Association between exposure to pesticides and allergic diseases in children and adolescents: a systematic review with meta-analysis

Abstract Objective: The study aimed to conduct a systematic review of the literature to verify the association between exposure to pesticides and allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) in children and adolescents. Method: A systematic review and meta-analysis were performed using the PRISMA method with the question "What is the association between exposure to pesticides and allergic diseases in children (asthma, allergic rhinitis, and atopic dermatitis)?" MEDLINE, EMBASE, SciELO, and Cochrane electronic databases were searched throughout the period in the literature up to September 2020. A total of 1296 studies were found, and 24 were selected. Results: Exposure to pesticides showed a two-fold greater risk of developing or exacerbating asthma in children and adolescents (odds ratio [OR] = 2.14 95% confidence interval [CI] 1.26-3.64, p < 0.01). There was no association between exposure to pesticides and the development of allergic rhinitis (OR = 2.73, 95% CI 0.13-57.8, p = 0.52) and atopic dermatitis (OR = 2.19, 95% CI 0.51-9.36, p = 0.29). Conclusions: Exposure to pesticides increases the risk of developing or exacerbating asthma in children and adolescents. There was no evidence of an association between exposure to pesticides and the development of allergic rhinitis and atopic dermatitis in children and adolescents, possibly due to the low number of studies found in this review.

Gestantes internadas no hospital psiquiátrico: um retrato da vulnerabilidade / Pregnant women admitted to the psychiatric hospital: a portrait of vulnerability

Resumo O hospital psiquiátrico foi (re)inserido na rede de atenção psicossocial no Brasil, tornando-se uma opção para tratamento na crise em saúde mental. Este artigo objetivou descrever o perfil e os cuidados ofertados às gestantes durante a internação em um hospital psiquiátrico. Trata-se de estudo quantitativo, transversal, observacional e descritivo, com dados de prontuários de janeiro/2015 a agosto/2019. A amostra teve um n=67, evidenciando uma população jovem, na maioria sem qualquer renda (incluindo assistências governamentais), com baixa escolaridade. As internações foram majoritariamente não voluntárias com queda no acompanhamento de pré-natal durante internação, o qual explicita uma situação de vulnerabilidade social, com questões de gênero, representando forte influência nos encaminhamentos de saúde para essas mulheres. A internação demonstrou uma fragilidade na integralidade do cuidado, reforçando um tratamento segregador. Ficou evidenciada a necessidade do cuidado articulado na atenção básica, considerando os determinantes sociais e direitos de cidadania, bem como a importância de se repensar o efetivo papel do hospital psiquiátrico.

Abstract The psychiatric hospital was (re)inserted in the psychosocial care network, in Brazil, becoming an option for treatment in the mental health crisis. This article aimed to describe the profile, and care offered to pregnant women during hospitalization in a psychiatric hospital. This is a quantitative, cross-sectional, observational, descriptive study with data from medical records from January/2015 to August/2019. The sample had an n=67, showing a young population, mostly without any sort of income (including governmental assistance), with low education. Admissions were mainly non-voluntary, with a drop in prenatal care during hospitalization, which exposes a situation of social vulnerability with gender issues, representing a strong influence on health referrals for these women. Hospitalization demonstrated a weakness in providing integral care, reinforcing a segregating treatment. The need for articulated care from Primary Care was highlighted, considering the social determinants and citizenship rights, as well as the importance of rethinking the effective role of the psychiatric hospital.

Associated factors with recurrent wheezing in infants: is there difference between the sexes?

Abstract Objective: Identify associated factors for recurrent wheezing (RW) in male and female infants. Methods: Cross-sectional multicentric study using the standardized questionnaire from the Estudio Internacional sobre Sibilancias en Lactantes (EISL). The questionnaire was applied to parents of 9345 infants aged 12-15 months at the time of immunization/routine visits. Results: One thousand two hundred and sixty-one (13.5%) males and nine hundred sixty-three (10.3%) females have had RW (≥3 episodes), respectively (p10 colds episodes (OR = 3.46; IC 95% 2.35-5.07), air pollution (OR = 1.33; IC 95% 1.12-1.59), molds at home (OR = 1.23; IC 95% 1.03-1.47), Afro-descendants (OR = 1.42; IC 95% 1.20-1.69), bronchopneumonia (OR = 1.41; IC; 1.11-1.78), severe episodes of wheezing in the first year (OR = 1.56; IC 95% 1.29-1.89), treatment with bronchodilators (OR = 1.60; IC 95% 1.22-2,1) and treatment with oral corticosteroids (OR = 1,23; IC 95% 0.99-1,52). Associated factors for RW for females were passive smoking (OR = 1.24; IC 95% 1.01-1,51), parents diagnosed with asthma (OR = 1.32; IC 95% 1,08-1,62), parents with allergic rhinitis (OR = 1.26; IC 95% 1.04-1.53), daycare attendance (OR = 1.48; IC 95% 1.17-1,88), colds in the first 6 months of life (OR = 2.19; IC 95% 1.69-2.82), personal diagnosis of asthma (OR = 1.84; IC 95% 1.39-2.44), emergency room visits (OR = 1.78; IC 95% 1.44-2.21), nighttime symptoms (OR = 2.89; IC 95% 2.34-3.53) and updated immunization (OR = 0.62; IC 95% 0.41-0.96). Conclusion: There are differences in associated factors for RW between genders. Identification of these differences could be useful to the approach and management of RW between boys and girls.

Motivos para a não notificação de incidentes de segurança do paciente por profissionais de saúde: revisão integrativa / Barriers to patient safety incident reporting by Brazilian health professionals: an integrative review

Resumo Realizou-se revisão integrativa que objetivou identificar e analisar publicações nacionais sobre motivos para a não notificação de incidentes de segurança do paciente por profissionais no contexto dos serviços de saúde brasileiros. Em janeiro de 2017 realizou-se busca no Portal da Biblioteca Virtual em Saúde, PubMed e Web of Science, por publicações dos últimos 10 anos. Identificou-se 1.007 publicações e, após aplicação dos critérios de inclusão e exclusão, analisou-se 8 artigos, sendo 5 de abordagem qualitativa e 3 quantitativa. Todas as pesquisas foram desenvolvidas em hospitais, exclusivamente com profissionais da enfermagem, sendo que 75% em serviços do Sudeste do país. A maioria dos estudos evidenciou subnotificação de incidentes, principalmente devido a: medo ou receio em notificar; notificação focada em eventos mais graves, falta de conhecimento sobre o tema ou como notificar e centralização da notificação no profissional enfermeiro. Embora o estudo desta temática seja incipiente no Brasil, a presente revisão encontrou importantes fragilidades e motivos apontados pelos profissionais para a não notificação de incidentes, revelando a necessidade de incentivar sua participação, eliminando ou reduzindo barreiras, com o objetivo de fortalecer a segurança dos pacientes.

Abstract An integrative review was performed to identify and analyze national studies on barriers to patient safety incident reporting by health professionals within Brazilian health services. A search in the Virtual Health Library (BVS) Portal, PubMed and Web of Science was performed in January 2017 for papers published in the last ten years. One thousand and seven publications were identified and, following application of inclusion and exclusion criteria, eight papers were analyzed, five of which were qualitative and three quantitative. All research was conducted in hospitals, exclusively with nursing professionals, and 75% was conducted in Southeast Brazil. Most studies showed an under-reporting of incidents, and the main reasons were fear about reporting, reporting focused on more severe incidents, lack of knowledge about the subject or how to report and, registered nurse-centered reporting. While study of this theme is still incipient in Brazil, this review found important weaknesses in the process and barriers to incident reporting by professionals, revealing a need for encouraging their participation, eliminating or reducing such barriers with a view to strengthening patient safety.

Trabalhadores usuários de drogas em recuperação em uma região industrial do Brasil / Workers recovering from drug addiction in an industrial region of Brazil

Contexto: O número de usuários de drogas ilícitas é estimado globalmente em 210 milhões de pessoas ao ano, das quais pelo menos 200.000 morrem em decorrência do uso. O consumo de drogas afeta não apenas o usuário, mas também a família, os amigos, os colegas de trabalho e a comunidade. Objetivo: O presente estudo traçou um perfil sociodemográfico de trabalhadores em tratamento para recuperação da dependência química na região de Campinas (SP). Método: Estudo transversal exploratório com dados colhidos por meio de questionário autoaplicado e anônimo em centros de recuperação para tratamento de dependência química no município de Campinas. A pesquisa foi conduzida entre julho de 2011 e julho de 2012 e analisou as condições de saúde e trabalho. A população estudada constituía-se de trabalhadores que estiveram em acompanhamento por mais de 30 dias, totalizando 200 pessoas. Resultados: A faixa etária de 18 a 54 anos representou 87,8% da amostra, com predominância de participantes com ensino médio completo e que desenvolviam alguma atividade remunerada, sendo que 54,5% estavam empregados formalmente, 48,4% com contratos inferiores a um ano, e 42,1% com faixa salarial abaixo de R$ 1.020,00. Conclusão: Este estudo apresenta informações pouco exploradas em outras pesquisas e com potencial para aprimorar as intervenções relacionadas à prevenção, ao tratamento e à reabilitação de trabalhadores em situação semelhante.

Context: The number of illicit drug users is estimated at 210 million people a year worldwide, of which at least 200,000 die as a consequence of the use. Drug use affects not only the user but also the family, friends, coworkers, and the community. Objective: This study outlines a sociodemographic profile of workers undergoing treatment for chemical dependency recovery in Campinas (SP). Method: Cross-sectional, exploratory study with data collected in rehabilitation centers for chemical dependency treatment in Campinas by means of a self-administered and anonymous questionnaire. The research was conducted between July 2011 and July 2012 and focused on the analysis of health and work conditions. The study included workers who were followed up for more than 30 days (n=200). Results: 87.8% of the population were aged 18­54 years, most of them had completed high school, had a remunerated activity, and of which 54.5% were formally employed, 48.4% with less than one year contracts and 42.1% with salary range below R$1,020.00 (Brazilian real). Conclusion: This study provides information not explored in other researches and has a potential value related to the prevention, treatment, and rehabilitation of workers in similar conditions.

Colorectal cancer: factors related to late diagnosis in users of the public health system treated at an Universitary Hospital in Curitiba, Paraná State, Brazil

ABSTRACT Background - The fourth most frequent tumor in the world, colorectal cancer is commonly diagnosed at an advanced stage. Objective - To analyze factors that interfere in the diagnosis of colorectal cancer in users of the Public Health System treated at an universitary hospital in Curitiba, Paraná State, Brazil. Methods - Cross-sectional, quantitative and descriptive study with 120 patients treated at the institution between 2012 and 2013. Data collection, carried out by means of medical record appointments and patients' interviews, addressed sociodemographic variables; clinical profile; timespan between symptoms, examination, diagnosis, treatment onset and difficulties encountered. Statistical analyses were performed by means of Stata 8.0. Results - Abdominal pain was the most frequent complaint and rectal bleeding presented the highest chance of advanced colorectal cancer diagnosis. From 52.5% of patients with late diagnosis of colorectal cancer, 81% reported difficulties in the health system. Conclusion - Results suggest that late diagnosis is due to symptom absence in the early stage of the disease, patients' lack of perception about the severity of the symptoms, need of better of health teams to search early diagnosis. Educational interventions are deemed necessary to the population and health teams, besides actions prioritizing the access to diagnostic testing for serious illnesses.

RESUMO Contexto - Quarto tumor mais frequente no mundo, o câncer colorretal comumente é diagnosticado em estádio avançado. Objetivo - Analisar fatores que interferem no diagnóstico do câncer colorretal de usuários do Sistema Único de Saúde, atendidos em hospital universitário de Curitiba. Métodos - Estudo transversal, quantitativo e descritivo com 120 pacientes atendidos na instituição em 2012 e 2013. A coleta de dados, realizada por meio de consulta ao prontuário e entrevista aos pacientes, abordou variáveis sociodemográficas; perfil clínico; tempo decorrido entre sintomas, atendimento, diagnóstico e início do tratamento e dificuldades encontradas. As análises estatísticas foram feita com pelo Stata 8.0. Resultados - Dor abdominal foi a queixa mais frequente e sangramento retal representou maior chance de diagnóstico avançado de câncer colorretal. Dos 52,5% dos pacientes que diagnosticaram a doença tardiamente, 81% relataram dificuldades com o serviço de saúde. Conclusão - Os resultados sugerem que o diagnóstico tardio é devido à ausência de sintomas na fase inicial da doença, falta de percepção dos pacientes sobre a gravidade dos sintomas, necessidade de maior preparo das equipes de saúde para o diagnóstico precoce. São necessárias intervenções educativas junto à população e equipes de saúde, além de ações que priorizem o acesso a exames diagnósticos de doenças graves.

Association between nutritional status and patterns of drug use in patients of Psychosocial Care Centers for Alcohol and Drugs / Associação entre o estado nutricional e padrões de uso de drogas em pacientes atendidos em Centros de Atenção Psicossocial Álcool e Drogas / Asociación entre el estado nutricional y estándares de uso de drogas en pacientes atendidos en Centros de Atención Psicossocial Alcohol y Drogas

The purpose of this study was to evaluate the nutritional status of patients at the start of treatment and at the third month of treatment at the Psychosocial Care Centers for Alcohol and Drugs in Curitiba, in the state of Paraná, and verify its relationship with socioeconomic and demographic aspects, as well as drug use patterns in the two groups. A total of 254 adults were evaluated, 175 from the group at the start of treatment, and 79 from the group in the third month. The two groups presented changes in nutritional status, both low weight and excess weight. Low weight was associated with women and the recent use of crack, and excess weight with alcohol use time and frequent use of marijuana. The study showed the great vulnerability of this population in relation to the nutritional aspect.

O objetivo deste estudo foi avaliar o estado nutricional de pacientes em início e no terceiro mês de tratamento nos Centros de Atenção Psicossocial Álcool e Drogas de Curitiba-PR e verificar a sua relação com os aspectos socioeconômicos, demográficos e padrões de uso de drogas nesses dois grupos. Foram avaliados 254 adultos, 175 do grupo de início de tratamento e 79 de terceiro mês. Ambos apresentaram alterações no estado nutricional, tanto baixo peso como excesso de peso. O baixo peso associou-se ao sexo feminino e uso recente de crack, e o excesso de peso ao tempo de uso de álcool e ao uso frequente de maconha. O estudo demonstrou a grande vulnerabilidade dessa população em relação ao aspecto nutricional.

El objetivo de este estudio fue evaluar el estado nutricional de pacientes en inicio y en el tercer mes de tratamiento en los Centros de Atención Psicossocial Alcohol y Drogas de Curitiba-PR y verificar su relación con los aspectos socioeconómicos, demográficos y estándares de uso de drogas en ésos dos grupos. Fueron evaluados 254 adultos, 175 del grupo de inicio de tratamiento y 79 de tercer mes. Ambos presentaron alteraciones en el estado nutricional, tanto bajo peso como exceso de peso. El bajo peso se asoció al sexo femenino y uso reciente de crack, y el exceso de peso al tiempo de uso de alcohol y al uso frecuente de marihuana. El estudio demostró la grande vulnerabilidad de esa población con relación al aspecto nutricional.

Accelerated phase chronic myeloid leukemia: evaluation of clinical criteria as predictors of survival, major cytogenetic response and progression to blast phase

BACKGROUND: Published criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome.METHODS: This is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10-29%, basophils ≥ 20%, platelets > 1 × 106/µL or <1 × 105/µL and white blood cells > 1 × 105/µL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin < 10 g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity.RESULTS: Risk factors for poor survival in multivariate analysis were Grades 3-4 hematologic toxicity (p-value = 0.001), blasts 10-29% (p-value = 0.023), and hemoglobin < 10 g/dL (p-value = 0.04). Risk factors for not achieving major cytogenetic response were blasts 10-29% (p-value = 0.007), hemoglobin < 10 g/dL (p-value = 0.001), and previous use of interferon (p-value = 0.032). Risk factors for progression to the blast phase were hemoglobin < 10 g/dL (p-value = 0.005), basophils ≥ 20% (p-value = 0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment > 12 months (p-value = 0.030).CONCLUSION: These data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used.

O padrão de uso de drogas por grupos em diferentes fases de tratamento nos Centros de Atenção Psicossocial Álcool e Drogas (CAPS-AD) / Drug use of groups in distinct phases of treatment in Psychosocial Care Centers for Alcohol and Drug (CAPS-AD)

Objetivo Analisar as características sociodemográficas e o padrão de uso de drogas em pacientes dos CAPS-AD de Curitiba, Paraná. Métodos Trata-se de um estudo observacional, transversal e descritivo em uma amostra de 268 indivíduos, 184 em início e 84 no terceiro mês de tratamento. Os questionários foram aplicados no período entre abril e setembro de 2012 e, além das variáveis sociodemográficas pesquisadas, obtiveram-se informações sobre quais substâncias eram utilizadas, tempo e frequência de uso. Para análise dos dados, utilizaram-se os programas Excel e Epi-Info. Médias e testes de qui-quadrado foram utilizados para a comparação dos grupos. Resultados Em ambos os grupos, predominaram sexo masculino, baixa escolaridade, baixa renda, ser da cor branca, residir com familiar ou amigo e possuir moradia própria. As drogas lícitas foram as mais utilizadas, e a maconha foi a droga ilícita mais utilizada na vida. O crack foi a droga mais utilizada no último ano e no último mês. Inalantes e alucinógenos foram os menos utilizados. Pacientes em terceiro mês de tratamento eram significativamente mais velhos, casados, tiveram menor uso na vida e no último mês de maconha, cocaína e crack, faziam uso mais frequente de álcool, e mais de um terço nunca tinha usado droga ilícita na vida. Conclusão Os achados deste estudo podem subsidiar o desenvolvimento de estratégias que possibilitem que grupos vulneráveis possam acessar e se manter em tratamento nos CAPS-AD.

Objective The purpose of the study was to analyze the socio-demographic characteristics and the pattern of drug use in patients of CAPS-AD in Curitiba, Paraná. Methods A descriptive cross-sectional study was carried out in a sample of 268 individuals, of which 184 in early phase and 84 in the third month of treatment. Between April and September of 2012, the data was collected with the application of a questionnaire that contained sociodemographic questions and information about characteristics of drug use as substances, time and frequency of use. For data analysis, the programs of Excel and Epi-Info were used. Averages and chi-square tests were calculated in order to compare the two groups. Results The predominant characteristics in both groups were: male, white color, low education, low income, reside with family or friend and own their house. Legal drugs were the most used. Marijuana was the illicit drug most used in life. Considering the last year and last month, crack was the most used. Inhalants and hallucinogens were the least used. Patients in the third month of treatment were significantly older, married and lifetime use of drugs was lower compared to the other group. Also, use of marijuana, cocaine and crack were lower in the last month. Nonetheless, they made more frequent use of alcohol and, over a third had never used illicit drugs in life. Conclusion The findings may help to guide new strategies to increase access to treatment of vulnerable groups and also to remain in treatment in the CAPS-AD.

HIV-1 genotypic resistance profile of patients failing antiretroviral therapy in Paraná, Brazil

Antiretroviral therapy (ART) has reduced morbidity and mortality related to human immunodeficiency virus (HIV) infection, but in spite of this advance, HIV mutations decrease antiretroviral susceptibility, thus contributing to treatment failure in patients. Genotyping HIV-1 allows the selection of new drugs after initial drug failure. This study evaluated the genotypic profile of HIV-1 isolates from treated (drug-experienced) patients in Paraná, Brazil. The prevalence of mutations in reverse transcriptase (RT) and protease (PR) genes were assessed. We analyzed 467 genotypes of patients with HIV-1 viral loads above 1,000 copies/mL. Mutations at HIV-1 RT and PR genes and previously used ART regimens were recorded. The most prevalent RT mutations were: 184V (68.31 percent), 215YF (51.6 percent), 103NS (46 percent), 41L (39.4 percent), 67N (38.54 percent), 210W (23.5 percent), 190ASE (23.2 percent), and 181C (17.4 percent). PR mutations were 90M (33.33 percent), 82ATFS (29 percent), 46I (26.8 percent) and 54V (22.2 percent). The prevalence of mutations was in line with previous national and international reports, except to nonnucleoside analogue reverse transcriptase inhibitors related mutations, which were more prevalent in this study. Previous exposure to antiretroviral drugs was associated with genotypic resistance to specific drugs, leading to treatment failure in HIV patients.

Genetic diversity of human immunodeficiency virus-1 isolates in Paraná, Brazil

OBJECTIVE: Because epidemiological data on circulating HIV subtypes among HIV-positive patients in the state of Paraná were not known until now, the aims of this study were to describe the genetic diversity profile of HIV-1 in treated patients in Paraná, Brazil, and report the differences in protease (PR) and reverse transcriptase (RT) mutations in HIV-1 subtypes. PATIENTS AND METHODS: A cross-sectional study was conducted from 2003 to 2006. Plasma viral RNA of 389 patients was extracted and PR and RT genes were polymerase chain reaction-amplified and sequenced. Sequences were subtyped and examined for antiretroviral resistance mutations. Data on gender of patient harboring the viruses and past history of antiretroviral treatment were also collected. RESULTS: Most viruses were either subtype B (61.44 percent) or subtype C (20.57 percent). Subtype C and F were more frequent in women (p < 0.00). The prevalence of subtypes was similar over the years studied. The most frequent RT mutations in all subtypes were M184V and mutations at codons 215, 41, 103, 67, 219, and 190. Mutations 41L, 210W, 215YF, and 74V were significantly more prevalent on subtype B, and the mutation 106M was significantly more prevalent on subtype C. The most frequent major PI mutations in all subtypes occurred at codons 46, 82, and 90. PR mutations 32I, 46I, and 84V were significantly more prevalent on subtype B. The minor PI mutations on codons 36, 93, and 63 were more prevalent on subtypes F, C, and B, respectively. CONCLUSION: We concluded that the predominant strain of HIV-1 in Paraná is subtype B, followed by subtype C. Some mutations at PR and TR had subtype predominance in accordance with other authors' report.

Avaliação da implantação de programa de atenção pré-natal no Município de Curitiba, Paraná, Brasil: estudo em coorte de primigestas / Evaluation of the prenatal care program in Curitiba, Paraná, Brazil: a cohort study of primigravidae

A assistência pré-natal tem sido alvo de avaliações acerca dos seus componentes essenciais e impactos em contextos diversos. Em 1999, um novo programa de atenção pré-natal para as mulheres usuárias do SUS passou a vigorar no Município de Curitiba, Paraná, Brasil, com modificações no fluxo de atendimento, número e distribuição de consultas, e procedimentos necessários a cada consulta, criando a oportunidade de realizar uma pesquisa com o objetivo de avaliar a sua implantação efetiva, tomando por referência as diretrizes técnicas estabelecidas pelo programa. O estudo abrangeu uma coorte de 660 primigestas, inscritas antes da vigésima semana de gravidez, entre março e agosto de 2000, com informações obtidas por meio de duas entrevistas domiciliares, consulta no cartão da gestante ou prontuário ambulatorial, e no prontuário hospitalar. A disponibilidade, acessibilidade e seguimento do protocolo pelos profissionais demonstram-se satisfatórias, mas mantém-se um início tardio e distribuição inadequada das consultas. Na classificação de adequação geral adotada, apenas 38,6 por cento das mulheres preencheram todos os requisitos. Os resultados contribuem para a compreensão das complexas determinações presentes no desempenho adequado de um programa de pré-natal.

Valorizando a dignidade materna / Appraising the maternal dignity

Abordagem integral e integrada da atençäo à saúde capaz de assegurar, pela soma de esforços dos diversos setores (inter e intra setoriais numa maternidade sem riscos e sofrimentos que sejam evitáveis à mäe e seu bebê