Immunotherapeutic Properties of Dexmedetomidine on Pain Management and Cardiovascular Function in Videolaparoscopic Cholecystectomies: A Randomized, Two-Arm, Double-Blinded, Placebo-Controlled Trial.

BACKGROUND: Laparoscopy represented one of the most innovative surgical techniques approached in the surgery field. Dexmedetomidine association with general anesthesia promotes the response control to trauma by altering the neuroinflammatory reflex, provides better clinical outcomes in the postoperative period and reduces the excessive use of drugs with risk for addiction. This trial aims to evaluate the potential drug treatment of dexmedetomidine on organic function, with the targets in neuroinflammation, perioperative pain control and blood pressure measurements in a medium-sized surgical model. METHODS: Fifty-two patients were randomized in two groups: Sevoflurane and Dexmedetomidine - A (dexmedetomidine infusion [1 µg/kg loading, .2-.5 µg/kg/h thereafter]) vs Sevoflurane and Saline .9% - B. Three blood samples were collected at three times: before surgery, 4 to 6 hours after surgery and 24 hours postoperatively. The primary outcome was inflammatory and endocrine mediators dosage analisys. Finally, we evaluated pain and opioid use as secondary outcomes, also the hemodynamic values. RESULTS: In Dexmedetomidine group A, a reduction of Interleukin 6 was found during 4-6 hours after surgery. A reduction of IL-10 was noted in the measurement of its values 24 hours after the procedure, with statistical significance. Also, systolic and diastolic blood pressure, as well heart rate were attenuated, and there was a lower incidence of pain and opioid consumption in the first postoperative hour (P < .0001) in the anesthetic recovery room. CONCLUSIONS: Dexmedetomidine provided anti-inflammatory activity, sympatholytic effect and analgesia with cardiovascular safety. It reinforces the therapeutic nature of highly selective α2-adrenergic agonists when combined within anesthetic interventions.

Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit.

OBJECTIVE: To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. METHODS: This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman's booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. RESULTS: The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). CONCLUSION: Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men's Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

Diferença na qualidade de vida de tabagistas, ex-tabagistas e não tabagistas usuários das Unidades de Atenção Primária do município de Juiz de Fora, Minas Gerais / Difference in the quality of life of smokers, ex-smokers and non-smokers users of Primary Care Units in Juiz de Fora, Minas Gerais

O objetivo do presente estudo foi associar status tabágico (tabagistas, ex-tabagistas e não tabagistas) e a qualidade de vida entre usuários das Unidades de Atenção Primária à Saúde(APS). Realizou-se um estudo transversal com 500 usuários de 50 Unidades de APS do município de Juiz de Fora/MG.Foi utilizado questionário estruturado para coleta de dados sociodemográficos e de saúde e o questionário WHOQOL-BREF para avaliar a qualidade de vida. Para análise de dados foi empregada Regressão Logística. Os resultados das análises multivariadas evidenciaram que há maior chance de melhor qualidade de vida total para indivíduos ex-tabagistas (OR: 1,90; IC: 1,10-3,29) e não tabagistas (OR: 1,84; IC:1,14-2,95)em relação aos tabagistas. Da mesma forma, uma maior renda e a autodeclaração de cor da pele branca foram relacionados a melhor qualidade de vida total. Indivíduos não tabagistas também apresentaram melhor qualidade de vida no domínio físico comparado aos tabagistas(OR:2,24; IC:1,40-3,59). Conclui-se que, ex-tabagistas e não tabagistas tiveram maior chance de apresentarem melhor qualidade de vida global quando comparado aos tabagistas. Não tabagistas também apresentaram maior chance de melhor qualidade de vida no domínio físico em relação aos tabagistas.

The objective of the present study was to associate smoking status (smokers, ex-smokers and non-smokers) and quality of life among users of primary healthcare units. A cross-sectional study was conducted with 500 users of 50 Primary Health Care Units in the city of Juiz de Fora. A structured questionnaire was used to collect socio-demographic and health data and the WHOQOL-BREF questionnaire to assess the quality of life. For data analysis, LogisticRegression was used. The results of the multivariate analyzes showed that there is a greater chance of a better overall quality of life for ex-smokers (OR: 1.90; CI: 1.10-3.29) and non-smokers (OR: 1.84; CI: 1.14-2.95) in relation to smokers. Likewise, higher income and self-reported White skin color were related to a better overall quality of life. Non-smokers also presented better quality of life in the physical domain compared to smokers (OR:2.24; CI:1.40-3.59). It was concluded that ex-smokers and non-smokers were more likely to have a better overall quality of life when compared to smokers. Non-smokers also had a greater chance of better quality of life in the physical domain compared to smokers.

Double screening for syphilis and HIV in pregnant women in a priority municipality for the elimination of vertical transmission in Brazil: incidence, risk factors and spatial analysis.

BACKGROUND: The Brazilian Ministry of Health (MoH) recommends double screening (DS) for syphilis and HIV during the first and third trimesters of antenatal care (ANC) to mitigate vertical transmission. We surveyed DS outcomes and their associated factors in a priority Brazilian municipality with >100 000 inhabitants who face challenges for both health problems. METHODS: A total of 399 women were followed up throughout pregnancy using medical records. Spatial and multinomial logistic analyses were performed. RESULTS: There was an incidence rate of 24.8%, 59.4% and 15.8% for 'full DS', 'partial DS' and 'without DS', respectively. Younger women and those with a history of both prematurity and multiparity were less likely to be in the 'full DS' category. There was an overlap of high-density clusters of 'full DS' and 'ANC in better quality basic health units', adherent to both the Family Health Strategy and the National Program for Access and Quality Improvement in Primary Care. CONCLUSIONS: The poor DS outcomes presented in 75% of the cases were mostly linked to delays in starting ANC appointments or their discontinuity. Thus, the MoH recommendations, accompanied by ongoing training, technical assistance and the periodic evaluation of their implementation, need to effectively reach providers and promote counseling and awareness about the importance of DS for pregnant women.

Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit

ABSTRACT Objective To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. Methods This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman's booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. Results The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). Conclusion Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men's Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

Prevalência da síndrome de Burnout em enfermeiros de um hospital público / Prevalence of burnout syndrome in nurses at a public hospital / Prevalencia del síndrome de Burnout en enfermeras de un hospital público

Objetivo: identificar a prevalência da Síndrome de Burnout, suas dimensões e analisar os fatores associados. Método: estudo transversal, realizado com 171 enfermeiros de um hospital público, em 2020. Foi utilizado o MBI-HSS para estimar a prevalência da SB, considerando sua presença quando verificada alteração em pelo menos uma de suas dimensões. Resultados: 9,9% dos participantes apresentaram alta exaustão emocional (EE), 7% alta despersonalização (DE) e 59,1% baixa realização profissional (RP). EE e DE foram associadas a modalidade contratual do tipo estatutário e recebimento de dois ou mais incentivos no exercício do trabalho. Pouca realização de atividades educativas foi associada a EE e a ausência de filhos a baixa RP. Conclusão: evidenciou-se uma alta prevalência da Síndrome de Burnout (62,6%). Reforça-se a importância de ações preventivas e de diagnóstico precoce que contribuam para a preservação da saúde física e mental desses trabalhadores e, consequentemente, para melhoria da qualidade da assistência.

Objective: to identify the prevalence and dimensions of Burnout syndrome, and to analyze associated factors. Method: this cross-sectional study with 171 nurses at a public hospital was conducted in 2020 using the MBI-HSS to estimate prevalence of Burnout syndrome, indicated by alteration in any of its dimensions. Results: 9.9% of participants displayed high emotional exhaustion (EE), 7% showed strong depersonalization (DE) and 59.1% reported poor professional achievement (PPA). EE and DE were associated with a statutory contract type and receiving two or more job incentives. Little educational activity was associated with EE and childlessness, with PPA. Conclusion: prevalence of Burnout syndrome was high (62.6%). This underlines the importance of preventive actions and early diagnosis that contribute to preserving these workers' physical and mental health and thus to improving the quality of care.

Objetivo: identificar la prevalencia de Síndrome de Burnout, sus dimensiones y analizar los factores asociados. Método: estudio transversal, realizado junto a 171 enfermeros de un hospital público, en 2020. Se utilizó el MBI-HSS para estimar la prevalencia de SB, considerando su presencia cuando hay alteración en, al menos, una de sus dimensiones. Resultados: 9,9% de los participantes tenían alto agotamiento emocional (EE), 7% alta despersonalización (DE) y 59,1% baja realización profesional (RP). EE y DE se asociaron con la modalidad contractual del tipo estatutario y tener dos o más incentivos en el ejercicio del trabajo. La realización de pocas actividades educativas se asoció con la EE y la ausencia de niños con la baja RP. Conclusión: hubo una alta prevalencia de Síndrome de Burnout (62,6%). Se destaca la importancia de acciones preventivas y de diagnóstico temprano que contribuyan a la preservación de la salud física y mental de estos trabajadores y, en consecuencia, a mejorar la calidad de la atención.

Factors associated with premature birth: a case-control study.

OBJECTIVE: To analyze the socioeconomic, demographic, environmental, reproductive, behavioral, and health-care factors associated with preterm birth. METHODS: Case-control study, with case group composed of preterm infants and the control group by full term live births. Each case was paired with two controls according to sex and date of birth. Interviews were carried out with the mothers, as well as analysis of medical records. A logistic regression model was used for data analysis following the hierarchical order of entry of the blocks. RESULTS: 221 live births were allocated in the case group and 442 in the control group. After analysis adjusted for other factors under study, the highest chances of prematurity were associated with being the first child (OR 1.96; 95%CI 1.34-2.86; p=0.001); mothers with the highest income (OR 2.08; 95%CI 1.41-3.08; p<0.001), mothers with previous preterm births (OR 3.98; 95%CI 2.04-7.79; p<0.001), mothers that suffered violence during pregnancy (OR 2.50; 95%CI 1.31-4.78; p=0.005) and underwent cesarean section (OR 2.35; 95%CI 1.63-3.38; p<0.001). Live births to mothers who had more than six prenatal consultations had a lower risk of prematurity (OR 0.39; 95%CI 0.26-0.58; p<0.001). CONCLUSIONS: The factors associated with a higher chance of prematurity were: higher family income, previous preterm child, primiparity, violence against pregnant women and cesarean section. Having attended more than six prenatal visits was associated with a lower chance of premature birth. Violence against pregnant women showed a strong and consistent association, remaining in all final models, and should serve as an alert for the population and professionals.

Higher Muscle Damage Triggered by Shorter Inter-Set Rest Periods in Volume-Equated Resistance Exercise.

Objectives: The aim of the manuscript was to analyze the effects of two rest periods between volume-equated resistance exercise (RE) on inflammatory responses (cytokines and leukocyte) and muscle damage. Methods: Ten trained men (26.40 ± 4.73 years, 80.71 ± 8.95 kg, and 176.03 ± 6.11 cm) voluntarily participated in training sessions consisting of five sets of 10 reps performed at 10-RM on (1) the barbell bench press followed by (2) leg press, with either 1- or 3-min rest between sets and exercises. Circulating concentrations of different biomarkers was measured before (Pre), and after 3 h (excepted for cytokines), 6, 12, and 24 h from exercise. The rate of perceived exertion (RPE) was recorded after each set on both planned visits. Results: We found greater increases triggered by the 1-min rest period in Creatine Kinase (CK), occurring from 12 to 24 h post-exercise compared to the 3-min rest condition. A significant increase in the 1-min rest condition was also observed in the total number of leukocytes, neutrophils, and monocytes. The 1-min rest period also triggered increases compared to baseline in pro-inflammatory cytokines [Interleukin 1 beta (IL-1ß), p = 0.004; tumor necrosis factor α (TNF-α), p = 0.01; and granulocyte-macrophage colony-stimulating factor (GM-CSF), p = 0.01], which were more evident after 6 and 12 h post-exercise. Similarly, increases in anti-inflammatory cytokines [Interleukin 5 (IL-5), p = 0.01; Interleukin 6 (IL-6), p = 0.01; and Interleukin 10 (IL-10), p = 0.01] at all time-points were observed. Conclusion: Our results indicate that a 1-min rest condition in volume-equated RE promoted greater overall muscle tissue damage with a longer duration of the inflammatory processes compared to a 3-min rest.

Prenatal and perinatal care in Governador Valadares, Minas Gerais state, Brazil / Assistência pré-natal e perinatal em Governador Valadares, Minas Gerais, Brasil

Abstract Introduction: Prenatal care and the procedures adopted during childbirth are essential to ensure a healthy pregnancy and delivery and prevent complications, without affecting the health of the mother and newborn. Objective: To analyze the prenatal and perinatal care provided in Governador Valadares, Minas Gerais state, Brazil, and to determine whether there is an association between adequate prenatal care and socioeconomic, demographic, behavioral and reproductive factors. Methods: Cross-sectional study with a pre-existing database. The adequacy of prenatal care was analyzed based on three criteria: 1) onset up to the 16th week and a minimum number of checkups according to gestational age; 2) professional practices during prenatal checkups; 3) counseling given to the pregnant women by healthcare professionals. Multivariate logistic regression was used for data analysis. Results: Participants were 437 postpartum women. Prenatal care was considered adequate for 72.5, 93.1 and 50.1% of the participants based on criteria 1, 2 and 3, respectively. The pregnant women who were most likely to receive inadequate prenatal care in relation to criterion 1 were those with the lowest schooling level (OR = 1.68; p = 0.046), who were single (OR = 2.18; p = 0.002), did not work during their pregnancy (OR = 2.18; p = 0.003) and whose pregnancy was unplanned (OR = 1.76; p = 0.023). With respect to perinatal care, the presence of a birth companion and skin-to-skin contact were adequate, but breastfeeding in the first hour of life was not. Conclusion: There is a need to improve the counseling provided by healthcare professionals and include breastfeeding in the first hour of life. The results could contribute to optimizing maternal and child health services in Governador Valadares.

Resumo Introdução: O acompanhamento pré-natal e as condutas adotadas durante o parto são essenciais para garantir o bom desenvolvimento da gestação, prevenir complicações e proporcionar um parto saudável, sem impacto na saúde da puérpera e do recém-nascido. Objetivo: Analisar a assistência pré-natal e perinatal oferecida em Governador Valadares, Minas Gerais, e verificar se há associação entre a adequação do pré-natal e os fatores socioeconômicos, demográficos, comportamentais e reprodutivos. Métodos: Estudo transversal com base de dados pré-existente. Para a análise da adequação do pré-natal foram utilizados três critérios: 1) início até 16ª semana e número mínimo de consultas de acordo com a idade gestacional; 2) práticas dos profissionais nas consultas de pré-natal; 3) orientações oferecidas às gestantes pelos profissionais. Para a análise dos dados foi utilizada regressão logística multivariada. Resultados: Participaram do estudo 437 puérperas. A assistência pré-natal foi considerada adequada para 72,5%, 93,1% e 50,1% das puérperas, considerando os critérios 1, 2 e 3, respectivamente. As gestantes que apresentaram maior chance de terem o pré-natal inadequado, com relação ao critério 1, foram as com menor escolaridade (RC = 1,68; p = 0,046), que não possuíam companheiro (RC = 2,18; p = 0,002), que não trabalharam durante a gestação (RC = 2,18; p = 0,003) e as que não planejaram a gravidez (RC = 1,76; p = 0,023). Com relação à assistência perinatal, a presença de acompanhante e contato pele a pele foram apropriados, mas a amamentação na primeira hora de vida foi inadequada. Conclusão: Observou-se a necessidade de aprimorar as orientações fornecidas pelos profissionais e incluir a amamentação na primeira hora de vida. Os resultados podem contribuir para otimizar os serviços de saúde materno-infantil em Governador Valadares.

Factors associated with premature birth: a case-control study / Fatores associados à prematuridade: estudo caso-controle

ABSTRACT Objective: To analyze the socioeconomic, demographic, environmental, reproductive, behavioral, and health-care factors associated with preterm birth. Methods: Case-control study, with case group composed of preterm infants and the control group by full term live births. Each case was paired with two controls according to sex and date of birth. Interviews were carried out with the mothers, as well as analysis of medical records. A logistic regression model was used for data analysis following the hierarchical order of entry of the blocks. Results: 221 live births were allocated in the case group and 442 in the control group. After analysis adjusted for other factors under study, the highest chances of prematurity were associated with being the first child (OR 1.96; 95%CI 1.34-2.86; p=0.001); mothers with the highest income (OR 2.08; 95%CI 1.41-3.08; p<0.001), mothers with previous preterm births (OR 3.98; 95%CI 2.04-7.79; p<0.001), mothers that suffered violence during pregnancy (OR 2.50; 95%CI 1.31-4.78; p=0.005) and underwent cesarean section (OR 2.35; 95%CI 1.63-3.38; p<0.001). Live births to mothers who had more than six prenatal consultations had a lower risk of prematurity (OR 0.39; 95%CI 0.26-0.58; p<0.001). Conclusions: The factors associated with a higher chance of prematurity were: higher family income, previous preterm child, primiparity, violence against pregnant women and cesarean section. Having attended more than six prenatal visits was associated with a lower chance of premature birth. Violence against pregnant women showed a strong and consistent association, remaining in all final models, and should serve as an alert for the population and professionals.

RESUMO Objetivo: Analisar os fatores socioeconômicos, demográficos, ambientais, reprodutivos, comportamentais e de assistência à saúde associados à prematuridade. Métodos: Estudo caso-controle, sendo o grupo caso composto de prematuros e o grupo controle, de nascidos vivos a termo. Cada caso foi pareado com dois controles, de acordo com o sexo e a data de nascimento. Foram realizadas entrevistas com as puérperas e análise de prontuários. Para análise dos dados, foi utilizada regressão logística, seguindo a ordem hierárquica de entrada dos blocos. Resultados: Participaram 221 nascidos vivos no grupo caso e 442 no grupo controle. Após análise ajustada para os demais fatores em estudo, as maiores chances de prematuridade foram associadas aos primeiros filhos (RC 1,96; IC95% 1,34-2,86; p=0,001), cujas mães possuíam maior renda (RC 2,08; IC95% 1,41-3,08; p<0,001), tiveram filho prematuro prévio (RC 3,98; IC95% 2,04-7,79; p<0,001), sofreram violência durante a gestação (RC 2,50; IC95% 1,31-4,78; p=0,005) e realizaram cesariana (RC 2,35; IC95% 1,63-3,38; p<0,001). Os nascidos vivos de mães que realizaram mais de seis consultas de pré-natal apresentaram menor chance de ser prematuros (RC 0,39; IC95% 0,26-0,58; p<0,001). Conclusões: Os fatores associados à maior chance de prematuridade foram: maior renda familiar, filho prematuro prévio, primiparidade, violência contra a gestante e cesariana. Ter realizado mais de seis consultas de pré-natal foi associado à menor chance de nascimento prematuro. A violência contra a gestante apresentou associação forte e consistente, permanecendo em todos os modelos finais, devendo servir de alerta para a população e os profissionais.

Salivary markers of stress and physical activities: a systematic review / Marcadores salivares de estrés y actividades físicas: una revisión sistemática / Marcadores salivares de estresse e atividades físicas: uma revisão sistemática

In recent years, stress levels during exercise are measured using different salivary markers. The aim of the study was to conduct a systematic review of the main salivary stress markers related to physical exercise and their effects on health of MEDLINE, LILACS, IBECS, BVS and SciELO databases between 2011 and 2018. The descriptors used in the search were “Biochemical” and “Marker”; “Stress” and “Physical” and “Exercise”; “Salivary chromogranin-A”; “Salivary Alpha-Amylase”; “Salivary IgA”; and “Salivary cortisol”, in three languages. After assessment of eligibility criteria, of the 13405 studies identified, 12 were included in the final review and, although saliva has clear advantages over blood by easy to collect and non-invasive, the use of these markers in the response to stress remains incomplete due to the different effects observed, considering that the information available in the literature involves different types of participants as study subjects and a range of protocols. (AU)

En los últimos años, se han medido los niveles de estrés durante el ejercicio mediante el análisis de diferentes marcadores salivales. El objetivo del estudio fue realizar una revisión sistemática de los principales marcadores salivares de estrés relacionados con el ejercicio y sus efectos en la salud en bases de datos MEDLINE, LILACS, IBECS, BVS y SciELO, de 2011 a 2018. Los descriptores utilizados en la investigación fueron "bioquímicos" y "marcadores"; "estrés" y "físico" y "ejercicio"; "cromogranina A salivar"; "alpha-amilase salivar"; "IgA salivar"; "cortisol salivar", en tres idiomas. Después de la evaluación de los criterios de elegibilidad, de los 13405 estudios identificados, 12 fueron incluidos en la revisión final y, aunque la saliva presentaba claras ventajas sobre la sangre por la fácil recolección y no invasión, el empleo de estos marcadores en la respuesta al estrés sigue incompleto por los distintos efectos observados, considerando los diferentes tipos de participantes como sujetos del estudio y la gama de protocolos. (AU)

Nos últimos anos, os níveis de estresse durante o exercício foram mensurados pela análise de diferentes marcadores salivares. O objetivo do estudo foi realizar uma revisão sistemática dos principais marcadores salivares de estresse relacionados ao exercício físico e seus efeitos na saúde em bases de dados MEDLINE, LILACS, IBECS, BVS e SciELO, no período de 2011 a 2018. Os descritores utilizados na pesquisa foram “bioquímicos” e “marcadores”; “estresse” e “físico” e “exercício”; “cromogranina A salivar”; “alfa-amilase salivar”; “IgA salivar”; e “cortisol salivar”, em três idiomas. Após a avaliação dos critérios de elegibilidade, dos 13405 estudos identificados, 12 foram incluídos na revisão final e, embora a saliva apresente claras vantagens sobre o sangue pela fácil coleta e não invisibilidade, o emprego desses marcadores na resposta ao estresse após o exercício permanece incompleto pelos distintos efeitos observados, considerando os diferentes tipos de participantes como sujeitos do estudo e a gama de protocolos. (AU)

Associação entre letramento funcional em saúde e adesão ao tratamento medicamentoso da hipertensão arterial sistêmica na atenção primária à saúde / Association between functional health literacy and adherence to antihypertensive medication in primary health care

O estudo analisa a associação entre letramento funcional em saúde e adesão à medicação anti-hipertensiva. Estudo transversal, com aplicação de formulário a 340 usuários da Estratégia Saúde da Família, segundo características sociodemográficas, relacionadas ao paciente, à doença e ao tratamento, à equipe e ao serviço de saúde. A adesão medicamentosa foi mensurada pela MMAS-8 e o letramento funcional em saúde foi medido pelo B-TOFHLA. Foi utilizado o modelo de regressão de Poisson. A prevalência de não adesão foi de 24,1% (IC95%:19,7­28,5). Baixo letramento funcional em saúde foi encontrado em 80,3% dos hipertensos. Os fatores associados à não adesão foram não acreditar na importância dos medicamentos, maior frequência na tomada dos medicamentos por dia, não compreensão das orientações e explicações dadas pelos profissionais de saúde e maior dificuldade em conversar com os profissionais. Conclui-se que, com mudanças baseadas na complexidade do regime terapêutico, e ainda identificando-se as limitações dos usuários em relação ao acesso e à compreensão das informações e orientações repassadas, a equipe de saúde pode elaborar estratégias que favoreçam a comunicação entre profissionais de saúde e usuários, compensando, assim, os baixos níveis de letramento funcional em saúde.

The study analyzes the association between functional health literacy and adherence to antihypertensive medication. Cross-sectional study, with application of a form to 340 users of the Family Health Strategy, according to sociodemographic characteristics, related to the patient, the disease and treatment, the team and the health service. Medication adherence was measured by MMAS-8 and functional health literacy was measured by B-TOFHLA. The Poisson regression model was used. The prevalence of non-adherence was 24.1% (95%CI: 19.7­28.5). Low functional health literacy was found in 80.3% of hypertensive individuals. Factors associated with non-adherence were not believing in the importance of medications, more frequent taking of medications per day, not understanding the guidelines and explanations given by health professionals, and greater difficulty in talking to professionals. It is concluded that, with changes based on the complexity of the therapeutic regimen, and still identifying the limitations of users in relation to access and understanding of the information and guidelines provided, the health team can develop strategies that favor communication between health professionals. health and users, thus compensating for the low levels of functional health literacy.

Violence against pregnant women and associated factors in the city of Governador Valadares.

OBJECTIVE: To characterize violence against women during pregnancy and to verify its association with socioeconomic, demographic, obstetric, behavioral factors, health care and diseases during pregnancy. METHODS: Cross-sectional study carried out with puerperal women whose birth took place at the Municipal Hospital of Governador Valadares, in Minas Gerais, from May 2017 to July 2018. Data collection was performed through interviews, and complementary information was obtained by analyzing the prenatal file and medical records. For data analysis, logistic regression was used. RESULTS: The total of 771 puerperal women participated in the study. Of these, 62 (8.0%) reported having suffered physical, psychological or sexual violence during pregnancy. The pregnant women most likely to have suffered violence were alcohol dependent (OR = 4.97; 95%CI 2.30-10.75; p < 0.001), those who did not perform prenatal care (OR = 3.88; 95%CI 1.00-15.09; p = 0.050), those who used health services in an emergency during pregnancy (OR = 2.47; 95%CI 1.42-4.30; p = 0.001) and who had gestational diabetes (OR = 2.59; 95%CI 1.06-6.32; p = 0.037) and sexually transmitted diseases (OR = 3.85; 95%CI 1.41-10.50; p = 0.009). CONCLUSION: Violence against pregnant women is associated with behavioral factors and related to health care and diseases during pregnancy. It is essential to recognize factors associated by health professionals through actions to track situations of violence against women since the beginning of prenatal care, in order to enable early intervention.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis.

Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Reproductive factors associated with overweight in adult women attended by the Family Health Strategy. / Fatores reprodutivos associados ao excesso de peso em mulheres adultas atendidas pela Estratégia Saúde da Família.

Overweight stands out as a growing health problem in the population, resulting in individual and societal burdens. This study aimed to identify the association between reproductive factors and overweight in women of reproductive age attended by a Primary Health Care Unit (UAPS).This is a cross-sectional study with home capitation and data collection in two PHC Units, in the city of Juiz de Fora (MG), Brazil, in women aged 20 to 59 years, whose outcome was the overweight measured by the Body Mass Index. The prevalence of overweight was 61.0% among the 2,018 women included in the analysis. In the multivariate analysis, overweight was associated with the variables age at menarche before 12 years of age, having children, age greater than or equal to 30years, and hypertension. The prevalence of overweight in women who had menarche before 12 years of age was 12.4% higher than those who had menarche aged 12 years or more, and the prevalence of overweight in women who had children was 58.2% higher than those who never had any. There was a high prevalence of overweight in the adult female population, emphasizing the influence of reproductive factors.

O excesso de peso se destaca como um problema de saúde crescente na população, resultando em ônus para o indivíduo e para a sociedade. O objetivo deste artigo é identificar a associação entre os fatores reprodutivos e o excesso de peso em mulheres de 20 a 59 anos de áreas cobertas pela Unidade de Atenção Primária à Saúde. Trata-se de um estudo transversal com captação domiciliar e coleta de dados em duas Unidades de Atenção Primária à Saúde, no município de Juiz de Fora, em mulheres de 20 a 59 anos, cujo desfecho foi o Excesso de Peso medido por meio do Índice de Massa Corporal. Entre as 2018 mulheres incluídas na análise, a prevalência de Excesso de Peso foi de 61,0%. Na análise multivariada, o Excesso de Peso apresentou associação com as variáveis idade da menarca antes dos 12 anos, ter filhos, idade maior ou igual a 30 anos e relato de hipertensão arterial. A prevalência de excesso de peso em mulheres que tiveram menarca antes dos 12 anos foi 12,4% maior do que naquelas que a tiveram com 12 anos ou mais; enquanto que a prevalência de Excesso de Peso em mulheres que tiveram filhos foi 58,2% maior do que entre as que nunca tiveram. Foi observada elevada prevalência de Excesso de Peso na população feminina adulta, com ênfase na influência dos fatores reprodutivos.

Fatores reprodutivos associados ao excesso de peso em mulheres adultas atendidas pela Estratégia Saúde da Família / Reproductive factors associated with overweight in adult women attended by the Family Health Strategy

Resumo O excesso de peso se destaca como um problema de saúde crescente na população, resultando em ônus para o indivíduo e para a sociedade. O objetivo deste artigo é identificar a associação entre os fatores reprodutivos e o excesso de peso em mulheres de 20 a 59 anos de áreas cobertas pela Unidade de Atenção Primária à Saúde. Trata-se de um estudo transversal com captação domiciliar e coleta de dados em duas Unidades de Atenção Primária à Saúde, no município de Juiz de Fora, em mulheres de 20 a 59 anos, cujo desfecho foi o Excesso de Peso medido por meio do Índice de Massa Corporal. Entre as 2018 mulheres incluídas na análise, a prevalência de Excesso de Peso foi de 61,0%. Na análise multivariada, o Excesso de Peso apresentou associação com as variáveis idade da menarca antes dos 12 anos, ter filhos, idade maior ou igual a 30 anos e relato de hipertensão arterial. A prevalência de excesso de peso em mulheres que tiveram menarca antes dos 12 anos foi 12,4% maior do que naquelas que a tiveram com 12 anos ou mais; enquanto que a prevalência de Excesso de Peso em mulheres que tiveram filhos foi 58,2% maior do que entre as que nunca tiveram. Foi observada elevada prevalência de Excesso de Peso na população feminina adulta, com ênfase na influência dos fatores reprodutivos.

Abstract Overweight stands out as a growing health problem in the population, resulting in individual and societal burdens. This study aimed to identify the association between reproductive factors and overweight in women of reproductive age attended by a Primary Health Care Unit (UAPS).This is a cross-sectional study with home capitation and data collection in two PHC Units, in the city of Juiz de Fora (MG), Brazil, in women aged 20 to 59 years, whose outcome was the overweight measured by the Body Mass Index. The prevalence of overweight was 61.0% among the 2,018 women included in the analysis. In the multivariate analysis, overweight was associated with the variables age at menarche before 12 years of age, having children, age greater than or equal to 30years, and hypertension. The prevalence of overweight in women who had menarche before 12 years of age was 12.4% higher than those who had menarche aged 12 years or more, and the prevalence of overweight in women who had children was 58.2% higher than those who never had any. There was a high prevalence of overweight in the adult female population, emphasizing the influence of reproductive factors.

Factors associated with low birthweight: a case-control study in a city of Minas Gerais.

OBJECTIVE To analyze the many factors regarding socioeconomic and healthcare-related variables linked to maternal diseases and the possible impact of the environmental disaster of Mariana, given the prenatal exposure to different water sources for human consumption that were associated with low birthweight in full-term live births in the Municipal Hospital of Governador Valadares, Minas Gerais. METHODS Case-control study, carried out with live births at the Municipal Hospital of Governador Valadares, from May 2017 to July 2018. The case group consisted of full-term live births and low birthweight, and the control group consisted of full-term live births with adequate weight, matched by gender and date of birth. For each case, two controls were selected. Data collection was performed through interviews with the puerperal women, and complementary information was obtained by analyzing the prenatal card and medical records. For data analysis, logistic regression was performed. RESULTS The study included 65 live births from the case group and 130 from the control group. After the analysis was adjusted for other factors under study, we found that the higher risks of low birthweight are associated with the first childbirth (OR = 2.033; 95%CI = 1.047-3.948; p = 0.036), smoking during pregnancy (OR = 2.850; 95%CI = 1.013-8.021; p = 0.047) and consumption of water supplied by the municipalities affected by the tailings from the Fundão dam failure (RC = 2.444; 95%CI = 1.203-4.965; p = 0.013). CONCLUSIONS The variables "water consumed during pregnancy," "previous pregnancies" and "maternal smoking" were associated with low birthweight in the population studied. The importance of epidemiological studies that assess water quality and its adverse health effects is reinforced, as well as greater prenatal control of first-time pregnant women and greater support of policies against smoking, especially during pregnancy.

Violence against pregnant women and associated factors in the city of Governador Valadares / Violência contra a gestante e fatores associados no município de Governador Valadares

ABSTRACT OBJECTIVE To characterize violence against women during pregnancy and to verify its association with socioeconomic, demographic, obstetric, behavioral factors, health care and diseases during pregnancy. METHODS Cross-sectional study carried out with puerperal women whose birth took place at the Municipal Hospital of Governador Valadares, in Minas Gerais, from May 2017 to July 2018. Data collection was performed through interviews, and complementary information was obtained by analyzing the prenatal file and medical records. For data analysis, logistic regression was used. RESULTS The total of 771 puerperal women participated in the study. Of these, 62 (8.0%) reported having suffered physical, psychological or sexual violence during pregnancy. The pregnant women most likely to have suffered violence were alcohol dependent (OR = 4.97; 95%CI 2.30-10.75; p < 0.001), those who did not perform prenatal care (OR = 3.88; 95%CI 1.00-15.09; p = 0.050), those who used health services in an emergency during pregnancy (OR = 2.47; 95%CI 1.42-4.30; p = 0.001) and who had gestational diabetes (OR = 2.59; 95%CI 1.06-6.32; p = 0.037) and sexually transmitted diseases (OR = 3.85; 95%CI 1.41-10.50; p = 0.009). CONCLUSION Violence against pregnant women is associated with behavioral factors and related to health care and diseases during pregnancy. It is essential to recognize factors associated by health professionals through actions to track situations of violence against women since the beginning of prenatal care, in order to enable early intervention.

RESUMO OBJETIVO Caracterizar a violência contra a mulher durante a gestação e verificar a associação com os fatores socioeconômicos, demográficos, obstétricos, comportamentais, de assistência à saúde e doenças na gestação. MÉTODOS Estudo transversal realizado com puérperas cujo parto ocorreu no Hospital Municipal de Governador Valadares, em Minas Gerais, no período de maio de 2017 a julho de 2018. A coleta de dados foi realizada por meio de entrevista, e informações complementares foram obtidas pela análise do cartão de pré-natal e prontuário. Para a análise dos dados, foi utilizada regressão logística. RESULTADOS Participaram do estudo 771 puérperas. Dessas, 62 (8,0%) relataram ter sofrido violência física, psicológica ou sexual durante a gestação. As gestantes com maior chance de terem sofrido violência foram as dependentes de álcool (RC = 4,97; IC95% 2,30-10,75; p < 0,001), as que não realizaram o pré-natal (RC = 3,88; IC95% 1,00-15,09; p = 0,050), as que usaram os serviços de saúde de forma emergencial durante a gravidez (RC = 2,47; IC95% 1,42-4,30; p = 0,001) e que apresentaram diabetes gestacional (RC = 2,59; IC95% 1,06-6,32; p = 0,037) e doenças sexualmente transmissíveis (RC = 3,85; IC95% 1,41-10,50; p = 0,009). CONCLUSÃO A violência contra a gestante está associada a fatores comportamentais e relacionados à assistência à saúde e doenças na gestação. É imprescindível o reconhecimento dos fatores associados pelos profissionais de saúde, por meio de ações de rastreamento de situações de violência contra a mulher desde o início do pré-natal, a fim de possibilitar intervenção precoce.

Factors associated with low birthweight: a case-control study in a city of Minas Gerais / Fatores associados ao baixo peso ao nascer: estudo caso-controle em cidade de Minas Gerais

ABSTRACT OBJECTIVE To analyze the many factors regarding socioeconomic and healthcare-related variables linked to maternal diseases and the possible impact of the environmental disaster of Mariana, given the prenatal exposure to different water sources for human consumption that were associated with low birthweight in full-term live births in the Municipal Hospital of Governador Valadares, Minas Gerais. METHODS Case-control study, carried out with live births at the Municipal Hospital of Governador Valadares, from May 2017 to July 2018. The case group consisted of full-term live births and low birthweight, and the control group consisted of full-term live births with adequate weight, matched by gender and date of birth. For each case, two controls were selected. Data collection was performed through interviews with the puerperal women, and complementary information was obtained by analyzing the prenatal card and medical records. For data analysis, logistic regression was performed. RESULTS The study included 65 live births from the case group and 130 from the control group. After the analysis was adjusted for other factors under study, we found that the higher risks of low birthweight are associated with the first childbirth (OR = 2.033; 95%CI = 1.047-3.948; p = 0.036), smoking during pregnancy (OR = 2.850; 95%CI = 1.013-8.021; p = 0.047) and consumption of water supplied by the municipalities affected by the tailings from the Fundão dam failure (RC = 2.444; 95%CI = 1.203-4.965; p = 0.013). CONCLUSIONS The variables "water consumed during pregnancy," "previous pregnancies" and "maternal smoking" were associated with low birthweight in the population studied. The importance of epidemiological studies that assess water quality and its adverse health effects is reinforced, as well as greater prenatal control of first-time pregnant women and greater support of policies against smoking, especially during pregnancy.

RESUMO OBJETIVO Analisar os fatores socioeconômicos, demográficos, ambientais, reprodutivos, comportamentais, de assistência à saúde, doenças maternas e, sobretudo, o possível impacto do desastre ambiental ocorrido em Mariana, pela exposição pré-natal a diferentes fontes de água para consumo humano, associados ao baixo peso ao nascer em nascidos vivos a termo no Hospital Municipal de Governador Valadares, Minas Gerais. MÉTODOS Estudo caso-controle, realizado com nascidos vivos no Hospital Municipal de Governador Valadares, no período de maio de 2017 a julho de 2018. O grupo caso foi composto por nascidos vivos a termo e baixo peso ao nascer e o grupo controle, por nascidos vivos a termo e com peso adequado, pareados por sexo e data de nascimento. Para cada caso foram selecionados dois controles. A coleta de dados foi realizada por meio de entrevista com as puérperas e informações complementares foram obtidas pela análise do cartão de pré-natal e prontuários. Para análise dos dados, foi realizada regressão logística. RESULTADOS Participaram do estudo 65 nascidos vivos pertencentes ao grupo caso e 130 ao grupo controle. Após a análise ajustada para os demais fatores em estudo, verificou-se que os riscos mais elevados de baixo peso ao nascer estão associados aos primeiros filhos (RC = 2,033; IC95% = 1,047-3,948; p = 0,036) e aos nascidos vivos cujas mães utilizaram cigarro durante a gestação (RC = 2,850; IC95% = 1,013-8,021; p = 0,047) e consumiram a água fornecida pelos serviços de abastecimento dos municípios atingidos pelos rejeitos provenientes do rompimento da barragem de Fundão (RC = 2,444; IC95% = 1,203-4,965; p = 0,013). CONCLUSÕES A água consumida na gestação, primiparidade e tabagismo materno apresentaram associação com baixo peso ao nascer na população estudada. Reforça-se a importância de estudos epidemiológicos, que avaliem a qualidade da água e seus efeitos adversos na saúde, assim como maior controle no pré-natal das gestantes que terão o primeiro filho e maior apoio das políticas contra o tabagismo, especialmente durante a gravidez.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis

Abstract Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.