Avaliação de Prejuízo Cognitivo em Sobreviventes de Câncer de Mama: Estudo Transversal / Assessment of Cognitive Impairment in Survivors of Breast Cancer: A Cross-sectional Study

Resumo Estudo prospectivo e transversal, para determinar a prevalência de prejuízo cognitivo decorrente da quimioterapia e explorar fatores preditores e mediadores em sobreviventes de câncer de mama. Utilizou-se o Termômetro de Distress, Escala de Ansiedade e Depressão, Functional Assessment of Chronic Illness Therapy-General e Cognitive Function. As sobreviventes (N = 62) reportaram uma alta prevalência de distress (46,8%) e de ansiedade (24,2%), com baixos escores nas subescalas déficit cognitivo e habilidades cognitivas percebidos. O funcionamento cognitivo esteve associado à idade (β = 1,42; p = 0,002), atuação profissional (β = -23,12; p = 0,004), depressão (β = -5,43; p = 0,001) e qualidade de vida (β = 1,24; p = 0,001). Prejuízo cognitivo deve ser considerado no serviço de Psico-Oncologia.

Abstract Prospective and cross-sectional study to determine the prevalence of cognitive impairment resulting from chemotherapy, and to explore predictors and mediators in survivors of breast cancer. We used the Distress Thermometer, Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy-General and Functional Assessment of Cancer Therapy-Cognitive Function. Survivors (N = 62) reported a high prevalence of distress (46.8%) and anxiety (24.2%), with low scores on cognitive deficit and cognitive skills perceived subscales. Cognitive functioning was associated with age (β = 1.42; p = 0.002), professional performance (β = -23.12; p = 0.004), depression (β = -5.43; p = 0.001), and quality of life (β = 1.24; p = 0.001). Cognitive impairment must be considered in Psycho-Oncology service.

Plant CDKs-Driving the Cell Cycle through Climate Change.

In a growing population, producing enough food has become a challenge in the face of the dramatic increase in climate change. Plants, during their evolution as sessile organisms, developed countless mechanisms to better adapt to the environment and its fluctuations. One important way is through the plasticity of their body and their forms, which are modulated during plant growth by accurate control of cell divisions. A family of serine/threonine kinases called cyclin-dependent kinases (CDK) is a key regulator of cell divisions by controlling cell cycle progression. In this review, we compile information on the primary response of plants in the regulation of the cell cycle in response to environmental stresses and show how the cell cycle proteins (mainly the cyclin-dependent kinases) involved in this regulation can act as components of environmental response signaling cascades, triggering adaptive responses to drive the cycle through climate fluctuations. Understanding the roles of CDKs and their regulators in the face of adversity may be crucial to meeting the challenge of increasing agricultural productivity in a new climate.

Influencia de los hábitos orales en el perfil miofuncional orofacial de niños de tres a cinco años / Influência dos hábitos orais no perfil miofuncional orofacial de crianças de três a cinco anos / Influence of oral habits on the myofunctional orofacial profile of children aged three to five years-old

Objetivo: Investigar la influencia de los hábitos orales en el perfil miofuncional de los niños de tres a cinco años. Material y métodos: Estudio transversal con 73 niños a través del protocolo de aplicación validado para la evaluación de los aspectos miofuncional orofacial y el cuestionario sobre los hábitos orales. Para el análisis de las variables, el nivel de significación fue del 5%. Resultados: La suma total de protocolo de Evaluación Miofuncional Orofacial con Valores (AMIOFE) fue de 91,6 ± 5,4 puntos (IC del 95%: 90,3 92,9), con un mínimo de 75 y un máximo de 100 puntos. Se observó relación significativa entre: la alimentación con biberón (p=0,014) y chupetes (p <0,001) con los aspectos y las posiciones de los articuladores; el uso del chupete y la función respiratoria (p=0,04) y la deglución (p=0,006); el uso de objetos en la boca y la función de masticación (p=0,001); la respiración oronasal y los aspectos y las posiciones de los articuladores (p <0,001) y la función de deglución (p=0,002). Además, la lactancia materna prolongada influyó positivamente el aspecto y la posición de los articuladores (p=0,001) y la función respiratoria (p=0,005). Conclusiones: Los hábitos de alimentación con biberón, los objetos en la boca, los chupetes y la respiración oronasal se relacionaron con cambios en los aspectos y posturas de los articuladores y las funciones estomatognáticas.

Objetivo: Verificar a influência dos hábitos orais no perfil miofuncional orofacial de crianças de três a cinco anos. Material e métodos: Estudo transversal, realizado com 73 crianças por meio da aplicação de protocolo validado para avaliação do aspecto miofuncional orofacial e o questionário sobre os hábitos orais. Para a análise entre as variáveis, o nível de significância utilizado foi de 5%. Resultados: A soma total do protocolo Avaliação Miofuncional Orofacial com Escores (AMIOFE) foi de 91,6+5,4 pontos (IC95%= 90,3 ­ 92,9), com o mínimo de 75 e máximo de 100 pontos. Foi observada relação significativa entre: o uso da mamadeira (p=0,014) e chupeta (p<0,001) com os aspectos e posturas dos órgãos fonoarticulatórios; uso da chupeta e as funções de respiração (p=0,04) e deglutição (p=0,006); o uso de objetos na boca e a função de mastigação (p=0,001); respiração oronasal e aspectos e posturas dos órgãos fonoarticulatórios (p<0,001) e função de deglutição (p=0,002). Também, ter recebido aleitamento materno por mais tempo influenciou positivamente o aspecto e postura dos órgãos fonoarticulatórios (p=0,001) e a função de respiração (p=0,005). Conclusão: Os hábitos de mamadeira, objetos, chupeta e respiração oral estiveram relacionados a alterações nos aspectos e posturas dos órgãos fonoarticulatórios e nas funções estomatognáticas.

Objective: Verify the influence of oral habits on miofunctional orofacial profile of children aged three to five yearsold. Material and methods: This cross sectional study included 73 children which underwent the application of validated protocol for evaluation of their myofunctional orofacial functions and a questionnaire about their oral habits. A significance level of 5% was set for the statistical analysis. Results: The Orofacial Myofunctional Evaluation with Scores (OMES) total sum was 91.6+5.4 points (CI95%= 90.3 ­ 92.9), with a minimum of 75 and maximum of 100 points. A significant association was identified between bottlefeeding (p=0.014) and pacifier (p<0.001) with respect to phonoarticulatory organs' appearance and posture, pacifier use and breathing (p=0.04) and swallowing functions (p=0.006); the use of objects in the mouth and the chewing function (p=0.001); oral breathing, phonoarticulatory organs' appearance and posture (p<0.001) and swallowing function (p=0.002). Besides, being breastfed for a longer time modified phonoarticulatory organs' appearance and posture (p=0.001) and breathing function (p=0.005). Conclusion: Feeding habits, plying with solid external objects in the mouth, pacifier use and mouth breathing were associated with changes in articulatory organs' appearance and posture, as well as, stomatognathic functions.

Metabolic Profile in Patients with Mild Obstructive Sleep Apnea.

BACKGROUND: Mild obstructive sleep apnea (OSA) is a highly prevalent disorder in adults. However, it is not clear whether mild OSA has significant metabolic complications. This study examined the prevalence of metabolic syndrome (MS) in patients with mild OSA compared to control group. METHODS: Adults (18-65 years of age) of both genders with a body mass index (BMI) ≤35 kg/m2 were included. The mild OSA group comprised of patients with an apnea-hypopnea index (AHI) score of ≥5 but ≤15 events/hr of sleep, independent of other symptoms. The control group (CG) comprised individuals with an AHI of <5 events/hr of sleep and an Epworth Sleepiness Scale score of <10. The following were used for both groups: two questionnaires on sleepiness, the maintenance of wakefulness test, and full-night polysomnography. Anthropometric measurements and fasting blood samples were obtained, including fasting glucose and insulin, total cholesterol and its subfractions [low-density lipoprotein, very low-density lipoprotein, and low-density lipoprotein cholesterol (HDL-c)], triglycerides (TG), and the TG/HDL-c ratio. In addition, the quantitative insulin sensitivity check index and homeostasis model assessment indices were calculated. RESULTS: Thirty-two percent of mild OSA patients had MS, 43.5% of mild OSA patients had hypertension, 14% showed dyslipidemia, and 56% had prediabetes. The OSA group showed increased TG (CG: 90.0 ± 51.9 vs. OSA: 140.3 ± 78.2 mg/dL, P = 0.004), and TG/HDL-c (CG: 1.9 ± 1.4 vs. OSA: 3.1 ± 2.0, P = 0.05), independent of adjustments. Independent of obesity (BMI <30 kg/m2), there was a negative correlation between total cholesterol and TG with mean oxygen saturation, independent of obesity (BMI <30 kg/m2). CONCLUSIONS: Our findings showed dysregulation in lipid profiles after adjustments for confounders in the mild OSA group, and there was a correlation between these parameters and sleep hypoxemia. The TG/HDL-c ratio in particular was high, suggesting that it might be investigated as a marker of a detrimental metabolic profile in these patients.

Impaired sustained attention and lapses are present in patients with mild obstructive sleep apnea.

BACKGROUND: Severe obstructive sleep apnea (OSA) directly affects the quality of life, mood, and sustained attention of individuals, but it has not yet been established in the literature, if these changes also affect patients with mild OSA. The purpose of this study was to investigate such negative effects on the parameters described above. METHODS: A controlled study was held at the Universidade Federal de Sao Paulo, Department of Psychobiology. Thirty-nine mild OSA patients and 25 controls were included. Volunteers could be of both genders with body mass index (BMI) ≤35 kg/m(2) and age between 18 and 65 years. Both groups were subjected to full-night polysomnography (PSG), the subjective assessment of mood (Beck Inventory of Anxiety and Depression), Functional Outcomes of Sleep Questionnaire (FOSQ), and the psychomotor vigilance task (PVT) five times during the day. We considered mild OSA patients those with apnea-hypopnea index (AHI) score between 5 and 15. The control group included subjects with AHI scores <5, respiratory disturbance index (RDI) scores ≤5, arousal index values ≤15, and Epworth Sleepiness Scale (ESS) values ≤9. RESULTS: Mild OSA patients were older and more obese than the controls. After adjusting for age, BMI, and schooling years, there was an increased number of total lapses (3.90 ± 4.16 and 2.43 ± 5.55, p = 0.004). CONCLUSIONS: Patients with mild OSA showed increased sustained attention lapses compared with normal subjects.

Quality of Life and Sleep of a Multidisciplinary Team in the Burns Treatment Unit of Hospital São Paulo / Qualidade de vida e de sono da equipe multidisciplinar na Unidade de Tratamento de Queimaduras do Hospital São Paulo

Introdução: O objetivo foi avaliar a qualidade de vida e do sono da equipe multidisciplinar da Unidade de Tratamento de Queimaduras. Métodos: O questionário Short Form-36 Medical Outcomes Survey (SF-36) e o Pittsburgh Sleep Quality Index (PSQI) foram utilizados em 50 trabalhadores da unidade. Resultados: A limitação dos aspectos físicos, da saúde geral, da vitalidade e da limitação da saúde social e mental foram significativamente correlacionada com o sono (p<0,05). Conclusões: Esse ambiente de trabalho não é propício para o autocuidado dos trabalhadores; ao contrário, é um lugar de mobilização para emoçõoes e para o estresse.

Background: The aim of this study was to assess the quality of life and sleep of the multidisciplinary team of the Burn Unit. Methods: The Short Form-36 Medical Outcomes Survey (SF-36) and Pittsburgh Sleep Quality Index (PSQI) were used in 50 workers. Results: The limitation of the physical aspects, the general health, vitality, and limitation of social and mental health were significantly correlated with sleep (p<0.05). Conclusions: The work environment is not conducive to workers' self-care; rather, it is a mobilizing place for emotions and stress.

Short sleep duration and obesity: mechanisms and future perspectives.

A reduction of sleep time has become common over the last century, and growing evidence from both epidemiological and laboratory-based studies suggests sleep curtailment is a new risk factor for the development of obesity. On this basis, the present review examines the role of sleep curtailment in the metabolic and endocrine alterations, including decreased glucose tolerance and insulin sensitivity, increased evening concentrations of cortisol, increased levels of ghrelin, decreased levels of leptin and increased hunger and appetite. It will be discussed how sleep restriction may lead to increase in food intake and result in greater fatigue, which may favour decreased energy expenditure. Altogether, evidences point to a possible role of decreased sleep duration in the current epidemic of obesity and therefore present literature highlights the importance of getting enough good sleep for metabolic health. Many aspects still need to be clarified and intervention studies also need to be conducted.

Estimulação ventricular mínima associada à estimulação na via de saída do ventrículo direito: análise do remodelamento atrial elétrico e mecânico atrial e da qualidade de vida / Minimal ventricular stimulation associated with stimulation of the right ventricular outflow tract: analysis of electrical and mechanical atrial remodeling and quality of life

O algoritmo de estimulação ventricular mínima (EVM) do marcapasso (MP) de dupla-câmara permite uma estimulação cardíaca fisiológica. Questiona-se se a associação de um sítio alternativo de estimulação ventricular pode reduzir a incidência de arritmias supraventriculares em longo prazo, sobretudo a fibrilação atrial (FA) crônica. Objetivo: Comparar a densidade de arritmia atrial, a dimensão do átrio esquerdo e a qualidade de vida quando do sinergismo entre a EVM (por meio do "suporte ao ritmo intrínseco" -"Intrinsic Rhythm Support - IRS plus) e a estimulação em via de saída do ventriculo direito (VSVD) com a estimulação em VSVD com a estimulação em VSVD isolada em pacientes com doença do nó sinusal (DNS) e/ou bloqueio atrioventricular (BAV) incomplet0o. Metodologia: Cinquenta pacientes foram submetidos ao implante de MP de dupla-câmara com o referido algoritmo. O eletrodo atrial foi posicionado no septo do átrio direito (AD) e o ventricular, na VSVD. Os pacientes foram randomizados em dois grupos: o Grupo I, com IRSplus ligado nos primeiros 6 meses, IRSplus desligado nos 6 meses seguintes e novamente IRS plus ligado nos 12 meses subsequentes: e o Grupo II, na sequência oposta à do Grupo I. Aos 6, 12, 18 e 30 meses todos os pacientes foram submetidos às seguintes avaliações: 1. seguimento de telemetria do MP pra avaliação da densidade...

Estudo epidemiológico da Unidade de Tratamento de Queimaduras da Universidade Federal de São Paulo / Epidemiological study of the Federal University of São Paulo Burn Unit

Introdução: Queimadura é um grave trauma, com repercussões sociais, econômicas e de saúde pública, que tem seu tratamento custeado basicamente pelo poder público, e necessita de dados epidemiológicos para a correta gestão pública e para campanhas de prevenção. Objetivo: Traçar o perfil epidemiológico dos pacientes atendidos na unidade de tratamento de queimaduras (UTQ) da Universidade Federal de São Paulo (UNIFESP). Método: Os dados foram coletados nos 12 primeiros meses de funcionamento, de julho de 2009 a junho de 2010. O estudo analisou o total de internações por mês; tipo de internação; sexo; idade; procedência; agente da queimadura; classificação quanto à extensão, gravidade do caso; SCQ; taxa de ocupação; período de internação; média mensal de cirurgias; tentativa de suicídio; lesão inalatória; taxa de mortalidade; solicitação de vagas e atendimento ambulatorial. Resultados: Dos 101 pacientes internados nesse período, 69,3% foram do sexo masculino, com média de internação mensal de 8,3 dias. A média da idade foi de 33,7 anos (11 meses a 90 anos). Líquido inflamável (40,6%) foi o mais frequente, álcool líquido (31,3%), seguido de líquido aquecido (25,7%). Pequeno queimado em 61,4%, com SCQ média de 11,3% (1 a 77,5%). A média mensal de cirurgias foi de 9,1, sendo que foram realizadas precocemente, entre 3 e 5 dias após a queimadura; 4,95% foram causadas por tentativa de suicídio, 10,9% apresentavam lesão inalatória na internação e 5,94% de taxa de mortalidade. Conclusão: Houve predomínio do sexo masculino, das queimaduras de segundo grau misto e de menor extensão. A mortalidade foi relacionada à presença da lesão inalatória.

Background: Burns is a serious trauma, affecting social, economic and public health, which has basically funded their treatment by the government, and needs of epidemiological data for the correct management and publishing for prevention. Purpose: Describe the epidemiological profile of patients treated at the UNIFESP burn care unit. Methods: Data were collected from July 2009 to June 2010. The study evaluated the total number of admissions per month, type of admission, sex, age, origin of the patient, burn agent, ranking as the extent, severity of the case, body surface total area burned, occupancy rate, hospital stay, mean of surgery, self extermination, inhalation injury, mortality rate, hospital bed request and outpatient care. Results: Of the 101 patients admitted during this period, 69.3% were male, mean hospital stay of 8.3 days monthly. The median age was 33.7 years old (11 months to 90 years.) Flammable liquid (40.6%) was the most frequent, liquid alcohol (31.3%), followed by heated liquid (25.7%). Small burned in 61.4%, with an average of 11.3% TBSA (1 to 77.5%). The monthly mean of surgeries was 9.1 and they were made precociously, between 3 to 5 days post burn. 4.95% were caused by self extermination, 10.9% had inhalation injury and 5.94% mortality rate. Conclusion: There was male, of second degree burns mixed and less extensive predominance. The mortality was related to the presence of inhalation injury.

Caracterização do desenvolvimento da alimentação em crianças de 6 aos 24 meses de idade do município de Canoas/RS / Characterization of feeding development in 6 to 24 month-old children in Canoas/RS

Objetivos: caracterizar a alimentação de crianças na faixa etária entre seis e 24 meses verificando a época de introdução, tipos de alimentos e texturas oferecidas conforme a faixa etária, bem como, verificar hábitos orais e constatar quem orientou os pais sobre alimentação. Métodos: a amostra foi composta por 100 crianças dos seis aos 24 meses, que frequentaram duas unidades básicas de saúde, em Canoas, RS. Foram realizadas entrevistas com os responsáveis. Resultados: constatouseque 98% (N=98) das crianças foram amamentadas exclusivamente, porém com duração média de dois meses e oito dias. O oferecimento de líquidos apresentou introdução precoce de chá com mediana de início aos 60 dias; 92% (N=92) das crianças usaram mamadeira e destas em 47% (N=47) aumentaram o furo. A chupeta era usada por 60% (N=60) da amostra e teve associação com o tempo de aleitamento. O início da oferta das frutas e sopas apresentou mediana de 150 dias e da carne, 210dias. Houve associação estatística entre a idade e o aumento da consistência. Verificou-se ainda, que os alimentos estão sendo ofertados em consistências adequadas para a idade. Conclusão: concluiuse que houve prática de aleitamento materno exclusivo com período menor ao que é recomendado.Os alimentos foram introduzidos precocemente, porém, a consistência está sendo adequada na alimentaçãoatual. Pode-se verificar, também, a grande frequência do uso de mamadeira e chupeta como hábitos orais deletérios. Ainda, a orientação sobre a alimentação foi feita por pessoas leigas, na sua maioria.

Purpose: to characterize the feeding in children aged from 6 to 24-month old; and specifically, to characterize the time of introduction, types of foods and textures offered according to child's age,to check oral habits and to verify who guided the parents about feeding. Methods: the sample was composed by 100 children of 6 to 24 months, which attended two Basic Health Care Units, in Canoas, RS. Interviews were accomplished with the sponsors. Results: it was verified that 98 (98%) of the children were exclusively breastfeed, however with medium duration of 2 months and 8 days. The offer of liquids presented a precocious introduction of tea at the beginning with median of 60 days; 92 (92%) of the children used bottle-feeding and in 47 (47%) of them increased the hole. The pacifier was used by 60 (60%) of the sample and had an association with the time of breast feeding. The beginning ofoffering fruits and soups presented a median of 150 days and meat in 210 days. There was a statistical association between the age and increase of consistence. It was still verified, that foods are being presented in appropriate consistence for the age. Conclusion: it was concluded that there was an exclusive practice of maternal breastfeeding with period shorter than it is recommended. Foods were introduced before the proper time; however, the consistence is being adapted in the current feeding. It can also be verified the great frequency for employing bottle-feeding and pacifier as a deleterious oralhabits. Most of the time, orientation about feeding was made by lay people.