An invisible villain: high perceived stress, its associated factors, and possible consequences in a population-based survey in southern Brazil

Abstract Introduction Much of the evidence on the relationship between stress, lifestyle, and other physical and mental health outcomes comes from studies conducted in high-income countries. There is therefore a need for research among populations in low and middle-income settings. Objectives To measure stress levels and identify factors associated with a high stress level and its consequences for health. Methods This was a population-based cross-sectional study carried out in 2016 with adults aged 18 years or older in a municipality in southern Brazil. A two-stage sampling strategy based on census tracts was used. Stress levels were measured with the Perceived Stress Scale (PSS-14) and classified into quartiles. The impact of the highest stress levelon each outcome was assessed with etiologic fractions (EF). Results The most stressed groups were: females (PR = 1.51, 95%CI 1.25-1.81), younger people (PR = 1.76, 95%CI 1.26-2.46), middle-aged individuals (PR = 1.60, 95%CI 1.17-2.19), those with lower schooling (PR = 1.56, 95%CI 1.20-2.02), the physically inactive (PR = 1.51, 95%CI 1.20-1.91), people who spent three or more hours watching television per day (PR = 1.29, 95%CI 1.12-1.50), and those with food insecurity (PR = 1.44, 95%CI 1.19-175). Possible consequences of high stress level were regular or poor self-perception of health (EF = 29.6%), poor or very poor sleep quality (EF = 17.3%), lower quality of life (EF = 45.6%), sadness (EF = 24.2%), and depressive symptoms (EF = 35.8%). Conclusions Stress plays an important role in several domains of health. Both public policies that target reduction of inequalities and specific stress-management interventions can reduce stress levels in populations, thereby decreasing the burden of other negative physical and mental health outcomes related to stress.

Caries experience and associated risk factors in Venezuelan 6-12-year-old schoolchildren

Abstract: This research aims to provide updated information on caries experience and associated risk factors in children 6-12 years old. A cross-sectional and descriptive study design was carried out with a non-probabilistic, convenient sample of 209 children male and female. Clinical examinations were performed by calibrated dental students following WHO detection criteria. Caries indices dmft and DMFT were calculated. Caries Risk Assessment data was collected using an adapted CAMBRA instrument; following the International Caries Care guidelines. Descriptive statistics were performed to analyze the results and Chi-square test, Contingency Coefficient (C) and Corrected Typified Residues were calculated to determine the association between variables. 58% of the total population had dental caries lesions in its more severe stages (cavitation) and 42% were apparently healthy (AHS) without any cavitated lesions. The mean dmft index was 1.34 ± 1.93, and the mean DMFT index was 0.63 ± 1.22. Lesion severity remained between 1-2 teeth affected on both dentitions. A statistically significant association (p = 0.035) between the health condition and toothbrushing was stablished with a degree of dependence of C = 0.144. A positive standardized residual of 2.1 was evident for schoolchildren that experience caries lesion that never brush their teeth and AHS that brushed their teeth more than once. No association (p = 0.081) was found between health condition and intake of sugary snacks and beverages. A severe dental caries experience with a statistically significant association between the health condition and toothbrushing with fluoridated toothpaste 1450 ppm > 1 a day and a positive correlation in schoolchildren that experience caries lesion that never brush their teeth.

Prevalence of crack cocaine use and its associated factors in patients treated in a specialized outpatient service / Prevalência e fatores associados ao uso de crack em pacientes em tratamento em serviço ambulatorial especializado

Abstract Background Despite the advance in studies addressing the use of crack cocaine, knowledge about the characteristics of users that seek treatment in the different modalities of care for substance use disorders is important to plan the operationalization of these services. Objective To analyze the prevalence and factors associated with the use of crack cocaine in outpatients. Method Cross-sectional study consisting in the analysis of the medical records of outpatients of a chemical dependency clinic located in the south of Brazil from 1999 to 2015. The Fisher's exact test and the Poisson regression model were used to analyze the data. Results Medical records from 1,253 patients were analyzed, and 1,196 (95.5%) of them contained information on the use of crack cocaine. Use of this substance was reported by 47% (95% CI [44, 50]) of the outpatients. The risk group was composed of adults aged 20-39 years, with no income, who had three or more children, did not consume alcohol or marijuana, had continuous family assistance, spontaneously looked for the service, and had already been hospitalized or assisted at a therapeutic community or psychosocial center. Conclusion There is great demand for the outpatient care of crack cocaine users. It is crucial that the risk factors guide treatment planning.

Resumo Introdução embora tenhamos avançado nos estudos sobre o consumo de crack, é importante o conhecimento das características dos usuários que buscam tratamento nas diferentes modalidades assistenciais para transtornos relacionados ao uso de substâncias para planejar a operacionalização desses dispositivos. Objetivo analisar a prevalência e os fatores associados ao uso de crack em pacientes em tratamento de modalidade clínico-ambulatorial. Método estudo transversal, com análise dos prontuários dos pacientes do período de 1999 a 2015 de um ambulatório de dependência química no Sul do Brasil. Para análise dos dados foi realizado o teste exato de Fisher e regressão de Poisson. Resultados foram analisados os prontuários de 1.253 pacientes, dos quais 1.196 (95,5%) continham informações sobre o uso de crack. O uso de crack foi relatado por 47% (IC 95% [44, 50]) dos pacientes. O grupo de risco consistiu em adultos de 20 a 39 anos, sem renda, com três ou mais filhos, que não consumiam álcool ou usavam maconha, que tinham acompanhamento familiar contínuo, que buscavam espontaneamente o serviço, que já haviam sido internados em hospital ou feito acompanhamento em comunidade terapêutica ou centro psicossocial. Conclusão existe uma grande demanda no atendimento ambulatorial de pacientes que usam crack. É imprescindível que os fatores de risco orientem o planejamento do tratamento.

Anca negative pauci-immune crescentic glomerulonephritis and mixed connective tissue disease: a case study / Glomerulonefrite crescêntica pauci-imune ANCA-negativa e doença mista do tecido conjuntivo: relato de um caso

Abstract One of the most common causes of rapidly progressive glomerulonephritis (RPGN) is pauci-immune crescentic glomerulonephritis (CrGN). In the majority of cases, this condition has a positive serologic marker, the anti-neutrophil cytoplasmic antibodies (ANCAs), but in approximately 10% there are no circulating ANCAs, and this subgroup has been known as the ANCA-negative pauci-immune CrGN. RPGN can be associated with systemic diseases, but there are only few case reports describing the association with mixed connective tissue disease (MCTD). The authors report a case of ANCA-negative CrGN associated with a MCTD.

Resumo Uma das causas mais comuns da glomerulonefrite rapidamente progressiva (GNRP) é a glomerulonefrite crescêntica (GNC) pauci-imune. Na maioria dos casos, a patologia apresenta um marcador sorológico positivo, o anticorpo anticitoplasma de neutrófilos (ANCA), mas em cerca de 10% dos pacientes não há ANCAs circulantes, perfazendo um subgrupo da patologia conhecido como GNC pauci-imune ANCA-negativa. A GNRP pode estar associada a doenças sistêmicas, mas são poucos os relatos de caso que descrevem sua associação com doença mista do tecido conjuntivo (DMTC). O presente artigo relata um caso de GNC ANCA-negativa associada a DMTC.

The language aspects of children with high abilities/giftedness: an integrative literature review / Os aspectos da linguagem de crianças com altas habilidades/superdotação: revisão integrativa da literatura

ABSTRACT Purpose: to analyze information and characteristics of the language of children diagnosed with high abilities and giftedness. Methods: an integrative literature review based on a search in LILACS, MEDLINE, and Google Scholar databases, combining the keywords "Speech-Language-Hearing and high abilities", "giftedness and child language". Results: a total of 45 articles that met the inclusion criteria were analyzed, of which 29 were excluded and 16 selected for the review. The analysis of these articles made it possible to verify, though superficially, the aspects in the oral and written language of children with high abilities and giftedness. These children's vocabulary and discourse are usually rich, with excellent comprehension skills. There is early interest in reading, besides noteworthy writing comprehension and decoding skills. The studies indicate that these capacities are atypical when compared with those of the population referred to as normal. The discourse of gifted children tends to be compatible with that of children two years older, and their language develops faster. Conclusion: the language of children diagnosed with high abilities and giftedness has particularities that must be better studied, as their development differs from that of other children.

RESUMO Objetivo: analisar informações e características sobre a linguagem de crianças com diagnóstico para altas habilidades e superdotação. Métodos: revisão integrativa da literatura realizada a partir da busca de dados em bases eletrônicas do Portal de Pesquisas da Biblioteca Virtual em Saúde, LILACS, MEDLINE, Google Scholar, utilizando combinação das palavras chaves "Fonoaudiologia e altas habilidades", "superdotação e linguagem infantil". Resultados: foram analisados 45 artigos que preencheram os critérios de inclusão, dentre os quais 29 foram excluídos e 16 selecionados para a revisão. A análise destes artigos permitiu verificar, ainda que superficialmente, os aspectos presentes na linguagem oral e escrita de crianças com altas habilidades e superdotação. O vocabulário e discurso destas crianças geralmente é rico, com excelente habilidade de compreensão. Há um interesse precoce pela leitura, além de notável habilidade de decodificação e compreensão da escrita. Os estudos indicam que, estas capacidades se apresentam de uma maneira atípica, quando comparadas a população tida como normal, cujo discurso tende a ser compatível com crianças 2 anos mais velhas e o desenvolvimento da linguagem ocorrendo de maneira mais acelerada. Conclusão: a linguagem das crianças diagnosticadas com altas habilidades e superdotação possui particularidades que devem ser melhor estudadas, pois o seu desenvolvimento se difere das demais crianças.

An atypical presentation of a severe and massive atheroembolic disease / Uma apresentação atípica de doença ateroembólica grave

ABSTRACT Atheroembolic renal disease (AERD) is a kidney manifestation of atherosclerosis as a systemic disease. AERD is defined as a renal impairment secondary to embolization of cholesterol crystals with consequent occlusion of renal vascularization. The current case report describes one patient with multiple risk factors but without any inciting event history who presents a very atypical clinical course of a severe and massive atheroembolic disease that developed spontaneously and silently.

RESUMO A doença renal ateroembólica (DRAE) é uma manifestação renal da aterosclerose enquanto patologia sistêmica. A DRAE é definida como uma disfunção renal secundária à embolização de cristais de colesterol seguida da oclusão da vascularização renal. O presente relato descreve o caso de um paciente com vários fatores de risco, porém sem um evento precipitante, que se apresentou com um curso clínico bastante atípico de doença ateroembólica grave de evolução espontânea e silenciosa.

Ética e integridade: condutas para produções científicas no brasil / Ética e integridad: conductas para producciones científicas en brasil / Ethics and integrity: code of conduct for scientific research in brazil

Objetivo: apresentar uma análise de dispositivos legais, que sejam norteadores de pesquisas científicas no Brasil quanto à ética, integridade e seus aspectos, em relação às práticas inadequadas de conduta na produção do conhecimento científico. Método: a coleta de dados ocorreu por meio de pesquisa documental, correspondente às publicações de órgãos norteadores de pesquisas científicas, lançadas entre os anos de 2010 e 2017. Resultados: a análise dos dados gerou um quadro de Orientações de Conduta e as Organizações geradoras. As fontes observadas apresentaram documentações diversificadas e concordância, no que diz respeito ao termo má conduta científica. Conclusão: percebeu-se que é necessário esforço por parte das instituições, nas ações preventivas e pedagógicas em relação à produção científica, bem como a padronização das regras de avaliação e de punição em má conduta.

Objetivo: presentar un análisis de dispositivos legales que sean parámetros para investigaciones científicas en Brasil asociados a la ética, la integridad y sus aspectos, en lo que se refiere a prácticas inadecuadas de conducta en la producción del conocimiento científico. Método: se recogieron los datos por medio de investigación documental, correspondiente a las publicaciones de órganos rectores de investigaciones científicas, publicadas entre los años de 2010 y 2017. Resultados: el análisis de los datos generó un cuadro de Orientaciones de Conducta y las Organizaciones generadoras. Las fuentes observadas presentaron documentaciones diversificadas y concordancia acerca del término mala conducta científica. Conclusión: se percibe que es necesario esfuerzo de las instituciones, en las acciones preventivas y pedagógicas en lo que se refiere a la producción científica, así como la estandarización de las reglas de evaluación y de punición en mala conducta.

Objective: To present an analysis of the legal mechanisms that guide scientific research in Brazil in ethics, integrity and its related aspects, regarding misconduct in the production of scientific knowledge. Method: Data was collected through documentary research of publications from regulatory agencies that set the standards for scientific research released in the 2010-2017 period. Results: Data analysis generated a chart of Guidelines of Conduct and the Institutions that generated the records. Despite the differences in the documents of the sources investigated, they all agreed on the term "research misconduct". Conclusion: The institutions should carry out preventive and pedagogical actions targeted to scientific research, as well as promote the standardization of the rules of evaluation and punishment of misconduct.

Evasão do tratamento da dependência de drogas: prevalência e fatores associados identificados a partir de um trabalho de Busca Ativa / Dropout of drug addicts treatment: prevalence and associated factors identified from the active surveillance of patients

Resumo Introdução A dependência de drogas é considerada um transtorno de etiologia heterogênea, existem diretrizes para o seu tratamento, mas ainda ocorre um alto índice de evasão. O estudo teve como objetivo identificar a prevalência e fatores associados à evasão do tratamento. Métodos Estudo transversal, com análise de 593 prontuários e de 30 entrevistas aplicadas em pacientes que não tiveram aderência em um ambulatório de dependência química em um município do sul do Rio Grande do Sul. Resultados O índice de abandono foi de 82%. O tempo de tratamento (Coef = -0,14; EP = 0,08; OR = 0,9), o atendimento com o assistente social (Coef = -0,68; EP = 0,33; OR = 0,5) e com psicólogo (Coef = -0,66; EP = 0,44; OR = 0,5) foram os principais fatores de proteção ligados à diminuição da probabilidade do abandono. O motivo de abandono mais relatado foi a colisão dos horários de atendimento com o de trabalho (33%, n = 10). Conclusão Torna-se necessário dar atenção ao fenômeno de evasão com o intuito de propiciar alternativas para o aumento da adesão e retorno dos pacientes.

Abstract Introduction Drug addiction is considered a heterogeneous etiology disorder, there are guidelines for their treatment, but still there is a high drop out rate. The research has the purpose to identify the prevalence and associated factors to the abandonment of the treatment. Methods Cross-sectional study, with a review of 593 medical records and 30 interviews applied to patients who had not adhered to treatment in a substance abuse clinic in a municipality located in southern Rio Grande do Sul. Results The dropout rate was 82%. The treatment time (Coef = -0.14, SE = 0.08; OR = 0.9), treatment with the social worker (Coef = -0.68, SE = 0.33, OR = 0.5) and psychological treatment (Coef = -0.66, SE = 0.44, OR = 0.5) decreased to the likelihood of abandonment. The most frequently reported reason in the interviews to justify the abandonment was the service's opening hours coinciding with working hours (33%, n = 10). Conclusion It is necessary to pay attention to the evasion phenomenon in order to provide alternatives to increasing compliance and the return of these patients.

Ischemic colitis: risk factors, diagnosis and prognosis in patients undergoing surgery / Colite isquémica: fatores de risco, diagnóstico e prognóstico em doentes submetidos a cirurgia

Objective: To identify risk factors, diagnosis and prognosis associated with ischemic colitis, focusing mainly on patients undergoing surgery. Materials and methods: This retrospective study included all patients admitted to the Centro Hospitalar de São João - E. P. E., diagnosed with ischemic colitis during the period from 2012 to 2013. Results: The study included 154 patients; 118 were undergoing medical treatment, with a 12% mortality rate, and 36 were undergoing surgery, with a 61% associated mortality rate. Hypertension was the most common risk factor in both groups. The presence of a large num- ber of cardiovascular risk factors in both groups, such as hypertension and dyslipidemia, was recorded, but we still found no direct relationship with development of ischemic coli- tis. Comorbidities that affect blood flow, such as the presence of thrombi or aneurysms, do provide a worse prognosis and therefore require a more aggressive treatment. Conclusion: The diagnosis of ischemic colitis is not always immediately established due to a nonspecific presentation. Surgical treatment should be reserved for severe cases with a worse prognosis associated.

RESUMO Objetivos: Identificar fatores de risco, diagnóstico e prognóstico associados à colite isquémica, incidindo mais em doentes submetidos à cirurgia. Materiais e métodos: O estudo retrospectivo incluiu todos os doentes admitidos no Centro Hospitalar de São João-E. P. E. com diagnóstico de colite isquémica durante o período de 2012 a 2013. Resultados: O estudo incluiu 154 doentes; desses, 118 foram submetidos a tratamento médico, com uma taxa de mortalidade de 12%, e 36 foram submetidos a tratamento cirúrgico, com uma taxa de mortalidade associada de 61%. Hipertensão arterial foi o fator de risco mais comum em ambos os grupos. Foi registada a presença de grande número de fatores de risco cardiovasculares em ambos os grupos, como hipertensão arterial e dislipidemia, mas ainda não foi encontrada nenhuma relação direta com o desenvolvimento de colite isquémica. Comorbilidades que afetam o fluxo sanguíneo, como a presença de trombos ou aneurismas, fazem prever um pior prognóstico e, por isso, exigem maior agressividade no tratamento. Conclusão: O diagnóstico de colite isquémica nem sempre é imediato, devido a uma apresentação pouco específica. O tratamento cirúrgico deverá ser reservado para casos mais severos, tendo pior prognóstico associado.

Atitudes infantis face aos cuidados de saúde e perceção de dor: papel mediador dos medos médicos / Children's attitudes regarding health care and perception of pain: the mediating role of medical fears

O presente estudo pretende contribuir para a compreensão das atitudes e opiniões das crianças acerca dos cuidados de saúde, com enfoque nos procedimentos médicos, instituições e eficácia dos profissionais. Participaram no estudo 381 crianças, recrutadas em diversas instituições escolares da área de Lisboa. As atitudes mais negativas foram atribuídas às instituições, enquanto as mais positivas incidiram na eficácia dos profissionais. Os procedimentos médicos foram considerados menos dolorosos comparativamente aos potenciais acidentes do quotidiano. Os níveis mais elevados de dor percebida foram reportados pelas crianças do sexo feminino e pelas do 1º ciclo de escolaridade. Os medos médicos mediaram significativamente a relação entre a perceção de dor e as atitudes infantis face aos cuidados de saúde. A maior perceção de dor mostrou estar associada a atitudes mais negativas, porém, esta relação ficou enfraquecida quando contemplados os medos infantis face a temáticas médicas. Em suma, é fundamental poder avaliar as atitudes infantis face aos cuidados de saúde, o que poderá contribuir para o desenvolvimento de programas de intervenção no âmbito da promoção de comportamentos.

This study sought to contribute to a better understanding of children's attitudes and opinions regarding health care, mainly in terms of medical procedures, institutions and the efficacy of health professionals. The sample included 381 children, recruited from different schools in Lisbon. The more negative attitudes were attributed to institutions, while positive attitudes were related to the efficacy of health professionals. Medical procedures were considered less painful compared to potential day-to-day accidents. Higher levels of pain were reported by children of the female sex and by children during the primary education phase. Medical fears mediated the relationship between the perception of pain and children's attitudes with respect to health care. Higher levels of pain perception were seen to be related to more negative attitudes regarding health care. However, this relationship was diminished when children's fears about medical issues were contemplated. In conclusion, a translated instrument to assess children's attitudes regarding health care is needed, as it may even contribute to the development of intervention programs within the scope of the promotion of attitudes towards health care.

Xylose reductase from the thermophilic fungus Talaromyces emersonii: cloning and heterologous expression of the native gene (Texr) and a double mutant (TexrK271R + N273D) with altered coenzyme specificity.

Xylose reductase is involved in the fi rst step of the fungal pentose catabolic pathway. The gene encoding xylose reductase (Texr) was isolated from the thermophilic fungus Talaromyces emersonii, expressed in Escherichia coli and purifi ed to homogeneity. Texr encodes a 320 amino acid protein with a molecular weight of 36 kDa, which exhibited high sequence identity with other xylose reductase sequences and was shown to be a member of the aldoketoreductase (AKR) superfamily with a preference for reduced nicotinamide adenine dinucleotide phosphate (NADPH) as coenzyme. Given the potential application of xylose reductase enzymes that preferentially utilize the reduced form of nicotinamide adenine dinucleotide (NADH) rather than NADPH in the fermentation of fi ve carbon sugars by genetically engineered microorganisms, the coenzyme selectivity of TeXR was altered by site-directed mutagenesis. The TeXR K271R+N273D double mutant displayed an altered coenzyme preference with a 16-fold improvement in NADH utilization relative to the wild type and therefore has the potential to reduce redox imbalance of xylose fermentation in recombinant S. cerevisiae strains. Expression of Texr was shown to be inducible by the same carbon sources responsible for the induction of genes encoding enzymes relevant to lignocellulose hydrolysis, suggesting a coordinated expression of intracellular and extracellular enzymes relevant to hydrolysis and metabolism of pentose sugars in T. emersonii in adaptation to its natural habitat. This indicates a potential advantage in survival and response to a nutrient-poor environment.

Miliary tuberculosis with positive acid-fast bacilli in a pediatric patient

CONTEXT: Tuberculosis is an important public health issue. The Brazilian government reported 78,460 new cases in 1999. Miliary tuberculosis is a severe form of this disease. OBJECTIVE: To report on an uncommon clinical presentation of miliary tuberculosis in a child. CASE REPORT: A 5-year old boy presented in the emergency room with fatigue and weight loss. He had had Staphylococcus aureus pneumonia 7 months before. Chest radiography revealed lobar consolidation and miliary pattern associated with small cavities in both upper lobes. Antibiotic therapy was started. The sputum was positive for acid-fast bacilli and hence the treatment recommended for tuberculosis (rifampicin, isoniazid [INH], pyrazinamide) was started. The patient was treated for 9 months and at the end of the follow-up period he had made a complete clinical recovery. CONCLUSION: Although in some particular cases sputum can be positive for acid-fast bacilli in children, limitations to the sputum test have forced pediatricians to base tuberculosis diagnosis on epidemiological data, clinical findings and radiographic pattern. In this particular case, we hypothesize that the sputum bacillus test was positive because bacilli grew inside residual pneumatoceles that were produced during previous pneumonia