Perception of malocclusion and school performance in adolescents: a systematic review

Abstract This study aimed to assess the potential association between perception malocclusion and school performance in children and adolescents. An electronic search was performed in ten databases. Based on the PECO acronym (Population, Exposition, Comparator, and Outcome), the eligibility criteria included observational studies that compared the school performance of children and adolescents with and without the perception of malocclusion. There were no restrictions on the language or year of publication. Two reviewers selected the studies, extracted the data, and assessed the risk of bias by using the Joanna Briggs Institute tool for cross-sectional studies. School performance was measured by analyzing student grades; levels of absenteeism; and child or adolescent self-perception and/or the perception of parents, guardians, close friends, and teachers regarding the impact of malocclusion on school performance. The data were described narratively/descriptively. The search resulted in 3,581 registers, of which eight were included in the qualitative synthesis. These studies were published between 2007 and 2021. Two studies concluded that there was no significant association between school performance and perception of malocclusion, five studies found that only some of the children with malocclusion had their school performance affected, and one study concluded that there was a significant association between perception of malocclusion and low school performance. Considering all variables and the very low certainty of evidence, the perception of malocclusion seems to negatively impact school performance when associated with external and subjective factors. Further studies using additional measurement standards are required.

Clinico-epidemiological profile of patients at children's psychosocial care centers in São Bernardo do Campo: a cross-sectional study

ABSTRACT BACKGROUDS: Child and Adolescent Psychosocial Care Centers (Centros de Atenção Psicossocial, CAPSI) are dedicated centers for persistent psychiatric disorders, which provide an individualized therapeutic approach based on extra-hospital services. OBJECTIVES: We aimed to describe the clinico-epidemiological profiles of the patients seeking interventions at the CAPSIs. DESIGN AND SETTING: A cross-sectional study was conducted in two CAPSI in São Bernardo do Campo, SP, Brazil. One CAPSI is dedicated to the treatment of alcohol- and drug-related disorders, and the other to the treatment of other mental disorders. METHODS: In July 2017, we reviewed all active medical records of these two CAPSI, and collected the patients information including sex, race, education, type of referral, initial complaints, psychiatric diagnoses, and medication utilization. RESULTS: Of the 233 patients, 69.5% were male and 42.5% lived with their immediate family. Most of the patients were referred from other health services. Complaints on admission included agitation and aggressive behavior (30.9%). Autism spectrum disorder (ASD) was the most prevalent diagnosis (46.8%), followed by depressive disorder (13.8%). Of the patients, 81.5% were on regular medical follow-up and 70.3% were on a single medication only. CONCLUSION: Aggression complaints are the most prevalent in CAPSI, and diagnoses of ASD and psychotic disorders are more common. This situation differs from most CAPSI that present school complaints as the most prevalent, in which diagnoses of attention-deficit/hyperactivity disorder and conduct disorders are likely to be more frequent. The epidemiological profile of each CAPSI should guide the implementation of human and structural resources targeting the most prevalent complaints and diagnoses.

Efeito da pandemia por Covid-19 nos cuidados de indivíduos com distrofia muscular de Duchenne / Covid-19 pandemic's effect on the care of individuals with Duchenne muscular dystrophy

INTRODUCTION: Since December 2019, the scientific community has been mobilized to contain the COVID-19 pandemic. Although individuals with Duchenne Muscular Dystrophy (DMD) have restrictive lung disease, risk of immunosuppression and associated cardiomyopathy, they are not considered to be a risk group for COVID-19. DMD is a neuromuscular, genetic and progressive disease, with early childhood development. In order to manage the disease, multidisciplinary follow-up is necessary to improve this patient's quality of life. OBJECTIVE: Identify the impact of the pandemic on the care of patients with DMD and its repercussions. METHOD: This is a cross-sectional, quantitative and descriptive study. The sample consisted of patients diagnosed with DMD aged between 4 and 18 years, followed up at the neuropediatrics service. Data collection was carried out by an interview with those responsible for the patient and evaluation of the medical records, using a questionnaire. Statistical analysis was descriptive using central tendency and dispersion measures. RESULTS: Among the 44 patients included, the median age was 12 years and the predominant type of gene mutation was deletion (56.8%). The median age of first symptoms was 4 years. Thirteen patients had contact with family members positive for COVID-19 and tested positive for the disease. Eleven received the vaccine against COVID-19. Medical followups suffered a great reduction in the pandemic period, as well as respiratory and motor physiotherapy. CONCLUSION: The pandemic interfered with multidisciplinary care for patients with DMD. As a chronic and degenerative disease, individuals with DMD require ongoing care, which was interrupted by the pandemic scenario.

INTRODUÇÃO: Desde dezembro de 2019, a comunidade científica está mobilizada para a contenção da pandemia pela COVID-19. Embora indivíduos portadores de Distrofia Muscular de Duchenne (DMD) apresentem doença pulmonar restritiva, risco de imunossupressão e cardiomiopatia associada, não são grupo de risco para a COVID-19. DMD é doença neuromuscular, genética e progressiva, de início na infância. Para manejo da doença, faz-se necessário acompanhamento multidisciplinar para melhora da qualidade de vida. OBJETIVO: Identificar o impacto da pandemia nos cuidados aos pacientes com DMD e suas repercussões. MÉTODOS: Trata-se de um estudo transversal, quantitativo e descritivo. A amostra foi composta por pacientes com diagnóstico de DMD com idade entre 4 e 18 anos acompanhados no serviço de neuropediatria. A coleta de dados foi realizada por entrevista com responsáveis e avaliação do prontuário, a partir de um questionário. A análise estatística foi descritiva com uso de medida de tendência central e dispersão. RESULTADOS: Dentre os 44 pacientes incluídos, a mediana de idade foi de 12 anos e o tipo de mutação gênica predominante a deleção (56,8%). A mediana de idade dos primeiros sintomas foi de 4 anos. Treze pacientes tiveram contato com familiares positivos para COVID-19 e testaram positivo para a doença. Onze receberam a vacina contra COVID-19. Os acompanhamentos médicos sofreram grande redução no período pandêmico, bem como a fisioterapia respiratória e motora. CONCLUSÃO: A pandemia interferiu nos atendimentos multidisciplinares aos pacientes com DMD. Como uma doença crônica e degenerativa, os indivíduos com DMD necessitam de cuidados contínuos, o que foi interrompido pelo cenário pandêmico.

Relationship between heart rate variability and subclinical thyroid disorders of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

The association between subclinical thyroid dysfunctions and autonomic modulation changes has been described by many studies with conflicting results. We aimed to analyze the association between subclinical hyperthyroidism (SCHyper), subclinical hypothyroidism (SCHypo), and heart rate variability (HRV) using the baseline from ELSA-Brasil. SCHyper and SCHypo were classified by use of medication to treat thyroid disorders, thyrotropin levels respectively above and under the reference range, and normal free thyroxine levels. For HRV, the participants underwent 10 min in supine position and the R-R intervals of the final 5 min were selected for analysis. We first used linear regression models to report crude data and then, multivariate adjustment for sociodemographic (age, sex, and race) and cardiovascular risk factors (hypertension, dyslipidemia, diabetes, smoking, body mass index, use of alcohol, and leisure physical activity) using the euthyroid group as reference. From 9270 subjects (median age, 50; interquartile range: 44-56), 8623 (93.0%) were classified as euthyroid, 136 (1.5%) as SCHyper, and 511 (5.5%) as SCHypo. Compared to euthyroid subjects, SCHyper participants presented significantly higher heart rate (68.8 vs 66.5 for euthyroidism, P=0.007) and shorter R-R intervals (871.4 vs 901.6, P=0.007). Although SCHyper was associated with lower standard deviation of NN interval (SDNN) (β: -0.070; 95% confidence interval (95%CI): -0.014 to -0.009) and low-frequency (LF) (β: -0.242, 95%CI: -0.426 to -0.058) compared to the euthyroid group, these differences lost significance after multivariate adjustment for confounders. No significant differences were found for HRV in SCHypo. No association was found between HRV and SCHyper or SCHypo compared to euthyroid subjects in this sample of apparently healthy subjects.

Characterization of the communication resources used by patients in palliative care - an integrative review / Caracterização dos recursos de comunicação utilizados por pacientes em cuidados paliativos - revisão integrativa

ABSTRACT The aim of this study was to integrative review of publications concerning the role of speech and language therapists in regards to communication strategies in palliative care, as well as the characterization of the types of communication used in these cases. The search was conducted in the databases SciELO, LILACS and PubMed from 2001 to 2016. The studies selected included abstracts or full articles addressing aspects of communication in palliative care, especially those related to speech and language therapy, with an emphasis on communication. Ten articles focused on communication, and published after 2004, were selected, half being literature reviews, two, case reports, two others, quantitative exploratory studies, and one, a qualitative exploratory study, with only 3 specifically describing the communication strategies used by speech and language therapists in patients in palliative care. The descriptors found were: palliative care, communication, speech and language therapy, quality of life, dysphagia, swallowing and elderly. Four of the ten articles showed the importance of patients communication in palliative care. When described, it is up to the speech and language therapist to provide family support, evaluate the patient, favore patient-family and patient-team intervention, manage and intervene in communication and swallowing. Finally, the most used communication strategies were non-verbal communication, communication board, electronic equipment, verbal communication and speech valve. The analysis of the characterization of the communication in palliative care over the past 15 years allowed concluding that the attention to communication is recent and is only described in a few reports, includes non-verbal communication in different ways as the most frequent resource, but provides oral communication as an important factor for maintaining dignity and comfort in this scenario. Speech and language therapist are the main interlocutors for the maintenance, mediation and adaptation of communication, within the multidisciplinary team as well as among patients, their family and the care team.

RESUMO O objetivo foi realizar uma revisão integrativa das publicações referentes ao papel do fonoaudiólogo em relação às estratégias de comunicação em cuidados paliativos, bem como a caracterização das formas de comunicação utilizadas nesses casos. As buscas foram realizadas nos bancos de dados da SciELO, LILACS e PubMed no período de 2001 a 2016. Foram selecionados os estudos cujos resumos, ou textos na íntegra, abordavam aspectos da comunicação em cuidados paliativos, principalmente os relacionados com a atuação fonoaudiológica, com ênfase em comunicação. Foram selecionados 10 artigos, com enfoque em comunicação, a partir de 2004, sendo metade de revisão bibliográfica, dois relatos de caso, outros dois exploratórios quantitativos e um exploratório qualitativo, com apenas 3 deles descrevendo especificamente as estratégias de comunicação utilizadas por um fonoaudiólogo com pacientes em cuidados paliativos. Os descritores encontrados foram: cuidados paliativos (Palliative care), comunicação (communication), fonoaudiologia, qualidade de vida, disfagia, deglutição e idoso. Quatro dos dez artigos apontaram a importância da comunicação dos pacientes em cuidados paliativos. Quando descrito, compete ao fonoaudiólogo: oferecer suporte familiar, avaliar o paciente, favorecer a intervenção paciente-família e paciente-equipe, gerenciar e intervir na comunicação e deglutição. Finalmente, as estratégias de comunicação mais utilizadas foram: comunicação não verbal, prancha de comunicação, equipamentos eletrônicos, comunicação verbal e válvula de fala. A análise da caracterização da comunicação em cuidados paliativos nos últimos 15 anos permitiu concluir que a atenção à comunicação é recente, com poucos relatos ainda descritos, inclui a comunicação não verbal de diferentes maneiras como o recurso mais frequente, mas prevê a comunicação oral como um importante fator para a manutenção da dignidade e conforto nesse cenário. O fonoaudiólogo é o principal interlocutor para a manutenção, mediação e adaptação da comunicação, tanto entre equipe multiprofissional, quanto entre o paciente, sua família e a equipe de cuidado.

Práticas educativas segundo os "Dez passos para o sucesso do aleitamento materno" em um Banco de Leite Humano / Educational practices in accordance with the "Ten steps to successful breastfeeding" in a Human Milk Bank

Resumo Este artigo objetivou avaliar práticas educativas segundo os “Dez Passos para o Sucesso do Aleitamento Materno” em Banco de Leite Humano. Estudo retrospectivo com informações sociodemográficas e gestacionais maternas e referentes ao bebê, obtidas de protocolo de atendimento de nutrizes (2009-2012). Tais dados foram associados aos passos relacionados a práticas educativas dentre os “Dez Passos”. Realizou-se análise descritiva, teste qui-quadrado e regressão de Poisson. Foram avaliadas 12.283 mães, com mediana de 29 (12-54) anos de idade. As orientações recebidas sobre amamentação no pré-natal (passo 3) prevaleceram entre mães de 30-39 anos e o contato pele/pele (passo 4) entre as orientadas. O treinamento sobre amamentação (passo 5) predominou entre aquelas que amamentaram exclusivamente. Notou-se maior prevalência de amamentação exclusiva (passo 6) e sob livre demanda (passo 8) e uso de bicos artificiais (passo 9) entre os lactentes de mães orientadas. Os achados apontam importante papel do profissional da saúde no treinamento mãe/filho sobre aleitamento materno e incentivo ao contato pele/pele, amamentação exclusiva e sob livre demanda. As orientações ofertadas necessitam aprimoramento a fim de reduzir o uso de bicos artificiais e potencializar a amamentação exclusiva.

Abstract This article sought to evaluate educational practices in line with the “Ten Steps to Successful Breastfeeding” in a Human Milk Bank. It involved a retrospective study using sociodemographic data about the pregnancy and the baby, obtained from a nursing mothers care protocol (2009-2012). These data were associated to steps related to educational practices from the “Ten Steps.” Descriptive analysis, chi-square test and Poisson regression were performed. 12,283 mothers, with a median of 29 (12-54) years old, were evaluated. The guidelines about breastfeeding received during prenatal care (step 3) prevailed among mothers aged 30-39 years and the skin to skin contact (step 4) prevailed among oriented mothers. Breastfeeding training (step 5) predominated among those who breastfed exclusively. Higher prevalence of exclusive breastfeeding (step 6), breastfeeding on demand (step 8) and use of artificial nipples (step 9) were noted among infants whose mothers were oriented. These findings indicate the important role of health professionals on mother/child training about breastfeeding, on encouragement of the skin/skin contact, exclusive breastfeeding and breastfeeding on demand. The guidelines indicated the need to improve in order to reduce the use of artificial nipples and enhance exclusive breastfeeding.

Is it possible to differentiate tuberculous and cryptococcal meningitis in HIV-infected patients using only clinical and basic cerebrospinal fluid characteristics?

Background. Tuberculous and cryptococcal meningitis (TBM and CM) are the most common causes of opportunistic meningitis in HIV infected patients from resource-limited settings, and the differential diagnosis is challenging. Objective. To compare clinical and basic cerebrospinal fluid (CSF) characteristics between TBM and CM in HIV-infected patients.Methods. A retrospective analysis was conducted of clinical, radiological and laboratory records of 108 and 98 HIV-infected patients with culture-proven diagnosis of TBM and CM, respectively. The patients were admitted at a tertiary centre in São Paulo, Brazil. A logistic regression model was used to distinguish TBM from CM and derive a diagnostic index based on the adjusted odds ratio (OR) to differentiate these two diseases.Results. In multivariate analysis, TBM was independently associated with: CSF with neutrophil predominance (odds ratio (OR) 35.81, 95% confidence interval (CI) 3.80 - 341.30, p=0.002), CSF pleocytosis (OR 9.43, 95% CI 1.30 - 68.70, p=0.027), CSF protein >1.0 g/L (OR 5.13, 95% CI 1.38 - 19.04, p=0.032) and Glasgow Coma Scale <15 (OR 3.10, 95% CI 1.03 - 9.34, p=0.044). Nausea and vomiting (OR 0.27, 95% CI 0.08 - 0.90, p=0.033) were associated with CM. Algorithm-related area under the receiver operating characteristics curve was 0.815 (95% CI 0.758 - 0.873, p<0.0001), but an accurate cut-off was not derived.Conclusion. Although some clinical and basic CSF characteristics appear useful in the differential diagnosis of TBM and CM in HIV infected patients, an accurate algorithm was not identified. Optimised access to rapid, sensitive and specific laboratory tests is essential

Fatores associados ao contato pele a pele entre mãe/filho e amamentação na sala de parto / Factors associated with skin to skin contact between mother/son and breastfeeding in the delivery room

RESUMO Objetivo Investigar fatores associados ao contato pele a pele entre mãe e filho e à amamentação na sala de parto entre nutrizes atendidas em um banco de leite humano. Métodos Foram avaliadas 12.283 mães em estudo retrospectivo (2009-2012) com dados secundários obtidos de protocolo estruturado. Adotou-se modelo de Poisson com abordagem hierarquizada em níveis distal, intermediário e proximal para dados sociodemográficos maternos; pré-natais e gestacionais; do bebê; e atenção hospitalar. Resultados Estiveram associados, respectivamente, à maior prevalência do contato pele a pele e da amamentação na sala de parto: parto normal (RP=1,34; IC95% 1,27-1,41 e RP=1,63; IC95% 1,45-1,83) e sem complicação (RP=1,24; IC95% 1,12-1,38 e RP=1,27; IC95% 1,03-1,56), peso ao nascer adequado (RP=1,23; IC95% 1,11-1,36 e RP=1,92; IC95% 1,48-2,48) e a termo (RP=1,18; IC95% 1,10-1,28 e RP=1,40; IC95% 1,17-1,67). Conclusão A forte influência da atenção hospitalar e as condições ao nascer do recém-nascido explicaram os desfechos em estudo. Ressalta-se a necessidade da adoção de medidas que priorizem o contato pele a pele e a amamentação na sala de parto nos grandes hospitais da capital, como a redução ou adiamento de intervenções na assistência pós-parto. Estudos longitudinais poderão esclarecer outras questões sobre o tema.

ABSTRACT Objective To investigate factors associated with skin to skin contact between mother and child and breastfeeding at the delivery room in mothers who visit a human milk bank. Methods This retrospective study (2009 to 2012) assessed the secondary data of 12,283 mothers obtained by a structured protocol. A distal-, intermediate-, and proximal-level hierarchical Poisson regression model analyzed the sociodemographic, maternal, prenatal, gestational, infant, and hospital care data. Results The following items were associated with a higher prevalence of skin to skin contact and breastfeeding in the delivery room: vaginal delivery (RP=1.34; 95%CI 1.27-1.41 and PR=1.63; 95%CI 1.45-1.83), uneventful delivery (PR=1.24; 95%CI 1.12-1.38 and PR=1.27; 95%CI 1.03-1.56), appropriate birth weight (PR=1.23; 95%CI 1.11-1.36 and PR=1.92; 95%CI 1.48-2.48), and term birth (PR=1.18; 95%CI 1.10-1.28 and PR=1.40; 95%CI 1.17-1.67). Conclusion The strong influence of hospital care and newborn birth conditions explained the study outcomes. Actions that promote skin to skin contact and breastfeeding in the delivery room of large hospitals in capital cities are needed, such as reduction or postponement of interventions during postnatal care. Longitudinal studies may clarify other issues on this subject.

Corpo e finitude: a escuta do sofrimento como instrumento de trabalho em instituição oncológica / Body and finitude: listening to suffering as a working tool in an oncological institution

Partindo do cotidiano da assistência a pacientes que chegam à Clínica da Dor do Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), o artigo procura examinar as consequências que traz, para o psíquico, o fato dele estar indissociavelmente ligado ao corpo. Quase sempre afetada profundamente pela doença, a concepção do corpo próprio traz alterações importantes quanto à identificação do sujeito, acarretando disfunções psíquicas, que não só causam sofrimento, como comprometem o tratamento oncológico. Desenvolvendo a conceituação psicanalítica do corpo, ressalta a incidência da linguagem e da fala em sua constituição, que não coincide com a do corpo biológico. Em seguida demonstra que a escuta da fala do paciente, por parte do profissional, é um instrumento de trabalho fundamental em instituição oncológica. Conclui por caracterizar duas posições possíveis a serem ocupadas por aquele que lida com a morte e com a finitude: poupar-se a si próprio do encontro com a dimensão finita e perecível da vida, sentindo pena do paciente, resignando-se e demitindo-se desse encontro; ou escutá-lo com compaixão, reconhecendo o inexorável comum a todos, de modo a que o sujeito possa sofrer isso não tão sozinho e venha a elaborar na palavra algo do horror que atravessa.

Based on the day-to-day care of patients in the Pain Clinic of a Brazilian cancer hospital (INCA), this article seeks to examine the consequences upon the psychic dimension of the fact of pain being intimately linked to the body. Almost always profoundly affected by the illness, the concept of the subject's own body deeply modifies this identification. This not only causes suffering, but also prejudices oncological treatment. Conceptualizing the body from a psychoanalytical standpoint, this article emphasizes the importance of language and the spoken word in its constitution, as the body perceived by psychoanalysis does not coincide with the biological body. The importance of listening to what the patients say is therefore seen as an important tool in the work of professionals in an oncological institution. Two possible positions regarding professionals dealing with the imminence of death and the finitude of life are then outlined. The first is refraining from being affected by the finite and perishable dimension of life, feeling pity for the patients, resigning and distancing oneself from their predicament. The second involves listening to the patients with compassion, acknowledging the inexorable finitude common to all, such that they may not suffer alone and share some of the horror they are experiencing.

Qualidade seminal, morfologia dos testículos e epidídimos de touros submetidos à dieta contendo gossipol / Seminal quality, testicle and epididymis morphology of bulls fed a diet containing gossypol

Objetivou-se avaliar o efeito da ingestão de gossipol livre sobre a qualidade espermática e a morfologia dos testículos e dos epidídimos de touros da raça Nelore. Doze touros receberam dieta contendo 3,3g de gossipol livre/touro/dia (caroço de algodão) (Grupo 1, n=6) e dieta isenta de gossipol (Grupo 2, n=6), respectivamente. Foram realizadas coletas de sêmen no início e no final do experimento, que teve duração de 73 dias. Ao final do estudo, foram retirados os testículos e os epidídimos dos touros para se estudar o efeito do gossipol livre sobre as características histológicas. O consumo médio de 3,3g de gossipol livre/touro/dia (média 7,1mg de gossipol livre/kg/dia) reduziu a motilidade e a concentração espermática e aumentou a porcentagem de defeitos espermáticos maiores e totais. Além disso, os animais apresentaram testículos com túbulos seminíferos de menor espessura de parede, menor número de camadas de células espermatogênicas, menor espessura do epitélio epididimário e menor número de espermatozoide no interior dos ductos epidídimários, em relação aos animais com dieta isenta de gossipol (Grupo 2). O consumo de 3,3g de gossipol livre/touro/dia acarretou alterações na morfologia e na morfometria dos testículos e dos epidídimos e reduziu a qualidade espermática dos touros.

The objective was to evaluate the effect of intake of free gossypol on sperm quality and morphology of the testicles and epididymis of Nelore bulls. Twelve bulls were fed diets containing 3.3g of free gossypol/bull/day (cottonseed) (Group 1, n = 6) and a diet free of gossypol (Group 2, n = 6), respectively. Semen samples were collected in the beginning and end of the experiment which lasted 73 days. In the end of the study the testes and epididymis of bulls were removed to study the effect of free gossypol on histological characteristics. The average consumption of 3.3g of free gossypol/bull/day (mean 7.1mg of free gossypol/kg/day) reduced motility and sperm concentration and increased the percentage of major and total sperm defects, as well as the animals showing testes with seminiferous tubules of smaller thickness, fewer layers of spermatogenic lineage cells, smaller epididymal epithelium thickness and smaller number of sperm within the epididymal ducts, compared to animals with a diet free of gossypol (Group 2). The consumption of 3.3g of free gossypol/bull/day led to changes in morphology and morphometry of the testes and epididymis and reduced sperm quality of bulls.

Experiência de ensino em medicina e enfermagem: promovendo a saúde da criança / A teaching experience in medicine and nursing: promoting children's health

Diante das mudanças curriculares do ensino médico e da importância da promoção de saúde e da atenção primária, este trabalho, fruto do PET-Saúde, possui como objetivo relatar uma experiência dos alunos do curso de Medicina e Enfermagem na integração entre ensino e serviço na Atenção Básica à Saúde. Além disso, mostra a importância do trabalho educativo na promoção de saúde e prevenção de doenças e evidencia os determinantes sociais no processo saúde-doença no território estudado. Este projeto foi dividido em duas fases: a primeira constou do cadastramento familiar do território adstrito à Unidade Saúde da Família do bairro utilizado como campo de ensino pela FMJ. A segunda trata da análise quanti-qualitativa realizada a partir dos dados colhidos, por meio dos quais foram elaboradas ações com foco na saúde da criança, saúde da mulher e saúde do adulto/idoso. Este artigo destaca as realizações na área de saúde da criança sobre os seguintes temas: acidentes na infância; aleitamento materno; obesidade; doenças respiratórias; anemia; e verminoses.

Given curricular changes in medical education and the importance of health promotion and primary care, the current study, which resulted from the Educational Program for Health Work (PET-Saúde), aimed to report on the experience of a group of medical and nursing students with the integration of educational activities and primary healthcare. The study also demonstrates the importance of educational work in health promotion and disease prevention and reveals social determinants in the health-disease process in the study area. The project included two phases: 1) enrollment of families in the coverage area of the Family Health Unit in the neighborhood used as the teaching area for the Jundiai School of Medicine (FMJ) and 2) a quantitative and qualitative data analysis, used to prepare activities with a focus on the health of children, women, and adults and the elderly. This article emphasizes the achievements in children's health on the following issues: prevention of childhood accidents; breastfeeding; obesity; respiratory diseases; anemia; and intestinal parasites.

Serum levels of brain-derived neurotrophicfactor correlate with the number of T2 MRI lesions in multiple sclerosis

The objective of the present study was to determine if there is a relationship between serum levels of brain-derived neurotrophic factor (BDNF) and the number of T2/fluid-attenuated inversion recovery (T2/FLAIR) lesions in multiple sclerosis (MS). The use of magnetic resonance imaging (MRI) has revolutionized the study of MS. However, MRI has limitations and the use of other biomarkers such as BDNF may be useful for the clinical assessment and the study of the disease. Serum was obtained from 28 MS patients, 18-50 years old (median 38), 21 women, 0.5-10 years (median 5) of disease duration, EDSS 1-4 (median 1.5) and 28 healthy controls, 19-49 years old (median 33), 19 women. BDNF levels were measured by ELISA. T1, T2/FLAIR and gadolinium-enhanced lesions were measured by a trained radiologist. BDNF was reduced in MS patients (median [range] pg/mL; 1160 [352.6-2640]) compared to healthy controls (1640 [632.4-4268]; P = 0.03, Mann-Whitney test) and was negatively correlated (Spearman correlation test, r = -0.41; P = 0.02) with T2/FLAIR (11-81 lesions, median 42). We found that serum BDNF levels were inversely correlated with the number of T2/FLAIR lesions in patients with MS. BDNF may be a promising biomarker of MS.

A disciplina de leitura: ritmo e oralidade na voz do texto / The discipline of reading: rhythm and the oral dimension in the voice of the text

Considerando que a prática psicanalítica envolve um cuidadoso trabalho de leitura, o presente artigo aborda a escuta da fala como inseparável da leitura de um texto. Usando os conceitos de Meschonnic, destaca nessa operação um elemento fundamental: a oralidade, considerada a voz do texto. Esta mantém a vivacidade do texto e seu caráter de enunciação, remetendo-o ao inconsciente. Vale-se também da noção de ritmo, que escande ao mesmo tempo em que revela a voz. Ressalta que aí estão dadas as coordenadas para se ritmar a cura, nos termos de Czermak, implicando uma disciplina de leitura a partir da qual são oferecidas as condições para que na posição ética de assujeitado à voz de seu próprio texto, o sujeito venha a tomar o lugar que terá feito seu.

Taking into account that psychoanalytic practice involves a careful way of reading, the present article approaches the listening of what is said as part of the reading of a text. It uses the concepts of Meschonnic to circumscribe a fundamental element: the oral dimension which is considered the 'voice' of a text. This dimension helps the text to maintain a live characteristic as well as its enunciation which leads to the unconscious. It uses the notion of rhythm that implies a scansion made in the text that makes for the appearance of the voice. It then emphasizes that a rhythm can be attached to the treatment, in accordance to Czermak, which implies a strict discipline of reading. From that point the conditions are offered to a subject for him/her to occupy an ethical position that implies becoming subjected to the voice of his/her own text.

A atualidade da novilíngua / The actuality of newspeak

Lançamos mão da discussão estabelecida por Orwell, em 1984, a propósito do extremo da desresponsabilização subjetiva, passando por Arendt e a questão da responsabilidade do sujeito, no intuito de aproximar a novilíngua de Orwell do demarcado por Czermak sobre o texto em nossa atualidade, definida por ele como paranóica. Com esse percurso, pudemos observar que o texto na atualidade caracteriza-se por enunciados cuja enunciação foi apagada, seguindo exatamente os propósitos da novilíngua.

We use Orwell's reflections in 1984 about the extreme subjective non-responsibility, passing through Arendt and subjective responsibility question, with the intention to approach Orwell's newspeak to that established by Czermak about current days text, defined by him as paranoiac. Thus, we could observe that present time text, exactly as the newspeak, present statements without enunciation.

Induction and secretion of elastinolytic and proteolytic activity in cultures of Paracoccidioides brasiliensis

P. brasiliensis parasitizes various human tissues and proteinases exported by this fungus may allow it to metabolize and invade host tissues. The influence of the culture medium on the production of proteinases by P. brasiliensis isolates was studied and the export of these enzymes was followed as a function of culture time. The fungus was grown in neopeptone, BSA, elastin orcollagen medium. The culture medium was assayed for azocollytic, elastinolytic and caseinolytic activity. Proteolytic activity was also analysed by electrophoresis of the culture medium on gelatin and casein substrate gels. P. brasiliensis expressed relatively high levels of azocoll, elastin and casein degrading activity in all types of medium, except in neopeptone medium. Generally, expression of azocollytic activity peaked during the third week of culture and caseinolytic activity during the fourth week of culture. Azocollytic activity was highest at pH 4.0 and caseinolytic activity at pH 8.0. Elastinolytic activity was also highest at pH 8.0. This activity, as well as the others, may provide the fungus with a source of carbon and nitrogen and may alsobe responsible for the invasion of host tissues, such as pulmonary elastic fiber, by P. brasiliensis.

A posição obsessiva frente ao saber: pontuações / The obsessive position towards knowledge: punctuations

O artigo parte do exame da relação da psicanálise com o saber. Trata-se de um laço em que a primeira não toma o saber como um objeto a ser plenamente apreendido. Em seguida observa como a posição obsessiva tenta preencher a impossibilidade de apreensão total de um objeto a ser conhecido. Aproximando a posição obsessiva de nossa posição no cotidiano aponta para conseqüências que se afastam da mobilidade subjetiva proposta pela psicanálise.

This article investigates the relation between psychoanalysis and knowledge. Psychoanalysis does not really consider knowledge as an object of its scrutiny. We then observe how the obsessive position tries to fill this impossible total apprehension of such an object. Approaching obsessive position to our everyday position, points to consequences that are distant from the psychoanalytical proposal of a mobile subject.

Divertículo de Meckel invertido como causa de intususcepción intestinal en el adulto: reporte de un caso / Inverted Meckel´s diverticulum as a cause of intestinal intussusceptions in the adult: a case report

Se reporta el caso de un paciente con divertículo de Meckel invaginado asociado a intususcepción con clínica de obstrucción intestinal intermitente y simulando un posible tumor de intestino delgado. Se discute su fisiopatología, clínica, estudio imagenológico y tratamiento.

Epidemiologia das dermatofitoses em instituições públicas da região de Araraquara - SP / Epidemiology of the dermatophytosis in public institutions of the region of Araraquara city - SP

As dermatofitoses são processos infecciosos de pele, pêlo e unhas muito comuns no mundo inteiro. Com o intuito de avaliar a epidemiologia das infecções causadas por estes fungos em Instituições Públicas de Araraquara, 105 amostras de indivíduos com suspeita clínica de dermatofitose foram examinadas no Laboratório de Micologia da Faculdade de Ciências Farmacêuticas, de agosto a dezembro de 2001 e, destas, 47 foram positivas para dermatófitos. Trichophyton rubrum foi a espécie prevalente (56,9%), seguida por Microsporum canis (17%), T. tonsurans (10,6%), T. mentagrophytes (8,5%) e Epidermophyton floccosum (4,3%). T. rubrum foi mais frequente nas lesões dos interdígitos (81,5%) e M. canis foi o principal envolvido nas lesões do couro cabeludo (58,3%). Portanto, houve predomínio de fungos antropofílicos e zoofílicos, respectivamente, dado este que está de acordo com as estatísticas dos estados brasileiros da região Sudeste e Sul, bem como de outras regiões do mundo em que estes fungos foram os mais frequentes isolados de tinha dos pés e do couro cabeludo. Neste estudo, foi também verificada elevada percentagem de T. tonsurans (41,7%) em tinha do couro cabeludo, dado este inédito na região Sudeste

Microbiota fúngica de um prédio com laboratórios da região de Araraquara - SP / Environment fungi of laboratory buildings in Araraquara - SP region

De setembro de 2000 a janeiro de 2001, foram coletadas amostras de 21 ambientes internos de um prédio com laboratórios didáticos, de pesquisa e de atendimento à comunidade, bem como da área externa, em Araraquara, estado de São Paulo. Foi utilizado aparelho que funciona de acordo com o princípio descrito por Andersen, o MAS-100R (MERCK), de simples estágio, que utiliza placas de Petri de 90mm de diâmetro contendo meio de agar Sabouraud-cloranfenicol. Após cinco dias de incubação à temperatura de 25ºC, as colônias foram contadas, reisoladas e identificadas resultando na descrição de 21 taxa. Clodophialophora spp. foi o fungo mais isolado, tanto em ambientes internos como externos, seguido pelos gêneros Penicillium spp. e Mycelia sterilia. De acordo com resolução nº 9, de janeiro de 2003 da ANVISA, fungos considerados inaceitáveis foram encontrados em nove ambientes internos e um dos ambientes apresentou quantidade de fungos (em unidades formadoras de colônia por meio cúbico - UFC/m3) acima do limite aceitável. Entre os fungos isolados, 16 foram relatados como fungos oportunistas, nove relacionados a doenças de plantas e sete associados a problemas alérgicos

The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil

The feasibility of allogeneic bone marrow transplantation (alloBMT) in a developing country has not yet been demonstrated. Many adverse factors including social and economic limitations may reduce the overall results of this complex and expensive procedure. Our objective was to characterize the most important clinical, social and economic features of candidates for transplantation and their potential donors as well as the influence of these factors on overall survival in a retrospective and exploratory analysis at a university hospital. From July 1993 to July 2001, candidates for BMT were referred to the Bone Marrow Transplantation Unit by Hematology and Oncology Centers from several regions of Brazil. A total of 1138 patients were referred to us as candidates for alloBMT. Median age was 25 years (range: 2 months-60 years), 684 (60.1 percent) were males and 454 (39.9 percent) were females. The clinical indications were severe aplastic anemia and hematological malignancies. From the total of 1138 patients, 923 had HLA-typing; 497/923 (53.8 percent) candidates had full match donors; 352/1138 (30.8 percent) were eligible for alloBMT. Only 235 of 352 (66.7 percent) were transplanted. Schooling was 1st to 8th grade for 123/235 (52.3 percent); monthly family income ranged from US$60 (7 percent) to more than US$400 (36 percent). Overall survival for patients with chronic myeloid leukemia, severe aplastic anemia and acute myeloid leukemia was 58, 60 and 30 percent, respectively. Thus, overall survival rates for the most frequent hematological diseases were similar to those reported in the International Registry, except for acute myeloid leukemia. This descriptive and exploratory analysis suggests the feasibility of alloBMT in a developing country like Brazil