizes it as an activity aligned with complementary and integrative practices (CIP), a qualitative cross-sectional study was performed in Embu das Artes, State of São Paulo. From the analysis, the following main themes arose: health concept, health outcomes, the return to traditional practices and habits and the reorientation of health services. It was possible to identify the close link between the cultivation of vegetable gardens and HP guidelines and fields of action, such as creating healthier environments, boosting community actions, developing personal skills, stimulating autonomy and empowerment and demands for the reorientation of services. The garden activities, set up in PHU areas, proved to be an implementation strategy of CIP. The conclusion reached is that vegetable gardening activities in community gardens are seen to be health promotion practices that integrate key elements of CIP.

Cuidado fisioterapêutico na função sexual feminina: intervenção educativa na musculatura do assoalho pélvico / Physical therapy care in female sexual function: educational intervention of the pelvic floor muscles

O estudo tem a finalidade de realizar uma intervenção educativa baseada em exercícios perineais de conscientização e fortalecimento da musculatura do assoalho pélvico (MAP) e de aplicar perineometria e palpação digital para comprovar sua eficácia. O treinamento destes músculos produz aumento na vascularização pélvica e na sensibilidade clitoriana, ocasionando otimização da satisfação sexual. A amostra foi constituída por 31 adultas jovens que atenderam aos critérios de inclusão. O assoalho pélvico foi avaliado através da palpação digital pelo método Perfect e pelos perineômetros Peritron (9300+) e Biofeedback pressório ou Perina, além da aplicação do questionário Female Sexual Function Index (FSFI). As mulheres foram submetidas a uma intervenção, sendo orientadas, através de cartilha, a realizarem em seus domicílios duas vezes semanais os exercícios de fortalecimento do assoalho pélvico. Mensalmente, as participantes foram reavaliadas pelos mesmos instrumentos e evoluíram para um novo nível de exercícios da MAP. Verificou-se potencialização da força da MAP ao longo da intervenção e melhora da satisfação sexual, tendo influência positiva mais significativa nas respostas sexuais envolvendo desejo, excitação e orgasmo. Conclui-se que é fundamental que haja uma interação multidisciplinar para trabalhar com disfunções sexuais da mulher e estabelecer um aumento da eficácia da terapêutica. (AU)

The study aimed to apply an educational intervention based on perineal exercises of awareness and strengthening of the pelvic floor muscles (PFM) and apply perineometry and digital palpation to prove its effectiveness. Training these muscles produces an increase in pelvic vascularity and clitoral sensitivity, resulting in optimization of sexual satisfaction. The sample consisted of 31 young adults who attended the inclusion criteria. The pelvic floor was assessed by digital palpation by Perfect method and the perineometer Peritron (9300+) and Biofeedback pressure Perina, in addition to the questionnaire Female Sexual Function Index (FSFI). The women were submitted to an intervention, being oriented to conduct in their households, twice a week, the strengthening exercises of the pelvic floor through a hornbook. Every month, the participants were re-evaluated by the same instruments and evolved to a new level of PFM exercises. There was potentiation of the PFM force during the intervention and improved sexual satisfaction, and most significant influence on the sexual responses involving desire, arousal and orgasm. It is concluded to be fundamental the existence of a multidisciplinary interaction to work with sexual dysfunction of women and provide therapeutic efficacy increase. (AU)

Inhibitory effect of the essential oil of Curcuma longa L. and curcumin on aflatoxin production by Aspergillus flavus Link.

Aflatoxins are highly toxic, mutagenic, teratogenic and carcinogenic mycotoxins. Consumption of aflatoxin-contaminated food and commodities poses serious hazards to the health of humans and animals. Turmeric, Curcuma longa L., is a native plant of Southeast Asia and has antimicrobial, antioxidant and antifungal properties. This paper reports the antiaflatoxigenic activities of the essential oil of C. longa and curcumin. The medium tests were prepared with the oil of C. longa, and the curcumin standard at concentrations varied from 0.01% to 5.0%. All doses of the essential oil of the plant and the curcumin standard interfered with mycotoxin production. Both the essential oil and curcumin significantly inhibited the production of aflatoxins; the 0.5% level had a greater than 96% inhibitory effect. The levels of aflatoxin B(1) (AFB(1)) production were 1.0 and 42.7 µg/mL, respectively, for the samples treated with the essential oil of C. longa L. and curcumin at a concentration of 0.5%.

Comparison of techniques used for functional evaluation of pelvic floor muscles / Comparação das técnicas utilizadas para avaliação funcional dos músculos do assoalho pélvico / Comparación entre las técnicas de evaluación funcional de los músculos del suelo pélvico

Objective: To identify and discuss techniques for evaluation of pelvic floor muscles (PFM) focusing on the most used and accessible techniques in health care. Methods: This is a quantitative exploratory and descriptive applied research. Data were collected from March to June 2016 at a higher education institution in the city of João Pessoa, Paraíba, Brazil. Initially, 31 healthy young women were submitted to pelvic floor evaluation using the following methods: PERFECT, vaginal cones, and perineometry using Perine and Peritron. The participants then performed exercises to strengthen PFM. The variables measured by the different methods were also recorded 30 and 60 days after the start of the program. ANOVA was used for repeated measures and Spearman's correlation test was used for the evaluation instruments with significance set at 5%. Results: The functional evaluation using all the methods was adequate in the PFM evaluation. In the digital palpation (PERFECT), the endurance response (E) was positively correlated to Perina (rho=0.688) and vaginal cones (rho=0.571), and muscle strength (P) was positively correlated to the Peritron technique (rho=0.506). Conclusion: There are several ways to evaluate PFM function and all of them provide sensory feedback to the patient. Given the low costs of digital palpation, the introduction of this technique into women's health services is likely to improve women's quality of life.

Objetivo: Identificar e discutir técnicas de avaliação dos músculos do assoalho pélvico (MAP) enfocando as mais usadas e acessíveis na assistência à saúde. Métodos: Trata-se de um estudo exploratório, com pesquisa descritiva e aplicada, e abordagem quantitativa. A coleta de dados foi realizada no período de março a junho de 2016 em uma instituição de ensino superior da cidade de João Pessoa-PB. Inicialmente, 31 adultas jovens e saudáveis foram submetidas à avaliação do assoalho pélvico utilizando os métodos: PERFECT, cones vaginais, perineometria com Perina e Peritron. Em seguida, as participantes se submeteram a exercícios para fortalecer os MAP. As variáveis quantificadas pelos diferentes métodos também foram registadas 30 e 60 dias após o início do programa. Aplicou-se ANOVA para medidas repetidas e teste de correlação Spearman`s em 5% entre os instrumentos de avaliação. Resultados: A avaliação funcional com todos os métodos foi adequada na avaliação dos MAP. Na palpação digital (PERFECT), a resposta de resistência (E) mostrou correlação positiva com o Perina (rho= 0.688) e com os cones vaginais (rho= 0.571), por sua vez, a força muscular (P) teve correlação positiva com a técnica do Peritron (rho= 0.506). Conclusão: Várias são as maneiras de avaliar a função do MAP e todas promovem feedback sensorial ao paciente. Com relação aos baixos custos da palpação digital, a introdução dessa técnica em serviços de saúde feminina provavelmente proporcionará melhora da qualidade de vida das mulheres.

Objetivo: Identificar y discutir técnicas de evaluación de los músculos del suelo pélvico (MSP) con énfasis en las técnicas más utilizadas y asequibles para el cuidado de la salud. Métodos: Estudio exploratorio de abordaje descriptivo y cuantitativo aplicado en investigación. La recogida de datos se dio entre marzo y junio de 2016 en una institución de educación superior de la ciudad de João Pessoa, PB, Brasil. A principio fue realizada la evaluación del suelo pélvico en 31 mujeres jóvenes y saludables con los siguientes métodos: PERFECTO, conos vaginales, perineometria con Perine y Peritron. Después las participantes realizaron ejercicios para fortalecimiento de los MSP. Las variables cuantificadas por métodos distintos fueron también registradas en 30 y 60 días después del inicio del programa. Se aplicó la ANOVA para medidas repetidas y la correlación de Spearman fue aplicada en el 5% de los instrumentos de evaluación. Resultados: La evaluación funcional con todos los métodos ha sido adecuada para la evaluación de los MSP. En la palpación digital (PERFECTO) la respuesta de resistencia (E) mostró una correlación positiva con la Perina (rho = 0.688) y los conos vaginales (rho = 0.571) y la fuerza del músculo (P) tuvo una correlación positiva con la técnica Peritron (Rho = 0.506). Conclusión: Hay varias maneras de evaluar la función de los músculos del suelo pélvico y promover la respuesta sensorial al paciente. El método PERFECTO permite cuantificar la intensidad, el número de contracciones, ambos rápido y lento, así como la duración de la contracción de la musculatura perineal y, por lo tanto, aunque sea un método barato, ha sido sensible y específico para el objetivo estimado. Respecto los bajos costes de la palpación digital, la introducción de esa técnica en los servicios de salud para mujeres probablemente puede mejorar la calidad de vida de las mujeres.

Prevalence of osteoporosis and vertebral fractures in postmenopausal women with type 2 diabetes mellitus and their relationship with duration of the disease and chronic complications.

UNLABELLED: Controversial data suggest that patients with type 2 diabetes mellitus have an increased risk of fractures despite having, in some studies, higher bone mineral density. METHODS: The aim of this study was to determine the prevalence of osteoporosis and morphometric vertebral fractures in 148 postmenopausal diabetic women, aged 61.87±7.85 years, and their relationship with clinical and metabolic factors and chronic complications of the disease. RESULTS: The prevalence of osteoporosis was 30.4% at lumbar spine (LS) and 9.5% at femoral neck (FN). The prevalence of vertebral fractures was 23%, mostly mild and located at the thoracic spine. Patients with fractures were older (P<.001), had been in the menopause for a long period (P=.005), had lower creatinine clearance (P=.026) had and lower bone mineral density at LS (P=.01) and FN (P=.042). The frequency of fractures increased with age (P<.001), with the duration of the disease (P=.037) and with the presence of retinopathy (P=.030). In patients with fractures, the prevalence of osteoporosis increased to 40% at LS (P=.004) and to 35.7% at FN (P=.049). After logistic regression adjustment, it was observed that the likelihood of presenting vertebral fractures was significantly increased at the age of 60 years or older (P<.001) and with the presence of osteoporosis at LS (P=.006), irrespective of blood glucose control. CONCLUSION: We found a high prevalence of osteoporosis and vertebral fractures in postmenopausal women with type 2 diabetes mellitus, irrespective of blood glucose control, and these conditions were more frequent in long-standing disease and in patients with retinopathy and impaired renal function.

Regulação de sangue no Brasil: contextualização para o aperfeiçoamento / Blood regulation in Brazil: contextualization for improvement

A utilização dos produtos do sangue como medicamentos essenciais e o reconhecimento das dimensões dos riscos transfusionais demandam dos países uma ação regulatória com foco em qualidade e segurança. Nesse campo, os órgãos reguladores têm papel fundamental em imprimir socialmente a garantia de que os componentes do sangue serão produzidos e utilizados de acordo com as normas técnicas vigentes. Assim, na busca para gerenciar os riscos sanitários envolvidos no processamento e uso do sangue, o modelo regulatório brasileiro, baseado na construção de uma política nacional de sangue, sob gestão do Estado, vem passando por aprimoramento conceitual e inovação de seus instrumentos. Com a inserção das boas práticas de fabricação preconizadas pela Organização Munidal da Saúde nas normativas brasileiras, o país avança na visão dos estabelecimentos de sangue como centros produtores de produtos biológicos originados do sangue para fins terapêuticos e fortalece a necessidade de desenvolvimento de mecanismos para a segurança no atendimento a doadores e receptores. O desenvolvimento de uma política nacional de sangue coordenada pelo Estado e a instituição de um sistema nacional de vigilância sanitária com poder fiscalizatório legitimado são elementos essenciais utilizados no Brasil para garantia de sangue em quantidade, qualidade, segurança e em tempo oportuno à população. Este artigo tem por objetivo discutir o contexto atual do modelo regulatório de sangue no Brasil na perspectiva de apontar desafios para o aperfeiçoamento desse modelo.

The use of blood products as essential medicines and the recognition of the high risk associated with blood transfusions require governments to take regulatory action with a focus on quality and safety. In this scenario, regulatory agencies play an essential role in socially advancing the guarantee that blood components will be produced according to current operating rules. Thus, in the effort to manage sanitary risks involved in the processing and use of blood, the Brazilian regulatory model, based on the construction of a national blood policy overseen by the State, has undergone conceptual improvement and review of the tools employed to achieve its goals. With the inclusion of good manufacturing practices as part of the Brazilian norms, as recommended by the World Health Organization, the country has moved forward in its view of blood facilities as manufacturing centers producing blood-derived biologics for therapeutic applications. It has also strengthened the need to develop safety mechanisms for blood donors and recipients. The development of a State-coordinated national blood policy and the institution of a national surveillance system with legitimate power of inspection are essential elements used in Brazil to guarantee the amount, quality, safety, and timeliness of blood supply to the population. The present article aims to discuss the present context of the blood regulatory model in Brazil so as to identify the challenges for improvement of this model.

Hortas comunitárias como atividade promotora de saúde: uma experiência em Unidades Básicas de Saúde / Community vegetable gardens as a health promotion activity: an experience in Primary Healthcare Units

ResumoA agricultura urbana e periurbana (AUP) vem sendo praticada em diferentes espaços, contribuindo para a melhoria da saúde nas comunidades e ambientes mais saudáveis. Objetivando identificar significados e repercussões da prática da AUP em Unidades Básicas de Saúde (UBS), enquanto uma atividade de Promoção da Saúde (PS), e em que medida sua dimensão terapêutica a caracteriza como uma atividade alinhada às práticas integrativas e complementares, foi realizado um estudo transversal com abordagem qualitativa no município de Embu das Artes, SP. Da análise, emergiram as seguintes categorias: concepção de saúde, resultados na saúde, resgate de práticas e hábitos tradicionais e reorientação dos serviços de saúde. Identificou-se a estreita ligação entre a prática das hortas e as diretrizes e campos de ação da PS como: criação de ambientes saudáveis, reforço da ação comunitária, desenvolvimento de habilidades pessoais, estímulo à autonomia e empoderamento e demandas por reorientação dos serviços. As atividades de horta instituídas nas UBS se mostraram uma estratégia de implementação das práticas integrativas e complementares (PIC). Conclui-se que as atividades de cultivo nas hortas comunitárias mostram-se como práticas promotoras da saúde que integram elementos fundamentais das PIC.

AbstractUrban and peri-urban agriculture (UPA) is being practiced in different settings, contributing to the improvement of health in communities and healthier environments. In order to identify the meanings and implications of the practice of UPA in Primary Healthcare Units (PHU) as an activity of health promotion (HP), and to what extent its therapeutic dimension characterizes it as an activity aligned with complementary and integrative practices (CIP), a qualitative cross-sectional study was performed in Embu das Artes, State of São Paulo. From the analysis, the following main themes arose: health concept, health outcomes, the return to traditional practices and habits and the reorientation of health services. It was possible to identify the close link between the cultivation of vegetable gardens and HP guidelines and fields of action, such as creating healthier environments, boosting community actions, developing personal skills, stimulating autonomy and empowerment and demands for the reorientation of services. The garden activities, set up in PHU areas, proved to be an implementation strategy of CIP. The conclusion reached is that vegetable gardening activities in community gardens are seen to be health promotion practices that integrate key elements of CIP.

Regulação de sangue no Brasil: contextualização para o aperfeiçoamento / Blood regulation in Brazil: contextualization for improvement

A utilização dos produtos do sangue como medicamentos essenciais e o reconhecimento das dimensões dos riscos transfusionais demandam dos países uma ação regulatória com foco em qualidade e segurança. Nesse campo, os órgãos reguladores têm papel fundamental em imprimir socialmente a garantia de que os componentes do sangue serão produzidos e utilizados de acordo com as normas técnicas vigentes. Assim, na busca para gerenciar os riscos sanitários envolvidos no processamento e uso do sangue, o modelo regulatório brasileiro, baseado na construção de uma política nacional de sangue, sob gestão do Estado, vem passando por aprimoramento conceitual e inovação de seus instrumentos. Com a inserção das boas práticas de fabricação preconizadas pela Organização Munidal da Saúde nas normativas brasileiras, o país avança na visão dos estabelecimentos de sangue como centros produtores de produtos biológicos originados do sangue para fins terapêuticos e fortalece a necessidade de desenvolvimento de mecanismos para a segurança no atendimento a doadores e receptores. O desenvolvimento de uma política nacional de sangue coordenada pelo Estado e a instituição de um sistema nacional de vigilância sanitária com poder fiscalizatório legitimado são elementos essenciais utilizados no Brasil para garantia de sangue em quantidade, qualidade, segurança e em tempo oportuno à população. Este artigo tem por objetivo discutir o contexto atual do modelo regulatório de sangue no Brasil na perspectiva de apontar desafios para o aperfeiçoamento desse modelo.

The use of blood products as essential medicines and the recognition of the high risk associated with blood transfusions require governments to take regulatory action with a focus on quality and safety. In this scenario, regulatory agencies play an essential role in socially advancing the guarantee that blood components will be produced according to current operating rules. Thus, in the effort to manage sanitary risks involved in the processing and use of blood, the Brazilian regulatory model, based on the construction of a national blood policy overseen by the State, has undergone conceptual improvement and review of the tools employed to achieve its goals. With the inclusion of good manufacturing practices as part of the Brazilian norms, as recommended by the World Health Organization, the country has moved forward in its view of blood facilities as manufacturing centers producing blood-derived biologics for therapeutic applications. It has also strengthened the need to develop safety mechanisms for blood donors and recipients. The development of a State-coordinated national blood policy and the institution of a national surveillance system with legitimate power of inspection are essential elements used in Brazil to guarantee the amount, quality, safety, and timeliness of blood supply to the population. The present article aims to discuss the present context of the blood regulatory model in Brazil so as to identify the challenges for improvement of this model.