Lactadherin immunoblockade in small extracellular vesicles inhibits sEV-mediated increase of pro-metastatic capacities

BACKGROUND: Tumor-derived small extracellular vesicles (sEVs) can promote tumorigenic and metastatic capacities in less aggressive recipient cells mainly through the biomolecules in their cargo. However, despite recent advances, the specific molecules orchestrating these changes are not completely defined. Lactadherin is a secreted 0protein typically found in the milk fat globule membrane. Its overexpression has been associated with increased tumorigenesis and metastasis in breast cancer (BC) and other tumors. However, neither its presence in sEVs secreted by BC cells, nor its role in sEV-mediated intercellular communication have been described. The present study focused on the role of lactadherin-containing sEVs from metastatic MDA-MB-231 triple-negative BC (TNBC) cells (sEV-MDA231) in the promotion of pro-metastatic capacities in non-tumorigenic and non-metastatic recipient cells in vitro, as well as their pro-metastatic role in a murine model of peritoneal carcinomatosis. RESULTS: We show that lactadherin is present in sEVs secreted by BC cells and it is higher in sEV-MDA231 compared with the other BC cell-secreted sEVs measured through ELISA. Incubation of non-metastatic recipient cells with sEV- MDA231 increases their migration and, to some extent, their tumoroid formation capacity but not their anchorage-independent growth. Remarkably, lactadherin blockade in sEV-MDA231 results in a significant decrease of those sEV-mediated changes in vitro. Similarly, intraperitoneally treatment of mice with MDA-MB-231 BC cells and sEV-MDA231 greatly increase the formation of malignant ascites and tumor micronodules, effects that were significantly inhibited when lactadherin was previously blocked in those sEV-MDA231. CONCLUSIONS: As to our knowledge, our study provides the first evidence on the role of lactadherin in metastatic BC cell-secreted sEVs as promoter of: (i) metastatic capacities in less aggressive recipient cells, and ii) the formation of malignant ascites and metastatic tumor nodules. These results increase our understanding on the role of lactadherin in sEVs as promoter of metastatic capacities which can be used as a therapeutic option for BC and other malignancies.

Comprehensive functional annotation of susceptibility variants identifies genetic heterogeneity between lung adenocarcinoma and squamous cell carcinoma / 医学前沿

Although genome-wide association studies have identified more than eighty genetic variants associated with non-small cell lung cancer (NSCLC) risk, biological mechanisms of these variants remain largely unknown. By integrating a large-scale genotype data of 15 581 lung adenocarcinoma (AD) cases, 8350 squamous cell carcinoma (SqCC) cases, and 27 355 controls, as well as multiple transcriptome and epigenomic databases, we conducted histology-specific meta-analyses and functional annotations of both reported and novel susceptibility variants. We identified 3064 credible risk variants for NSCLC, which were overrepresented in enhancer-like and promoter-like histone modification peaks as well as DNase I hypersensitive sites. Transcription factor enrichment analysis revealed that USF1 was AD-specific while CREB1 was SqCC-specific. Functional annotation and gene-based analysis implicated 894 target genes, including 274 specifics for AD and 123 for SqCC, which were overrepresented in somatic driver genes (ER = 1.95, P = 0.005). Pathway enrichment analysis and Gene-Set Enrichment Analysis revealed that AD genes were primarily involved in immune-related pathways, while SqCC genes were homologous recombination deficiency related. Our results illustrate the molecular basis of both well-studied and new susceptibility loci of NSCLC, providing not only novel insights into the genetic heterogeneity between AD and SqCC but also a set of plausible gene targets for post-GWAS functional experiments.

The influence of reproductive information quality on the probability of unplanned and unwanted pregnancies in Brazil / A influência da qualidade da informação reprodutiva na probabilidade de gravidez não planejada e indesejada no Brasil

Background: Unplanned pregnancies are a significant risk factor for inadequate use of prenatal care, and unplanned newborns are prone to having low birth weight. Women with unplanned pregnancies have a higher probability of reporting medical problems before and during pregnancy. In fact, the wellbeing of the entire household may be affected. Moreover, unplanned pregnancies have been associated with a higher social burden on taxpayers. Methods: The paper uses propensity score matching approaches to estimate the effect of having correct fertility information on the probability of having unplanned pregnancies. The data was collected from a nationally representative sample of Brazilian women between the ages of 15 and 49 years. Results: Only 26% of pregnant women have the correct information about fertility levels over the menstrual cycle. Women endowed with correct information are 12% less likely to have unwanted pregnancies and 24% less likely to have unplanned pregnancies. Conclusions: Basic fertility knowledge is an important predictor of unplanned pregnancies in Brazil, but only a small share of Brazilian women have this knowledge. More optimistically, offering access to basic fertility information to women of childbearing age can significantly decrease the instances of unplanned pregnancies, thus generating significant benefits to public health and social security systems.

Introdução: A gravidez não planejada é um fator de risco significativo para uso inadequado do cuidado pré-natal, e os recém-nascidos não planejados são propensos a ter baixo peso ao nascer. Mulheres com gravidez não planejada têm maior probabilidade de relatar problemas médicos antes e durante a gravidez. De fato, o bem-estar de toda a família pode ser afetado. Além disso, gravidezes não planejadas têm sido associadas a maior ônus social para os contribuintes. Métodos: O artigo usa abordagens de Propensity Score Matching para estimar o efeito de ter informações corretas de fertilidade sobre a probabilidade de ter gravidezes não planejadas. Os dados foram coletados de uma amostra nacionalmente representativa de mulheres brasileiras com idades entre 15 e 49 anos. Resultados: Apenas 26% das mulheres grávidas têm informações corretas sobre os níveis de fertilidade ao longo do ciclo menstrual. Mulheres com informações corretas têm 12% menos chances de ter uma gravidez indesejada e 24% menos probabilidade de ter uma gravidez não planejada. Conclusões: O conhecimento básico sobre fertilidade é um importante preditor de gravidez não planejada no Brasil, no entanto apenas uma pequena parcela das mulheres brasileiras tem esse conhecimento. De forma mais otimista, oferecer acesso a informações básicas sobre fertilidade para mulheres em idade fértil pode diminuir significativamente os casos de gravidez não planejada, gerando benefícios significativos para os sistemas de saúde pública e de seguridade social.

Relations among adolescents' life purpose, household chores, and school performance / Relações entre projetos de vida, tarefas domésticas e desempenho escolar em adolescentes / Relaciones entre proyectos de vida, tareas domésticas y desempeño escolar en adolescentes

This study investigated relations among adolescents' life purposes, household responsibilities, and school impairment. Participants were 113 Brazilian adolescents, between 14 and 16 years old, students from municipal schools. The instruments were a record of biosociodemographic data, the Household and Sibling Care Questionnaire, and a written testimony of life purpose. Results indicated a significant difference for the relation among household responsibilities level and purposes related to material goods (t = -2.88, p = 0.00), and no significant results for school performance variables. However, when the sample was stratified by sex, different relations were found, and school impairment was only found in the female group (t = -3.13, p = 0.00). We concluded that there are relations among the investigated variables, which justifies new studies, and that the sex variable should be considered when analyzing these relations.

Este estudo investigou relações entre projetos de vida, tarefas domésticas e prejuízos no desempenho escolar em adolescentes. Participaram 113 adolescentes brasileiros, de 14 a 16 anos, alunos de escolas municipais. Foram utilizados uma ficha de dados biossociodemográficos, o Questionário de Tarefas Domésticas e de Cuidado entre Irmãos (QTDCI) e um depoimento escrito sobre projetos de vida. Os resultados indicaram diferença significativa para a relação entre tarefas domésticas e projetos relacionados a bens materiais (t = -2,88, p = 0,00), e nenhuma diferença significativa nas variáveis de desempenho escolar. Contudo, quando estratificada a amostra por sexo, encontraram-se relações diferentes, e prejuízo escolar apenas no grupo feminino (t = -3,13, p = 0,00). Concluiu-se que há relações entre as variáveis investigadas, o que justifica a realização de novos estudos, e que se deve considerar a variável sexo quando se analisam essas relações.

Este estudio investigó relaciones entre proyectos de vida, tareas domésticas y prejuicios en el desempeño escolar en adolescentes. Participaron 113 adolescentes brasileños, de 14 a 16 años, alumnos de escuelas municipales. Se utilizó una ficha de datos biosociodemográficos, el Cuestionario de Tareas Domésticas y Cuidado entre Hermanos y un testimonio escrito sobre proyectos de vida. Los resultados indicaron diferencia significativa para la relación entre tareas domésticas y proyectos relacionados con bienes materiales (t = -2,88, p = 0,00), y ninguna diferencia significativa en las variables de desempeño escolar. Sin embargo, cuando estratificada la muestra por sexo, se encontraron relaciones diferentes, y perjuicio escolar sólo en el grupo femenino (t = -3,13, p = 0,00). Se concluyó que hay relaciones entre las variables investigadas, lo que justifica la realización de nuevos estudios, y que se debe considerar la variable sexo cuando se analizan esas relaciones.

Diretriz metodológica para estudos de avaliação econômica de tecnologias em saúde no Brasil / Methodological guidelines for economic evaluation studies of health technologies in Brazil

Objetivos: Resumir os principais pontos da Diretriz de Avaliação Econômica em Saúde (AES) do Ministério da Saúde. Métodos: As diretrizes para AES no Brasil foram desenvolvidas por intermédio de múltiplas rodadas de trabalho iterativas por grupo multidisciplinar de especialistas em economia da saúde e foram submetidas à consulta pública. Resultados: O problema deve ser definido por meio de uma questão de pesquisa estruturada. O estudo pode ser baseado em dados primários ou em modelagem, em que o primeiro aumenta a validade interna dos resultados e o segundo, a capacidade de generalização do estudo. Quando o trabalho for baseado em modelagem e focado em doença crônica, o modelo de Markov pode ser usualmente empregado, quando não houver necessidades que apontem para simulação de eventos discretos (como competição dos indivíduos por recursos escassos) ou modelos de transmissão dinâmica (em vacinação e/ou doenças infecciosas com alta transmissão entre indivíduos). O horizonte temporal preferencial é o de tempo de vida, e a taxa de desconto padrão é de 5% para custo e efetividade. Os custos devem representar a perspectiva do Sistema Único de Saúde (SUS), podendo ser estimados por macrocusteio ou microcusteio. Sempre que possível, os resultados devem ser apresentados no formato de custo por ano de vida salvo ajustado para qualidade, para facilitar comparações com outros estudos. Análises de sensibilidade devem ser extensamente empregadas, de forma a avaliar o impacto da incerteza nos resultados produzidos. Conclusões: Espera-se que, com a padronização da metodologia proposta na Diretriz, a produção de AES no país tenha incremento na sua qualidade e reprodutibilidade.

Objectives: To summarize the main points from the Brazilian's Ministry of Health Economic Evaluations (HEE) guideline. Methods: The guideline was developed through multiple rounds of iterative work, conducted by a multidisciplinary team of specialists in health economics, and where submitted to public consultation. Results: The decision problem should be defined through a structured research question. The study can be either primary data or model-based; in the first case, there is greater internal validity, while the second generates a superior generalizability. When the study is model-based and focused on a chronic disease, a Markov model can be usually employed, except for situations that points towards the need of a discrete event simulation (such as competition of individuals for scarce resources) or a dynamic transition model (for example, vaccination models and infectious diseases with high transmission rates between individuals). The preferred time horizon is the lifetime one, and the default discount rate is 5% for both costs and effectiveness. Costs should represent the Unified Health System (SUS) perspective and can be estimated through either gross-costing or micro-costing. Results should be presented as costs per quality adjusted life years (QALYs) whenever possible, to facilitate comparison with other studies. Sensitivity analyses should be widely employed, in order to evaluate the impact of uncertainty in the results produced by the model. Conclusions: It is expected that, with the standardization proposed in this guideline, the HEE production in Brazil has gains in quality and reproducibility.

Tabagismo e uso de anticoncepcionais orais relacionados a fenômenos tromboembólicos: relato de caso e revisão de literatura / Smoking and the use of oral contraceptives related to thromboembolic events: a case report and literature review

Objetivo: Fazer revisão de literatura sobre tabagismo e uso de anticoncepcionais orais (ACO) relacionados a fenômenos tromboembólicos, com apresentação do caso clínico de trombose proximal de artéria mesentérica superior e extensa necrose de intestino delgado em paciente do sexo feminino com coagulopatia provável por associação de uso de anticoncepcional oral com tabagismo. Materiais e métodos: Revisão bibliográfica, com seleção de artigos científicos nacionais e internacionais por meio de busca no banco de dados do PubMed, Lilacs e SciELO. Resultados: A relação entre uso de contraceptivos orais combinados e risco aumentado de doenças tromboembólicas baseia­se na ação pró­coagulante dos ACO, torna­se fator de risco para a ocorrência de trombose arterial e venosa. Já o tabagismo, isoladamente, apresenta risco moderadamente aumentado de trombose venosa em comparação com não fumantes. Ademais, observou­se relação entre trombose de artéria mesentérica superior com uso de anticoncepcional oral associado ao tabagismo. Conclusões: Todos os estudos analisados confirmaram o uso de ACO e o tabagismo como fatores de risco para o desenvolvimento de doenças tromboembólicas. O estudo feito com base na história clínica da paciente sugere um caso de trombose arterial secundária a coagulopatia pela combinação de fumo com o uso de ACO combinado.(AU)

Purpose: Conduct a review of the literature on smoking and use of oral contraceptives related to thromboembolic events, with presentation of the case of proximal thrombosis of the superior mesenteric artery and extensive necrosis of the small intestine in a female patient with probable coagulopathy caused by the association of oral contraceptive with smoking. Materials and methods: This study consisted of a literature review, with selection of national and international scientific articles through research in PubMed, Lilacs and SciELO database. Results: The relationship between the use of combined oral contraceptives and increased risk of thromboembolic disease is based on the procoagulant action of OCs, which translates into a risk factor for the occurrence of arterial and venous thrombosis. Smoking alone has moderately increased risk of venous thrombosis compared with non­smokers. Besides that, there is a relation between the superior mesenteric artery thrombosis with the use of oral contraceptives associated with smoking. Conclusion: All analysed studies have confirmed the use of OCs and smoking as risk factors for the development of thromboembolic diseases. The study based on the clinical history of the patient suggests a case of secondary arterial thrombosis coagulopathy by combining smoking with the use of combined OCs.

Incidência de hérnias incisionais em pacientes submetidos a laparotomias medianas em um hospital de ensino no interior do estado do Rio Grande do Sul / Incidence of incisional hernias in patients submitted to midline laparotomy in a teaching hospital in the interior of Rio Grande do Sul

Introdução: Avaliar o comportamento da parede abdominal dos pacientes submetidos à laparotomia mediana em um programa de residência médica em cirurgia geral no interior do estado do Rio Grande do Sul. Métodos: Trata-se de um estudo longitudinal de cará- ter descritivo que avalia o comportamento da parede abdominal após laparotomia mediana, no período de 2011 a 2014, em pacientes com idade superior a 13 anos. Resultados: Dos 30 pacientes avaliados, 12 apresentaram hérnia incisional (40%); destes, 25% eram obesos e 25% diabéticos. Em 17% dos casos com hérnia incisional, houve infecção de ferida operatória. No grupo que apresentou hérnia, a maioria dos pacientes teve o fechamento de sua parede realizado por residentes do primeiro ano (R1). Em 42% dos casos com hérnia, foi utilizado poliglactina 910 para fechamento da parede abdominal. Os pacientes que foram diagnosticados com hérnia incisional permaneceram internados uma média de 4 dias a menos que os pacientes que não apresentaram hérnia. Todos os pacientes foram submetidos à laparotomia mediana e 29 deles foram submetidos à cirurgia de urgência, não sendo possível realizar uma comparação entre estas variáveis. Conclusão: De todos os parâmetros analisados, o tipo de fio de sutura utilizado para fechamento da parede, bem como por quem este fechamento foi realizado e o tempo que estes pacientes permaneceram internados foram os mais expressivos quanto ao desenvolvimento de hérnia incisional(AU)

Background: To evaluate the behavior of the abdominal wall in patients undergoing laparotomy in a medical residency program in general surgery in the interior of Rio Grande do Sul. Methods: This is a descriptive longitudinal study that evaluates the behavior of the abdominal wall after laparotomy, in the period from 2011 to 2014 in patients aged over 13 years. Results: Of the 30 patients evaluated, 12 had incisional hernia (40%), and of these, 25% were obese and 25% were diabetic. In 17% of the cases with incisional hernia, there was wound infection. In the group with hernia, most patients had the closing of their wall performed by a first year resident (R1). In 42% of the cases with hernia, polyglactin 910 was used for closure of the abdominal wall. The patients diagnosed with incisional hernia remained hospitalized an average of four days less than did those without hernia. All patients underwent midline incision and 29 of them underwent emergency surgery, but it was not possible to make a comparison between these variables. Conclusion: Of all the analyzed parameters, the type of suture used to lock the wall, who performed this closure and the length of time these patients remained hospitalized were the most significant ones regarding the development of incisional hernia(AU)

Intervention Planning Using a Laser Navigation System for CT-Guided Interventions: A Phantom and Patient Study

OBJECTIVE: To investigate the accuracy, efficiency and radiation dose of a novel laser navigation system (LNS) compared to those of free-handed punctures on computed tomography (CT). MATERIALS AND METHODS: Sixty punctures were performed using a phantom body to compare accuracy, timely effort, and radiation dose of the conventional free-handed procedure to those of the LNS-guided method. An additional 20 LNS-guided interventions were performed on another phantom to confirm accuracy. Ten patients subsequently underwent LNS-guided punctures. RESULTS: The phantom 1-LNS group showed a target point accuracy of 4.0 +/- 2.7 mm (freehand, 6.3 +/- 3.6 mm; p = 0.008), entrance point accuracy of 0.8 +/- 0.6 mm (freehand, 6.1 +/- 4.7 mm), needle angulation accuracy of 1.3 +/- 0.9degrees (freehand, 3.4 +/- 3.1degrees; p < 0.001), intervention time of 7.03 +/- 5.18 minutes (freehand, 8.38 +/- 4.09 minutes; p = 0.006), and 4.2 +/- 3.6 CT images (freehand, 7.9 +/- 5.1; p < 0.001). These results show significant improvement in 60 punctures compared to freehand. The phantom 2-LNS group showed a target point accuracy of 3.6 +/- 2.5 mm, entrance point accuracy of 1.4 +/- 2.0 mm, needle angulation accuracy of 1.0 +/- 1.2degrees, intervention time of 1.44 +/- 0.22 minutes, and 3.4 +/- 1.7 CT images. The LNS group achieved target point accuracy of 5.0 +/- 1.2 mm, entrance point accuracy of 2.0 +/- 1.5 mm, needle angulation accuracy of 1.5 +/- 0.3degrees, intervention time of 12.08 +/- 3.07 minutes, and used 5.7 +/- 1.6 CT-images for the first experience with patients. CONCLUSION: Laser navigation system improved accuracy, duration of intervention, and radiation dose of CT-guided interventions.

Grupos de convivencia como suporte ao idoso na melhoria da saude / Companionship groups as support to improve the health of the elderly

O estudo buscou conhecer a representação da população idosa sobre o grau de satisfação, quanto aos benefícios obtidos na melhoria da saúde, com a convivência em grupos. As redes de relações são importantes fontes de suporte social e satisfação com a vida. Considerou o grau de satisfação como um dos indicadores de bem-estar no envelhecimento com qualidade de vida, descrevendo o nível de satisfação na participação social de idosos da Espanha e do Brasil que se filiam a grupos/centros de convivência. A população em estudo foi composta por 262 idosos do Brasil e 262 idosos da Espanha que faziam parte de grupos/centros de convivência onde as universidades tinham inserção. O corpus da pesquisa, arquivado no banco de dados do grupo de pesquisa em Envelhecimento da UNISC, se baseou nas narrativas dos idosos entrevistados, que refletem a visão deles sobre a participação em grupos de convivência e suas experiências pessoais. A análise qualitativa das entrevistas foi realizada por meio da técnica da análise de conteúdo. Pode-se observar que as relações sociais e o suporte social, sendo este emocional, instrumental ou informacional, favorecem a melhora da saúde. As atividades mais comentadas e realizadas pelos idosos, do Brasil e da Espanha, são as relacionadas à sociabilidade, expressas no contato com os amigos, ocasião em que buscam compartilhar alegrias, tristezas e conhecimentos.

This study aimed to know the representation of the elderly population about the degree of satisfaction with benefits obtained in health improvement within companionship groups. Relationship nets are important sources of social support and satisfaction with life. It considered satisfaction levels as welfare indicator in aging with quality of life, describing the satisfaction level in social participation of elderly in Spain and in Brazil that are affiliated to companionship centers/groups. The study population included 262 elderly people in Brazil and 262 in Spain that were part of companionship centers/groups where the universities had insertion. The research corpus, archived in the UNISC Aging research group database, was built from narratives made by the interviewed elderly, reflecting their view of their participation in companionship groups and their personal experiences. The qualitative analysis of interviews was performed through the content analysis technique. It has been observed that social relationships and social support, being emotional, instrumental or informational, favor health improvement. The activities that have been most commented and performed by the elderly, in Brazil and Spain, are the ones related to sociability, shown in the contact with friends, when joys, sorrows and knowledge are shared.

Relações familiares e o convivívio social entre idosos / Family relationship and social interaction among elderly

Esta pesquisa surgiu da necessidade em conhecer a percepção dos idosos sobre seus relacionamentos sociais, familiares e com os grupos de convivência dos quais participam no Brasil e na Espanha. A metodologia utilizada é quali-quantitativa. Os resultados parciais mostram a satisfação dos idosos (97%) com as relações estabelecidas nos grupos de amigos, formados principalmente a partir de grupos de convivência para a terceira idade, e apontam para uma população idosa com características ligadas à independência e autonomia, mais ativa e satisfeita com suas relações familiares e de amizade. Percebe-se uma preocupação especial com a qualidade de vida por parte do idoso, sendo a convivência e as atividades realizadas nos grupos fatores importantes para uma melhora significativa na saúde física e mental.

This research arose from a need to know the perception of the elderly about their social relationships, family and the support groups, they participate in Brazil and Spain. The methodology used is quali-quantitative. Partial results show the satisfaction of the elderly (97%) with the relations established in the group of friends, consisting mainly of groups of living for the elderly and point to an elderly population with characteristics related to independence and autonomy, more active seniors and satisfied with their family relationships and friendships. It also indicated a particular concern with the quality of life by the elderly, and the living and the activities carried out in groups are an important factor that provides a significant improvement in physical and mental health.

Promoção do envelhecimento saudável: adoção de uma prática multidisciplinar na atenção à saúde do idoso (UNISC / Promotion of healthy aging: adoption of a multidisciplinary practice in the health care of the elderly (UNISC)

Este artigo tem o propósito de socializar a experiência de um projetode Extensão da Universidade de Santa Cruz do Sul (UNISC),Promoção do Envelhecimento Saudável4 –, que abrange Enfermagem,Nutrição e Psicologia. É desenvolvido desde 1997 e vem seadequando às realidades, tendo por referência a experiência dosdocentes nas ações para o envelhecimento com qualidade de vida,realizado há dez anos pela equipe interdisciplinar do Serviço Escola da UNISC. O objetivo é socializar a experiência, que reúne idososao longo do ano para a discussão de temas relacionados à saúdeno envelhecimento. Cada área, por meio dos seus conhecimentosespecíficos, busca através de encontros de saúde e de atendimentosindividualizados construir coletivamente o melhor processo decuidado. Com as interlocuções ocorrem momentos ricos de trocasde experiências, conhecimentos, informações e intervenções paraque o usuário seja percebido na sua integralidade e busque a responsabilidadefrente a sua saúde. Os resultados demonstram umamelhora no nível de saúde, diminuindo complicações decorrentesdas doenças crônicas.

This article aims to share the experience of a project of the UniversityExtension of Santa Cruz do Sul (UNISC), Promotion of HealthyAging – Adoption of a multidisciplinary practice in the Health Careof the Elderly, which includes nursing, nutrition and psychology. Itis developed since 1997 and has been adjusting to the realities,with reference to the experience of teachers in the actions for theaging, quality of life, held for ten years by an interdisciplinary teamof Integrated Health Services, medical-school UNISC. The goal is to socialize the experience, which brings together seniors throughoutthe year to discuss issues related to health in aging. Each area,through its expertise, through meetings of seeking health care andindividualized collectively build a better process of care. Interlocutionsmoments occur with the rich exchange of experiences, knowledge,information and assistance so that the user is perceived in itsentirety and look forward the responsibility to your health. The resultsshow an improvement in the level of health, reducing complicationsarising from chronic diseases.

Atendimento à unidade familiar do idoso: experiência multidisciplinar / Family care unit for the elderly: multidisciplinary experience

A proposta deste trabalho é relatar a experiência do atendimentodomiciliar à população idosa realizado por um grupo de acadêmicose professores de cursos da área da saúde no Programa TerceiraIdade da Universidade de Santa Cruz do Sul/UNISC. O atendimentodomiciliar teve como objetivos proporcionar uma assistência humanizadae integral e estimular a maior participação do idoso e de suafamília no tratamento proposto. Uma interação maior entre pacientefamília-equipe foi observada a partir do atendimento domiciliar, sema formalidade característica dos serviços de saúde.

The purpose of this study is to report the experience of home care tothe elderly conducted by a group of scholars and teachers of coursesin the area of health in the Elderly Program, University of SantaCruz do Sul - UNISC. Home care aimed to provide a humanizedand comprehensive care and encourage greater participation of theelderly and their families in the proposed treatment. Greater interactionbetween patient-family-team was observed from the home carewithout the formality characteristic of health services.

Enterobiasis infections among Thai school children: spatial analysis using a geographic information system

Background: Enterobius vermicularis (Nematoda: Oxyuroidae) is a nematode worm, parasitic in the intestine of humans, and especially infects school children in most parts of the world. Infection occurs after ingesting drinks or food contaminated by the pinworm eggs. Samut Prakan province is located south-east of the Bangkok metropolitan area.Objective: To analyze enterobiasis infections among Thai school children in Samut Prakan province of Thailand, using a geographic information system.Methods: A total of 1,255 school children from eleven primary schools in the Samut Prakan province were drawn by stratified random sampling and tested for the presence of E. vermicularis eggs from December 2000 to March2001.Results: Diagnostic results and socioeconomic information about students and their families were integrated into a Geographic Information System (GIS) and spatially interpreted, using SavGIS programmes. Other needed environmental data, extracted from satellite images using remote sensing, was used for further analysis. Laboratory analysis revealed a 17.5% overall prevalence with 10.5% of the children having a low infection rate, 2.6% a moderate, and 4.4% a heavy infection rate. The prevalence of E. vermicularis showed geographical heterogeneity with the lowest prevalence in the provincial administrative center. Parents’ occupation was significantly correlated with the presence of infection.Conclusion: Spatial analysis can help to identify patterns of high risk for enterobiasis otherwise called oxyuriasis.

Enfisema lobar congénito: presentación de un caso / Congenital labor emphysema: a case report

El enfisema lobar congénito es una entidad poco frecuente que determina dificultad respiratoria en el lactante pequeño. Se caracteriza por la hiperinsuflación de un lóbulo pulmonar, particularmente del lóbulo superior izquierdo. Puede representar un dilema diagnostico y terapéutico. Presentamos una niña de tres meses que ingreso con fiebre, dificultad respiratoria moderada y disminución del murmullo vesicular en hemitórax izquierdo.

Lactante sibilante atípico: consideraciones diagnósticas. Hendidura laríngea / Atypical sibilant lactate: diagnostic considerations. Laryngeal cleft

El síndrome bronquial obstructivo es un motivo de consulta frecuente en la edad pediátrica. En este trabajo se presenta el caso de un paciente con antecedentes de internaciones recurrentes por infecciones respiratorias agudas bajas y trastorno de deglución con diagnóstico de hendidura laríngea. Se realiza una breve descripción de la hendidura laríngea, sus características clínicas, diagnóstico y tratamiento. Se enumeran los diagnósticos diferenciales de los niños con sibilancias atípicas, sus signos y síntomas y su evaluación inicial.

Association between ambient temperature and hospital emergency room visits for cardiovascular diseases:a case-crossover study / 中华流行病学杂志

Objective To explore the association between ambient average temperature and hospital emergency room visits for cardiovascular diseases(International Classification of Diseases,Tenth Vision ICD-10:I00-I99) in Beijing,China.Methods Data was collected on daily hospital emergency room visits for cardiovascular diseases from Peking University Third Hospital,including meteorological data(daily average temperature,relative humidity,wind speed,and atmospheric pressure) from the China Meteorological Data Sharing Service System,and on air pollution from the Beijing Municipal Environmental Monitoring Center.Time-stratified case-crossover design was used to analyze data on 4 seasolls.Results After adjusting data on air pollution,1 degree(℃) increase of ambient average temperature would associate with the emergency room visits of odds ratio(Ors)as 1.282(95%CI:1.250-1.315).1.027(95%CI:1.001-1.055),0.661(95%CI:0.637-0.687),and 0.960 (95%CI:0.937-0.984) in spring,summer,autumn,and winter respectively.After controlling the influence of relative humidity,wind speed,and atmospheric pressure,1℃ increase in the ambient average temperature would be associated with the emergency room visits on Ors value as 1.423 (95%CI:1.377-1.471).1.082(95%CI:1.041-1.124),0.633(95%CI:0.607-0.660)and 0.971(95%CI:0.944-1.000) in spring,summer,auttmm,and winter respectively.Conclusion These data on outcomes suggested that the elevated level of ambient temperature would increase the hospital emergeney room visits for cardiovascular diseases in spring and summer while the elevated level of ambient temperature would decrease the hospital emergency room visits for the cardiovascular diseases in autumn and winter,suggesting that patients with cardiovascular diseases should pay attention to the climate change.

Association between the concentration of particulate matters and the hospital emergency room visits for circulatory diseases: a case-crossover study / 中华流行病学杂志

Objective To explore the association between the concentration of particulate matters with an aerodynamic diameter of <10 μm ( PM10 ) and the hospital emergency room visits for circulatory diseases ( International Classification of Diseases, tenth vision ICD-10 : 100-199) in Beijing, China. Methods We collected data for daily hospital emergency room visits of circulatory diseases ( ICD-10:I00-I99 ) from Peking University Third Hospital and from the ambient air PM10 through the Beijing Municipal Environmental Monitoring Center. A time-stratified case-crossover design was used to evaluate associations between circulatory disease health outcomes and PM10.Results The no-lagged unidirectional case-crossover design with 1:4 matched pairs had the highest odds ratios (ORs) between PM10 and the hospital emergency room visits for circulatory diseases. After adjusting the temperature and the relative humidity, a 10μg/m3 increased in the PM10 were found associated with the emergency room visits on value of ORs of 1.006(95% CI:1.003-1.008) for the total circulatory diseases ( ICD-10:I00-I99), 1.003 (95% CI:0.996-1.010) for coronary heart disease ( ICD-10:I20-I25 ), 1.005 ( 95 % CI:0.997-1.013 ) for cardiac arrhythmia ( ICE)-10:I47-I49), 1.019 (95 % CI:1.005-1.033 ) for heart failure disease ( ICD-10:I50 ),and 1.003 ( 95 % CI : 0.998-1.007 ) for cerebrovascular diseases ( ICD-10:I60-I69 ), respectively. Conclusion These findings suggested that elevated levels of ambient PM10 were positively associated with hospital emergency room visits for the total number of circulatory diseases and heart failure disease.

Perfil lipídico da dieta alimentar como fator de risco para doenças cardiovasculares em idosas ativas / The alimentary diet lipidic profile as factor of risk for cardiovascular diseases in active aged woman

O objetivo deste trabalho é avaliar o perfil lipídico da dieta e sua correlação com os fatores de risco para doenças cardiovasculares, em uma amostra de 130 mulheres acima de 60 anos. Para avaliar o estado nutricional utilizaram-se o Índice de Massa Corporal (IMC) e Circunferência da Cintura (CC), e a análise da dieta foi feita através do recordatório alimentar de 24 horas. Como resultados, observou-se que 65,4 por cento da amostra encontram-se em sobrepeso, 32,3 por cento em eutrofia e 2,3 por cento com baixo peso. Quanto ao fator de risco, avaliado através da circunferência abdominal, constatou-se que 38,5 por cento das idosas estavam dentro da normalidade, 20,8 por cento estavam em risco aumentado e 40,8 por cento em risco muito aumentado, representando 61,6 por cento da população estudada em risco para o desenvolvimento de doenças cardiovasculares. Identificou-se forte associação entre índice de massa corporal e circunferência abdominal nas idosas avaliadas (p<0,05). Avaliando-se a dieta alimentar das idosas, notou-se que, em média o consumo de calorias é de 1440,56 (+39,04), o consumo médio de lipídios totais e insaturados em relação ao valor energético total (VET) foram de 29,28 por cento (+8,87) e 13,31 por cento(+5,77) respectivamente. A média de colesterol alimentar foi de 156 mg (+91,62) e de fibras, 16,84 g (+8,87). Faz-se necessária uma análise mais detalhada e intervenção eficaz para a promoção da melhora do perfil lipídico e da saúde geral dessa população.

The aim of this study is to evaluate the diet lipidic profile and its relationship with cardiovascular diseases (DVC) risk factors in a sample of 130 women above 60 years. To evaluate the nutritional state, it was used the Body Mass Index (BMI) and the Waist Circumference (WC) and the analysis of the diet was made through last 24-hours meals remember. We observed that 65.4% of the sample was overweight, 32.3% was in a normal level and 2.3% indicated low weight. Related to the risk factors, that we evaluated through the abdominal circumference, 38.5% of the women were in a normal level, 20.8% were in an increased risk level and 40.8% in a very increased risk level, results that classificate 61.6% of the studied population risking to develop cardiovascular illnesses. We evidenced some strong association between the Body Mass Index and the Abdominal Circumference (p<0.05). Evaluating it alimentary diet of the aged ones, noticed that, on average the consumption of calories is of 1440,56 (+39,04), the average consumption of total and insaturated fat in relation to the total energy value had been of 29,28% (+8,87) and 13.31% (+5,77) respectively. The alimentary cholesterol average was of 156 mg (+91,62) and staple fibres, 16,84 g (+8,87). An analysis some more detailed becomes necessary and efficient intervention looking for an improvement in the lipidic profile and the general health characteristics of this population.