Comparison of aspirin treatment strategies for primary prevention of cardiovascular diseases: A decision-analytic Markov modelling study / 北京大学学报(医学版)

OBJECTIVE@#To compare the expected population impact of benefit and risk of aspirin treatment strategies for the primary prevention of cardiovascular diseases recommended by different guidelines in the Chinese Electronic Health Records Research in Yinzhou (CHERRY) study.@*METHODS@#A decision-analytic Markov model was used to simulate and compare different strategies of aspirin treatment, including: Strategy ①: Aspirin treatment for Chinese adults aged 40-69 years with a high 10-year cardiovascular risk, recommended by the 2020 Chinese Guideline on the Primary Prevention of Cardiovascular Diseases; Strategy ②: Aspirin treatment for Chinese adults aged 40-59 years with a high 10-year cardiovascular risk, recommended by the 2022 United States Preventive Services Task Force Recommendation Statement on Aspirin Use to Prevent Cardiovascular Disease; Strategy ③: Aspirin treatment for Chinese adults aged 40-69 years with a high 10-year cardiovascular risk and blood pressure well-controlled (< 150/90 mmHg), recommended by the 2019 Guideline on the Assessment and Management of Cardio-vascular Risk in China. The high 10-year cardiovascular risk was defined as the 10-year predicted risk over 10% based on the 2019 World Health Organization non-laboratory model. The Markov model simulated different strategies for ten years (cycles) with parameters mainly from the CHERRY study or published literature. Quality-adjusted life year (QALY) and the number needed to treat (NNT) for each ischemic event (including myocardial infarction and ischemic stroke) were calculated to assess the effectiveness of the different strategies. The number needed to harm (NNH) for each bleeding event (including hemorrhagic stroke and gastrointestinal bleeding) was calculated to assess the safety. The NNT for each net benefit (i.e., the difference of the number of ischemic events could be prevented and the number of bleeding events would be added) was also calculated. One-way sensitivity analysis on the uncertainty of the incidence rate of cardiovascular diseases and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted.@*RESULTS@#A total of 212 153 Chinese adults, were included in this study. The number of people who were recommended for aspirin treatment Strategies ①-③ was 34 235, 2 813, and 25 111, respectively. The Strategy ③ could gain the most QALY of 403 [95% uncertainty interval (UI): 222-511] years. Compared with Strategy ①, Strategy ③ had similar efficiency but better safety, with the extra NNT of 4 (95%UI: 3-4) and NNH of 39 (95%UI: 19-132). The NNT per net benefit was 131 (95%UI: 102-239) for Strategy ①, 256 (95%UI: 181-737) for Strategy ②, and 132 (95%UI: 104-232) for Strategy ③, making Strategy ③ the most favorable option with a better QALY and safety, along with similar efficiency in terms of net benefit. The results were consistent in the sensitivity analyses.@*CONCLUSION@#The aspirin treatment strategies recommended by the updated guidelines on the primary prevention of cardiovascular diseases showed a net benefit for high-risk Chinese adults from developed areas. However, to balance effectiveness and safety, aspirin is suggested to be used for primary prevention of cardiovascular diseases with consideration for blood pressure control, resulting in better intervention efficiency.

Os dragões dos primórdios: o término e a persistência do infantil¹ / The dragons of primeval days termination and the persistence of the infantile / Los dragones del principio: la terminación y la persistencia de lo infantil / Les dragons des commencements: la terminaison et la persistance de l'infantile

Em nenhum outro momento a persistência do infantil é mais evidente do que no processo do término. Freud foi incaracteristicamente sincero ao dizer que questionava se uma verdadeira transformação era alcançada no término. Ele observou: "Às vezes bem se pode duvidar que os dragões dos primordios estejam realmente extintos". A intensidade e a onipresença do infantil em nosso trabalho serão mais bem vislumbradas pelo estudo da defesa contra o infantil.

The persistence of the infantile is nowhere more apparent than in the termination process. Freud was uncharacteristically candid in saying that he questioned whether a true transformation was achieved at termination. He noted: "One feels inclined to doubt sometimes whether the dragons of primeval days are really extinct". The intensity and pervasiveness of the infantile in our work may best be glimpsed by studying the defense against the infantile.

En ningún otro momento la persistencia de lo infantil es tan evidente como en el proceso de la terminación. Freud fue inusualmente sincero al decir que se preguntaba si una verdadera transformación era alcanzada en la terminación. Él observó: "Una persona se siente inclinada, a veces, a dudar si los dragones del principio realmente fueron extinguidos". La intensidad y la omnipresencia de lo infantil en nuestro trabajo se pueden vislumbrar mejor por medio del estudio de la defensa contra lo infantil.

Nulle part la persistance de l'infantile n'est plus apparente que dans le processus de terminaison. Freud était étrangement sincère lorsqu'il mettait en question si une vraie transformation était atteinte dans la terminaison. Il a remarqué : « Parfois, on se sent incliné à douter que les dragons des jours primitifs seraient vraiment disparus ¼. L'intensité et la diffusion de l'infantile dans notre travail peuvent être mieux aperçues, lorsque l'on étudie la défense contre l'infantile.

Conhecimento e prática de mulheres atendidas na atenção primária a saúde sobre o exame Papanicolaou / Knowledge and practice of women attended in primary health care about Papanicolau test / Conocimiento y práctica de las mujeres asistidas en atención primaria de salud sobre el examen de Papanicolau

Objetivo: avaliar o conhecimento e a prática de mulheres atendidas em Unidades Básica de Saúde em relação ao exame Papanicolaou. Método: trata-se de um estudo quantitativo, descritivo com delineamento transversal. Foram entrevistadas 320 mulheres residentes na área de abrangência de três Unidades Básicas de Saúde da cidade de Caxias - MA. Resultados: apesar da quase totalidade das mulheres entrevistadas terem ouvido falar do exame Papanicolaou 311 (97,2%), mais da metade delas apresentou um conhecimento inadequado 233 (72,8%). Percebeu-se também, que apesar de mais da metade serem classificadas como tendo um conhecimento inadequado, a maioria das mulheres apresentaram uma prática adequada 187 (58,44%). Conclusão: desta forma, este estudo mostrou que não houve uma associação entre o nível de conhecimento e a prática das mulheres. Portanto, existe conhecimento precário da maioria das mulheres sobre o exame preventivo do Câncer do Colo do Útero, tendo como consequência uma atribuição errônea sobre a finalidades do mesmo

Objective: to evaluate the knowledge and practice of women assisted in Basic Health Units in relation to the Pap smear. Method: this is a quantitative, descriptive study with a cross-sectional design. 320 women living in the area covered by three Basic Health Units in the city of Caxias-MA were interviewed. Results: although almost all of the women interviewed heard about the Pap smear exam 311 (97.2%), more than half of them had inadequate knowledge 233 (72.8%). It was also noticed that despite the fact that more than half were classified as having inadequate knowledge, most women had an adequate practice 187 (58.44%). Conclusion: thus, this study showed that there was no association between the level of knowledge and the practice of women. Therefore, there is a precarious knowledge of the majority of women about the cervical cancer preventive exam, resulting in an erroneous attribution about its purposes

Objetivo: analizar el conocimiento y la práctica de las mujeres atendidas en las unidades básicas de salud en relación con la prueba de Papanicolaou. Metodo: este es un estudio cuantitativo, descriptivo con un diseño transversal. Se entrevistó a 320 mujeres que viven en el área cubierta por tres Unidades Básicas de Salud en la ciudad de Caxias-MA. Resultados:aunque casi todas las mujeres entrevistadas escucharon sobre el examen de Papanicolaou 311 (97.2%), más de la mitad tenían conocimiento inadecuado 233 (72.8%). También se observó que, aunque más de la mitad se clasificaron como de conocimiento inadecuado, la mayoría de las mujeres tenían una práctica adecuada 187 (58.44%). Conclusiones:por lo tanto, este estudio mostró que no había asociación entre el nivel de conocimiento y la práctica de las mujeres. Por lo tanto, existe un conocimiento precario de la mayoría de las mujeres sobre el examen preventivo del cáncer de cuello uterino, lo que resulta en una atribución errónea sobre sus propósitos

Trastornos de la conducta alimentaria en adolescentes: rol del pediatra: recomendaciones de la Rama de Adolescencia de la Sociedad Chilena de Pediatría / Eating disorders in adolescents: role of the pediatrician: recommendations of the Adolescence Branch of the Chilean Society of Pediatrics

Los trastornos de la conducta alimentaria (TCA) han adquirido relevancia en la pediatría chilena. Su tratamiento debe ser realizado, de preferencia, por equipos multidisciplinarios especializados o con alto grado de capacitación en la problemática. Sin embargo, los pediatras generales tienen un rol fundamental tanto en la prevención como en la pesquisa temprana de estas patologías. El objetivo de esta publicación es proporcionarles recomendaciones prácticas sobre las intervenciones que pueden llevar a cabo durante la atención de adolescentes, para la prevención de los TCA, la pesquisa precoz y evaluación de quienes ya los presentan, y su derivación oportuna a tratamiento especializado.

Eating disorders (ED) have become relevant in Chilean pediatrics. Their treatment must be prefe rably carried out by multidisciplinary teams with specialty or a high degree of training in the pro blem. However, general pediatricians have a fundamental role both in the prevention and in the early detection of these pathologies. The purpose of this publication is to provide them with practical recommendations on interventions that can be carried out during adolescent care for the prevention of ED, the early detection and evaluation of those who already have them, and their timely referral to specialized treatment.

Conocimiento del autoexamen de mama y testículo en estudiantes universitarios / Knowledge of university students on breasts and testicles self-examination

Introducción: El autoexamen de mama y el autoexamen de testículos son métodos de detección temprana sencillos, económicos, seguros, no invasivos, que no requieren ningún instrumento especial para su ejecución y que permiten una mayor conciencia y conocimiento del propio cuerpo. Objetivo: Determinar el conocimiento de la práctica del autoexamen de mama o testículo en un grupo de estudiantes universitarios. Métodos: Estudio descriptivo, transversal. Se aplicó un cuestionario sobre conocimientos de autoexamen de mama o testículo, consumo de tabaco, alcohol y variables sociodemográficas. El análisis de datos incluyó distribución de frecuencias, porcentajes y razones de prevalencia. Resultados: Del total de la muestra, el 43,9 por ciento eran hombres, de ellos el 30,7 por ciento manifestó conocer cómo se debía realizar el autoexamen de testículo. Los masculinos pertenecientes a estratos altos, los que se encontraban cursando tercer año y quienes tenían estudios afines con la facultad de salud mostraron las mayores tasas de conocimiento. De las mujeres, el 73,7 por ciento conocía cómo realizar el autoexamen de mama, demostrando tasas mayores de conocimientos las que cursaban cuarto año, las que pertenecían a estratos altos y las que tenían estudios afines con la facultad de salud. No se encontró asociación estadística con el conocimiento del autoexamen de testículo; mientras que ser mayor de 22 años y pertenecer a estratos altos fueron factores predisponentes para el autoexamen de mama. Conclusiones: Las mujeres tienen mayor percepción de la importancia del autocuidado para su salud, a la vez que manifiestan mayor conocimiento de los procedimientos para realizar el autoexamen. No obstante, existen hombres y mujeres que no saben aún como realizarlo, de ahí la importancia de desarrollar e implementar programas de educación, prevención y promoción del autoexamen en los estudiantes universitarios(AU)

Introduction: Breasts self-examination and testicles self-examination are simple, economic, safe, non-invasive early detection's methods that do not require any special tool for their performance and that foster a higher awareness and knowledge on your own body. Objective: To determine the knowledge of the breast or testicles self-examination practice in a group of university students. Methods: Descriptive, cross-sectional study. It was performed a questionnaire on the knowledge of the breast or testicles self-examination, tobacco and alcohol consumption, and socio-demographic variables. Data analysis included frequencies and percentages distribution, and prevalence ratios. Results: From the total of the sample, 43,9 percent were men, and 30,7 percent of them expressed to have knowledge on how to perform the testicles self-examination. Males corresponding to high strata, the ones that were in third year of the major, and those who had studies related to the Health's Faculty showed higher rates of knowledge. From women, 73,7 percent knew how to perform the breasts self-examination showing higher rates of knowledge the ones that were in the fourth year of the major, the ones that belonged to higher strata and the ones that had studies related with the Health's Faculty. There was not found statistic association with the knowledge on testicles self-examination; while being older than 22 years old and belonging to high strata were predisposing factors for breasts self-examination. Conclusions: Women have higher perception of the importance for health of self-care, while they show more knowledge on the procedures to perform self-examination. Nevertheless, there are men and women that do not know yet how to perform it, that is why it is important to develop and implement programs of education, prevention and promotion of the self-examination in university students(AU)

Aspirina en la prevención primaria. Metaanálisis estratificado por riesgo cardiovascular basal / Aspirin in primary prevention. Meta-analysis stratified by baseline cardiovascular risk

Resumen Introducción: La utilidad de la aspirina en la prevención primaria es todavía objeto de controversia. Los avances médicos y la variabilidad del riesgo cardiovascular podrían explicar la heterogeneidad de los estudios publicados, y las poblaciones de alto riesgo tendrían mayor beneficio. Objetivo: Analizar los efectos de la aspirina en pacientes sin antecedentes cardiovasculares y evaluar los resultados de acuerdo con el riesgo cardiovascular de las poblaciones. Métodos: Se incluyeron estudios que evaluaron el uso de la aspirina en comparación con placebo en la prevención primaria. Se analizó la combinación de muerte cardiovascular, infarto agudo de miocardio (IAM) y accidente cerebrovascular (ACV) isquémico. El punto final de seguridad fue la combinación de ACV hemorrágico y sangrado mayor. Se clasificaron los estudios en riesgo bajo y moderado/ alto, de acuerdo con el número de episodios en la rama de placebo. Resultados: Se evaluaron 13 estudios (n = 164,225), ocho de riesgo cardiovascular bajo (n = 118,455) y cinco de moderado/alto (n = 45,770). Se observó una reducción del punto final combinado en el grupo de aspirina (OR 0.90; IC 95%, 0.85-0.94), sin diferencias en mortalidad cardiovascular (OR 0.94; IC 95%, 0.86-1.04). No se identificaron diferencias entre los subgrupos de riesgo. Se reconocieron mayores complicaciones hemorrágicas en el grupo de aspirina (OR 1.45; IC 95%, 1.32-1.60), sin diferencias entre los subgrupos de riesgo. Conclusión: La aspirina se relacionó con una leve disminución de IAM y ACV isquémico en términos absolutos, sin diferencias en la mortalidad cardiovascular. Esto, junto con el aumento de las complicaciones hemorrágicas, se traduce en una ausencia de beneficio clínico neto. El riesgo cardiovascular basal de la población no modificó los resultados.

Abstract Background: The usefulness of aspirin in primary prevention continues to be the subject of debate. Medical advances and the variability of cardiovascular risk could explain the heterogeneity of the published studies. High risk populations would have greater benefit. Objective: Analyzing the effects of aspirin in patients without cardiovascular disease and evaluating the results according to the cardiovascular risk of the populations. Methods: Studies evaluating aspirin versus placebo in primary prevention were included. The primary endpoint was the combined cardiovascular death, acute myocardial infarction (AMI) and ischemic stroke. The final safety point was the combination of hemorrhagic stroke and major bleeding. The studies were classified into low and moderate/high risk, according to the number of events in the placebo arm. Results: Thirteen studies were evaluated (n = 164,225), eight of low cardiovascular risk (n = 118,455) and five of moderate/high risk (n = 45,770). There was a reduction of the combined endpoint in the aspirin group (odds ratio [OR] 0.90; 95% confidence interval [CI], 0.85-0.94), without differences in cardiovascular mortality (OR 0.94; 95% CI, 0.86-1.04). No differences were observed when comparing the risk subgroups. Greater hemorrhagic complications were observed in the aspirin group (OR 1.45; 95% CI, 1.32-1.60), without differences between the risk subgroups. Conclusion: Aspirin was associated with a slight decrease in AMI and ischemic stroke in absolute terms, with no differences in cardiovascular mortality. This accompanied by the increase in hemorrhagic complications, results in an absence of net clinical benefit. The baseline cardiovascular risk of the population did not affect the results.

Factores asociados a hidrocefalia congénita / Factors associated to congenital hydrocephaly

RESUMEN La hidrocefalia congénita constituye un síndrome polimórfico, que reúne afecciones diversas que conllevan a la discapacidad mental y a la muerte, puede aparecer como una malformación aislada o asociarse a otras, relacionada con un gran número de defunciones. La mayoría de los casos diagnosticados prenatalmente no llegan al nacimiento, lo cual significa que es necesario la prevención preconcepcional de los factores de riesgo asociados, los cuales son disímiles y en su mayoría prevenibles. Se revisó la bibliografía actualizada en las bases de datos bibliográficas Scielo y ClinicalKey, además de tesis de terminación de las especialidades Embriología Médica, Ginecobstetricia, Pediatría y Medicina Interna. Entre los factores de riesgo asociados se destacan el déficit de ácido fólico, las infecciones maternas, así como agentes físicos y químicos. El objetivo fue exponer los referentes teóricos relacionados con la hidrocefalia congénita y sus factores asociados, basándose en los fundamentos teóricos más actualizados (AU).

SUMMARY Congenital hydrocephaly is a polymorphic syndrome comprising diverse diseases that lead to mental disability and death. It could appear like an isolated malformation or associated to other malformations and is related to a great number of deceases. Most of the cases diagnosed prenatally are not borne, meaning not only that incidence is slow, but also that a great work is needed in the pre-conceptive prevention of the associated risk factors that are different and mostly preventable and modifiable. That is why it is an important multifactorial health problem. Among the associated risk factors the most important are folic acid deficit, maternal infections, and also physical and chemical agents. The theoretical referents related to congenital hydrocephaly and its associated factors are declared the aim of this research on the basis of the most updated theoretical principles (AU).

OM-85 BV for primary prevention of recurrent airway infections: a pilot randomized, double-blind, placebo-controlled study / OM-85 BV para prevenção primária de infecções recorrentes das vias aéreas: estudo piloto, randomizado, duplo-cego, placebo-controlado

ABSTRACT Objective To compare the frequency of respiratory tract infections in children treated with OM-85 BV and placebo during the 3-month therapy period, and observation for a further 3 months after treatment. Methods A randomized, double-blind, placebo-controlled trial was conducted with 54 children (6 months to 5 years old) with no past history of recurrent respiratory infections attending daycare center. Family members were instructed to administer one capsule per day for 10 consecutive days, for 3 months of OM-85 BV or placebo. Telephone interviews were conducted every 30 days. Results There was no significant difference in the number of respiratory infections between the groups. The mean number of respiratory tract infection in the OM-85 BV Group in the first 3 months was 0.92±0.87, and in the Placebo Group was 0.74±1.02, and at 6 months it was 1.62±1.47 and 1.03±1.34, respectively. Conclusion OM-85 BV was not effective in the primary prevention of respiratory tract infections. Although most authors recommend the use of this immunostimulant in children with a history of recurrent respiratory infections, more studies are needed to define its usefulness in the primary prevention of respiratory infections in healthy children exposed to few risk factors.

RESUMO Objetivo Comparar a frequência de infecções do trato respiratório em crianças tratadas com OM-85 BV e placebo durante o período de terapia de 3 meses, e observação por mais 3 meses após o tratamento. Métodos Foi realizado estudo randomizado, duplo-cego, controlado por placebo com 54 crianças (6 meses a 5 anos) sem história prévia de infecções respiratórias recorrentes, que frequentavam creches. Os membros da família foram instruídos a administrar uma cápsula por dia durante 10 dias consecutivos, durante 3 meses, de OM-85 BV ou placebo. Entrevistas telefônicas foram realizadas a cada 30 dias. Resultados Não houve diferença significativa no número de infecções respiratórias entre os grupos. O número médio de infecções do trato respiratório no Grupo OM-85 BV nos primeiros 3 meses foi de 0,92±0,87 e, no Grupo Placebo, de 0,74±1,02, e aos 6 meses foi de 1,62±1,47 e 1,03±1,34, respectivamente. Conclusão O OM-85 BV não foi eficaz na prevenção primária de infecções do trato respiratório. Embora a maioria dos autores recomende o uso deste imunoestimulante em crianças com história de infecções respiratórias recorrentes, mais estudos são necessários para definir sua utilidade na prevenção primária de infecções respiratórias em crianças saudáveis expostas a poucos fatores de risco.

Consenso de prevención cardiovascular en la infancia y la adolescencia. Versión resumida. Recomendaciones / Consensus on Cardiovascular Prevention in Childhood and Adolescence. Brief version. Recommendations

La enfermedad cardiovascular secundaria a aterosclerosis es la principal causa de morbimortalidad en la población adulta a nivel mundial. Aunque las manifestaciones clínicas de aterosclerosis (enfermedad coronaria, accidente cerebrovascular y arteriopatía periférica) son excepcionales en la población pediátrica, la presencia de factores de riesgo para enfermedad cardiovascular, así como la adquisición de hábitos que favorecen su desarrollo, se observan ya desde edades tempranas. En el presente documento, se elaboraron recomendaciones, con dos objetivos principales: prevenir la aparición de factores de riesgo para enfermedad cardiovascular (prevención primordial) y detectar y tratar los que favorecen el desarrollo de aterosclerosis clínica (prevención primaria). Si bien las recomendaciones están dirigidas a la población pediátrica, el objetivo del trabajo conjunto de la Sociedad Argentina de Pediatría y la Sociedad Argentina de Cardiología es asegurar un abordaje integral y consensuado de la prevencion cardiovascular a lo largo de toda la vida, incluso, desde antes de la concepción.

Cardiovascular disease secondary to atherosclerosis is the leading cause of morbimortality in the adult population worldwide. Although clinical manifestations of atherosclerosis (coronary heart disease, stroke and peripheral vascular disease) are extremely rare in the pediatric population, the presence of risk factors for cardiovascular disease and the development of health-behavior patterns that promote them are observed since early childhood.In this document, recommendations were developed addressing two main goals: prevention of the risk factors development for cardiovascular disease (primordial prevention) and early detection and treatment of the risk factors to prevent clinical atherosclerosis (primary prevention). Even though the recommendations are addressed to the pediatric population, the aim of the collaborative work between the Sociedad Argentina de Pediatría and the Sociedad Argentina de Cardiología is to ensure a comprehensive and consensual approach of lifetime cardiovascular prevention beginning even before conception.

A resposta brasileira à epidemia de HIV/AIDS em tempos de crise / The Brazilian response to the HIV/AIDS epidemic amidst the crisis

Resumo A "crise" é um fenômeno que corresponde a políticas globais e locais com repercussões sociais, políticas e econômicas e é o contexto para este artigo, que visa refletir sobre a resposta brasileira à epidemia de HIV/AIDS. Examinamos dimensões deste fenômeno, como a revisão de consensos das políticas de austeridade, seus impactos e a construção de "antiagendas" que dificultam a narrativa dos direitos humanos, gênero, sexualidade e saúde e obstaculizam o trabalho de prevenção e o cuidado na área de HIV/AIDS. Tal guinada conservadora pode ser associada à censura a materiais especializados e à mudança recente na estrutura de gestão do Ministério da Saúde, à extinção de centenas de conselhos participativos no âmbito do executivo federal e à nova Política Nacional sobre Drogas que substitui a orientação de "redução de danos" para a de "abstinência". Todos esses fenômenos reaquecem uma antiga preocupação: que o "vírus ideológico" venha a suplantar o vírus biológico, acentuando o quadro de estigma e de discriminação. Somados à agressiva orientação socioeconômica neoliberal que ameaça o Estado brasileiro, tais fatos afetariam a continuidade das respostas institucionais ao HIV/AIDS.

Abstract "Crisis" is a phenomenon that is part of global and local policies with social, political, and economic repercussions. It is the context of this paper that aims to reflect on the Brazilian response to the HIV/AIDS epidemic. We examined the realms of this phenomenon, such as the review of the consensus on austerity policies, their impact and the construction of "anti-agendas" that hinder the narrative of human rights, gender, sexuality, and health and hamper HIV/AIDS prevention and care. Such a conservative move can be associated with censorship of specialized materials and the recent change of management in the structure of the Ministry of Health, the extinction of hundreds of participatory councils within the Executive Branch and the new National Policy on Drugs that replaces the guidance "harm reduction" with one of "abstinence". All these phenomena revive an old concern, that is, that the "ideological virus" will outweigh the biological virus, exacerbating the situation of stigma and discrimination. Besides the neoliberal socioeconomic orientation that threatens the Brazilian state, such facts would affect the continuity of institutional responses to HIV/AIDS.

Perfil epidemiológico das crianças vítimas de queimaduras em um hospital infantil da Serra Catarinense / Epidemiological profile of the burned children at a children's hospital of the Serra Catarinense / Perfil epidemiológico de niños víctimas de quemaduras en un hospital infantil de la sierra catarinense

Objetivos: Identificar o perfil epidemiológico dos pacientes acometidos por queimadura internados em um hospital infantil da Serra Catarinense. Método: Estudo descritivo, retrospectivo e transversal realizado por meio de análise prontuários de crianças (0 a 15 anos, 11 meses e 29 dias) internadas por queimadura em um hospital infantil da Serra Catarinense, no período de janeiro de 2013 a dezembro de 2018. Variáveis analisadas foram idade, sexo, tempo médio de internação, necessidade de internação em unidade de terapia intensiva (UTI), desfecho final, agente causal, região do corpo acometida e superfície corporal queimada (SCQ). Resultados: Foram analisados 78 prontuários, com média de idade de 4,2 anos, sendo maior a prevalência do sexo masculino (n=47; 60,3%). O tempo médio de internação foi 11 dias (62,8%), sendo que 4 pacientes (5%) necessitaram de internação em UTI e, destes, um foi a óbito. O principal agente causal foi líquido aquecido (n=61; 78%). Em relação às áreas acometidas 41% (n=32) apresentaram envolvimento da cabeça e a maior parte do casos computados apresentaram SCQ maior que 20% (n=18; 23,1%). Conclusão: A fase mais suscetível à queimadura é a pré-escolar, com predominância no sexo masculino, sendo que o acidente é por escaldadura e que acomete várias regiões do corpo, principalmente parte superior do mesmo. Assim, programas preventivos devem chamar a atenção dos pais e cuidadores quanto à avaliação dos riscos, de modo a antecipá-los, afastando ou tornando-os indisponíveis às crianças.

Objective: To identify the epidemiological profile of burn patients admitted to a children hospital of Serra Catarinense. Methods: A descriptive, retrospective, and cross-sectional study carried out through the analysis of medical records of children (0 to 15 years, 11 months and 29 days) hospitalized by burns in a children hospital of Serra Catarinense, from January 2013 to December 2018. Variables assessed were age, gender, average length of stay, need for admission to the intensive care unit (ICU), final outcome, causative agent, affected body region and burned body surface (SCQ). Results: 78 medical records were analyzed, with a mean age of 4.2 years, most of the sample was male (n=47; 60.3%). The average length of stay was 11 days (62.8%), with 4 patients (5%) requiring ICU admission and one patient dying. The main causative agent was heated fluid (n=61; 78%) and in relation to the affected areas, 41% (n=32) of the cases presented head involvement and most of the computed cases presented SQ greater than 20% (n=18; 23.1%). Conclusion: The results of the study indicate that the most susceptible phase to burn is the preschool, with predominance in males, and the accident is by scalding and affecting various regions of the body, especially the upper part of it. Thus, preventive programs should draw the attention of parents and caregivers to risk assessment in order to anticipate them, driving them away or unavailable to children.

Objetivo: identificar el perfil epidemiológico de pacientes con quemaduras ingresados en un hospital de niños de la sierra catarinense. Método: Estudio descriptivo, retrospectivo y transversal realizado a través del análisis de historias clínicas de niños (0 a 15 años, 11 meses y 29 días) hospitalizados por quemaduras en un hospital de niños de la sierra catarinense, de enero de 2013 a diciembre de 2018. Las variables evaluadas fueron la edad, el sexo, la duración promedio de la estadía, la necesidad de ingreso a la unidad de cuidados intensivos (UCI), el resultado final, el agente causal, la región corporal afectada y la superficie corporal quemada (SCQ). Resultados: Fueron analisadas 78 histórias clínicas de pacientes com edad de 4,2 años, con mayor prevalencia de varones (n=47; 60,3%). El tiempo promedio de estadía fue de 11 días (62,8%), con 4 pacientes (5%) que requirieron ingreso a la UCI y de estos, uno falleció. El principal agente causal fue los liquidos calientes (n=61; 78%). Con respecto a las áreas afectadas, el 41% (n=32) la cabeza y la mayoría de los casos presentaron un SCQ superior al 20% (n=18; 23,1%). Conclusión: Los resultados del estudio indican que la fase más susceptible a las quemaduras es la preescolar, con predominio en los hombres, y el agente causador los líquidos calientes, afectando varias regiones del cuerpo. Por lo tanto, los programas preventivos deben llamar la atención de los padres y cuidadores sobre la evaluación de riesgos para anticiparlos, alejándolos o no disponibles para los niños.

El final de la aspirina en la prevención primaria de las enfermedades cardiovasculares / The end of aspirin in primary prevention of cardiovascular diseases

Introducción: En la actualidad la aspirina es la droga de mayor uso a nivel internacional. Durante el año 2018, al menos parcialmente, se cuestionó la proporción riesgo/beneficio de la aspirina en la prevención primaria. Objetivo: Actualizar el verdadero valor riesgo/beneficio de la aspirina en la prevención primaria de las enfermedades cardiovasculares. Métodos: Se realizó una revisión de los trabajos publicados en los últimos cinco años, relacionados con el uso de la aspirina en la prevención primaria de las enfermedades cardiovasculares, de las cuales se tomaron 20 publicaciones, en Medline, Embase, y SciELO. Desarrollo: Existen importantes estudios aleatorizados, independientes y de gran calidad que han puesto en duda calidad de la aspirina en la prevención primaria. Resultados: Los primeros resultados del estudio THEMIS contribuirán a entender sobre la función futura de agentes antiplaquetarios en la prevención primaria para evitar las consecuencias de la ruptura de la placa ateroesclerótica en pacientes con posibilidades de sufrir de ruptura de la placa ateroesclerótica asintomático Conclusiones: Se descartan las ventajas del uso de la aspirina como profilaxis primaria de la enfermedad cardiovascular, debido a la frecuente aparición de sangrado en ocasiones grave; sin embargo, sigue proponiéndola como un medicamento muy útil en la profilaxis secundaria, además de promover el uso de las estatinas(AU)

Introduction: Aspirin is currently the most widely used drug worldwide. During 2018, at least partially, the risk/benefit ratio of aspirin in primary prevention was questioned. Objective: To update the true risk/benefit value of aspirin in the primary prevention of cardiovascular diseases. Methods: A review of the papers published in the last five years, on the use of aspirin in the primary prevention of cardiovascular diseases, was carried out. Twenty publications were selected in Medline, Embase, and SciELO. Discussion: There are important, high-quality, randomized, independent studies that have questioned the quality of aspirin in primary prevention. Results: The first results of the THEMIS study will contribute to understanding the future role of antiplatelet agents in primary prevention as to avoid the consequences of atherosclerotic plaque rupture in patients with the possibility of suffering from asymptomatic atherosclerotic plaque rupture. Conclusions: The advantages of the use of aspirin as a primary prophylaxis of cardiovascular disease are ruled out, due to the frequent appearance of sometimes serious bleeding; however, aspirin continues to be proposed as a very useful medicine in secondary prophylaxis, in addition to promoting the use of statins(AU)

Síndrome hemolítico urémico asociado a Shigatoxina: ¿Cómo prevenirlo? / Shiga-toxin associated hemolytic uremic syndrome: how to prevent it?

Resumen: El síndrome hemolítico urémico (SHU) asociado a infección intestinal por bacterias productoras de Shigatoxina, que afecta principalmente a población infantil, puede causar morbilidad aguda grave, secuelas crónicas en varios órganos, y la muerte prematura en algunos de ellos. Dado su carácter zoonótico, adecuadas medidas de manejo agropecuario y correcta higiene de lo que consumimos es indispensable a la hora de prevenir la infección. Actualmente, una vez gatillado el SHU el manejo es médico y, principalmente, de soporte. En los últimos años diversas estrategias terapéuticas se han ido desarrollando para evitar que esta enfermedad ocurra, o, al menos, que pueda ser atenuada en sus consecuencias de morbi-mortalidad. El presente artículo describe acciones específicas a diferentes niveles de prevención de esta patología.

Abstract Hemolytic uremic syndrome (HUS) associated with intestinal infection by Shiga toxin-producing bacteria, which mainly affects children, can cause severe acute morbidity, chronic sequelae in seve ral organs, and premature death in some of them. Given its zoonotic nature, adequate measures of agricultural management and proper hygiene of what we consume are essential to prevent infection. Once the HUS is triggered, medical management is currently mainly supportive. In recent years, va rious therapeutic strategies have been developed to prevent this disease from occurring or, at least, to mitigate its morbidity and mortality consequences. This article describes specific actions at different levels of prevention of this pathology.

Correlação entre aterosclerose carotídea e disfunção ventricular esquerda ao ecocardiograma / Correlation between carotid atherosclerosis and left ventricular dysfunction at echocardiography

As doenças cardiovasculares são a maior causa de morbimortalidade no mundo. A prevenção primária, por meio do diagnóstico precoce, é necessária para possibilitar o tratamento adequado e controlar a evolução da doença, reduzindo a mortalidade e os gastos em saúde pública. Correlacionar aterosclerose em artéria carótida (avaliada pelo Eco Doppler) e disfunção ventricular esquerda (avaliada pelo ecocardiograma), além de correlacionar tais achados com o risco cardiovascular dos pacientes estudados. Método: Foram analisados 286 prontuários de pacientes que realizaram os exames Eco Doppler carotídeo e ecocardiograma transtorácico. Os dados analisados foram: presença de placa aterosclerótica e grau de estenose, fração de ejeção do ventrículo esquerdo e presença de alterações contráteis difusas ou segmentares do ventrículo esquerdo. Resultados: Dos 238 laudos de Eco Doppler carotídeo, 18 tinham estenose maior que 70% em artéria carótida e 14 destes apresentavam alteração contrátil do ventrículo esquerdo (p = 0,045). Dos pacientes que tinham risco cardiovascular muito alto, 61 apresentavam estenose em artéria carótida (p < 0,001); 51 pacientes com risco cardiovascular muito alto apresentavam alteração contrátil (p < 0,001). Dos 266 laudos de ecocardiograma, 37 registravam fração de ejeção do ventrículo esquerdo reduzida. Desses, 25 tinham risco cardiovascular muito alto (p < 0,001). Conclusão: Houve relação positiva entre estenose de artéria carótida, redução da fração de ejeção do ventrículo esquerdo e alteração contrátil do ventrículo esquerdo (difusa ou segmentar) com risco cardiovascular muito alto. Também foi possível correlacionar a estenose carotídea com alteração contrátil, apesar deste estudo não demonstrar correlação entre estenose carotídea e redução da fração de ejeção do ventrículo esquerdo

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Primary prevention, through early diagnosis, is necessary to enable proper treatment and control disease progression, reducing mortality and public health expenditures. Objective: Correlate carotid artery atherosclerosis (evaluated by Doppler echocardiography) and left ventricular dysfunction (evaluated by echocardiography) and to correlate the findings with the patients' cardiovascular risk. Method: A total of 286 medical records of patients who underwent carotid Doppler echocardiography and transthoracic echocardiography were analyzed. The data analyzed were: presence of atherosclerotic plaque and degree of stenosis, left ventricular ejection fraction and presence of diffuse or segmental left ventricular contractile disorders. Results: Of the 238 reports of carotid Doppler echocardiography, 18 had stenosis greater than 70% in the carotid artery and 14 of those had left ventricular contractile disorders (p = 0.045). Of the patients with very high cardiovascular risk, 61 had carotid artery stenosis (p < 0.001); 51 patients with very high cardiovascular risk had contractile disorders (p < 0.001). Of the 266 echocardiography reports, 37 had reduced left ventricular ejection fraction. Of these, 25 had very high cardiovascular risk (p < 0.001). Conclusion: There was a positive relationship between carotid artery stenosis, reduced left ventricular ejection fraction and left ventricular (diffuse or segmental) contractile disorder with very high cardiovascular risk. It was also possible to correlate carotid stenosis with contractile disorder, although this study did not demonstrate any correlation between carotid stenosis and reduced left ventricular ejection fraction

Real-life challenge: training program on drug use and adolescence in primary health care / Desafio na vida real: capacitação sobre uso de drogas e adolescência na atenção básica

ABSTRACT Guidelines emphasize the importance of approaching substance use by adolescents, particularly in primary health care. However, there are problems with its incorporation. The objective of this study was to present the training stages on the theme for professionals in primary health care. Researchers conducted logistic structuring, content elaboration and evaluation of difficulties before and after training. Sixty percent of professionals involved in the care of adolescents in a medium-sized city participated in the study. More than half of them stated having difficulties in the approach, mainly theoretical limitations and short consultations. After the training, the professionals informed whether they felt more prepared, but practical difficulties remained.

RESUMO Diretrizes ressaltam a importância da abordagem do uso de substâncias por adolescentes, particularmente na atenção básica. Todavia, observam-se problemas para sua incorporação. O objetivo deste estudo foi apresentar as etapas de capacitação no tema para profissionais da atenção básica. Realizou-se estruturação logística, elaboração do conteúdo e avaliação das dificuldades antes e após a capacitação. Participaram 60% dos profissionais envolvidos no atendimento de adolescentes em município de médio porte. Mais da metade afirmou ter dificuldades na abordagem, principalmente limitações teóricas e pouco tempo para atendimento. Após o treinamento, os profissionais informaram se sentir mais preparados, mas dificuldades práticas se mantiveram.

Interventions to reduce accidents in childhood: a systematic review / Intervenções para redução de acidentes na infância: revisão sistemática

Abstract Objective: To review the literature on interventions planned to prevent the incidence of injuries in childhood. Source of data: The PubMed, Web of Science, and Bireme databases were searched by two independent reviewers, employing the single terms accidents, accident, injuries, injury, clinical trial, intervention, educational intervention, and multiple interventions, and their combinations, present in the article title or abstract, with no limits except period of publication (2006-2016) and studies in human subjects. Synthesis of data: Initially, 11,097 titles were located. Fifteen articles were selected for the review. Eleven were randomized trials (four carried out at the children's households, five in pediatric healthcare services, and two at schools), and four were non-randomized trials carried out at the children's households. Four of the randomized trials were analyzed by intention-to-treat and a protective effect of the intervention was observed: decrease in the number of risk factors, decrease in the number of medical consultations due to injuries, decrease in the prevalence of risk behaviors, and increase of the parents' knowledge regarding injury prevention in childhood. Conclusion: Traumatic injuries in childhood are amenable to primary prevention through strategies that consider the child's age and level of development, as well as structural aspects of the environment.

Resumo Objetivo: Revisar a literatura sobre intervenções voltadas à prevenção de acidentes na infância. Fonte dos dados: As bases PubMed, Web of Science e Bireme foram rastreadas por dois revisores independentes, com os termos accidents, accident, injuries, injury, clinical trial, intervention, educational intervention e multiple interventions, e suas combinações, presentes no título ou resumo do artigo, sem limites, exceto o período de publicação (2006-2016), e estudos realizados em humanos. Síntese dos dados: Foram localizados inicialmente 11.097 títulos. Foram selecionados 15 artigos para esta revisão, dos quais 11 eram ensaios randomizados (quatro feitos em domicílios, cinco em serviços de saúde e dois em escolas) e quatro, ensaios não randomizados realizados em domicílios. Quatro dos estudos randomizados foram analisados por intenção de tratar e mostraram efeito favorável da intervenção: redução de fatores de risco para acidentes, diminuição do número de atendimentos médicos por acidentes, menor frequência de comportamentos de risco e maior conhecimento dos pais sobre prevenção de acidentes na infância. Conclusão: As lesões traumáticas na infância são passíveis de prevenção primária por meio de estratégias que levem em conta a idade e o nível de desenvolvimento da criança, bem como aspectos estruturais do ambiente.

Diagnóstico de factores de riesgo asociados a defectos de pared abdominal a mujeres con descendencia afectada. Provincia Matanzas, enero 2013-enero 2016 / Diagnosis of risk factors associated to abdominal wall defects in women with affected descendants. Province of Matanzas, January 2013-January 2016

Introducción: los defectos de pared abdominal constituyen un espectro de malformaciones anatómicas estructurales de etiología diversa, con severidad y pronóstico variable. Los factores de riesgo son disímiles, muchos modificables. Objetivo: identificar los factores de riesgo asociados a defectos de pared abdominal diagnosticados prenatalmente en la provincia de Matanzas. Materiales y métodos: se realizó una investigación de corte transversal sobre los factores de riesgo en las mujeres con diagnóstico de defectos de pared abdominal en la provincia Matanzas, de enero 2013 a enero 2016, a través de una encuesta, previa prueba piloto para cálculo de confiabilidad (alfa de Cronbach) y validez (regresión lineal). Resultados: el valor de ambos coeficientes fue superior a 0.7, por lo que la encuesta fue confiable y válida. Los factores de riesgo para estos defectos más frecuentes fueron la combinación de factores ambientales, no suplementación periconcepcional de ácido fólico y exposición a sustancias químicas. La necesidad de recibir información preconcepcional de las mujeres fue alta. Conclusiones: los factores de riesgo más frecuentes fueron la combinación de factores ambientales y la no suplementación periconcepcional de ácido fólico (AU).

Introduction: the defects of the abdominal wall are a spectrum of structural anatomic malformations of diverse etiology, with variable severity and prognosis. The risk factors are dissimilar, many of them modifiable. Objective: to identify the risk factors associated to abdominal wall defects diagnosed before birth in the province of Matanzas. Materials and methods: a cross-sectional research was carried out on the risk factors in women with diagnose of defects of the abdominal wall in the province of Matanzas, from January 2013 to January 2016, through an inquiry, after a pilot test to calculate reliability (Crombach alpha), and validity (lineal regression). Results: the value of both coefficients was higher than 0.7, so the inquiry was reliable and valid. The risk factors for these more frequent defects were the combination of environmental factors, the lack of peri conceptional supplementation of folic acid and exposition to chemical substances. The necessity of receiving pre-conceptional information from the part of the women was high. Conclusions: the more frequent risk factors were the combination of environmental factors and the lack of peri conceptional supplementation of folic acid (AU).

Imunização na gravidez, puerpério e amamentação / Immunization in pregnancy, puerperium and breastfeeding

A vacinação materna representa uma ferramenta promissora na melhoria da saúde materna e infantil para diversas condições infecciosas. A maior susceptibilidade das gestantes às condições infecciosas, assim como a capacidade da mãe transferir anticorpos através da placenta, oferecendo proteção vital a seus conceptos antes que os mesmos sejam vacinados, têm despertado atenção maior à imunização materna. A FEBRASGO, em conformidade com a Sociedade Brasileira de Imunizações e Ministério da Saúde, recomenda três vacinas de rotina para todas gestantes: influenza, difteria - tétano -coqueluche acelular (dTpa), além da vacina de hepatite B, disponíveis no sistema público na totalidade. Esta revisão descreve as vacinas recomendadas na gestação, além de vacinas e imunoglobulinas de uso específico, e contraindicações da imunização na gestação e puerpério. Aborda, ainda, estratégias de melhoria de adesão à imunização pela gestante, visando alcançar altas taxas de cobertura vacinal, uma estratégia fundamental em saúde pública, com objetivo de reduzir a morbimortalidade infecciosa de gestantes e recém-nascidos.(AU)

El programa RADAR para la prevención del suicidio en adolescentes de la región de Aysén, Chile: resultados preliminares / RADAR: a program for the prevention of suicide in adolescents in the region of Aysen, Chile, preliminary results

OBJETIVO: Dar a conocer los resultados preliminares del programa comunitario RADAR (Red para la Atención y Derivación de Adolescentes en Riesgo suicida). MÉTODO: Durante el 2016, RADAR fue implementado como prueba de concepto en dos colegios de Puerto Aysén de la Región de Aysén, Chile. Se capacitó un total de 409 participantes (entre alumnos, profesores de los colegios, apoderados y profesionales de la salud) para la pesquisa y derivación de adolescentes en riego de suicidio. RESULTADOS: De un total de 144 alumnos que pasaron los sistemas de pesquisa de RADAR, se detectaron 29 casos en riesgo suicida (20%) y 27 fueron derivados oportunamente al Servicio de Urgencia del Hos pital de Puerto Aysén. En la segunda campaña de pesquisa de RADAR, 3 meses después, el 90% de los casos ya no presentaba riesgo suicida. CONCLUSIÓN: Estos resultados muestran la alta proporción de adolescentes en riesgo suicida que no son visibilizados por el sistema de salud y la factibilidad de implementar RADAR en la comunidad como una intervención preventiva efectiva.

OBJECTIVE: We present the preliminary results of the implementation of RADAR: a community suicide prevention program in adolescents implemented in two high schools in a south region of Chile. METHOD: In a pilot study, during 2016, we implemented RADAR in two high schools of Puerto Aysen, in in the Region of Aysen of Chile. A total of 409 actors were trained (among students, school teachers, caregivers and health professionals) for the screening and referral of high suicide risk adolescents. RESULTS: Out of a total of 144 students who passed the RADAR screening systems, 29 cases were detected as suicide risk (20%) and 27 of them were opportunely referred to the Emergency Service of the Hospital of Puerto Aysen. In the second RADAR screening campaign, 3 months later, 90% of the cases no longer presented suicide risk. CONCLUSION: These results show the high proportion of ado lescents at risk of suicide who are not visible by the health system and the feasibility of implementing RADAR in the community as an effective suicide prevention intervention.

Modelo socio-pedagógico de formación del Técnico Superior en Enfermería para labor de prevención / Socio-pedagogical model in Higher Technician´s Nursing Training for prevention work

Introducción: En el perfil del Técnico Superior en Enfermería se establece la formación de un técnico consciente de su práctica social y comunitaria que contribuya a aportar a la sociedad una atención con calidad y calidez. Objetivo: Proponer un modelo socio-pedagógico de formación del Técnico Superior en Enfermería para la labor de prevención. Material y métodos: A partir de la consulta a artículos publicados en base de datos y documentos normativos del contexto ecuatoriano, se elaboró la propuesta del modelo. Se emplearon métodos del nivel teórico en la comprensión y explicación del proceso de formación del Técnico Superior en Enfermería. Desarrollo: Se propone un modelo cuya intencionalidad socio-pedagógica esté planteada desde la perspectiva de la comunidad a partir de una dirección pedagógica, una orientación epistemológica y criterios lógicos de sistematización de los contenidos y la práctica, y considerar las características inherentes a la lógica de formación profesional del TSE en el Instituto Superior Tecnológico Bolivariano de Tecnología (ITB). Conclusiones: Se reconocen como subsistemas de la modelación: el contexto escolar comunitario y el contexto preventivo comunitario, construido a partir del método sistémico estructural funcional desde un enfoque cualitativo. El modelo es resultado teórico de un proyecto de formación doctoral en Ciencias Pedagógicas a partir del convenio Cuba-Ecuador(AU)

Introduction: The technician´s awareness of its social and community practice that contributes to a higher quality and affectionate attention to society is established in the profile of the Higher Technician´s Nursing Training. Objective: To propose a socio-pedagogical model in the Higher Technician´s Nursing Training for prevention work. Material and methods: A model proposal was made after a review of articles published in the database, and normative documents in the Ecuadorian context. Theoretical methods were applied for the comprehension, and explanation in the training of the Higher Technician in Nursing. Development: A model is proposed, which socio-pedagogical intent is posed from the community perspective starting from a pedagogical direction, an epistemological approach, and logical systematization criteria of theory and practice, also considering the characteristics inherent to the sense of professional formation of the higher technician in nursing in the Bolivarian Technological Institute of Technology. Conclusions: Community and school context, and community preventive service, built from a functional-structural systemic method with a qualitative approach were recognized as modeling subsystems. The model is a theoretical result of a project on doctoral programs in Pedagogical Sciences from the Cuba-Equator Agreement(AU)