Differences in Receipt of Neurologist Evaluation During Hospitalization for Ischemic Stroke by Race, Sex, Age, and Region: The REGARDS Study.

BACKGROUND AND OBJECTIVES: Improving access to health care providers with clinical expertise in stroke care may influence the use of recommended strategies for reducing disparities in quality of care. Few studies have examined differences in the receipt of evaluation by neurologists during the hospital stay. We examined the proportion of individuals hospitalized for acute ischemic stroke who received evaluation by a neurologist during the hospital stay and characterized differences in receipt of neurologist evaluation by race (Black vs White), sex, age, and study region (Stroke Belt residence vs other) among those experiencing a stroke who were participating in a national cohort study. METHODS: This cross-sectional study was conducted using medical record data abstracted from 1,042 participants enrolled in the national Reasons for Geographic and Racial Differences in Stroke cohort study (2003-2007) who experienced an adjudicated ischemic stroke between 2003 and 2016. Participants with a history of stroke before baseline, in-hospital death, hospice discharge following their stroke, or incomplete records were excluded resulting in 839 cases. Differences were assessed using modified Poisson regression adjusting for participant-level and hospital-level factors. RESULTS: Of the 839 incident strokes, 722 (86%) received evaluation by a neurologist during the hospital stay. There were no significant differences by age, race, or sex, yet Stroke Belt residents and those receiving care in rural hospitals were significantly less likely to receive neurologist evaluation compared with non-Stroke Belt residents (relative risk [RR] 0.95; 95% CI 0.90-1.01) and participants receiving care in urban hospitals (RR 0.74; 95% CI 0.63-0.86). Participants with a greater level of poststroke functional impairment (modified Rankin scale) and those with a greater number of risk factors were more likely to receive neurologist evaluation compared with those with lower levels of poststroke functional impairment (RR 1.04; 95% CI 1.01-1.06) and fewer risk factors (RR 1.02; 95% CI 1.00-1.04). DISCUSSION: While differences in access to neurologists during the hospital stay were partially explained by patient need in our study, there were also significant differences in access by region and urban-rural hospital status. Ensuring access to neurologists during the hospital stay in such settings may require policy-level and/or system-level changes.

Mental Health and Feeding Styles in Parents of Formula-Fed Infants.

Background: Nonresponsive feeding styles can contribute to rapid weight gain in infancy and subsequent obesity in childhood. There is a need to investigate factors such as parental mental health symptoms (stress, depression, and anxiety) that may contribute to nonresponsive feeding styles. The purpose of this study was to investigate the relationship between parental mental health symptoms and feeding styles in parents of healthy, term formula-fed infants during the first year of life. Methods: A cross-sectional, descriptive correlational design was employed using online surveys. We recruited participants through Facebook groups and pediatricians' offices. Instruments included a demographic questionnaire, the Perceived Stress Scale-10, Patient Health Questionnaire-Depression Module-9, 7-item Generalized Anxiety Disorder Assessment, and Infant Feeding Style Questionnaire. Results: Participants were 306 parents of formula-fed infants. Greater depressive symptoms was the strongest predictor of the pressuring style (ß = 0.54), while greater symptoms of stress (ß = -0.13) and anxiety (ß = -0.28) were associated with lower pressuring scores. Greater depressive symptoms was the strongest predictor of the laissez-faire style (ß = 0.48), while greater symptoms of stress (ß = -0.17) and anxiety (ß = -0.23) were associated with lower laissez-faire scores. Engaging in ≤50% of the infant's feeds was the strongest control variable predictor for the pressuring and laissez-faire styles. None of the mental health variables were significantly related to the restrictive style. Conclusions: We recommend increased screening for depressive symptoms in parents of infants and responsive feeding support, especially for those experiencing depressive symptoms.

Maternal Mortality: A National Institutes of Health Pathways to Prevention Panel Report.

The National Institutes of Health's (NIH) Pathways to Prevention panel on postpartum health provides a consensus statement on the evidence, research gaps, and future priorities to prevent maternal morbidity and mortality. The panel reviewed an NIH-commissioned evidence review and workshop that included epidemiologic studies, demonstration interventions, and other maternal morbidity and mortality research to create these national recommendations. The panel concludes that a maternal morbidity and mortality crisis reflects a systemic failure of current U.S. health care, research efforts, and social policies. The panel recommends improving maternal health through a "maternal morbidity and mortality prevention moonshot" that adopts a comprehensive, multilevel life course conceptual framework; strengthens the research methods used within the science of maternal health; establishes and conducts national prevention, treatment, and policy interventions; and reimburses evidence-informed clinical approaches to improve maternal health across the life course. Without a national focus on fundamentally transformative interventions and other initiatives aimed at redressing structural racism and inequities in health care, current interventions and clinical advances in maternal morbidity and mortality prevention will remain tragically insufficient.

Beliefs and Decision-Making of First-Time Mothers Planning to Use a Breast Pump.

Beliefs and decision-making processes associated with breast pump use in first-time mothers providing human milk to healthy, term newborns soon after birth are explored in this qualitative, descriptive study. Eight women participated in an individual semistructured interview in a community hospital in the southeastern United States. Guided by the theory of planned behavior, conventional content analysis about prenatal and early postpartum beliefs of planning and utilizing breast pumps yielded themes of Resource Gathering, Intention Refining, and Behavior Navigating. An understanding of these beliefs gives insight into ways health professionals can increase collaboration with expectant and new mothers about the selection and safe use of breast pumps, resource availability at various stages, and infant-feeding goals.

Comparing infertility-related stress, coping, and quality of life among assisted reproductive technology and non-assisted reproductive technology treatments.

Women who undergo assisted reproductive technology (ART) treatments experience infertility-related stress and have low quality of life (QOL). However, there is limited understanding of infertility-related stress, coping, or QOL among women who undergo non-ART treatments. The purpose of this study was to examine infertility-related stress, coping, and QOL among women who undergo ART and non-ART infertility treatments. Using a descriptive correlational cross-sectional design, we recruited 200 women who underwent infertility treatments. Participants completed the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Fertility Problem Stress Scale, COMPI Coping Styles Scale, Fertility Quality of Life tool, and a demographic infertility survey. Data analysis included descriptive statistics, independent t-test, chi-square, and hierarchical multiple regression. Women who underwent non-ART had more personal stress, used more active-avoidance coping, and had lower emotional, social, and treatment environment QOL compared to those in ART treatment. Women who underwent ART treatments used more meaning-based coping but had lower treatment tolerability QOL. Stress and coping contribute to core QOL differently among infertility treatment groups. Both treatment groups report low satisfaction with emotional services. Regardless of the treatment type, women who undergo infertility treatments may need care to address their psychological health.

Patient and family perceptions of interprofessional collaborative teamwork: An integrative review.

AIMS: To understand the patient and family perceptions of teamwork by synthesising existing evidence using the Interprofessional Education Collaborative Core Competencies for Interprofessional Collaborative Practice as a guiding framework. BACKGROUND: Advances in healthcare have resulted in more people living longer with health conditions, and patients and families have become the primary caregivers. The role of the interprofessional collaborative team supports a paradigm shift to a care model with the patient and family at the centre of healthcare decisions. However, patient and family views of interprofessional collaborative team care have rarely been studied. METHODS: The authors applied Whittmore and Knafl's methodology to conduct an integrative review of the literature. Databases searched included Cumulative Index to Nursing and Allied Health Literature, PubMed and PsycINFO along with reference searches. The studies included were those related to patient and family perceptions of teamwork published from 2000 to 2020. The IPEC Core Competencies for Interprofessional Collaborative Practice served as the guiding framework for analysis. A PRISMA flow chart documented the search, inclusion and exclusion criteria for the review. RESULTS: Seventeen articles met the inclusion criteria. The findings identified differing perspectives by patients of the impact of the interprofessional collaborative team in their care which suggests that interventions to increase knowledge about interprofessional collaborative team care from the patient and family perspective may be beneficial. CONCLUSIONS: There is limited research on understanding IPC teams from the patient and family viewpoint. This review reveals incongruencies in patient and provider perspectives of IPC teams and suggests the need for additional research about patient and family perspectives of teamwork. To fully implement the IPC team vision, perceptions of teamwork must be fully understood.

O impacto da pandemia da covid-19 na microbiota intestinal do lactente / The impact of the covid-19 pandemic on the infant gut microbiota / El impacto de la pandemia de covid-19 en la microbiota intestinal del lactante

A COVID-19 resultou em milhares de óbitos e até o presente momento assola diversos pacientes com as suas implicações. Uma das consequências da doença foi o isolamento social, realizado por quase todos os países, o que configurou a alteração de diversos padrões de convivência e principalmente de exposição a outros agentes não patogênicos e patogênicos essenciais para o desenvolvimento da microbiota. Com isso, o seguinte projeto tem como objetivo a descrição dos impactos da pandemia da COVID-19 na microbiota intestinal de lactentes do período pandêmico e as consequências geradas no sistema imunológico imaturo, prejudicando seu desenvolvimento e maturação. A metodologia consiste na análise e seleção de artigos científicos publicados nos últimos 10 anos com auxílio de Descritores em Ciências da Saúde (DeCS) específicos nas línguas inglesa e portuguesa para o tema da pesquisa, sendo a combinação dos descritores feita por meio de operadores booleanos. Conclui-se que a composição da microbiota intestinal é iniciada intraútero e influenciada pela via de parto, contato pele a pele após o nascimento e pela presença da amamentação materna. A modificação das práticas durante a pandemia da COVID-19, pode alterar a microbiologia neonatal, assim como impactar na maturação do sistema imunológico do lactente, predispondo futuramente à doenças gastrointestinais, metabólicas e atópicas, como asma.

COVID-19 has resulted in thousands of deaths and until now is affecting many patients with its implications. One of the consequences of the disease was social isolation, carried out by almost all countries, which resulted in changes in different patterns of coexistence and mainly exposure to other non-pathogenic and pathogenic agents essential for the development of the microbiota. Therefore, the following project aims to describe the impacts of the COVID-19 pandemic on the microbiota of infants during the pandemic period and the consequences generated on the immature immune system, damaging its development and maturation and relating microbiology, essentially intestinal, throughout the project. The methodology consists of the analysis and selection of scientific articles published in the last 10 years with the help of specific Health Sciences Descriptors in English and Portuguese for the research topic, with the combination of descriptors made using Boolean operators. It is concluded that the composition of the intestinal microbiota begins in utero and is influenced by the mode of delivery, skin-to- skin contact after birth, and the presence of maternal breastfeeding. Modifying practices during the COVID-19 pandemic may alter neonatal microbiology and impact the maturation of the infant's immune system, potentially predisposing them to future gastrointestinal, metabolic, and atopic diseases such as asthma.

El COVID-19 ha provocado miles de muertes y todavía afecta a muchos pacientes con sus implicaciones. Una de las consecuencias de la enfermedad fue el aislamiento social, llevado a cabo por casi todos los países, que resultó en cambios en diferentes patrones de convivencia y principalmente exposición a otros agentes patógenos y no patógenos esenciales para el desarrollo de la microbiota. Com eso, el siguiente proyecto tiene como objetivo describir los impactos de la pandemia de COVID-19 en la microbiota de los lactantes durante el periodo pandémico y las consecuencias generadas sobre el sistema inmunológico inmaduro, perjudicando su desarrollo y maduración y relacionando la microbiología, fundamentalmente intestinal, a lo largo del proyecto. La metodología consiste en el análisis y selección de artículos científicos publicados en los últimos 10 años con la ayuda de Descriptores en Ciencias de la Salud específicos en inglés y portugués para el tema de investigación, con la combinación de descriptores realizada mediante operadores booleanos. Se concluye que la composición de la microbiota intestinal comienza intraútero y está influenciada por la vía de parto, el contacto piel a piel después del nacimiento y la presencia de la lactancia materna. La modificación de las prácticas durante la pandemia de COVID-19 puede alterar la microbiología neonatal y afectar la maduración del sistema inmunológico del lactante, predisponiéndolo potencialmente a enfermedades gastrointestinales, metabólicas y atópicas en el futuro, como la asma.

Fatores associados a não adesão terapêutica em pessoas com hipertensão que procuraram assistência por emergência / Factors associated with therapeutic non-adherence among hypertensive individuals who seek emergency care / Factores asociados a la no adhesión a la terapia en personas hipertensas que buscan asistencia por emergencias

RESUMO: Objetivo: analisar fatores associados à não adesão terapêutica em pessoas com Hipertensão Arterial que procuraram serviços de pronto atendimento por emergência e/ou complicação hipertensiva. Método: estudo transversal realizado entre dezembro de 2019 a outubro de 2020, com 238 pessoas residentes em um município de médio porte do Sul do Brasil, mediante aplicação da Escala de Adesão Terapêutica de Oito Itens de Morisky. Na análise se utilizou Regressão Logística Múltipla. Resultados: 86 (36,1%) participantes foram considerados não aderentes. Foi observada maior chance de não adesão em pessoas com menos de 60 anos (Odds Ratio=2,04), que buscaram assistência nos serviços de pronto atendimento nos três anos em estudo (Odds Ratio=5,08) e que tinham vínculo com profissionais da Atenção Primária à Saúde (Odds Ratio=1,96). Conclusão: reconhecer os fatores associados com a não adesão à terapêutica possibilitará aos profissionais realizar intervenções educativas e assistir as pessoas com hipertensão de acordo com suas necessidades, prevenindo/postergando complicações.

ABSTRACT Objective: to analyze factors associated with therapeutic non-adherence among individuals with Arterial Hypertension who seek emergency care and/or assistance due to hypertensive complications. Method: this is a cross-sectional study conducted from December 2019 to October 2020 with 238 people living in a medium-sized municipality from southern Brazil using Morisky's 8-Item Medication Adherence Scale. Multiple Logistic Regression was used in the analysis. Results: a total of 86 (36.1%) participants were considered as non-adherent. A higher change of non-adherence was observed in people younger than 60 years of age (Odds Ratio=2.04), who sought emergency services in the three years under study (Odds Ratio=5.08), and who had a bond with Primary Health Care professionals (Odds Ratio=1.96). Conclusion: acknowledging the factors associated with non-adherence to the therapy will allow professionals to conduct educational interventions and assist people with hypertension according to their needs, thus preventing/postponing complications.

RESUMEN Objetivo: analizar factores asociados a la no adhesión a la terapia en personas con Hipertensión Arterial que asisten a servicios de urgencia por emergencias y/o complicaciones derivadas de la hipertensión. Método: estudio transversal realizado entre diciembre de 2019 y octubre de 2020 con 238 residentes en un municipio de mediano porte del sur de Brasil, utilizando la Escala de Adherencia Terapéutica de 8 ítems de Morisky. En el análisis se utilizó Regresión Logística Múltiple. Resultados: se consideró que 86 (36,1%) participantes no cumplían con la terapia. Se observó una mayor probabilidad de no adhesión en personas menores de 60 años (Odds Ratio=2,04), que buscaron asistencia en los servicios de urgencia en los tres años en estudio (Odds Ratio=5,08) y que tenían una relación con profesionales de Atención Primaria de la Salud (Odds Ratio=1,96). Conclusión: reconocer los factores asociados a la no adhesión a la terapia permitirá que los profesionales realicen intervenciones educativas y asistan a las personas con hipertensión arterial según sus necesidades, previniendo/posponiendo complicaciones.

Conhecimento e comportamentos de pessoas surdas em relação às infecções sexualmente transmissíveis / Conocimiento y conductas de personas sordas en relación a las infecciones de transmisión sexual / Knowledge and behaviors of deaf people in relation to sexually transmitted infections

Objetivo: identificar o conhecimento e os comportamentos de risco para infecções sexualmente transmissíveis em pessoas surdas. Método: estudo transversal realizado com 110 pessoas surdas residentes no noroeste do Paraná, selecionadas com a técnica da bola de neve. Os dados foram coletados mediante instrumento estruturado e submetidos à análise estatística descritiva e inferencial (uso de regressão logística múltipla). Resultados: a maioria possuía pouca informação sobre as formas de transmissão e prevenção das infecções sexualmente transmissíveis (menos de 40% de acertos em relação a hepatite, a gonorreia e a sífilis, sendo que 20,9% já teve sintoma de infecção sexualmente transmissível). Nove dos 26 que tiveram relação sexual casual não usaram preservativo. Pessoas bilíngues bimodal apresentaram mais chance de conhecer formas de transmissão e prevenção das infecções sexualmente transmissíveis e ter comportamentos sexuais seguros. Considerações finais: os surdos em estudo demonstraram pouco conhecimento sobre as formas de transmissão e prevenção de infecções sexualmente transmissíveis, o que constitui desafio para os profissionais de saúde.

Objetivo: identificar los conocimientos y las conductas de riesgo en relación con las infecciones de transmisión sexual en personas sordas. Método: estudio transversal realizado con 110 personas sordas que viven en el noroeste do Paraná, seleccionadas mediante la técnica de la bola de nieve. Los datos se recolectaron mediante un instrumento estructurado y se los sometió a análisis estadístico descriptivo e inferencial (uso de regresión logística múltiple). Resultados: la mayoría poseía escasa información sobre las formas de transmisión y prevención de las infecciones de transmisión sexual (menos de 40% de respuestas correctas con respecto a hepatitis, gonorrea y sífilis, donde el 20,9% ya presentó algún síntoma de una infección de transmisión sexual). Nueve de los 26 participantes que tuvieron relaciones sexuales casuales utilizaron preservativos. Las personas bilingües bimodales presentaron mayor probabilidad de conocer formas de transmisión y prevención de las infecciones de transmisión sexual y de realizar conductas sexuales seguras. Consideraciones finales: las personas sordas incluidas en el estudio demostraron tener escasos conocimientos sobre las formas de transmisión y prevención de infecciones de transmisión sexual, lo que representa un desafío para los profesionales de la salud.

Objective: To identify the knowledge and risk behaviors for sexually transmitted infections among deaf people. Method: A cross-sectional study conducted with 110 deaf individuals living in northeastern Paraná, selected by means of the snowball technique. The data were collected by means of a structured instrument and submitted to descriptive and inferential analysis (use of multiple logistic regression). Results: Most of the participants had limited information on the transmission and prevention means for sexually transmitted infections (less than 40% of correct answers in relation to hepatitis, gonorrhea and syphilis; and 20.9% have already had symptoms of some sexually transmitted infection). Nine of the 26 subjects that had casual sexual relationships did not use condoms. Bimodal bilingual people presented more chances of knowing transmission and prevention means for sexually transmitted infections and of indulging in safe sex behaviors. Final considerations: the deaf people under study showed limited knowledge about the transmission and prevention means for sexually transmitted infections, which represents a challenge for health professionals.

Curcumin supplementation reduces blood glucose and serum lipids of Brazilian women with high waist circumference: a randomized clinical trial

ABSTRACT Objective: To evaluate the effect of curcumin supplementation on the body compositions and biochemical parameters of Brazilian women with high waist circumferences. Materials and methods: This is a blind, randomized, placebo-controlled clinical trial conducted in 2016 with 35 Brazilian women with high waist circumference (WC). In total, 80 participants were randomized [38 in the placebo group (PG) and 42 in the supplemented group (SG)], but at the end of the protocol, 20 individuals in the PG and 15 in the SG were evaluated. The sample consumed one capsule of curcumin (500 mg/day) (Curcumin C3 Complex®) or a placebo for 90 days. Body weight, height, body mass index, WC, body fat, fat free mass, fasting glucose (FG), lipid profile [triglycerides (TGs), total cholesterol (TC), HDL-c and LDL-c], physical activity level and food intake (energy, carbohydrate, total fat and protein) data were evaluated before and after the intervention. Results: Curcumin supplementation reduced body mass (p < 0.040) but did not alter other anthropometric parameters or body composition (p ≥ 0.050). In relation to the biochemical profile, the SG saw reductions in FG (p < 0.001), TGs (p < 0.001) and TC (p = 0.001) compared with the PG. At the baseline and during the intervention, the practice of physical activity and food intake did not differ between the SG and PG (p ≥ 0.050). Conclusion: Curcumin supplementation improved the blood glucose and lipid profile of Brazilian women with high WC, without altering body composition. New studies with larger sample sizes and longer durations are important for identifying more robust data regarding the proposal of this work.

Curcumin supplementation reduces blood glucose and serum lipids of Brazilian women with high waist circumference: a randomized clinical trial.

Objective: To evaluate the effect of curcumin supplementation on the body compositions and biochemical parameters of Brazilian women with high waist circumferences. Methods: This is a blind, randomized, placebo-controlled clinical trial conducted in 2016 with 35 Brazilian women with high waist circumference (WC). In total, 80 participants were randomized [38 in the placebo group (PG) and 42 in the supplemented group (SG)], but at the end of the protocol, 20 individuals in the PG and 15 in the SG were evaluated. The sample consumed one capsule of curcumin (500 mg/day) (Curcumin C3 Complex®) or a placebo for 90 days. Body weight, height, body mass index, WC, body fat, fat free mass, fasting glucose (FG), lipid profile [triglycerides (TGs), total cholesterol (TC), HDL-c and LDL-c], physical activity level and food intake (energy, carbohydrate, total fat and protein) data were evaluated before and after the intervention. Results: Curcumin supplementation reduced body mass (p < 0.040) but did not alter other anthropometric parameters or body composition (p ≥ 0.050). In relation to the biochemical profile, the SG saw reductions in FG (p < 0.001), TGs (p < 0.001) and TC (p = 0.001) compared with the PG. At the baseline and during the intervention, the practice of physical activity and food intake did not differ between the SG and PG (p ≥ 0.050). Conclusion: Curcumin supplementation improved the blood glucose and lipid profile of Brazilian women with high WC, without altering body composition. New studies with larger sample sizes and longer durations are important for identifying more robust data regarding the proposal of this work.

Association between urinary sodium excretion and hard outcomes in non-dialysis chronic kidney disease patients.

BACKGROUND: Restriction of sodium intake is routinely recommended for patients with chronic kidney disease (CKD). Whether or not sodium intake is associated with the progression of CKD and mortality remains uncertain. We evaluated the association between urinary sodium excretion (as a surrogate for sodium intake) with the occurrence of renal failure and mortality in patients with non-dialytic CKD. METHODS: We conducted a retrospective study of patients followed at a CKD clinic care hospital from October 2006 to March 2017. Adult patients with non-dialytic CKD were included. Using a time-to-event analysis, we examined the association of urinary sodium excretion as a categorical variable (categorized as quintiles: 1st quintile: 0.54-2.51 g; 2nd quintile: 2.52-3.11 g, 3rd quintile: 3.12-3.97 g, 4th quintile: 3.98-5.24 g and 5th quintile: 5.26-13.80 g) and the outcomes of interest. The primary outcome was defined as progression to end-stage renal disease requiring any type of renal replacement therapy. The secondary outcome was mortality. RESULTS: Two hundred five patients were included in the study (mean follow up of 2.6 years) with a mean eGFR of 26 (19-41) ml/min/1.73m2. 37 patients (18%) required renal replacement therapy and 52 (25,3%) died. There was association between urinary sodium excretion and need for renal replacement therapy (adjusted HR 0.245; 95%CI 0.660-0.912). There was no association between urinary sodium excretion and mortality in adjusted models. CONCLUSION: Moderate sodium intake was associated with a lower risk of renal failure.

From diagnosis to complications: experiences of those who live with systemic lupus erythematosus.

OBJECTIVE: To understand how people with lupus experience the diagnosis and how they deal with complications arising from the disease. METHOD: Qualitative study, whose data were collected between February and July 2019, through semi-structured interviews with 26 individuals and submitted to content analysis. RESULTS: Three categories emerged that show illness from lupus as a difficult experience, permeated by sadness, fear and suffering, which, in addition to being linked to society's lack of knowledge about the disease, negatively impacts the lives of those who experience it. Furthermore, they show that the time of living with the disease favors the development of self-care strategies and greater therapeutic adherence and, consequently, longer periods of disease remission. CONSIDERATIONS: More disclosure about the disease and its implications in the daily lives of those affected is essential, culminating in greater understanding of family, friends and colleagues and improvements in health care and quality of life for these people.

Infertility-related stress and quality of life in women experiencing concurrent reproductive trauma.

PURPOSE: To compare differences in infertility-related stress and quality of life (QOL) among women with infertility and concurrent reproductive trauma, defined as pregnancy loss during the infertility experience. MATERIALS AND METHODS: We used a descriptive, cross-sectional study design to recruit 205 women who underwent infertility treatments from infertility-related Facebook support groups and pages. Participants completed the Copenhagen Multi-center Psychosocial Infertility Fertility Problem Stress Scale, the Fertility Quality of Life tool, and a supplemental infertility demographic form. Statistical analyses included descriptive statistics, Pearson correlations, multivariate analysis of variance (MANOVA), univariate ANOVA, and eta squared. Statistical significance was evaluated using a Bonferroni adjusted alpha = .05/7 = .007. RESULTS: Participants with concurrent reproductive trauma had significantly higher social stress (p < .001), and significantly lower emotional QOL (p = .003) than women with infertility alone. Although not statistically significant, participants with concurrent reproductive trauma reported higher personal and marital stress scores and lower mind/body, relational, and social QOL scores than women with infertility alone. CONCLUSIONS: Women with concurrent reproductive trauma may need psychological support to combat the emotional distress of pregnancy loss during infertility treatment.

Protocolo clínico dos sistemas de limas mecanizadas Recioproc Blue e Trunatomy / Clinical protocol of the mechanized files system Reciproc Blue and TruNatomy

A introdução de sistemas rotatórios mecanizados utilizando instrumentos de níquel- titânio (NiTi) trouxe significativo progresso e agilidade ao tratamento endodôntico, minimizando a ocorrência de iatrogenias. Com o avanço da tecnologia, novos sistemas foram introduzidos no mercado a fim de melhorar o desempenho das limas de níquel-titânio. Alguns desses sistemas utilizam uma cinemática diferente, o movimento reciprocante, e prometem apresentar vantagens em suas propriedades físicas como maior resistência à fratura. Ao mesmo tempo, novos tratamentos térmicos foram desenvolvidos a fim de aprimorar as propriedades mecânicas e aumentar ainda mais a resistência à fratura dos instrumentos, e assim, proporcionar uma rotina clínica mais segura. Dentre as inovações mais recentes no campo dos instrumentos endodônticos estão os sistemas que preconizam um menor desgaste dentinário, tratamentos mais conservadores visando manter o máximo de estrutura dental sadia. Estes novos tipos de limas têm a particularidade de serem instrumentos finos e flexíveis, de forma a conseguir uma instrumentação segura, minimamente invasiva e suficientemente eficaz. Este trabalho irá abordar os sistemas TruNatomy, tratado termicamente e com características de preparo conservador, e Reciproc Blue, que agrega segurança devido a sua maior resistência à fratura e simplicidade de uso por se tratar de um único instrumento reciprocante. Será ainda proposto um passo a passo clínico sistemático para instrumentação mecanizada utilizando estes dois sistemas, visando a orientação de profissionais quanto aos seus protocolos de utilização.

The introduction of mechanized rotary systems using nickel-titanium (NiTi) instruments brought significant progress and agility to endodontic treatment, minimizing the occurrence of iatrogenic events. With the advancement of technology, new systems were introduced in order to improve the NiTi files performance. Some of these systems use a different kinematics, the reciprocating motion, and promise to present advantages in their physical properties, such as greater resistance to fracture. At the same time, new heat treatments were developed in order to improve the mechanical properties and increase even more the fracture resistance of the instruments, and thus, provide a safer clinical routine. Among the most recent innovations in the field of endodontic instruments are systems that advocate less dentin wear, more conservative treatments aimed at maintaining maximum healthy tooth structure. These new types of files have the particularity of being thin and flexible instruments, in order to achieve a safe, minimally invasive and sufficiently effective instrumentation. This work will address the TruNatomyTM systems, thermaly treated and conservative, and Reciproc Blue, which adds safety due to its greater resistance to fracture and simplicity of use because it is a single reciprocating instrument. A systematic clinical step-by- step for mechanized instrumentation using these two systems will also be proposed, aiming to guide professionals regarding their use protocols.

From diagnosis to complications: experiences of those who live with systemic lupus erythematosus / Del diagnóstico a lascomplicaciones: experiencias de aquellosqueviven con lupus sistémicoeritematoso / Do diagnóstico às complicações: experiências de quem convive com lúpus eritematoso sistêmico

ABSTRACT Objective: To understand how people with lupus experience the diagnosis and how they deal with complications arising from the disease. Method: Qualitative study, whose data were collected between February and July 2019, through semi-structured interviews with 26 individuals and submitted to content analysis. Results: Three categories emerged that show illness from lupus as a difficult experience, permeated by sadness, fear and suffering, which, in addition to being linked to society's lack of knowledge about the disease, negatively impacts the lives of those who experience it. Furthermore, they show that the time of living with the disease favors the development of self-care strategies and greater therapeutic adherence and, consequently, longer periods of disease remission. Considerations: More disclosure about the disease and its implications in the daily lives of those affected is essential, culminating in greater understanding of family, friends and colleagues and improvements in health care and quality of life for these people.

RESUMEN Objetivo: Comprender cómo las personas con lupus experimentan el diagnóstico y cómo afrontan las complicaciones derivadas de la enfermedad. Método: Estudio cualitativo, cuyos datos fueron recolectados entre febrero y julio de 2019, mediante entrevistas semiestructuradas con 26 individuos y sometidos a análisis de contenido. Resultados: Surgieron tres categorías que muestran la enfermedad por lupus como una experiencia difícil, impregnada de tristeza, miedo y sufrimiento, que además de estar vinculada al desconocimiento de la sociedad sobre la enfermedad, impacta negativamente en la vida de quienes la padecen. Además, muestran que el tiempo de convivencia con la enfermedad favorece el desarrollo de estrategias de autocuidado y una mayor adherencia terapéutica y, en consecuencia, mayores periodos de remisión de la enfermedad. Consideraciones: Es esencial una mayor divulgación sobre la enfermedad y sus implicaciones en la vida diaria de los afectados, que culmine en una mayor comprensión de la familia, amigos y colegas y mejoras en la atención médica y la calidad de vida de estas personas.

RESUMO Objetivo: Compreender como pessoas com lúpus experienciaram o diagnóstico e como lidam com as complicações advindas da doença. Método: Estudo qualitativo, cujos dados foram coletados entre fevereiro e julho de 2019, mediante entrevistas semiestruturadas com 26 indivíduos e submetidos à análise de conteúdo. Resultados: Emergiram três categorias que mostram o adoecimento por lúpus como uma experiência difícil, permeada por tristeza, medo e sofrimento, que além de estar atrelado ao desconhecimento da sociedade sobre a doença, impacta negativamente na vida de quem o vivencia. Para além disso, evidenciam que o tempo de convivência com a doença favorece o desenvolvimento de estratégias de autocuidado e maior adesão terapêutica e, por consequência, maiores períodos de remissão da doença. Considerações: Imprescindível mais divulgação sobre a doença e suas implicações no cotidiano dos acometidos, culminando em maior compreensão de familiares, amigos e colegas e melhorias na atenção à saúde e qualidade de vida destas pessoas.