[Adherence to nutritional recommendations and sociodemographic variables in patients with diabetes mellitus]. / Adesão às recomendações nutricionais e variáveissociodemográficas em pacientes com diabetes mellitus.

OBJECTIVE: To determine if there is a relationship between adherence to nutritional recommendations and sociodemographic variables in Brazilian patients with type 2 diabetes mellitus. METHODS: Cross-sectional observational study using a stratified random sample of 423 individuals. The Food Frequency Questionnaire (FFQ) was used, and the Fisher's exact test was applied with 95% confidence interval (p<0.05). RESULTS: Of the 423 subjects, 66.7% were women, mean age of 62.4 years (SD = 11.8), 4.3 years of schooling on average (SD = 3.6) and family income of less than two minimum wages. There was association between the female gender and adherence to diet with adequate cholesterol content (OR: 2.03; CI: 1.23; 3.34), between four and more years of education and adherence to fractionation of meals (OR: 1 92 CI: 1.19; 3.10), and income of less than two minimum wages and adherence to diet with adequate cholesterol content (OR: 1.74; CI: 1.03, 2.95). CONCLUSION: Adherence to nutritional recommendations was associated with the female gender, more than four years of education and family income of less than two minimum wages.

Age is not associated with hospital admission or uncontrolled symptoms of asthma if proper treatment is offered.

BACKGROUND: Aging modifies immune response and respiratory physiology. Few studies evaluate the effect of age on asthma. The aim of our study was to evaluate whether age is associated with uncontrolled symptoms and hospital admissions due to asthma in a setting where patients were receiving proper treatment. METHODS: We enrolled 401 patients with uncontrolled asthma who were inhaled corticosteroid-naive. The follow-up period was 1 year. They received medications for asthma, performed spirometry, a symptoms questionnaire, and all emergency room visits and hospital admissions due to asthma were reported. The primary end point was hospital admission during the follow-up period. RESULTS: Baseline data demonstrated that subjects >55 years of age had a later onset of asthma and a longer duration of symptoms. Adjusted logistic regression models demonstrated that older age at enrollment did not predict asthma control in the follow-up: hospital admission due to asthma [odds ratio (OR) 1.7 and 95% confidence interval (CI) 0.6-4.7], symptoms score (OR 0.6 and 95% CI 0.3-1.1) and emergency room visits due to asthma (OR 0.9 and 95% CI 0.6-1.3). Older age was associated with worse lung function (OR 1.8 and 95% CI 1.1-3.3). CONCLUSION: This study allows us to conclude that older age is associated with a later onset of asthma and a longer duration of symptoms. Age does not predict hospital admissions or poor control of asthma symptoms if proper treatment is offered. It does, however, predict worse lung function.

Modulation of the oscillatory mechanics of lung tissue and the oxidative stress response induced by arginase inhibition in a chronic allergic inflammation model.

BACKGROUND: The importance of the lung parenchyma in the pathophysiology of asthma has previously been demonstrated. Considering that nitric oxide synthases (NOS) and arginases compete for the same substrate, it is worthwhile to elucidate the effects of complex NOS-arginase dysfunction in the pathophysiology of asthma, particularly, related to distal lung tissue. We evaluated the effects of arginase and iNOS inhibition on distal lung mechanics and oxidative stress pathway activation in a model of chronic pulmonary allergic inflammation in guinea pigs. METHODS: Guinea pigs were exposed to repeated ovalbumin inhalations (twice a week for 4 weeks). The animals received 1400 W (an iNOS-specific inhibitor) for 4 days beginning at the last inhalation. Afterwards, the animals were anesthetized and exsanguinated; then, a slice of the distal lung was evaluated by oscillatory mechanics, and an arginase inhibitor (nor-NOHA) or vehicle was infused in a Krebs solution bath. Tissue resistance (Rt) and elastance (Et) were assessed before and after ovalbumin challenge (0.1%), and lung strips were submitted to histopathological studies. RESULTS: Ovalbumin-exposed animals presented an increase in the maximal Rt and Et responses after antigen challenge (p<0.001), in the number of iNOS positive cells (p<0.001) and in the expression of arginase 2, 8-isoprostane and NF-kB (p<0.001) in distal lung tissue. The 1400 W administration reduced all these responses (p<0.001) in alveolar septa. Ovalbumin-exposed animals that received nor-NOHA had a reduction of Rt, Et after antigen challenge, iNOS positive cells and 8-isoprostane and NF-kB (p<0.001) in lung tissue. The activity of arginase 2 was reduced only in the groups treated with nor-NOHA (p <0.05). There was a reduction of 8-isoprostane expression in OVA-NOR-W compared to OVA-NOR (p<0.001). CONCLUSIONS: In this experimental model, increased arginase content and iNOS-positive cells were associated with the constriction of distal lung parenchyma. This functional alteration may be due to a high expression of 8-isoprostane, which had a procontractile effect. The mechanism involved in this response is likely related to the modulation of NF-kB expression, which contributed to the activation of the arginase and iNOS pathways. The association of both inhibitors potentiated the reduction of 8-isoprostane expression in this animal model.

Atopy is not associated with poor control of asthma.

INTRODUCTION: Atopy is part of the immunopathology of allergic diseases; however, the effect of atopy on the prognosis of asthma in adult patients is not established yet. The aim of this study is to investigate whether there is an association between lack of control of asthma and sensitization to aeroallergens. The relation between rhinitis severity and atopy was also investigated. METHODS: Six hundred and thirty-nine patients aged ≥ 20 years with uncontrolled and untreated asthma were enrolled. They were followed for 1 year, received inhaled corticosteroids combined with long-acting beta-2 agonists, performed spirometry, skin prick test to aeroallergens, and reported emergency room visits due to asthma. Questionnaires (Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ)) were applied to evaluate asthma symptoms and quality of life. Rhinitis diagnosis and severity were evaluated. RESULTS: Baseline data demonstrated that atopic patients were younger and had earlier onset of asthma. Gender, body mass index, and lung function were similar between atopic and nonatopic patients. Low schooling had a borderline association with nonatopic asthma. Follow-up data demonstrated that there was no significant difference between atopic and nonatopic patients in asthma symptoms, quality of life, frequency of patients with uncontrolled asthma, emergency room visit, hospital admission, airway obstruction, nor response to treatment. Rhinitis severity was also similar between atopic and nonatopic individuals. CONCLUSIONS: In conclusion, positive skin prick test to common aeroallergens was not found to be predictor of asthma control among adults.

Cost-effectiveness analysis of a state funded programme for control of severe asthma.

BACKGROUND: Asthma is one of the most common chronic diseases and a major economical burden to families and health systems. Whereas efficacy of current therapeutical options has been clearly established, cost-effectiveness analysis of public health interventions for asthma control are scarce. METHODS: 81 patients with severe asthma (12-75 years) joining a programme in a reference clinic providing free asthma medication were asked retrospectively about costs and events in the previous 12 months. During 12 months after joining the programme, information on direct and indirect costs, asthma control by lung function, symptoms and quality of life were collected. The information obtained was used to estimate cost-effectiveness of the intervention as compared to usual public health asthma management. Sensitivity analysis was conducted. RESULTS: 64 patients concluded the study. During the 12-months follow-up within the programme, patients had 5 fewer days of hospitalization and 68 fewer visits to emergency/non scheduled medical visits per year, on average. Asthma control scores improved by 50% and quality of life by 74%. The annual saving in public resources was US$387 per patient. Family annual income increased US$512, and family costs were reduced by US$733. CONCLUSION: A programme for control of severe asthma in a developing country can reduce morbidity, improve quality of life and save resources from the health system and patients families.

Integralidade do cuidado de enfermagem do pré-natal ao puerpério / Completeness of nursing care from prenatal to puerperium

Objetivo: compreender a integralidade do cuidado de enfermagem do pré-natal ao puerpério. Método: pesquisa de campo, com abordagem qualitativa, realizada na unidade hospitalar, localizada na região metropolitana de Fortaleza/CE. A coleta de dados ocorreu no período de abril a maio de 2021, com a participação de 26 puérperas. Resultados: a mulher, no tocante à sua integralidade durante o ciclo do pré-natal ao puerpério, obteve um cuidado com o foco biológico, surgindo a família como um apoio para os aspectos emocionais. O enfermeiro é o profissional responsável pela criação da confiabilidade da gestante e família, durante o momento do pré-natal até o puerpério. Conclusão: a integralidade do cuidado desenvolvido pelo enfermeiro encontra desafios relacionados à necessidade de uma visão que contemple o processo saúde-doença que rodeia essa mulher.

Objective: To understand the comprehensiveness of nursing care from prenatal care to puerperium. Method: Field research, with a qualitative approach, carried out in a hospital located in the metropolitan region of Fortaleza/CE. Data collection took place from April to May 2021 with the participation of 26 postpartum women. Results: The woman, regarding her completeness during the cycle from prenatal to postpartum obtained a care with the biological focus, emerging the family as a support for the emotional aspects. The nurse is the professional responsible for creating the reliability of the pregnant woman and her family, from the prenatal period to postpartum. Conclusion: The integrality of care provided by nurses faces challenges related to the need for a vision that contemplates the health-disease process that surrounds this woman.

Metabolite profiling, antioxidant and antibacterial activities of Brazilian propolis: Use of correlation and multivariate analyses to identify potential bioactive compounds.

The production of propolis by honeybees results from a selective collection of exudates from various plant species and present many potentialities in the pharmaceutical industry. The objective of this study was to investigate the chemical profile of Brazilian propolis, as well as their in vitro antioxidant and antibacterial activities. Gas chromatography-mass spectrometry was applied for chemical profiling of propolis extracts. Total phenolic compounds were quantified by Folin-Ciocalteu and antioxidant properties were assessed by 2,2-diphenyl-1-picrylhydrazyl radical scavenging assay. Antibacterial activity was assessed against Staphylococcus aureus, Bacillus subtilis, and Micrococcus luteus. Correlation and multivariate statistical analysis were used to identify potential bioactive compounds in the extracts. Twenty-nine metabolites were identified along with 34 other metabolites that were classified into the following classes: triterpenoids (12), acetyltriterpenoids (3), sesquiterpenes (6), steroids (4), and hydrocarbons (9). The antioxidant capacity (IC50) ranged from 21.50 to 78.77µg/mL, whereas the content of total phenolic compounds ranged from 31.88 to 204.30mg GAE/g of dry weight. Total phenolic compounds and methyl retinoate showed a positive correlation with the antioxidant capacity, whereas tetradecanal, γ-palmitolactone and ethyl hydrocinnamate showed a negative correlation. Different sets of metabolites are shown to correlate with the antibacterial activity of the extracts, which is largely dependent on the type of microorganism. This innovative approach allowed us to identify likely bioactive compounds in the extracts, although the mechanism(s) underlying antibacterial activity encompass a complex trait, which might involve synergistic effects.

Diagnosis of pulmonary tuberculosis by score system in children and adolescents: a trial in a reference center in Bahia, Brazil.

Since 2002, the Brazilian Ministry of Health has recommended a score system for tuberculosis diagnosis of children and adolescents that does not need bacteriological positivity, because most cases in this age group have few bacteria. An observational, transversal study was carried out at the outpatient health care service of the reference medical service in Salvador, Bahia, including 164 patients with pulmonary tuberculosis, with ages ranging between 1 and 15 years of age, who were treated from 1990 to 2001. The gold standard used to establish the diagnosis was clinical, radiological, epidemiological and based on follow-up data. The score system for diagnosis purposes was tested retrospectively. The median age and the average age of the 164 patients were 6 and 6.62 years (SD +/- 4.33), respectively. About 65% of the sample reported a history of close contact with a tuberculous adult. The BCG vaccine coverage was 70.7% (116/164). It was found that 26% (43/164) of the patients had severe malnutrition. Out of this group, 26/43 (60.47%) were < 5 mm reactive to the tuberculin test. On the other hand, out of the 91 patients with tuberculin test < 5 mm, 29% (26/ 91) had severe malnutrition. The use of the score gave the following distribution: a) TB very likely in 81.7% (134/164) of the patients; b) possible TB in 15.9% (26/164) and TB unlikely in 2.4% (4/164). Among patients who had been vaccinated more than 2 years before, there was a 9 times higher risk of finding a tuberculin test above 10 mm in individuals with probable TB in comparison with the patients with possible or unlikely TB.

Clinical and radiological analysis of children and adolescents with tuberculosis in Bahia, Brazil.

We reviewed the clinical and radiological characteristics of tuberculosis (TB) in children and adolescents at the Hospital Especializado Octávio Mangabeira, (HEOM) in Salvador, Bahia. This study included 275 TB patients aged 1 to 15 years seen between January 1990 and November 2001. Standardized forms were filled out on the basis of a review of patient records and x-rays. Through a retrospective and descriptive analysis, it was found that 51.6% were male, 35.3% were aged 1 to 5 years, 28% were aged 6 to 10 and 36.7% were aged 11 to 15. Among all patients, 79.6% lived in the city of Salvador. A history of contact with TB was found in 63.9%, most frequently among children under 5 years old; 77.2% were vaccinated with Bacillus Calmette-Guerin (BCG). The most frequently observed symptoms were coughing (76%), fever (73.1%) weight loss (53.1%), and 4.7% were asymptomatic. Pulmonary TB was most frequent (57.8%) and extra-pulmonary TB occurred in 24.4%, with a predominance of hilar adenopathy. Both forms occurred simultaneously in 17.8%. In 53.1% of the cases the diagnosis was not determined by bacteriology or pathological anatomy; in these cases diagnosis was reached through clinical and radiological criteria, contact history, a tuberculin test > or = 10mm and a positive response to tuberculostatic drugs.

Pseudotumoral form of primary progressive tuberculosis: a diagnosis to be considered.

The diversity of clinical presentations of primary progressive tuberculosis (TB) and the difficulty in establishing the diagnosis of paucibacillary forms is the subject of painstaking research, as well as a cause of delay in therapy. We report the case of a 10-year-old black child who presented with chest pain and progressive widening of the upper mediastinum. Computerized tomography of the chest revealed multiple calcifications that were not identified with X-rays. Biopsy through mediastinoscopy was compatible with a diagnosis of tuberculosis. Despite exhaustive investigation that included direct examination, culture for mycobacteria and PCR (Polymerase Chain Reaction) of tissue samples, the etiologic agent was not revealed. Tuberculin conversion was observed during the follow-up and resolution period of the lesion, after administration of isoniazid, rifampicin and pyrazinamide. The nodal pseudotumoral form of tuberculosis is rare in immunocompetent children and it may simulate neoplastic disease; therefore, it should be included in the list of differential diagnoses of masses located in the anterosuperior mediastinum.

Prevalence of pathogens in cystic fibrosis patients in Bahia, Brazil.

INTRODUCTION: Recurrent respiratory infections account for most of the morbidity and mortality of cystic fibrosis patients. MATERIALS AND METHODS: The objective was to determine the prevalence of pathogens isolated from lower respiratory tract secretions in cystic fibrosis patients. In this descriptive observational study, data from 69 patients was collected from medical records. RESULTS: The microorganisms that were identified included 36.2 P. aeruginosa, 28.9% S. Aureus, 4.3% K. pneumoniae, 1.5% H. influenzae, 1.5% E. coli, 1.5% S. maltoophilia, and in 27.5% the flora was normal. The prevalence of P. aeruginosa was 83% in patients under two years of age, demonstrating early colonization. CONCLUSION: P. aeruginosa and S. aureus were the most prevalent pathogens; there was also early infection/colonization by P. aeruginosa. This information will contribute to improved therapeutic measures for patients of the Bahia Cystic Fibrosis Reference Center.

Clinical characteristics and prognosis in near-fatal asthma patients in Salvador, Brazil.

OBJECTIVE: To determine the frequency of near-fatal asthma in a group of severe asthma patients, as well as the clinical characteristics and prognosis of these patients within a one-year follow-up period. METHODS: A prospective study involving 731 low-income patients with severe asthma treated at a referral outpatient clinic located in the city of Salvador, Brazil. The patients were submitted to spirometry at admission, received medications for asthma, and were monitored regarding the frequency of asthma exacerbations during the follow-up period. A subsample of 511 patients also completed questionnaires regarding asthma symptoms and asthma-related quality of life. RESULTS: Of the 731 patients studied, 563 (77%) were female. The median age was 47 years, and 12% were illiterate. Most of the patients had rhinitis, and 70 patients (10%) reported near-fatal asthma prior to admission. Of these 70 patients, 41 (59%) reported having been intubated previously. The patients reporting a history of near-fatal asthma at admission were more likely to have asthma exacerbations during the follow-up period and to respond poorly to therapy than were those not reporting such a history. At the end of the follow-up period, the scores on the two questionnaires were similar between the two groups of patients. CONCLUSIONS: The frequency of near-fatal asthma was high in this group of low-income patients with severe asthma. The patients with a history of near-fatal asthma had a worse prognosis than did those without such a history, although both groups had received the same kind of treatment. Curiously, the intensity of symptoms and the quality of life at the end of the study were similar between the two groups.

The impact of a program for control of asthma in a low-income setting.

The prevalence of asthma is increasing in developing countries and the burden of uncontrolled asthma affects patients, families, and the health system. This is to summarize, evaluate, and discuss previous reports on the impact of a targeted and comprehensive approach to the most severe cases of asthma in a low-income setting. A Program for Control of Asthma (ProAR) was developed in Salvador, Bahia, Brazil, prioritizing the control of severe asthma. By facilitating referrals from the public health system and providing proper multidisciplinary but simple management including education and medication, for free, the Program enrolled 2385 patients in 4 reference clinics. They are offered regular follow up and discharged back to primary health care only when asthma control can be maintained without requirement of a combination of an inhaled corticosteroid and a long-acting ß2 agonist. ProAR has markedly reduced health resource utilization and decreased the rate of hospital admissions because of asthma in the entire City (2.8 million inhabitants) by 74%. Moderate to severe rhinitis was associated with lack of control of asthma. The average income of the families in the ProAR was US$2955 a year, and they spent 29% of all their income attempting to control the severe asthma of one member, a unbearable expenditure for a low-income family. The ProAR was shown to be cost-effective, reducing costs to the public health system (US$387 patient/year) and the families (US$789 patient/year). In a low-income setting of Brazil, an intervention prioritizing the control of severe asthma was feasible, effective, and reduced costs.

Adherence to nutritional recommendations and sociodemographic variables in patients with diabetes mellitus / Adhesión a las recomendaciones de nutrición y variables sociodemográficas en pacientes con diabetes mellitus / Adesão às recomendações nutricionais e variáveis sociodemográficas em pacientes com diabetes mellitus

OBJECTIVETo determine if there is a relationship between adherence to nutritional recommendations and sociodemographic variables in Brazilian patients with type 2 diabetes mellitus.METHODSCross-sectional observational study using a stratified random sample of 423 individuals. The Food Frequency Questionnaire (FFQ) was used, and the Fisher's exact test was applied with 95% confidence interval (p<0.05).RESULTSOf the 423 subjects, 66.7% were women, mean age of 62.4 years (SD = 11.8), 4.3 years of schooling on average (SD = 3.6) and family income of less than two minimum wages. There was association between the female gender and adherence to diet with adequate cholesterol content (OR: 2.03; CI: 1.23; 3.34), between four and more years of education and adherence to fractionation of meals (OR: 1 92 CI: 1.19; 3.10), and income of less than two minimum wages and adherence to diet with adequate cholesterol content (OR: 1.74; CI: 1.03, 2.95).CONCLUSIONAdherence to nutritional recommendations was associated with the female gender, more than four years of education and family income of less than two minimum wages.

OBJETIVOVerificar si hay relación entre la adhesión a las recomendaciones de nutrición y las variables sociodemográficas de pacientes brasileños con diabetes mellitus tipo 2.MÉTODOSEstudio observacional seccional, con muestra aleatoria estratificada constituida de 423 individuos. Se utilizó el Cuestionario de Frecuencia de Consumo Alimentario. Se aplicó el Test Exacto de Fisher con intervalo de confianza del 95% (p-valor<0,05).RESULTADOSDe los 423 sujetos, el 66,7% eran mujeres, promedio de edad de 62,4 (DP=11,8) años, promedio de años de estudio de 4,3 (DP=3,6) y renta familiar inferior a dos sueldos mínimos. Se encontró asociación entre sexo femenino y adhesión a la dieta con adecuado contenido de colesterol (OR:2,03; IC:1,23;3,34), entre cuatro años y más de estudio y adhesión al fraccionamiento de las comidas (OR:1,92; IC:1,19;3,10), renta inferior a dos sueldos mínimos y adhesión a la dieta con adecuado contenido de colesterol (OR:1,74; IC:1,03;2,95).CONCLUSIÓNLa adhesión a las recomendaciones de nutrición estuvo asociada con el sexo femenino, escolaridad superior a cuatro años y renta familiar inferior a dos sueldos mínimos.

OBJETIVOVerificar se há relação entre a adesão às recomendações nutricionais e variáveis sociodemográficas de pacientes brasileiros com diabetes mellitus tipo 2.MÉTODOSEstudo observacional seccional, com amostra aleatória estratificada constituída por 423 indivíduos. Utilizou-se o Questionário de Frequência de Consumo Alimentar. Aplicou-se o Teste Exato de Fisher com intervalo de confiança de 95% (p-valor<0,05).RESULTADOSDos 423 sujeitos, 66,7% eram mulheres, média de idade 62,4 (DP=11,8) anos, média de anos de estudo de 4,3 (DP=3,6) e renda familiar inferior a dois salários mínimos. Foi encontrada associação entre sexo feminino e adesão à dieta com adequado teor de colesterol (OR:2,03; IC:1,23;3,34), entre quatro anos e mais de estudo e adesão ao fracionamento das refeições (OR:1,92; IC:1,19;3,10), renda inferior a dois salários mínimos e adesão à dieta com adequado teor de colesterol (OR:1,74; IC:1,03;2,95).CONCLUSÃOA adesão às recomendações nutricionais foi associada ao sexo feminino, escolaridade superior a quatro anos e renda familiar inferior a dois salários mínimos.

Alcohol consumption and emotional problems related to diabetes mellitus / Consumo de álcool e problemas emocionais relacionados ao diabetes mellitus / Consumo de alcohol y problemas emocionales relacionados a la diabetes mellitus

This study aimed to analyze the use of alcohol and emotional problems in patients with diabetes. The convenience sample consisted of 82 patients with type 2 diabetes in two centers of university extension in 2010. For data collection we used the Alcohol Use Disorders Identification Test and the Problem Areas in Diabetes. The results showed that 93.9% of patients had low risk for alcohol and 21.9% rated their emotional problems as relevant. We conclude that alcohol use and emotional problems are important variables for planning a diabetes education program...

Este estudo teve como objetivo analisar o uso de álcool e os problemas emocionais de pacientes com diabetes. A amostra de conveniência foi constituída por 82 pacientes com diabetes tipo 2, em dois centros de extensão universitária, em 2010. Para coleta de dados, foram utilizados os instrumentos Alcohol Use Disorder Identification Test e o Problem Areas in Diabetes. Os resultados mostraram que 93,9% dos pacientes apresentaram baixo risco para uso de álcool e 21,9% classificaram os problemas emocionais enfrentados como relevantes. Conclui-se que o uso de álcool e os problemas emocionais constituem variáveis importantes para o planejamento de programa educativo em diabetes...

Este estudio tuvo como objetivo analizar el uso de alcohol y los problemas emocionales de pacientes con diabetes. La muestra de conveniencia fue constituida por 82 pacientes con diabetes tipo 2 en dos centros de extensión universitaria, en 2010. Para recogida de datos fueron utilizados los instrumentos Alcohol Use Disorder Identification Test y el Problem Areas in Diabetes. Los resultados mostraron que 93,9% de los pacientes presentaron bajo riesgo para uso de alcohol y 21,9% clasificaron los problemas emocionales enfrentados como relevantes. Se concluye que el uso de alcohol y los problemas emocionales constituyen variables importantes para la planificación de programa educativo en diabetes...

[Digital cervicography criteria: improving sensitivity in uterine cervical cancer diagnosis]. / Critérios de positividade para cervicografia digital: melhorando a sensibilidade do diagnóstico do câncer cervical.

This study aimed to validate the scoring criteria for digital cervicography. The study enrolled 300 women submitted to a clinical protocol using cytological examination alone, digital cervicography without image magnification (Evaluation 1), and digital cervicography plus additional image magnification and considering the positive criteria (Evaluation 2). Women's mean age was 27.6 years. Positive criteria for digital cervicography were identified in 111 positive cases with pre-cancerous cervical lesions (100%) and in 8 cases classified as false positives (2.6%). Evaluations 1 and 2 classified the tests as positive (163; 54.3%) and suspected (146; 48.6%), respectively. According to the findings, digital cervicography was more sensitive (99.1%) and cytology more specific (100%). Digital cervicography sensitivity increased by 4.5 times when the positive criteria were applied as compared to cytology alone, besides involving low cost, thus suggesting that it is a viable technique.

Análise dos níveis pressóricos em gestantes no diagnóstico precoce da síndrome hipertensiva gestacional / Blood pressure analysis among pregnant women for an early diagnosis of gestational hypertensive syndrome / Análisis de los niveles presóricos en gestantes en el diagnóstico precoz del síndrome hipertensivo gestacional

O objetivo foi comparar os níveis pressóricos em gestantes aferidos na sala de preparo de um Centro de Saúde da Família com as medidas verificadas no consultório seguindo as Diretrizes Brasileiras de Hipertensão. Estudo comparativo e quantitativo tendo como amostra 94 gestantes. A coleta de dados ocorreu no período de setembro a novembro de 2011 em duas etapas: a primeira se consistiu da coleta dos valores da PA aferidos rotineiramente pelos funcionários da sala de preparo, nesta foi realizada observação da técnica de aferição da PA. A segunda etapa ocorreu no consultório no qual foi realizada aferição da PA seguindo a VI Diretrizes Brasileiras de Hipertensão. Foram encontradas disparidades em 87% das aferições variando de -38 a 28mmHg para pressão sistólica e -26 a 20mmHg para pressão diastólica. Conclui-se que existe diferença significativa entre as medidas de pressões arteriais verificadas rotineiramente na sala de preparo e as medidas realizadas no consultório.

The objective was to compare the blood pressure (BP) levels of pregnant women, measured in a preparation room of a Family Health Center and verified in the consultation room following the Brazilian Guidelines for Hypertension. This comparative and quantitative study was performed with 94 pregnant women. Data collection was conducted between September and November of 2011 in two phases: the first consisted of collecting BP measurements by the preparation room staff, and observing the technique used for the measurement. The second phase occurred in the consultation room, when the BP was measured once again, following the 6th Brazilian Guidelines for Hypertension. Differences were observed in 87% of the measurements, ranging from - 38 to 28mmHg for systolic BP and - from 26 to 20mmHg for diastolic BP. It is concluded that a significant difference exists between the BP measurements taken in the preparation room and those taken in the consultation room.

Se objetivó comparar niveles presóricos en gestantes medidas en sala de preparto de un Centro de Salud de la Familia con las medidas verificadas en consultorio, siguiendo las Directivas Brasileñas de Hipertensión. Estudio comparativo y cuantitativo, con muestra de 94 gestantes. Datos recolectados de setiembre a noviembre de 2011 en dos etapas: la primera consistió en recolección de valores de PA medidos rutinariamente por los empleados de la sala de preparto, en ésta se realizó observación de la técnica de medición de PA. La segunda etapa aconteció en el consultorio donde fue efectuada medición de PA siguiendo las VI Directivas Brasileñas de Hipertensión. Fueron encontradas disparidades en 87% de las mediciones, variando de -38 a 28mmHg para presión sistólica y -26 a 20mmHg para diastólica. Se concluye en que existe diferencia significativa entre las medidas de presiones arteriales verificadas rutinariamente en sala de preparto y las realizadas en consultorio.

Acceptance of digital cervicography complementary to Papanicolaou cytology: a descriptive-exploratory study / Aceptación de la cervicografía digital complementar la citología de papanicolaou: estudio descriptivo exploratorio / Aceitação da cervicografia digital complementar a citologia de papanicolaou: estudo descritivo-exploratório

Aim: Analyze the acceptability of digital cervicography as a complementary method to Papanicolaou cytology for diagnosing cervical cancer. Method: An exploratory-descriptive study, quantitative approach. The survey had 63 participants and data was collected between June and August 2012. For data evaluation we used the results of cytologic collection and digital cervicography. Result: 100% of acceptance verified within participants. Regarding the Papanicolaou cytology, 96.8% of glandular, 8% of metaplastic, and 100% of squamous epithelium were found. Inflammation was found in 58.6% of the sample and malignant cell alterations in 1.6%. Discussion: The low sensitivity level of Papanicolaou cytology and the good acceptability rates of digital cervicography suggest the complementarity of these for cancer diagnosis. Conclusion: The implementation of digital cervicography as an exam complementary to Papanicolaou cytology is of great importance in order to increase the sensitivity level at cervical cancer detection.

Objetivo: evaluar la aceptación de la Cervicografia Digital como método complementar a la citología de Papanicolaou para diagnóstico del cáncer de cuello uterino. Método: estudio descriptivo exploratorio, enfoque cuantitativo. La investigación conto con 63 participantes, los datos fueron recolectados entre junio y agosto de 2012. Para evaluación de los datos se tuvo el resultado de recolección citológica, y la cervicografia digital. Resultado: Se verifico 100% de aceptabilidad de la cervicografia digital entre las participantes. Cuanto al examen de Papanicolaou, se verifico 100% de epitelio escamoso, 96,8%, glandular e 8%, metaplásico. La inflamación estuvo presente en 58,6% de la muestra y las alteraciones celulares malignas en 1,6%. Discusión: La baja sensibilidad de la citología de Papanicolau y la buena aceptabilidad y eficacia de la cervicografia digital sugiren a complementariedad de estos en el diagnóstico del cáncer. Conclusión: La implementación de la cervicografia digital como examen complementar a citología de Papanicolaou es de grande valia para aumentar la sensibilidad en el rastreo del cáncer de cuello uterino.

Objetivo: avaliar a aceitação da Cervicografia Digital como método complementar a citologia de Papanicolaou para diagnóstico do câncer de colo uterino. Método: estudo descritivo-exploratório, abordagem quantitativa. A pesquisa contou com 63 participantes, os dados foram coletados entre junho e agosto de 2012. Para avaliação dos dados teve-se o resultado da coleta citológica, e a cervicografia digital. Resultado: Verificou-se 100% de aceitabilidade da cervicografia digital entre as participantes. Quanto ao exame de Papanicolaou, verificou-se 100% de epitélio escamoso, 96,8%, glandular e 8%, metaplásico. A inflamação esteve presente em 58,6% da amostra e as alterações celulares malignas em 1,6%. Discussão: A baixa sensibilidade da citologia de Papanicolau e a boa aceitabilidade e eficácia da cervicografia digital sugerem a complementariedade destes no diagnóstico do câncer. Conclusão: A implementação da cervicografia digital como exame complementar a citologia de Papanicolaou é de grande valia para aumentar a sensibilidade no rastreamento do câncer de colo uterino.

Impact that a program to control severe asthma has on the use of Unified Health System resources in Brazil.

OBJECTIVE: To quantify the use of health care resources among patients enrolled in the Bahia State Asthma and Allergic Rhinitis Control Program. METHODS: As of January of 2006, 1405 patients had enrolled in the program, which is carried out in four referral centers in the city of Salvador. These patients formed the basis of this retrospective/prospective, observational cohort study. The preliminary analysis involved 269 consecutive patients, all above the age of 12 and diagnosed with severe asthma. After being seen by pulmonologists, nurses, pharmacologists and psychologists, the patients received inhaled asthma medications. Based on patient interviews and charts, the year preceding enrollment in the program was compared with the first year enrolled in the program in terms of the following quantifiable parameters: hospital admissions; emergency room visits; courses of oral corticosteroids; and days of school/work missed due to asthma attacks. RESULTS: In this sample of patients with severe asthma, enrollment in the program resulted in significant reductions in the number of emergency room visits and hospital admissions (of 85% and 90%, respectively). There were also reductions in the number of school/work days missed due to asthma attacks and in the number of courses of oral corticosteroids (of 86% and 67%, respectively). CONCLUSION: A program designed to control severe asthma in referral outpatient clinics and including pharmacological services at no charge can lead to a pronounced reduction in the demand for Unified Health Care System resources.

Estimativa do fluxo dos resíduos de equipamentos elétricos e eletrônicos no município de Belo Horizonte, Minas Gerais, Brasil / Flow of e-waste at the city of Belo Horizonte, Minas Gerais, Brazil

O objetivo deste trabalho foi determinar o fluxo dos resíduos de equipamentos elétricos e eletrônicos (REEE) no município de Belo Horizonte - Minas Gerais, Brasil. Para atingir o objetivo, pesquisaram-se a estimativa de geração, a quantidade e o peso dos materiais recicláveis e de substâncias tóxicas presentes. Os resultados mostraram que o potencial de geração é de 153 mil toneladas de resíduos para o período de 2008 a 2023, e a principal destinação dada pelos consumidores particulares para o descarte desses resíduos é a doação. Concluiu-se que as iniciativas de gerenciamento ambientalmente adequadas são oriundas de iniciativas privadas e aplicadas somente em equipamentos de informática e telefonia móvel, e que os demais resíduos estão sendo manipulados sem as devidas precauções de saúde e segurança do trabalhador, bem como dispostos de forma irregular.

The aim of this study was to obtain an understanding of the flow of e-waste at the city of Belo Horizonte - Minas Gerais, Brazil. An estimative of the amount of e-waste generated and the domestic and second hand flow were investigated to achieve this goal. The results estimated approximately 153,000 tones of e-waste generated for the period of 2008 to 2023, and the main domestic disposal given by the consumers is donation. We concluded that the environmental management initiatives usually comes from the private sector and are applied to computers and mobile phones only. Other e-wastes are handled using improper tools, creating health and safety hazards for the workers, as well as those e-wastes have been arranged in an irregular way.