Saúde Cardiovascular e Fibrilação ou Flutter Atrial: Um Estudo Transversal do ELSA-Brasil / Cardiovascular Health and Atrial Fibrillation or Flutter: A Cross-Sectional Study from ELSA-Brasil

Resumo Fundamento A associação entre o status de saúde cardiovascular ideal ( ideal cardiovascular health ( ICVH) e diagnóstico de fibrilação ou flutter atrial (FFA) foi menos estudado em comparação a outras doenças cardiovasculares. Objetivos Analisar a associação entre o diagnóstico de FFA e métricas e escores de ICVH no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos Este estudo analisou dados de 13141 participantes com dados completos. Os traçados eletrocardiográficos foram codificados de acordo com o Sistema de Minnesota, em um centro de leitura centralizado. As métricas do ICVH (dieta, atividade física, índice de massa corporal, tabagismo, glicemia de jeju, e colesterol total) e escores do ICVH foram calculados conforme proposto pela American Heart Association . Modelos de regressão logística bruta e ajustada foram construídos para analisar associações de métricas e escores do ICVH com diagnóstico de FFA. O nível de significância foi estabelecido em 0,05. Resultados A idade mediana da amostra foi de 55 anos, e 54,4% eram mulheres. Nos modelos ajustados, os escores de ICVH não apresentaram associação significativa com diagnóstico de FFA prevalente [odds ratio (OR):0,96; intervalo de confiança de 95% (IC95%):0,80-1,16; p=0,70). Perfis de pressão arterial ideal (OR:0,33; IC95%:0,1-0,74; p=0,007) e colesterol total ideal (OR:1,88; IC95%:1,19-2,98; p=0,007) foram significativamente associados com o diagnóstico de FFA. Conclusões Não foram identificadas associações significativas entre escores de ICVH global e diagnóstico de FFA após ajuste multivariado em nossas análises, devido, ao menos em parte, às associações antagônicas da FFA com métricas de pressão arterial e de colesterol total do ICVH. Nossos resultados sugerem que estimar a prevenção da FFA por meio de escore de ICVH global pode não ser adequado, e as métricas do ICVH devem ser consideradas separadamente.

Abstract Background The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. Objective To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. Results The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15-0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19-2.98; p=0.007) profiles were significantly associated with AFF diagnosis. Conclusions No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.

Evaluation of an undergraduate occupational health program in Iran based on alumni perceptions: a structural equation model / 보건의료교육평가

PURPOSE: Evaluating educational programs can improve the quality of education. The present study evaluated the undergraduate occupational health program at the Semnan University of Medical Sciences in Semnan, Iran, with a focus on the associations between alumni perceptions of the learning environment and the outcomes of the occupational health program. METHODS: A cross-sectional questionnaire survey was conducted among alumni of the undergraduate occupational health program. We asked alumni to rate their perceptions of the items using a 4-point Likert scale. The associations between alumni perceptions of the educational program and curriculum, faculty, institutional resources, and learning outcomes were modeled and described using structural equation modeling procedures. RESULTS: A descriptive analysis of alumni perceptions indicated low evaluations for the administrative system, practical and research-based courses, and the number of faculty members. We found that a structural model of the evaluation variables of curriculum, faculty qualifications, and institutional resources significantly predicted undergraduate educational outcomes. The curriculum had direct and indirect effects on learning outcomes, mediated by faculty. CONCLUSION: The findings of our study highlight the usefulness of the structural equation modeling approach for examining links between variables related to the learning process and learning outcomes. Surveys of alumni can provide data for reassessing the learning environment in the light of the professional competencies needed for occupational health graduates.

Impact of histopathological profile on disease progression of breast cancer patients during the 1st 1-2 years follow-up: Evidence from the Philippine DOH-Breast Cancer Medicine Access Program

INTRODUCTION: Current international consensus confirms that certain histopathologic factors such as tumor morphology, histologic grade and presence of lymphovascular invasion are correlated with prognosis. This retrospective cohort study evaluated the correlation between histopathologic profile and time to disease progression (UP) within the first 1-2 years follow-up of Filipino Stage I-Ill early breast cancer patients.METHODS: This is a retrospective cohort study which included breast cancer patients enrolled in the Department of Health¬Breast Cancer Medicine Access Program (DOH-BCMAP) at the medical oncology clinics of two tertiary hospitals in Manila. Clinical and histopathologic factors were gathered from patient records, and the patients were grouped according to the modified St. Gallen definition of risk categories for patients with breast cancer. Kaplan-Meier survival analysis determined the average UP as well as progression-free survival (PFS). Multivariate logistic regression determined factors contributing to disease progression.RESULTS AND CONCLUSION: Of the 326 patients enrolled in this study, 18% showed progression, with a median HP of 14 months. UP was comparable among the low-, intermediate- and high-risk groups. PFS during the 1st 1-2 years follow-up was estimated to be at 78% for the high-risk group, 83% for the intermediate-risk group, and 86% for the low-risk group. During this 1st 1-2 years follow-up, no studied factors of interest were shown to be significantly correlated with outcome among this predominantly intermediate to high risk for recurrence breast cancer patients. Follow-up of this patients up to 5 or more years would define sustained gains from the DOH-BCMAP.

Khmer American Mothers' Knowledge about HPV and HBV Infection and Their Perceptions of Parenting: My English Speaking Daughter Knows More

PURPOSE: The purpose of this study is to explore and describe Khmer mothers' understanding of HBV and HPV prevention as well as their perception of parenting on health and health education of their daughters in the US. METHODS: The qualitative pilot study guided by the revised Network Episode Model and informed by ethnographic analysis and community-based purposive sampling method were used. Face-to-face audiotaped interviews with eight Khmer mothers were conducted by bilingual female middle-aged community health leaders who spoke Khmer. RESULTS: The findings revealed that Khmer mothers clearly lacked knowledge about HBV and HPV infection prevention and had difficulty understanding and educating their daughters about health behavior, especially on sex-related topics. The findings showed that histo-sociocultural factors are integrated with the individual factor, and these factors influenced the HBV and HPV knowledge and perspective of Khmer mothers' parenting. CONCLUSIONS: The study suggests that situation-specific conceptual and methodological approaches that take into account the uniqueness of the sociocultural context of CAs is a novel method for identifying factors that are significant in shaping the perception of Khmer mothers' health education related to HBV and HPV prevention among their daughters. The communication between mother and daughter about sex and the risk involved in contracting HBV and HPV has been limited, partly because it is seen as a "taboo subject" and partly because mothers think that schools educate their children regarding sexuality and health.

Measuring adolescents' perceptions of parenting style during childhood: psychometric properties of the parenting styles and dimensions questionnaire / Medindo a percepção dos estilos parentais de adolescentes durante a infância: as propriedades psicométricas do estilo parental e do questionário de dimensões

The paper analyzes the psychometric properties of the G1 version of the Parenting Styles and Dimensions Questionnaire, a self-report instrument designed to investigate how adolescents or adults were parented during childhood. The sample included 1451 Italian adolescents in high school. Three studies tested the scale's structure, invariance, and convergent validity. The first found slightly acceptable fit indexes for a 40-item scale measuring three factors (authoritative, authoritarian, and permissive styles); the factors presented good reliability (ρc .62-.96). Multigroup confirmative analyses found factor loadings invariant in the father version, whereas 12 items resulted not invariant in the mother version (second study). Good convergent validity was found with the Parental Bonding Index and the Parental Monitoring Scale (third study). Discussion of results is provided within the parenting styles literature...

O presente trabalho analisa as propriedades psicométricas da versão G1 do Parenting Styles and Dimensions Questionnaire (Questionário de Estilo e Dimensões de Parentalidade), um instrumento de autorrelato projetado para investigar retrospectivamente como adolescentes ou adultos foram criados durante a infância. A amostra incluiu 1451 adolescentes italianos cursando o ensino médio. Três estudos foram apresentados, nos quais a estrutura da escala, sua invariância, e sua validade convergente são testadas. O primeiro estudo encontrou índices ligeiramente aceitáveis para uma escala de 40 itens medindo três fatores (estilos autoritativo, autoritário, permissivo); os fatores apresentaram uma boa confiabilidade (ρcrange .62-.96). Análises confirmativas multigrupo descobriram que as cargas de fatores foram invariantes, na versão do pai, enquanto que doze itens resultaram não invariantes na versão da mãe. Uma boa validade convergente foi encontrada com Parental Bonding Index, e Parental Monitoring Scale no terceiro estudo. A discussão dos resultados é provida na literatura de estilos parentais...

A Prospective, Randomized, Placebo-Controlled, Trial Comparing the Effectiveness of Gabapentin, Ondansetron & Dexamethasone in Prevention of Nausea &Vomiting after Laparoscopic Cholecystectomy.

Gabapentin is an anticonvulsant drug that has been shown useful in postoperative nausea and vomiting (PONV). AIM: We compared the effects of gabapentin on PONV with ondansetron, dexamethasone and placebo in patients undergoing laparoscopic cholecystectomy under general anesthesia. One-hundredtwenty patients undergoing elective laparoscopic cholecystectomy were randomly assigned to one of the following four groups: gabapentin group (G) received 600mg oral gabapentin capsule two hours before surgery +IV 2ml saline 10-15 minutes before surgery; ondansetron group (O) received an oral placebo two hours before surgery +IV 4mg ondansetron 10-15 minutes before surgery; dexamethasone group (D) received oral placebo two hours before surgery +IV 8mg dexamethasone 10-15 minutes before surgery and placebo group (P) received oral placebo two hours before surgery +IV 2ml saline 10-15 minutes before surgery. Granisetron IV 1mg was used as rescue medication for emesis. Nausea and vomiting were assessed by direct questioning of the patients at 1, 2, 6, 12 and 24 hours after surgery. RESULTS: We found that the incidence of PONV (by simple yes or no) in first 24 hours was significantly lower in gabapentin (40%) dexamethasone (30%) and ondansetron group (36.7%) as compared to placebo group (66.7%) (P<0.05). The number of patients requiring rescue antiemetics was significantly decreased in gabapentin (30%), dexamethasone (26.7%) and ondansetron (26.7%) group versus placebo group (60%) (P<0.05). Gabapentin is as effective as ondansetron and dexamethasone as an antiemetic in laparoscopic cholecystectomy patients.

Parasitoses intestinais de indígenas da comunidade Mapuera (Oriximiná, Estado do Pará, Brasil): elevada prevalência de Blastocystis hominis e encontro de Cryptosporidium sp e Cyclospora cayetanensis / Intestinal parasitosis in Indians of the Mapuera community (Oriximiná, State of Pará, Brazil): high prevalence of Blastocystis hominis and finding of Cryptosporidium sp and Cyclospora cayetanensis

Foi avaliada a ocorrência de parasitoses intestinais em indígenas da aldeia Mapuera (Oriximiná, Estado do Pará, Brasil). No contexto de apreciações congêneres, expressa contribuição para adequado conhecimento do assunto, significativo sob o ponto de vista médico-sanitário. O exame parasitológico das fezes, de 83 pessoas, realizado por meio de quatro métodos, pode ser considerado como dotado de razoável amplitude para estabelecer diagnósticos. Ocorreu encontro de cistos de protozoários e de ovos de helmintos de múltiplos tipos, até mesmo em expressivas porcentagens, merecendo destaque a muito freqüente presença de Blastocystis hominis (57,8 por cento), como também o encontro de Cryptosporidium sp (3,6 por cento) e de Cyclospora cayetanensis (10,8 por cento), comentado especificamente. O verificado demonstra que tais índios vivem em ambiente onde prevalecem más condições higiênicas, em especial, facilitador da disseminação de protozoários e helmintos pelo contato com o solo ou ingestão de água e alimentos contaminados.

Occurrences of intestinal parasitosis in Indians of the Mapuera community (Oriximiná, State of Pará, Brazil) were evaluated. Within the context of group assessment, this study makes a contribution towards adequate knowledge of this subject, which is significant from a medical-sanitary point of view. Parasitological examination of feces from 83 individuals, performed using four different methods, could be considered to have reasonable amplitude for establishing diagnoses. Protozoan cysts and helminth eggs of many types were found, even with significant percentages. The frequent presence of Blastocystis hominis (57.8 percent), along with findings of Cryptosporidium sp (3.6 percent) and Cyclospora cayetanensis (10.8 percent), deserved highlighting with specific comments. The findings show that these Indians live in an environment in which poor hygiene conditions prevail. In particular, these facilitate the dissemination of protozoa and helminths through contact with the soil or through intake of contaminated water and food.

Assessment of right ventricular function in children with congenital heart disease Doppler tissue imaging

To assess right ventricular dysfunction in children with congenital heart disease [CHD] by measurement of tricuspid annular diastolic velocity Aa/Ea ratio by doppler tissue imaging [DTI]. A case-control study was performed on 141 children with CHD who were referred to Aliasghar Hospital of Zahedan, Iran for cardiac catheterization from April 2004 to December 2005. Tricuspid inflow velocity [A/E ratio] and Aa/Ea ratio was measured by DTI. Patients were catheterized afterwards. Cumulative data were analyzed by Statistical Package for Social Sciences and evaluated using t-test and correlation. There was significant correlation between Aa/Ea ratio by DTI, and hemodynamic criteria derived at catheterization. It was also diagnosed that 77 patients of 141 had right ventricular dysfunction by DTI, whereas 74 of them showed this problem at catheterization. The sensitivity of this method for evaluation of right ventricular dysfunction was 95%, and specificity was 98%. The positive predictive value 95%, and negative predictive value 98% were assessed. Finding of this study showed that we can use DTI for diagnosis of right ventricular dysfunction in children with CHD, and it can be used instead of catheterization especially in unstable patients

Uma avaliação sobre a eficácia do método CSF no diagnóstico de helmintíases intestinais / An evaluation of the efficacy of the CSF method for diagnosing intestinal helminthiases

O método CSF, recentemente proposto para diagnóstico de helmintíases intestinais foi comparado com outros (direto; Faust e cols; sedimentação espontânea em água; Kato-Katz) habitualmente usados com essa finalidade. Houve desempenho satisfatório, revelando que tal técnica pode ser adotada em tarefas para diagnóstico ou análise epidemiológicas.

The recently proposed CSF method for diagnosing intestinal helminthiases was compared with the other methods (direct; Faust et al.; spontaneous sedimentation in water; and Kato-Katz) that are routinely for this purpose. The CSF method performed satisfactorily, thus showing that this technique can be adopted for use in diagnoses or epidemiological analyses.

Observações sobre Blastocystis hominis e Cyclospora cayetanensis em exames parasitológicos efetuados rotineiramente / Observations on Blastocystis hominis and Cyclospora cayetanensis in routine parasitological examinations

Relatamos algumas observações, efetuadas com exames parasitológicos de fezes, em atividades rotineiras: os métodos de Faust e cols e de sedimentação espontânea em água não servem para evidenciação de Blastocystis hominis; foram encontradas expressivas porcentagens de presença desse protozoário, sobretudo quando realizada coloração pela hematoxilina férrica; houve 0,7 por cento de registro de positividade para Cyclospora cayetanensis, sugerindo inclusão habitual de pesquisa, por técnicas apropriadas, de tal parasita.

We report some observations made from routine parasitological examinations on feces. The methods of Faust et al. and of spontaneous sedimentation in water are not enough to identify Blastocystis hominis. Significant percentage presence of this protozoan was found, especially when staining with iron hematoxylin was performed. Cyclospora cayetanensis was found in 0.7 percent of the cases, which suggests that this parasite should also routinely be investigated by appropriate techniques.

Elevada porcentagem de blastocistose em escolares de São Paulo, SP / Blastocystosis: a high proportion of cases found in schoolchildren of São Paulo, State of São Paulo, Brazil

Em exame parasitológico de fezes de 227 alunos de escola pública de São Paulo (SP), encontramos 87 (38,3 por cento) positivas para Blastocystis hominis. A blastocistose ainda suscita controvérsias e indefinições, merecedoras de esclarecimentos sobretudo para evitar contratempos no âmbito da saúde pública e das atenções médico-assistenciais.

Blastocistose: controvérsias e indefinições / Blastocystosis: controversy and ill-defined

A blastocistose, enterite devida ao Blastocystis hominis, ainda causa controvérsias. É comum verificar que expressivo número de médicos, patologistas e profissionaisque exercem atividades no âmbito da saúde pública conhecem ainda pouco sobre aspectos nosológicos desse protozoário. Essa situação faz com que, por vezes, sejam adotadas condutas inadequadas na clínica...

Blastocistose: controvérsias e indefinições / Blastocystosis: controversy and indefinedness

Blastocistose é a infecçäo causada pelo Blastocystis hominis. Está relacionada com várias controvérsias e indefinições, sem dúvida muito importantes sobretudo pelas implicações médico-assistenciais que suscitam. A propósito, pendência expressiva diz respeito à patogenicidade do referido protozoário, que precisa ser categoricamente definida. Ao lado dessa particularidade outros assuntos exigem elucidações através de pesquisas bem conduzidas, para que a blastocistose fique devidamente situada no contexto da saúde pública. Aspecto também digno de atençäo é o diagnóstico pelo exame parasitológico de fezes, necessariamente executável por meio de métodos adequados, como o direto e os permanentes, exemplificados pelos que usam a a hematoxilina férrica ou a tionina. O emprego de técnicas impróprias propicia resultados falsos-negativos, conturbando o aconselhável bom conhecimento da real participaçäo do microrganismo em questäo

Conservação de oocistos de Cryptosporidium em fezes para exame parasitológico / Preservation of Cryptosporidium oocystis in fecal specimens for parasitological examination

Por meio de dispositivo facilmente acessível que contém formol a 10 por cento tamponado, dispensa refrigeraçäo, permite execuçäo de maneira higiênica, evita o mau odor e garante biossegurança é possível evidenciar satisfatoriamente oocistos de Cryptosporidium em fezes, sendo utilizado o método de Kinyoun. O sistema possibilita conservaçäo adequada até durante período prolongado, facilitando a execuçäo de tarefas assistências e epidemiológicas

Microwave treatment of human milk to prevent transmission of Chagas disease

It is recognized that breast feeding is an alternative means of transmission of Chagas disease. However, thermal treatment of milk can prevent this occurrence. As domestic microwave ovens are becoming commonplace, the efficacy of microwave thermal treatment in inactivating Trypanosoma cruzi trypomastigotes in human milk was tested. Human milk samples infected with T. cruzi trypomastigotes (Y strain) from laboratory-infected mice, were heated to 63 ºC in a domestic microwave oven (2 450 MHz, 700 W). Microscopical and serological examinations demonstrated that none of the animals inoculated orally or intraperitoneally with infected milk which had been treated, got the infection, while those inoculated with untreated, infected milk, became infected. It was concluded that the simple treatment prescribed, which can easily be done at home, was effective in inactivating T. cruzi trypomastigotes contained in human milk

Identification of Cryptosporidium spp. oocysts in fecal smears stained with Heidenhain's iron hematoxylin

There is no paucity of methods for diagnosing Cryptosporidium spp. infection. The merits of immunoassays notwithstanding, microscopic identification of Cryptosporidium spp. oocysts in fecal samples remains an important diagnostic procedure. It owes the persistence of its use to such characteristics as dispensing with expensive equipment and kits, requiring only basic laboratory facilities, and having a low probability of false positive results when permanent slides are prepared, which can be re-examined in case of doubt. Cryptosporidium spp. oocysts can be readily identified in fecal smears prepared according to a regressive iron hematoxylin staining technique. The number of steps and their duration, as well as costs, were reduced to a minimum without loss of image quality and permanence of the preparations

In vitro antimicrobial activity of Psidium guajava (Native Guava) lyophilized leaf crude extract on methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA)

BACKGROUND: Guava is a native plant in the Philippines and is available throughout the year. Several studies show that it exhibits anti-microbial activity on different bacteria. However, little is known on its anti-MRSA activity. The leaves of this plant if proven to have antibacterial properties against MRSA would be a very cost-effective drug against MRSA infected wounds.METHODS: This study determined the in vitro antimicrobial activity of a 50 percent solution of the lyophilized guava leaf crude aqueous extract on Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) in comparison with 30 mg vancomycin and 10 mg fusidic acid. The inhibitory effects of the three treatments were tested on two reference strains (MRSA ATCC 43300 and MSSA ATCC 25923), and four clinical MRSA isolates (1 MRSA from blood, and 3 MRSA from wound), using Disc Diffusion Assay. Microdilution Broth Assay was done to determine the Minimum Inhibitory Concentration (MIC) of guava extract and vancomycin.RESULTS: The highest inhibition was observed in fusidic acid (36 mm) followed by guava (21 mm) and then by vancomycin (18 mm). Vancomycin and guava have the same inhibitory effects against MSSA reference strain and MRSA wound 2 isolate. The effects of the three treatments on MRSA reference strain are comparable with all the clinical MRSA isolates. Guava is more effective to MRSA reference strain (24.6 mm) than MSSA reference strain (17.6 mm). However, vancomycin and fusidic acid have the same effects on both MRSA and MSSA reference strains. The effects of guava and fusidic acid on all clinical MRSA isolates (20.25 mm and 36.85 mm, respectively) are greater than their effects on MSSA ATCC 25923 (17.6 mm and 32.2 mm, respectively). Furthermore, Microdilution Broth Assay results showed that using 50 percent guava solution utilizing 1X10 exponent 8 CFU/ml, too many to count colonies were observed while there was inhibition of growth at 1X10 exponent 5 and 1X10 exponent 4 CFU/ml concentrations. Thus, it could then be probable that the MIC of lyophilized guava extract is 50 percent using bacterial concentrations ranging from 10 exponent 8 to 10 exponent 6 CFU/ml. However, colony formation was observed for 2 mg vancomycin utilizing 1X10 exponent 4 CFU/ml.CONCLUSION: Fifty percent (50 percent) solution of the lyophilized leaf crude aqueous extract inhibited the growth of methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus. The efficacy of guava as an antimicrobial agent on both MRSA and MSSA strains is greater than vancomycin but lower than fusidic acid. Based on the in vitro results, guava can be considered as a good alternative medication for Staphylococcal infection especially with drug resistant Staphylococcus aureus strains. MIC of guava extract was confirmed to be 50 percent utilizing bacterial concentrations ranging from 1X10 exponent 8 and 1X10 exponent 6 CFU/ml. (Author)

Anticoncepçäo: a visäo do professor / Contraception: teacher's view

O levantamento de opiniöes e conhecimento de professores acerca da anticoncepçäo, feito entre docentes da 5§ a 8§ séries do 1§ Grau da rede pública no Recife, revela alto grau de desconhecimento sobre métodos anticoncepcionais, assim como um descompasso, por parte de professores católicos, entre sua fé e os preceitos da Igreja tradicional opositora da maioria das práticas anticoncepcionais