Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry / 대한뇌졸중학회지

Background@#and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). @*Results@# Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). @*Conclusions@# Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.

Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry / 대한뇌졸중학회지

Background@#and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). @*Results@# Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). @*Conclusions@# Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.

Aspectos clínicos de pacientes infanto-juvenis em terapia nutricional enteral domiciliar: uma revisão integrativa / Clinics aspects in children and youth patients in home enteral nutrition: an integrative review

Resumo A Terapia Nutricional Enteral Domiciliar é um método eficaz para garantir o aporte nutricional de um indivíduo em seu domicílio. Sendo assim, o objetivo do estudo foi investigar os aspectos clínicos comumente recorrentes em pacientes pediátricos em terapia nutricional enteral domiciliar. A pesquisa de artigos foi realizada por meio das bases de dados: Scientific Eletronic Library Online (SciElo) e US National Library of Medicine National Institutes of Health (PubMed) utilizando as seguintes palavras-chaves: 'home enteral nutrition', 'home tube feeding' e 'children'. Foram selecionados 16 estudos realizados nos países: Brasil, Chile, Espanha, França, Holanda, Itália, Polônia e Monte Sinai, os quais trouxeram evidências que as principais condições clínicas relatadas para a indicação na terapia nutricional enteral domiciliar são as doenças neurológicas, neoplasias em geral e doenças do trato gastrointestinal. Apenas dois estudos abordaram os aspectos negativos da terapia domiciliar que são os episódios de engasgos, tosse, vômitos, diarreia e constipação intestinal. Deste modo, por meio das condições clínicas relatadas observa-se que a indicação da TNED é essencial para estes pacientes, podendo preveni-los da desnutrição hospitalar, diminuição do tempo de permanência, reinternações e redução dos custos hospitalares, além de trazer maior conforto para o paciente pediátrico por estar mais próximo dos familiares.

Abstract Home Enteral Nutrition is an effective method to ensure the nutritional compliance of an individual at home. The aim of this study was investigate the clinical aspects commonly recurrent in children and youth patients in home enteral nutrition. Research of articles was carried out through the databases: Scientific Electronic Library Online (SciElo) and US National Library of Medicine National Institutes of Health (PubMed) using the following keywords: 'home enteral nutrition', 'home tube feeding' and 'children'. Sixteen studies were selected in countries as Brazil, Spain, France, Netherlands, Italy, Poland and Monte Sinai, in which it was presented evidence that the main clinical conditions related to enteral nutritional therapy are neurological diseases, neoplasia in general and the upper and lower gastrointestinal tract diseases. Only two studies had reported the negative aspects of home therapy as episodes of gagging, coughing, vomiting, diarrhea, and constipation. Thus, through the clinical conditions reported, it is observed that the indication of home enteral nutrition is essential for these patients, which can prevent them from hospital malnutrition, decrease length of stay, rehospitalizations and reduce hospital costs, as well as bring greater comfort to patients by being closer to their family.

Baby led weaning: an integrative review of scientific evidence from 2011 to 2019 / Baby-led weaning: uma revisão integrativa das evidências científicas de 2011 a 2019

INTRODUCTION: Baby-led weaning (BLW) is an alternative approach to introducing food to infants that has become popular. OBJECTIVE: To investigate the scientific evidence regarding the BLW method and its modified version, Baby-Led Introduction to Solids (BLISS). METHODS: The research was carried out between June 2018 and June 2019, through the databases US National Library of Medicine National Institutes of Health (PubMed) using the following keywords: 'BLW', 'Baby-led weaning', 'BLISS', and 'Baby-Led Introduction to Solids'. All original articles from in English published between 2011 and 2019 have been included. RESULTS: Twenty-five studies were included in the analysis. Research on BLW/BLISS focused mainly on the themes: characteristics, behaviors and attitudes of mothers and children, knowledge of mothers and health professionals about feeding methods, weight and body mass index evaluation of children, evaluation of energetic and nutrient intake of children and evaluation of episodes of choking and gag reflex. CONCLUSION: Most research deals with BLW-related experiences and there is still little evidence on the method in terms of adequacy of energy and nutrient intake and growth in childhood. Positive points to child can be observed such as prolonged breastfeeding, greater independence when feeding and better response to satiety. The methods of food introduction do not differ in relation to the occurrence of episodes of choking.

INTRODUÇÃO: O Baby-led weaning (BLW) é uma abordagem alternativa para a introdução alimentar aos lactentes que tem se tornado popular. OBJETIVO: Investigar as evidências científicas a respeito do método BLW e sua versão modificada Baby-Led Introduction to Solids (BLISS). MÉTODOS: A pesquisa de artigos foi realizada entre junho de 2018 e junho de 2019, por meio da base de dados US National Library of Medicine National Institutes of Health (PubMed) utilizando as seguintes palavras-chaves: 'BLW', 'Baby-led weaning', 'BLISS', e 'Baby-Led Introduction to Solids'. Foram incluídos todos os artigos originais encontrados no idioma inglês, publicados entre 2011 e 2019. RESULTADO: Vinte e cinco estudos foram incluídos na análise. As pesquisas sobre BLW/BLISS focaram principalmente nos temas: características, comportamentos e atitudes de mães e crianças, conhecimento de mães e profissionais de saúde sobre os métodos de introdução alimentar, avaliação de peso e de índice de massa corporal, avaliação da ingestão energética e de nutrientes e avaliação de episódios de engasgo e reflexo de gag das crianças. CONCLUSÃO: A maioria das pesquisas aborda experiências relacionadas ao BLW/BLISS e ainda existem poucas evidências sobre o método em termos de adequação de ingestão de energia e nutrientes e de crescimento na infância. Pontos positivos para a criança podem ser observados como aleitamento materno prolongado, maior independência ao se alimentar e melhor resposta à saciedade. Os métodos de introdução alimentar não diferem entre si em relação à ocorrência de episódios de engasgos.

Aleitamento materno: conhecimentos, atitudes e práticas dos participantes de um congresso de pediatria em Minas Gerais / Breastfeeding: knowledge, attitudes and practices of participants in a pediatrics congress in Minas Gerais

Apesar de a recomendação da Organização Mundial de Saúde de manter o aleitamento materno exclusivo por seis meses e continuado por dois anos ou mais, as taxas de prevalência do aleitamento materno são baixas. Têm sido explorados os determinantes do desmame precoce e, entre os fatores mais relacionados a ele, está a falta de informação materna sobre amamentação. Aliado a isso, a falta de conhecimento dos profissionais de saúde que atuam na assistência à criança, em relação ao aleitamento materno, tem sido estudado, visando melhorar a informação às gestantes e lactantes e, assim, aumentar a prevalência das crianças em aleitamento materno. O objetivo do presente estudo é investigar o conhecimento, as práticas e atitudes dos participantes de um congresso mineiro tradicional na área de pediatria sobre o aleitamento materno. Foi realizado um estudo transversal, por meio da aplicação de um questionário, para os participantes inscritos no Congresso Mineiro de Pediatria, realizado no período de 6 a 8 de junho de 2018, em Belo Horizonte, Minas Gerais. A proficiência dos participantes, quanto ao conhecimento sobre aleitamento materno, variou entre nove a 32 pontos, em um total de 33 pontos. Foi encontrada diferença estatística significativa entre a proficiência dos estudantes e dos profissionais (p-valor: 0,01), com uma média maior entre os profissionais. O ano de formatura também influenciou na nota, mostrando que os profissionais formados entre 2013 a 2017 tiveram maior nota que os formados em anos anteriores (p-valor: <0.0001). Foi encontrada diferença estatística significativa também no cenário de atividade profissional: os participantes que exercem a maior parte de sua atividade profissional, no setor público, apresentaram maior proficiência (p-valor: 0,01) assim como os profissionais que fizeram residência médica em Pediatria (p-valor: 0,02). As outras variáveis analisadas não mostraram diferenças significativas. É possível que alguns fatores tenham influenciado positivamente na proficiência dos participantes, como, por exemplo, a Iniciativa do Hospital Amigo da Criança e a participação em Congressos Médicos de atualização. Apesar disso, os participantes do Congresso Mineiro de Pediatria, no ano de 2018, apresentaram proficiência abaixo do mínimo esperado em aleitamento materno, o que aponta para a necessidade de capacitações periódicas dos profissionais e uma maior ênfase no currículo de graduação sobre o tema

The prevalence rates on breastfeeding are low despite the recommendation of the World Health Organization to maintain exclusive breastfeeding for six months, continued for another two years or more. The determinants of early weaning have been explored, and the lack of maternal information on breastfeeding is among the most prominent factors. Furthermore, the lack of knowledge of childcare health professionals regarding breastfeeding has been studied to improve the information for pregnant and lactating women and, thus, increase the prevalence of breastfeeding. The objective of this study is to investigate the knowledge, practices, and attitudes of the participants of a traditional conference in pediatrics, concerning breastfeeding, held in the state of Minas Gerais, Brazil. A cross-sectional study was carried out by applying a questionnaire to the participants registered in the Minas Gerais Conference on Pediatrics, held from June 6th to 8th, 2018, in Belo Horizonte, Minas Gerais. The proficiency demonstrated by the participants regarding the knowledge on breastfeeding ranged from nine to 32 points, in a total of 33 points. A statistically significant difference was found between the proficiency of students and professionals (p-value: 0.01), with a higher average among professionals. The year of graduation also influenced the score, showing that the professionals who graduated between 2013 and 2017 had a higher score than those who graduated in previous years (p-value: <0.0001). Another statistically significant difference was found in the scenario of professional activity, in which the participants who perform most of their professional activity in the public sector (p-value: 0.01) and those who completed a medical residency in Pediatrics (p-value: 0.02) showed higher proficiency. The other variables analyzed showed no significant differences. Some factors may have positively influenced the proficiency of the participants, such as the Baby-Friendly Hospital Initiative and participation in updating Medical Conferences. Despite this, the participants of the Minas Gerais Conference on Pediatrics, held in 2018, showed proficiencies below the minimum expected in breastfeeding, which indicates the need for periodic training of professionals and a greater emphasis on the undergraduate curriculum on the subject.

Health in the National Curricular Parameters: establishing relationships with Physical Education

Abstract Aim: The promulgation of the 1996 Education Guidelines and Bases Law promotes debate on the construction of National Curricular Parameters (NCPs) for Basic Education, emerging traditional disciplines and transversal themes. Considering the relevance of NCPs today, the objective of this research was to analyze NCPs related to health and to identify relationships between health and physical education in NCPs for Physical Education in Elementary and High School. Method: This is a documentary study that analyzed the respective documents. Paul Ricœur's hermeneutic approach was used for the interpretation of these documents. Discussion: In this section, it was identified that these documents recognize health as a right; present a dynamic conception of health and emphasize the importance of citizen education. However, the documents contradict each other by emphasizing a reduction of Physical Education to physical exercise, remodeling of habits, emphasized valorization of biological mechanisms, and contradictory facts to understand health dynamics. Conclusion: Finally, the conclusions emphasize the main points in each document, showing that there are advances but there are also divergences between them related to health issues and even setbacks. In addition, new investigations related to this theme are suggested.

Nebulizadores: fonte de contaminação bacteriana em pacientes com fibrose cística? / Nebulizers in cystic fibrosis: a source of bacterial contamination in cystic fibrosis patients?

OBJETIVO: Determinar se os nebulizadores de pacientes com fibrose cística são fonte de contaminação microbiana e verificar se a técnica e a frequência de desinfecção dos nebulizadores é apropriada. MÉTODOS: Estudo de corte transversal observacional, sem grupo controle. Foram coletadas amostras de 28 pacientes com fibrose cística, no domicílio do paciente, sem aviso prévio sobre o motivo da visita. Foram colhidas três amostras por paciente: do reservatório do nebulizador, da máscara/bocal e do próprio paciente (swab da orofaringe/escarro). As amostras foram acondicionadas adequadamente e levadas para análise. Os pacientes, seus pais ou responsáveis preencheram um questionário sobre métodos de limpeza e desinfecção dos nebulizadores. RESULTADOS: Foram obtidas 84 amostras dos 28 pacientes. Destes, 15 (53,5 por cento) eram do gênero masculino. A mediana de idade foi de 11 anos (variação: 1-27 anos). Dos 28 pacientes, 15 apresentaram culturas de escarro/orofaringe positivas. As bactérias encontradas com maior frequencia foram Streptococcus aureus (8/15) e Pseudomonas aeruginosa (4/15). A cultura obtida dos nebulizadores identificou diversos patógenos, sem nenhum predominante. Não houve associações entre os resultados das culturas obtidas dos nebulizadores e aquelas dos pacientes em 27 casos (96,7 por cento). A limpeza e a desinfecção não eram realizadas de forma adequada em 22 casos (78,6 por cento). CONCLUSÕES: Nesta amostra de pacientes, apesar das técnicas de desinfecção inadequadas, os nebulizadores não foram uma fonte de contaminação microbiana.

OBJECTIVE: To determine whether nebulizers are a source of microbial contamination in patients with cystic fibrosis, as well as whether the technique and frequency of disinfection of these devices is appropriate. METHODS: This was a cross-sectional, uncontrolled observational study. Samples were collected from 28 patients with cystic fibrosis. Samples were collected at the homes of the patients, who were not previously informed of the purpose of the visit. Three samples were collected from each patient: one from the nebulizer chamber, one from the mask/mouthpiece, and one from the patient (oropharyngeal swab /sputum). The samples were properly stored and taken for analyses. The patients, their parents, or their legal guardians completed a questionnaire regarding nebulizer cleaning and disinfecting methods. RESULTS: We collected 84 samples from the 28 patients. Of those 28 patients, 15 (53.5 percent) were male. The median age of the patients was 11 years (range, 1-27 years). Of the 28 patients, 15 presented with positive oropharyngeal swab /sputum sample cultures. The most common bacterial isolates were Staphylococcus aureus (in 8 patients) and Pseudomonas aeruginosa (in 4 patients). Although the samples obtained from the nebulizers presented with various pathogens in culture, no specific species predominated. In 27 cases (96.7 percent), there were no associations between the samples obtained from the nebulizers and those obtained from the patients in terms of the results of the cultures. Cleaning and disinfection of nebulizers were inappropriate in 22 cases (78.6 percent). CONCLUSIONS: In this sample of patients, despite the inappropriate disinfection techniques, nebulizers were not found to be a source of microbial contamination.

Triagem auditiva em neonatos / Neonatal hearing screening

A preocupação de se identificar precocemente a deficiência auditiva se deve à melhora no prognóstico se a intervenção é feita em tempo hábil. Objetivo: Revisar estudos que preconizam realização de Triagem Auditiva Neonatal, o seu histórico e os indicadores de risco para deficiência auditiva propostos pelo Joint Committee on Infant Hearing. Fonte de dados: Pesquisa bibliográfica na base de dados MEDLINE e LILACS. Síntese dos dados: A triagem auditiva no Brasil vem se expandindo. Observa-se aumento da conscientização dos profissionais e da população acerca do exame além, do maior conhecimento e possibilidade de identificação e intervenção precoces. Verifica-se a existência de um esforço contínuo, para divulgação do teste, dos profissionais envolvidos nos Programas de Triagem Auditiva Neonatal e que, com auxílio da mídia, reforçada pela aprovação de leis municipais e estaduais, vem atingindo maior parcela da população. As emissões otoacústicas são utilizadas amplamente em programas de triagem auditiva e o Potencial Evocado Auditivo de Tronco Encefálico automático vem ganhando espaço nas triagens de neonatos de alto risco. Conclusão: A literatura pesquisada demonstra que a prevalência da deficiência auditiva é alta e que as conseqüências apresentadas, quando não identificada precocemente podem ser devastadoras para o desenvolvimento de fala, linguagem, cognitivo e social. As técnicas disponíveis atualmente para avaliação auditiva são altamente sensíveis e com especificidade adequada para se detectar precocemente a deficiência auditiva.

The concern to identify the early hearing loss is due to improvement in the prognosis. Objective: Review studies that advocate holding of Neonatal Hearing Screening, its history and indicators of risk for hearing impairment proposed by the Joint Committee on Infant Hearing. Data Sources: Information Sources in the database MEDLINE and LILACS. Summary of data: The sorting hearing in Brazil has been expanding. There is increasing awareness of professionals and elsewhere about the examination addition, the increased knowledge and possibility of early identification and intervention. There is the existence of an ongoing effort to disclose the test, the professionals involved in the Neonatal Hearing Screening Program, and that, with the help of the media, strengthened by the adoption of municipal and state laws, is achieving greater portion of the population. The otoacoustic emissions are widely used in screening programs for hearing and the Auditory Brainstem Response. Thuk space has gained the automatic screening of newborns at high risk. Conclusion: The literature search shows that the prevalence of hearing loss is high and that the consequences presented, if not identified early can be devastating to the development of speech, language, cognitive and social techniques currently available for evaluation the hearing are highly sensitive and specificity to detect the early hearing disability.