Hypertensive disorders during pregnancy as a major cause of preterm birth and adverse perinatal outcomes: findings from a Brazilian National Survey.

OBJECTIVE: This study aimed to evaluate the prevalence of hypertensive disorders during pregnancy among Brazilian women with preterm births and to compare the epidemiological characteristics and perinatal outcomes among preterm births of women with and without hypertension. METHODS: This was a secondary cross-sectional analysis of the Brazilian Multicenter Study on Preterm Birth. During the study period, all women with preterm births were included and further split into two groups according to the occurrence of any hypertensive disorder during pregnancy. Prevalence ratios were calculated for each variable. Maternal characteristics, prenatal care, and gestational and perinatal outcomes were compared between the two groups using χ2 and t-tests. RESULTS: A total of 4,150 women with preterm births were included, and 1,169 (28.2%) were identified as having hypertensive disorders. Advanced maternal age (prevalence ratio (PR) 2.49) and obesity (PR= 2.64) were more common in the hypertensive group. The gestational outcomes were worse in women with hypertension. Early preterm births were also more frequent in women with hypertension. CONCLUSION: Hypertensive disorders of pregnancy were frequent among women with preterm births, and provider-initiated preterm births were the leading causes of premature births in this group. The factors significantly associated with hypertensive disorders among women with preterm births were obesity, excessive weight gain, and higher maternal age.

Mapping the learning styles of medical students in Brazil.

BACKGROUND: Medical education has evolved based on the application of pedagogical actions that place the student as the protagonist of the learning process through the use of active teaching methodologies. Within this context, higher education teachers should use strategies that focus on the student and his/her context and avoid traditional teaching methods. Specifically in medical schools, there is an even greater challenge since the teaching methods of medical curricula differ from those used in previous schooling. Consequently, students acquire their own style of processing information that is often incompatible with the profile of medical schools. This may be one of the factors responsible for the lack of motivation among undergraduates. OBJECTIVE: The aim of this study was to characterize the learning styles of students enrolled in a Brazilian medical school using the Felder-Soloman Index of Learning Styles (ILS). METHODS: This was a cross-sectional, descriptive, quantitative study that included students from the 1st to the 6th year of a Brazilian medical school. The students participating in this study voluntarily answered 44 questions about learning styles of the Felder-Silverman instrument validated in Brazil. The instrument was divided so that each domain consisted of 11 questions with two response options in which only one could be selected. For each domain, a score (1 point) was assigned to the selected option (a, b) of the question and the learning style category was determined as the difference between these values. For data collection and tabulation, we used the Learning Syle Platform (EdA Platform) developed based on Felder's studies since this system processes information about the dimension analyzed, the preferred style, and the most striking characteristics of each style. RESULTS: The results showed that sensing was the preferred learning style of the students, followed by the sequential and visual styles. It was not possible to determine whether gender or age influences the choice of learning methods because of the homogeneity of the results. CONCLUSIONS: The present data will enable teachers of the institution involved in this study to plan pedagogical actions that improve the students' self-awareness, as well as their teaching-learning skills, by choosing the most adequate active methodologies for the medical education programs considering the individuality of each student and class.

Hypertensive disorders during pregnancy as a major cause of preterm birth and adverse perinatal outcomes: findings from a Brazilian National Survey

ABSTRACT Objective This study aimed to evaluate the prevalence of hypertensive disorders during pregnancy among Brazilian women with preterm births and to compare the epidemiological characteristics and perinatal outcomes among preterm births of women with and without hypertension. Methods This was a secondary cross-sectional analysis of the Brazilian Multicenter Study on Preterm Birth. During the study period, all women with preterm births were included and further split into two groups according to the occurrence of any hypertensive disorder during pregnancy. Prevalence ratios were calculated for each variable. Maternal characteristics, prenatal care, and gestational and perinatal outcomes were compared between the two groups using χ2 and t-tests. Results A total of 4,150 women with preterm births were included, and 1,169 (28.2%) were identified as having hypertensive disorders. Advanced maternal age (prevalence ratio (PR) 2.49) and obesity (PR= 2.64) were more common in the hypertensive group. The gestational outcomes were worse in women with hypertension. Early preterm births were also more frequent in women with hypertension. Conclusion Hypertensive disorders of pregnancy were frequent among women with preterm births, and provider-initiated preterm births were the leading causes of premature births in this group. The factors significantly associated with hypertensive disorders among women with preterm births were obesity, excessive weight gain, and higher maternal age.

Parâmetros de referência espaço-temporais de um sensor inercial para sujeitos brasileiros sadios / Spatial-temporal gait parameters based on a wearable inertial sensor of healthy Brazilian subjects

Gait analysis in a laboratory may be expensive, time-consuming, and restricted to a controlled environment. Validated wearable technology may be an alternative to such analysis. However, wearable technologies should demonstrate reference values of a healthy population. Objective: To establish spatio-temporal gait reference values of an accelerometer (G-Walk) in a healthy Brazilian population. Methods: This is a cross-sectional study with 124 healthy subjects evaluated with G-Walk in the 6-minute and 10-meter walk tests (6MWT and 10MWT). Gait parameters of Velocity, Cadence, Distance, and gait symmetry variables were retrieved for analysis. Clinical and demographical characteristics were also collected and tested with simple linear regression as covariables of the gait characteristics. The bootstrapped 5th percentile of the gait parameter established the reference values. If a covariable influence was found, the reference values were established by subgroup analysis according to the covariable. Results: The study analyzed 114 subjects, mostly women (67.74%), aged 39.36 (SD 12.18). Height was a covariable of cadence for the 10MWT and cadence and stride length for the 6MWT. Age and sex combined were covariables of 6MWT velocity, and sex alone was a covariable of 6MWT. All reference values for symmetry were above 89%, velocity at the 10MWT was above 1.0m/s, and distance at the 6MWT was 354m and 359.5 for females and males, respectively. Conclusions: Our study generated reference values for spatio-temporal gait analysis with G-Walk of a population of a major urban area, considering the covariables of age, height, and sex.

Análises da marcha em laboratório tem custo elevado, demandando tempo e ambiente controlado. Wearables são equipamentos portáteis que podem ser alternativas aos laboratórios. Valores de referência podem determinar parâmetros para análises de marcha de pessoas com patologias. Objetivo: Estabelecer valores de referência espaço-temporais de um acelerômetro (G-Walk) em uma população saudável. Métodos: Trata-se de um estudo transversal com indivíduos saudáveis avaliados com G-Walk nos testes de caminhada de 6 minutos e de 10 metros (TC6 e TC10). Velocidade, cadência, distância e de simetria da marcha foram analisados. Características clínicas e demográficas também foram testadas com regressão linear simples como covariáveis das características da marcha. Os valores de referência foram estabelecidos pelo quinto percentil dos parâmetros por bootstrap e na presença de covariáveis demográficas, os valores foram estabelecidos por análise de subgrupos, de acordo com a covariável. Resultados: O estudo analisou 114 sujeitos, em sua maioria mulheres (67,74%), com idade de 39,36 (DP 12,18). A altura foi uma covariável da cadência do TC10 e da cadência e comprimento da passada do TC6. Idade e sexo combinados foram covariáveis da velocidade do TC6, e o sexo foi uma covariável do TC6. Todos os valores de referência para simetria foram superiores a 89%, a velocidade no TC10 foi superior a 1,0m/s e a distância no TC6 foi de 354m e 359,5m para mulheres e homens, respectivamente. Conclusões: Nosso estudo gerou valores de referência para análise espaço-temporal da marcha com o equipamento G-Walk em uma população de uma grande área urbana, considerando as covariáveis idade, altura e sexo.

Acquisition of food for away-from-home consumption in Brazil between 2002 and 2018 / Aquisição de alimentos para consumo fora do domicílio no Brasil entre 2002 e 2018

Abstract The aim of the study was to assess the evolution of food acquisition for away from home consumption in Brazil from 2002 to 2018. The trend of food purchases for out-of-home consumption in Brazil was evaluated by comparing food purchase data from the Household Budget Surveys (HBS) of 2002-2003, 2008-2009, and 2017-2018. The frequency of food acquisition was estimated according to sociodemographic variables and the mean cost. In 2002-2003, the frequency of purchase of food for out-of-home consumption was 35.2% (95%CI: 34.4-35.9), increasing to 41.2% (95%CI: 40.4-42.0) in 2008-2009, followed by a decline in 2017-2018 (32.3%; 95%CI: 31.7-32.9). A declining trend was observed in the frequency of purchases of alcoholic beverages and soft drinks and fast foods maintained the frequency between the last two surveys. Spending on this type of food increased between 2002-2003 and 2008-2009, while the mean value of this type of expenditure was maintained between 2008-2009 and 2017-2018. Brazilians increased food purchases for out-of-home consumption between 2002-2003 and 2008-2009, declining in 2017-2018. A consistent fall in the purchase of alcoholic beverages and soft drinks was observed over time, while the group of meals grew significantly.

Resumo O objetivo desse estudo foi avaliar a evolução da aquisição de alimentos para consumo fora de casa no Brasil de 2002 a 2018. A tendência de compra de alimentos para consumo fora de casa no Brasil foi avaliada pela comparação de dados de compra de alimentos das Pesquisas de Orçamentos Familiares (POF) de 2002-2003, 2008-2009 e 2017-2018. A frequência de aquisição de alimentos foi estimada de acordo com variáveis sociodemográficas e o custo médio. Em 2002-2003, a frequência de compra de alimentos para consumo fora do domicílio foi de 35,2% (IC95%: 34,4-35,9), aumentando para 41,2% (IC95%: 40,4-42,0) em 2008-2009, seguido por um declínio em 2017-2018 (32,3%; IC95%: 31,7-32,9). Foi observada tendência de queda na frequência de compras de bebidas alcoólicas e refrigerantes, enquanto fast food manteve a frequência entre as duas últimas pesquisas. Os gastos com esse tipo de alimentação aumentaram entre 2002-2003 e 2008-2009, enquanto o valor médio desse tipo de gasto se manteve entre 2008-2009 e 2017-2018. Os brasileiros aumentaram as compras de alimentos para consumo fora de casa entre 2002-2003 e 2008-2009, diminuindo em 2017-2018. Uma queda consistente na compra de bebidas alcoólicas e refrigerantes foi observada ao longo do tempo, enquanto o grupo das refeições apresentou aumento significativo.

Acquisition of food for away-from-home consumption in Brazil between 2002 and 2018.

The aim of the study was to assess the evolution of food acquisition for away from home consumption in Brazil from 2002 to 2018. The trend of food purchases for out-of-home consumption in Brazil was evaluated by comparing food purchase data from the Household Budget Surveys (HBS) of 2002-2003, 2008-2009, and 2017-2018. The frequency of food acquisition was estimated according to sociodemographic variables and the mean cost. In 2002-2003, the frequency of purchase of food for out-of-home consumption was 35.2% (95%CI: 34.4-35.9), increasing to 41.2% (95%CI: 40.4-42.0) in 2008-2009, followed by a decline in 2017-2018 (32.3%; 95%CI: 31.7-32.9). A declining trend was observed in the frequency of purchases of alcoholic beverages and soft drinks and fast foods maintained the frequency between the last two surveys. Spending on this type of food increased between 2002-2003 and 2008-2009, while the mean value of this type of expenditure was maintained between 2008-2009 and 2017-2018. Brazilians increased food purchases for out-of-home consumption between 2002-2003 and 2008-2009, declining in 2017-2018. A consistent fall in the purchase of alcoholic beverages and soft drinks was observed over time, while the group of meals grew significantly.

Access to government social programs and the tuberculosis control program: a multicenter study.

OBJECTIVES: to analyze government social initiatives aimed at people with tuberculosis and the possibilities of access to government social programs and income transfers through the perception of tuberculosis program managers. METHODS: descriptive, qualitative study with 19 managers from Belém, Recife, Campo Grande, and Rio de Janeiro, Brazil. Thematic content analysis was used. RESULTS: there is no specific government social support for people with tuberculosis; the benefits are intended for people in social vulnerability. There are partnerships between the institutions of the secondary social healthcare network, social assistance, and community institutions. FINAL CONSIDERATIONS: the support of official bodies is important for the control of tuberculosis; however, the profile of people's vulnerability is a determining factor for access to/destination of resources from these government social support programs.

Educação médica em reanimação cardiopulmonar: transposição didática do presencial-tradicional para o remoto-interativo com simulação / Medical education in Cardiopulmonary Resuscitation: Didactic transposition from traditional-presential to remote-interactive with simulation

Resumo: Introdução: A transposição didática do processo de ensino-aprendizagem presencial-tradicional para o remoto-interativo com simulação em reanimação cardiopulmonar foi uma estratégia implementada por docentes para promover a educação cognitiva, psicomotora e reflexiva sobre aspectos éticos de estudantes de Medicina primeiranistas em tempos de pandemia. Relato de experiência: Trata-se de um relato de experiência de abordagem descritiva e reflexiva, resultado colaborativo multiprofissional e multidisciplinar de oito docentes, visando atingir objetivos educacionais. Ocorreu em 2021, na Faculdade de Medicina de Jundiaí (FMJ), nas disciplinas de Fundamentos Assistenciais e Noções de Primeiros Socorros, e Bioética e Humanidades Médicas. As atividades foram planejadas para serem realizadas com os 120 estudantes matriculados, por meio da plataforma Google Sala de Aula, vinculada à conta institucional, de maneira síncrona e assíncrona. Combinaram-se diferentes estratégias de ensino, materiais, mídias e linguagens com materiais didáticos on-line hipermidiáticos e off-line multimidiáticos, compostos por diferentes tipos/formatos. Discussão: A transposição foi singular e desafiadora para docentes e discentes. Fundamentou-se o trabalho colaborativo interprofissional docente na integração das duas disciplinas e na materialização da educação nas dimensões teóricas e práticas simuladas. Acredita-se que a abordagem utilizada, combinando alguns meios tecnológicos, simuladores artesanais, possibilitou, no contexto das restrições impostas pela pandemia em curso, o ensino e a aprendizagem em suporte básico de vida, na temática reanimação cardiopulmonar. Os estudantes tiveram a oportunidade de desenvolver competências cognitivas, técnicas e comportamentais, e avaliar o seu progresso, realizando e recebendo feedbacks imediatos, bem como por meio de avaliação formativa sem atribuição de nota. Conclusão: A transposição didática do processo de ensino e aprendizagem mediada por tecnologias possibilitou que os estudantes se aproximassem do conteúdo teórico e participassem de simulações clínicas em seus lares com segurança. Porém, não há um estudo comparativo que mostre que o desenvolvimento foi semelhante ao presencial. Consequentemente, será necessário que a assessoria pedagógica avalie as possíveis lacunas de aprendizagem e como poderão ser superadas ao longo do curso.

Abstract: Introduction: The didactic transposition of the traditional in-person teaching-learning process to the remote-interactive one with simulation in cardiopulmonary resuscitation was a strategy implemented by teachers to promote cognitive, psychomotor, and reflective education on the ethical aspects of first-year medical students in times of pandemic. Experience report: This is an experience report with a descriptive and reflective approach, which is a multiprofessional and multidisciplinary collaborative result of eight teachers, aiming to achieve educational goals. It took place in 2021, at the School of Medicine of Jundiaí (FMJ), in the disciplines of Basic Care and First Aid Notions and Bioethics and Medical Humanities. The activities were planned to be carried out with the 120 enrolled students, through the Google Classroom platform, linked to the institutional account, synchronously and asynchronously. Different teaching strategies, materials, media, and languages ​​were combined with online hypermedia and offline multimedia teaching materials, consisting of different types/formats. Discussion: The transposition was unique and challenging for teachers and students. The collaborative interprofessional teaching work was fundamental for the integration of the two disciplines and the materialization of education in the simulated theoretical and practical dimensions. It is believed that the approach used, combining some technological means, craft simulators, allowed the teaching and learning in basic life support in the cardiopulmonary resuscitation topic in the context of the restrictions imposed by the ongoing pandemic. The students had the opportunity to develop cognitive, technical, and behavioral skills, as well as assess their progress, performing and receiving immediate feedback, as well as through formative assessment without grade assignment. Conclusion: The didactic transposition of the teaching and learning process mediated by technologies allowed students to approach the theoretical content and safely participate in clinical simulations in their homes. However, there is no comparative study that shows that the development was similar to in-person teaching. Consequently, it will be necessary for the pedagogical advisory board to evaluate the possible learning gaps and how they can be overcome throughout the course.

Access to government social programs and the tuberculosis control program: a multicenter study / Acceso a los programas sociales gubernamentales y al programa de control de la tuberculosis: un estudio multicéntrico / Acesso aos programas sociais governamentais e o programa de controle da tuberculose: um estudo multicêntrico

ABSTRACT Objectives: to analyze government social initiatives aimed at people with tuberculosis and the possibilities of access to government social programs and income transfers through the perception of tuberculosis program managers. Methods: descriptive, qualitative study with 19 managers from Belém, Recife, Campo Grande, and Rio de Janeiro, Brazil. Thematic content analysis was used. Results: there is no specific government social support for people with tuberculosis; the benefits are intended for people in social vulnerability. There are partnerships between the institutions of the secondary social healthcare network, social assistance, and community institutions. Final Considerations: the support of official bodies is important for the control of tuberculosis; however, the profile of people's vulnerability is a determining factor for access to/destination of resources from these government social support programs.

RESUMEN Objetivos: analizar las iniciativas sociales gubernamentales dirigidas a las personas con tuberculosis y las posibilidades de acceso a los programas sociales gubernamentales y de transferencia de renta, en la percepción de los gestores de programas de tuberculosis. Métodos: estudio descriptivo, cualitativo, con 19 gestores de Belém, Recife, Campo Grande y Rio de Janeiro. Se utilizó el análisis de contenido temático. Resultados: no hay soporte social gubernamental específico para personas con tuberculosis; los beneficios son destinados a las personas en vulnerabilidad social. Hay colaboraciones entre las instituciones de la red social secundaria de salud, asistencia social e instituciones comunitarias. Consideraciones Finales: el apoyo de las instancias oficiales es importante para el control de la tuberculosis, con todo el perfil de vulnerabilidad de las personas es factor determinante para el acceso al/destinación de los recursos de esos programas gubernamentales de apoyo social.

RESUMO Objetivos: analisar as iniciativas sociais governamentais voltadas para as pessoas com tuberculose e as possibilidades de acesso aos programas sociais governamentais e de transferência de renda, na percepção dos gestores de programas de tuberculose. Métodos: estudo descritivo, qualitativo, com 19 gestores de Belém, Recife, Campo Grande e Rio de Janeiro. Utilizou-se a análise de conteúdo temática. Resultados: não há suporte social governamental específico para pessoas com tuberculose; os benefícios são destinados às pessoas em vulnerabilidade social. Existem parcerias entre as instituições da rede social secundária da saúde, assistência social e instituições comunitárias. Considerações Finais: o apoio das instâncias oficiais é importante para o controle da tuberculose, contudo o perfil de vulnerabilidade das pessoas é fator determinante para o acesso ao/destinação dos recursos desses programas governamentais de apoio social.

Perda de imunobiológicos e sua repercussão na gestão do programa estadual de imunizações, Ceará-Brasil / Loss of immunobiologicals and their repercussion in the management of the state immunization program, Ceará-Brasil / Pérdida de inmunobiológicos y su repercusión en la gestión del programa estatal de inmunización, Ceará-Brasil

Objetivo: Identificar a ocorrência de perdas físicas e técnicas de imunobiológicos no estado do Ceará e seu impacto financeiro. Métodos: Pesquisa do tipo exploratório-descritiva, retrospectiva, com abordagem quantitativa. Para as perdas físicas foram avaliados 511 formulários de registro de desvio de qualidade em imunobiológicos; para as perdas técnicas, considerou-se todas as doses de vacinas que não foram utilizadas depois de expirado o prazo de validade, após abertura do frasco, assim como as doses não aplicadas. Resultados: As perdas totais atingiram 12,5 milhões de doses de imunobiológicos, representando um gasto de R$42,8 milhões. O principal motivo das perdas físicas durante o período estudado foi à queda de energia, representando 55,84%. A pesquisa não demonstrou evidência de relação direta entre as perdas totais de vacinas e as coberturas vacinais. Conclusão: Apesar do elevado número de doses desperdiçadas e do impacto financeiro proporcionado, apenas duas vacinas, BCG e hepatite B ultrapassaram o padrão estabelecido pela OPAS; para resolver a problemática da falta de energia, medidas de prevenção devem ser viabilizadas, como a instalação de grupos geradores e a correta execução dos protocolos de contingência recomendados pelo PNI. (AU)

Objective: To identify the occurrence of physical losses and immunobiological techniques in the state of Ceará and its financial impact. Methods: Exploratory-descriptive, retrospective research with a quantitative approach. For physical losses, 511 quality deviation registration forms were evaluated in immunobiologicals; for technical losses, we considered all doses of vaccines that were not used after the expiry date, after opening the bottle, as well as the doses not applied. Results: Total losses reached 12.5 million doses of immunobiologicals, representing an expense of R $ 42.8 million. The main reason for physical losses during the period studied was the power outage, representing 55.84%. The research showed no evidence of a direct relationship between total vaccine losses and vaccine coverage. Conclusion: Despite the high number of missed doses and the financial impact provided, only two vaccines, BCG and hepatitis B exceeded the standard established by PAHO; to solve the problem of power outages, preventive measures must be put in place, such as the installation of generator sets and the correct execution of the contingency protocols recommended by the PNI. (AU)

Objetivo: Identificar la ocurrencia de pérdidas físicas y técnicas inmunobiológicas en el estado de Ceará y su impacto financiero. Métodos: Investigación exploratoria-descriptiva, retrospectiva con enfoque cuantitativo. Para pérdidas físicas, se evaluaron 511 formularios de registro de desviación de calidad en inmunobiológicos; para pérdidas técnicas, se consideraron todas las dosis de vacunas que no se utilizaron después de la fecha de caducidad, después de abrir el frasco, así como las dosis no aplicadas. Resultados: Las pérdidas totales llegaron a 12,5 millones de dosis de inmunobiológicos, lo que representó un gasto de R $ 42,8 millones. El principal motivo de las pérdidas físicas durante el período estudiado fue el corte de energía, que representó el 55,84%. La investigación no mostró evidencia de una relación directa entre las pérdidas totales de vacunas y la cobertura de vacunas. Conclusion: A pesar del alto número de dosis omitidas y el impacto económico proporcionado, solo dos vacunas, BCG y hepatitis B superaron el estándar establecido por la OPS; para solucionar el problema de los cortes de energía se deben implementar medidas preventivas, como la instalación de grupos electrógenos y la correcta ejecución de los protocolos de contingencia recomendados por el PNI. (AU)

Perspectivas de graduandos em saúde sobre a temática minorias sexuais e de gênero na formação / Perspectives of undergraduate health students on the theme of sexual and gender minorities in training / Perspectivas de estudiantes de licenciatura en salud sobre el tema de las minorías sexuales y de género en formación

Objetivo: Caracterizar as perspectivas de graduandos da área de saúde sobre a temática minorias sexuais e de gênero na formação profissional. Métodos: Trata-se de um estudo descritivo com análise secundária dos dados qualitativos de 262 estudantes de graduação em saúde de duas Instituições de Ensino Superior no Estado de São Paulo (Brasil). Resultados: A maioria era solteiro (66%), do sexo feminino (83,4%), identidade de gênero feminina (81,2%) e heterosexual (90,6%). A maioria dos estudantes referiu não ter sofrido violência motivada pela identidade de gênero ou orientação sexual (95,4%), já ter tido essa temática durante a formação (61,7%), estar preparado profissionalmente frente a isso (88,4%) e para cuidar dessa população (77,5%). Dos discursos analisados frente à pergunta "Como você acha que a sua formação acadêmica poderia contribuir para lidar com as minorias sexuais?" emergiram duas categorias centrais: "saber lidar com as minorias sexuais e de gênero" e "tornar-se um profissional de saúde aberto à diversidade humana". Conclusão: Evidenciam-se áreas potenciais para a construção de competências sensíveis às minorias sexuais desde a graduação em saúde. (AU)

Objective: To characterize the perspectives of undergraduate students in the health field on the theme of sexual and gender minorities in professional training. Methods: This is a descriptive study with secondary analysis of the qualitative data of 262 undergraduate health students from two Higher Education Institutions in the State of São Paulo (Brazil). Results: Most was single (66%), female (83.4%), female gender identity (81.2%) and heterosexual (90.6%). Most students reported not having suffered violence motivated by gender identity or sexual orientation (95.4%), having already had this theme during training (61.7%), being professionally prepared for it (88.4%) and to care for the population (77.5%). From the speeches analyzed before the question "How do you think your academic training could contribute to dealing with sexual minorities?" two central categories emerged: "knowing how to deal with sexual and gender minorities" and "becoming a health professional open to human diversity". Conclusion: Potential areas for the construction of skills sensitive to the sexual minorities are evident since graduation in health. (AU)

Objetivo: Caracterizar las perspectivas de los estudiantes de pregrado en el campo de la salud sobre el tema de las minorías sexuales y de género en la formación profesional. Métodos: Se trata de un estudio descriptivo con análisis secundario de los datos cualitativos de 262 estudiantes del área de salud de dos Instituciones de Educación Superior en el Estado de São Paulo (Brasil). Resultados: La mayoría era soltero (66%), mujer (83,4%), identidad de género femenina (81,2%) y heterosexual (90,6%). La mayoría de los estudiantes refirió no haber sufrido violencia motivada por identidad de género u orientación sexual (95,4%), haber tenido ya esta temática durante la formación (61,7%), estar preparados profesionalmente para ello (88,4%) y atender a la población (77,5%). De los discursos analizados antes de la pregunta "¿Cómo crees que tu formación académica podría contribuir al trato con las minorías sexuales?" Surgieron dos categorías centrales: "saber lidiar con las minorías sexuales y de género" y "convertirse en un profesional de la salud abierto a la diversidad humana". Conclusión: Las áreas potenciales para la construcción de habilidades sensibles a las minorías sexuales son evidentes desde la graduación en salud. (AU)

Os registos de enfermagem nas revistas portuguesas (1958-1998): Um estudo bibliométrico / Nursing records in Portuguese journals (1958-1998): A bibliometric study / Los registros de enfermería en las revistas portuguesas (1958-1998): Un estudio bibliométrico

Resumo Contexto: As alterações verificadas na documentação em enfermagem suscitaram a realização de um estudo histórico sobre a evolução dos registos de enfermagem, entre 1958, com a criação do Ministério da Saúde e Assistência e 1998, ano da criação da Ordem dos Enfermeiros. Neste sentido, tornou-se pertinente fazer a análise das publicações sobre registos de enfermagem, nas revistas portuguesas, no período em estudo. Objetivo: Identificar e analisar a produção científica sobre registos de enfermagem publicada nas revistas portuguesas de enfermagem, entre 1958 e 1998. Metodologia: Efetuou-se um estudo bibliométrico com a consulta de 504 revistas portuguesas de enfermagem publicadas entre 1958 e 1998, aplicando descritores e critérios de inclusão. Resultados: Obteve-se uma amostra final de 22 artigos relacionados com vários aspetos dos registos de enfermagem. Conclusão: Os registos de enfermagem foram assunto de publicação nas revistas portuguesas a partir de 1984. O número de publicações aumentou à medida que surgiram alterações na profissão de enfermagem. Os registos de enfermagem acompanharam a reconfiguração profissional e são determinantes para a autonomia da profissão.

Abstract Background: The changes observed in nursing documentation prompted a historical study on the evolution of nursing records between 1958, when the Ministry of Health and Assistance was created, and 1998, when the Ordem dos Enfermeiros (Portuguese Nursing and Midwifery Regulator) was established. Thus, the analysis of publications on nursing records in Portuguese journals during this period was considered relevant. Objective: To identify and analyze the scientific production on nursing records published in Portuguese nursing journals between 1958 and 1998. Methodology: A bibliometric study was conducted by consulting 504 Portuguese nursing journals published between 1958 and 1998, using descriptors and inclusion criteria. Results: A final sample of 22 articles related to different aspects of nursing records was obtained. Conclusion: Nursing records have been a publication subject in Portuguese journals since 1984. The number of publications increased as changes occurred in the nursing profession. Nursing records have accompanied the nursing career's professional reconfiguration and are essential for the profession's autonomy.

Resumen Contexto: Los cambios en la documentación en enfermería motivaron un estudio histórico sobre la evolución de los registros de enfermería entre 1958, con la creación del Ministerio de Sanidad y Asistencia, y 1998, año en que se creó el Colegio de Enfermería. En este sentido, se consideró importante analizar las publicaciones sobre los registros de enfermería en las revistas portuguesas durante el período de estudio. Objetivo: Identificar y analizar la producción científica sobre registros de enfermería publicada en revistas de enfermería portuguesas entre 1958 y 1998. Metodología: Se realizó un estudio bibliométrico en el que se consultaron 504 revistas de enfermería portuguesas publicadas entre 1958 y 1998, para lo cual se aplicaron descriptores y criterios de inclusión. Resultados: Se obtuvo una muestra final de 22 artículos relacionados con diversos aspectos de los registros de enfermería. Conclusión: Los registros de enfermería fueron objeto de publicación en revistas portuguesas a partir de 1984. El número de publicaciones aumentó a medida que surgieron cambios en la profesión de enfermería. Los registros de enfermería han acompañado la reconfiguración profesional y son esenciales para la autonomía de la profesión.

Perception and knowledge of pharmacogenetics among Brazilian psychiatrists.

Pharmacogenetics (PGx) can optimize drug therapy in psychiatry and is particularly important in admixed populations. Here we developed and successfully validated a questionnaire for assessing the perception and knowledge of PGx among Brazilian psychiatrists. Overall, the participants showed some familiarity with PGx. Most psychiatrists reported to have knowledge of PGx and recognized its usefulness in psychiatry; however, they declared concerns regarding PGx education, the request of tests and their interpretation, cost-effectiveness, and ethical issues. PGx testing is relatively prevalent in their clinical practice, but education on the topic is lacking. Bivariate analysis revealed significant associations. Psychiatrists > 40 years of age more frequently had a positive perception of other clinicians' familiarity with PGx. Psychiatrists in private health services showed less self-reported competency in the use of PGx testing. Furthermore, women had better perception of PGx education. The present study adds knowledge about PGx in psychiatry and encourages the development of educational and training resources for PGx to improve its clinical implementation.

Continuation Rates of the 52-mg Levonorgestrel-releasing Intrauterine System according to the Primary Reason for its Use.

OBJECTIVE: To evaluate whether continuation rates with the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone. METHODS: A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis. RESULTS: Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group. CONCLUSION: The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.

OBJETIVO: Avaliar a taxa de continuação até 5 anos de uso do sistema intrauterino liberador de 52-mg levonorgestrel por dia (SIU LNG) -IUS) é diferente entre mulheres que o usam exclusivamente como anticoncepcional que entre as que usam exclusivamente por razões médicas. MéTODOS: Estudo retrospectivo realizado em uma clínica de Planejamento Familiar 5.034 usuárias de SIU LNG, 4.287 que optaram pelo método apenas como anticoncepcional e 747 que o usavam somente por razoes médicas. A taxa de continuação de um até cinco ano foi calculada por meio de análise de tabela de vida RESULTADOS: No início a taxa de continuação foi significativamente maior no grupo da anticoncepção: 85,8 versus 83,4 e 77,4 versus 76,0 por 100 anos-mulher no 1° e 2° ano de uso, respectivamente. Houve mais descontinuações por sangrado-manchado no grupo de razões médicas nos dos primeiros anos. A taxa de continuação não foi significativamente diferente desde o terceiro até o quinto ano de uso. Nenhuma mulher de ambos os grupos descontinuou por amenorreia. CONCLUSãO: A taxa de continuação foi significativamente maior no grupo de anticoncepção durante os dos primeiros anos de uso. Amenorreia não foi motivo de descontinuação em ambos os grupos, sugerindo que a orientação a esse respeito foi adequada. Entretanto, a orientação referente ao longo período de sangramentos irregulares nos dois primeiros anos após a inserção, precisaria ser melhorado.

Continuation rates of the 52-mg levonorgestrel-releasing intrauterine system according to the primary reason for its use / Taxas de continuação com o sistema intrauterino de liberação de levonorgestrel de 52mg de acordo com o motivo principal de seu uso

Abstract Objective To evaluate whether continuation rates with the 52-mg levonorgestrelreleasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone. Methods A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis. Results Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group. Conclusion The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.

Resumo Objetivo Avaliar a taxa de continuação até 5 anos de uso do sistema intrauterino liberador de 52-mg levonorgestrel por dia (SIU LNG) -IUS) é diferente entre mulheres que o usam exclusivamente como anticoncepcional que entre as que usam exclusivamente por razões médicas. Métodos Estudo retrospectivo realizado em uma clínica de Planejamento Familiar 5.034 usuárias de SIU LNG, 4.287 que optaram pelo método apenas como anticoncepcional e 747 que o usavamsomente por razoesmédicas. A taxa de continuação de um até cinco ano foi calculada por meio de análise de tabela de vida Resultados No início a taxa de continuação foi significativamente maior no grupo da anticoncepção: 85,8 versus 83,4 e 77,4 versus 76,0 por 100 anos-mulher no 1° e 2° ano de uso, respectivamente. Houve mais descontinuações por sangrado-manchado no grupo de razões médicas nos dos primeiros anos. A taxa de continuação não foi significativamente diferente desde o terceiro até o quinto ano de uso. Nenhuma mulher de ambos os grupos descontinuou por amenorreia. Conclusão A taxa de continuação foi significativamente maior no grupo de anticoncepção durante os dos primeiros anos de uso. Amenorreia não foi motivo de descontinuação em ambos os grupos, sugerindo que a orientação a esse respeito foi adequada. Entretanto, a orientação referente ao longo período de sangramentos irregulares nos dois primeiros anos após a inserção, precisaria ser melhorado.

Análise da equidade na distribuição do financiamento federal à Atenção Primária à Saúde entre os municípios do Ceará / Analysis of equity in the distribution of federal funding to primary health care among the municipalities of Ceará, Brazil / Análisis de equidad en la distribución del financiamiento federal a la atención primaria de salud entre los municipios de Ceará, Brasil

Objetivo: analisar a equidade na distribuição dos recursos da Atenção Primária à Saúde nos municípios do estado do Ceará. Metodologia: trata-se de um estudo ecológico, utilizando dados secundários de domínio público dos 184 municípios cearenses, entre 2004 e 2014. Coletou-se dados populacionais no Departamento de Informática do Sistema Único de Saúde; recursos recebidos de custeio da atenção primária no Fundo Nacional de Saúde e índice de desenvolvimento municipal no Instituto de Pesquisa e Estratégia Econômica do Ceará. Calculou-se o gasto com atenção básica total e per capita por porte populacional dos municípios, sendo a análise realizada por gráficos de dispersão e boxplot. Resultados: foi revelada variação de aumento sequencial entre municípios de grande porte>municípios de pequeno porte>municípios de médio porte. O gasto per capita com a atenção básica apresentou variação: municípios de médio porte>municípios de grande porte>municípios de pequeno porte. Entre 2000 e 2014, o gasto com atenção básica per capita sobressai nos municípios de pequeno porte, passando de R$ 45,23 (2004) para R$ 132,97 (2014); nos municípios de médio porte de R$ 32,52 para R$ 97,05; e municípios de grande porte, de R$ 29,14 para R$ 82,10. Análises gráficas constataram maior crescimento dos gastos entre municípios de pequeno porte, de 2004 e 2012, apresentando queda em 2014. Conclusão: a política de financiamento da atenção primária do governo federal beneficiou os municípios de pequeno porte, apresentando tendência crescente de recursos entre 2000 e 2012, porém, em 2014, essa tendência se inverteu, o que é preocupante para a manutenção da Atenção Primária como base do Sistema Único de Saúde.

Objective: to analyze the equity in the distribution of resources of primary health care in municipalities of the state of Ceará. Methods: this is an ecological study, using secondary data from the public domain of 184 municipalities in Ceará, between 2004 and 2014. Population data were collected at the Informatics Department of the Unified Health System; resources were received from the cost of primary care in the National Health Fund and municipal development index in the Institute of Research and Economic Strategy of Ceará. The expenditure on total primary care and per capita was calculated by population size of the municipalities, and the analysis was performed using scatterplots and boxplots. Results: a sequential increase variation was revealed between large municipalities> small municipalities> medium-sized municipalities. Per capita spending on primary care are varied: medium-sized municipalities> large municipalities> small-sized municipalities. Between 2000 and 2014, spending on primary health care per capita stands out in small municipalities, from R $ 45.23 (2004) to R $ 132.97 (2014); in medium-sized municipalities from R $ 32.52 to R $ 97.05; and large municipalities, from R $ 29.14 to R $ 82.10. Graphical analyzes found greater growth in spending between small municipalities, from 2004 to 2012, decreasing in 2014. Conclusion: the federal government's primary health care financing policy benefited small municipalities, with an increasing trend of resources between 2000 and 2000. 2012, however, in 2014, this trend was reversed, which is worrying for the maintenance of Primary Care as the basis of the Unified Health System.

Objetivo: analizar la equidad en la distribución de recursos de Atención Primaria de Salud en los municipios del estado de Ceará. Metodología: se trata de un estudio ecológico, utilizando datos secundarios de dominio público de 184 municipios de Ceará, entre 2004 y 2014. Los datos poblacionales fueron recolectados en el Departamento de Informática del Sistema Único de Salud; recursos recibidos del costo de atención primaria en el Fondo Nacional de Salud e índice de desarrollo municipal en el Instituto de Investigación y Estrategia Económica de Ceará. El gasto en atención primaria total y per cápita se calculó por tamaño de población de los municipios, y el análisis se realizó mediante diagramas de dispersión y diagramas de caja. Resultados: se reveló una variación de aumento secuencial entre municipios grandes> municipios pequeños> municipios medianos. El gasto per cápita en atención primaria varió: municipios medianos> municipios grandes> municipios pequeños. Entre 2000 y 2014, se destaca el gasto en atención primaria de salud per cápita en los municipios pequeños, de R $ 45,23 (2004) a R $ 132,97 (2014); en municipios medianos de R $ 32,52 a R $ 97,05; y grandes municipios, de R $ 29,14 a R $ 82,10. Los análisis gráficos encontraron un mayor crecimiento en el gasto entre municipios pequeños, de 2004 a 2012, disminuyendo en 2014. Conclusión: la política de financiamiento de la atención primaria de salud del gobierno federal benefició a los municipios pequeños, con una tendencia creciente de recursos entre 2000 y 2000. 2012, sin embargo, en En 2014 se revirtió esta tendencia, preocupante para el mantenimiento de la Atención Primaria como base del Sistema Único de Salud.

To Combine or Not to Combine Physical Therapy With tDCS for Stroke With Shoulder Pain? Analysis From a Combination Randomized Clinical Trial for Rehabilitation of Painful Shoulder in Stroke.

Purpose: Transcranial Direct Current Stimulation (tDCS) is an intervention that seems to be an ideal tool to enhance the effects of rehabilitation therapies given it facilitates generation of plasticity in the stimulated brain area. In stroke this strategy has been highly utilized; however, the results have been mixed. In this trial we have evaluated the analgesic and functional effects of Transcranial Direct Current Stimulation (tDCS) combined with physiotherapy in stroke survivors with shoulder pain. Methods: Twenty-six stroke surviving adults with shoulder pain received 10 sessions of passive mobilization and performed upper limb exercises using a cycle ergometer, combined with active or sham tDCS. The intensity of pain in the hemiplegic shoulder was measured using the Visual Analog Scale (VAS); secondary outcomes were the level of motor impairment, handgrip strength, range of motion, motor function of the upper limbs, and quality of life (QOL) assessed before and after 10 sessions and 1 month after the end of the treatment. Results: A clinically important pain reduction (3 points) was found in both groups and was maintained at follow-up; there was no significant difference between groups (p = 0.3). Similarly, the shoulder range of motion improved, motor function and quality of life improved showed no significant differences between groups. One result that needs to be underscored is that both groups had a significant effect size toward improvement in all of these outcomes. Conclusions: We discuss in this study that tDCS is not a useful combination strategy when the physical therapy has a large effect by itself and we also review other negative trials of combined therapy under this framework of ceiling effect of the main physical therapy. Trial registry: Trial registration: Brazilian Registry of Clinical Trials, RBR-8F5MNY (http://www.ensaiosclinicos.gov.br/rg/RBR-8f5mny/). Registered on June 2, 2017. Beginning of the recruitment of the volunteers: august, 2017.

Multidimensional assessment of women after severe maternal morbidity: the COMMAG cohort study.

OBJECTIVES: To perform a multidimensional assessment of women who experienced severe maternal morbidity (SMM) and its short-term and medium-term impact on the lives and health of women and their children. DESIGN: A retrospective cohort study. SETTING: A tertiary maternity hospital from the southeast region of Brazil. PARTICIPANTS: The exposed population was selected from intensive care unit admissions if presenting any diagnostic criteria for SMM. Controls were randomly selected among women without SMM admitted to the same maternity and same time of childbirth. PRIMARY AND SECONDARY OUTCOME VARIABLES: Validated tools were applied, addressing post-traumatic stress disorder (PTSD) and quality of life (SF-36) by phone, and then general and reproductive health, functioning (WHO Disability Assessment Schedule), sexual function (Female Sexual Function Index (FSFI)), substance abuse (Alcohol, Smoking and Substance Involvement Screening Test 2.0) and growth/development (Denver Developmental Screening Test) of children born in the index pregnancy in a face-to-face interview. RESULTS: All instruments were applied to 638 women (315 had SMM; 323 were controls, with the assessment of 264 and 307 children, respectively). SF-36 score was significantly lower in the SMM group, while PTSD score was similar between groups. Women who had SMM became more frequently sterile, had more abnormal clinical conditions after the index pregnancy and a higher score for altered functioning, while proportions of FSFI score or any drug use were similar between groups. Furthermore, children from the SMM group were more likely to have weight (threefold) and height (1.5 fold) for age deficits and also impaired development (1.5-fold). CONCLUSION: SMM impairs some aspects of the lives of women and their children. The focus should be directed towards monitoring these women and their children after birth, ensuring accessibility to health services and reducing short-term and medium-term repercussions on physical, reproductive and psychosocial health.

Maternal Work and Spontaneous Preterm Birth: A Multicenter Observational Study in Brazil.

Spontaneous preterm birth (sPTB) is a major pregnancy complication involving biological, social, behavioural and environmental mechanisms. Workload, shift and intensity may play a role in the occurrence of sPTB. This analysis is aimed addressing the effect of occupational activities on the risk for sPTB and the related outcomes. We conducted a secondary analysis of the EMIP study, a Brazilian multicentre cross-sectional study. For this analysis, we included 1,280 singleton sPTB and 1,136 singleton term birth cases. Independent variables included sociodemographic characteristics, clinical complications, work characteristics, and physical effort devoted to household chores. A backward multiple logistic regression analysis was applied for a model using work characteristics, controlled by cluster sampling design. On bivariate analysis, discontinuing work during pregnancy and working until the 7th month of pregnancy were risks for premature birth while working during the 8th - 9th month of pregnancy, prolonged standing during work and doing household chores appeared to be protective against sPTB during pregnancy. Previous preterm birth, polyhydramnios, vaginal bleeding, stopping work during pregnancy, or working until the 7th month of pregnancy were risk factors in the multivariate analysis. The protective effect of variables compatible with exertion during paid work may represent a reverse causality. Nevertheless, a reduced risk associated with household duties, and working until the 8th-9th month of pregnancy support the hypothesis that some sort of physical exertion may provide actual protection against sPTB.

Effects of Transcranial Direct Current Stimulation (tDCS) and Exercises Treadmill on Autonomic Modulation of Hemiparetic Patients Due To Stroke-Clinic Test, Controlled, Randomized, Double-Blind.

Background: After a Stroke, there is an autonomic nervous system (ANS) changes. Transcranial Direct Current Stimulation (tDCS) can promote the reorganization of the affected circuits. Objective: To evaluate the effects of tDCS applied before a session of physical activity on the treadmill, in the modulation of the autonomic nervous system of post-stroke patients. Methodology: Cross-over study, were randomized 12 adult hemiparetic subjects in 2 groups, Group 1 (active tDCS before exercise on the treadmill) and Group 2 (sham tDCS before exercise on the treadmill). Stimulation times were 20 min; treadmill time was 20 min. The heart rate variability (HRV) and Variability of Systolic Blood Pressure (VSBP) were evaluated for 15 min, in 3 periods (pre and post tDCS and during exercise recovery on the treadmill). Results: There was no difference in the VSBP and the HRV between the groups, compared with the baseline data; however, in the intragroup analysis, the parasympathetic modulation after active tDCS increased by 18% over baseline by the RMSSD with IC 95% (-7.85 to -0.34). In group 1, the post-tDCS active and post-exercise periods presented a value of variance above baseline, indicating a better prognosis. In group 2, there was a significant reduction of 38% of Variance values (p = 0.003) after tDCS sham. Conclusion: tDCS does not generate immediate effects on HRV and VSBP, except for intragroup comparison, which has greater participation in parasympathetic modulation in the group receiving active tDCS.