Economic attractiveness of domestic rainwater harvesting in Brazilian cities.

Brazil is the fifth largest country by area in the world, with a variety of climates in its territory. This work assesses the economic attractiveness of domestic rainwater harvesting direct feed systems, for the replacement of non-drinking water, in 148 locations of the Brazilian territory considering hourly rainfall data for the 14-year period between 2008 and 2021. The water tariff and consumption data for each location were also considered along with estimated hourly and monthly consumption patterns. With annual operating expenses at 1% of the capital expenditure and an annual discount rate of 8%, the net present value for the 14-year period is positive in only 15 locations, which are among those with the highest water tariffs in the country. The results of these base case simulations discourage the installation of domestic RWH systems in most of the Brazilian locations considered. However, the results also show that, depending on house occupancy, filtration equipment cost, water tariff, and catchment area, outcomes more favorable to the installation of RWH systems are obtained, especially in cities of Brazil's southern and southeastern regions.

First Description of the Nuclear and Mitochondrial Genomes and Associated Host Preference of Trichopoda pennipes, a Parasitoid of Nezara viridula.

Trichopoda pennipes is a tachinid parasitoid of several significant heteropteran agricultural pests, including the southern green stink bug, Nezara viridula, and leaf-footed bug, Leptoglossus phyllopus. To be used successfully as a biological control agent, the fly must selectively parasitize the target host species. Differences in the host preference of T. pennipes were assessed by assembling the nuclear and mitochondrial genomes of 38 flies reared from field-collected N. viridula and L. phyllopus. High-quality de novo draft genomes of T. pennipes were assembled using long-read sequencing. The assembly totaled 672 MB distributed among 561 contigs, having an N50 of 11.9 MB and a GC of 31.7%, with the longest contig at 28 MB. The genome was assessed for completeness using BUSCO in the Insecta dataset, resulting in a score of 99.4%, and 97.4% of the genes were single copy-loci. The mitochondrial genomes of the 38 T. pennipes flies were sequenced and compared to identify possible host-determined sibling species. The assembled circular genomes ranged from 15,345 bp to 16,390 bp and encode 22 tRNAs, two rRNAs, and 13 protein-coding genes (PCGs). There were no differences in the architecture of these genomes. Phylogenetic analyses using sequence information from 13 PCGs and the two rRNAs individually or as a combined dataset resolved the parasitoids into two distinct lineages: T. pennipes that parasitized both N. viridula and L. phyllopus, and others that parasitized only L. phyllopus.

Conhecimentos e práticas sobre telemedicina entre alergistas e imunologistas brasileiros / Telemedicine knowledge and practices among Brazilian allergists and immunologists

Introdução: O objetivo deste estudo foi avaliar as características das práticas de telemedicina (TM) entre médicos alergistas/ imunologistas (A/I) brasileiros e avaliar seu conhecimento sobre as recomendações regulatórias. Métodos: Uma pesquisa eletrônica autorreferida foi enviada por e-mail uma vez por semana entre agosto e outubro/2021 a 2.600 médicos A/I brasileiros. Resultados: 205 (7,9%) participantes preencheram os formulários. 143 (70,2%) médicos usaram TM em sua prática clínica, e 184 (89,9%) nunca o usaram antes da pandemia de COVID-19. Dentre os médicos, 192 (93,8%) utilizaram a TM para consultas de acompanhamento, 186 (91%) para verificação de exames complementares e 136 (66,7%) nas primeiras consultas. Cento e quarenta e três médicos A/I (70,2%) sentiram-se seguros em seu diagnóstico por meio da TM, e 7 (3,5%) responderam que não conseguiram encontrar um diagnóstico correto usando a TM. Os principais benefícios da TM relatados foram: maior acessibilidade, principalmente em áreas mais distantes 159 (77,6%), redução dos custos de deslocamento 158 (77,1%) e segurança quanto à transmissão do COVID-19 145 (71,2%). Por outro lado, algumas desvantagens da TM foram listadas pelos participantes: ausência de exame físico 183 (89,7%), relação médico-paciente fragilizada 59 (28,8%) e problemas de Internet 45 (22%). Em relação ao campo jurídico/ético, 105 (51,4%) dos especialistas aplicaram o termo de consentimento e 34 (16,7%) registraram a teleconsulta, ambas as etapas exigidas em uma consulta de TM, conforme recomendações regulatórias locais. Além disso, plataformas online inadequadas para TM, como aplicativos de mídia social e programas de reuniões online não específicos, foram relatadas como sendo usadas por 131 (64,1%) dos participantes. Oitenta (40%) não leram as declarações e recomendações oficiais que regulamentam a prática da TM no Brasil. Conclusões: Observouse um uso crescente de TM no Brasil, influenciado principalmente pela pandemia de COVID-19. Apesar de ser ferramenta útil na pandemia, com vantagens e desvantagens, há necessidade de conhecer as recomendações regulatórias.

Introduction: The aim of this study was to evaluate the characteristics of telemedicine (TM) practices among Brazilian allergists/immunologists (A/I) and to assess their knowledge of regulatory recommendations. Methods: A self-report electronic survey was sent by email once a week between August and October 2021 to 2,600 Brazilian A/I physicians. Results: A total of 205 (7.9%) participants completed the survey. TM was used in clinical practice by 143 (70.2%) physicians, and 184 (89.9%) had never used it before the COVID-19 pandemic. Among participants, 192 (93.8%) used TM for follow-up consultations, 186 (91%) for checking complementary exams, and 136 (66.7%) for first consultations. The number of A/I physicians (70.2%) that felt confident in their diagnosis using TM was 143, and 7 (3.5%) reported that they could not reach the correct diagnosis using TM. Participants reported that the main benefits of TM were greater accessibility, especially in more distant areas (159, 77.6%), reduced travel costs (158, 77.1%), and safety regarding the transmission of COVID-19 (145, 71.2%). Conversely, the lack of physical examination (183, 89.7%), poor doctor-patient relationship (59, 28.8%), and internet connection problems (45, 22%) were mentioned as disadvantages. Regarding legal/ethical aspects, 105 (51.4%) physicians reported applying a consent form and 34 (16.7%) reported making a record of the teleconsultation, both of which are required for TM consultations, according to local regulatory recommendations. The use of inappropriate online platforms for TM, such as social media applications and nonspecific online meeting programs, was reported by 131 (64.1%) participants. Eighty (40%) participants did not read the official statements and recommendations that regulate the practice of TM in Brazil. Conclusions: An increasing use of TM was observed in Brazil, mainly influenced by the COVID-19 pandemic. Despite being a useful tool in the pandemic, with advantages and disadvantages, physicians should have knowledge of regulatory recommendations.

Fully independent validation and updating of a clinical pharmacy prioritizing risk score in an infectious disease hospital ward.

AIMS: The aim of this study was to validate and update the risk score originally developed at Hospital de Clínicas de Porto Alegre, verifying its performance in an infectious disease population. METHODS: This is an observational study with consecutive selection of admission in a ward of participants with infectious diseases. Predictors were age, number of medications, intravenous drugs, potentially dangerous drugs, renal dysfunction, liver dysfunction, use of nasoenteral tube, nasogastric tube, gastrostomy feeding, jejunostomy feeding, oral enteral tube, total parenteral nutrition, cardiac or pulmonary dysfunction and immunosuppression. Outcome was defined as preventable prescription incidents by a clinical pharmacist. A GEE model was fit to make predictions each week. RESULTS: A total of 219 patients participated in the study, 79.25% of whom had prescription incidents in the first week of admission. Predictors of the updated model were number of drugs prescribed, number of intravenous drugs, use of tubes, truncated age at 36 years and week of hospitalization. The performance of the original model was poor. The updated model's discrimination and calibration were moderate (overall AUC 0.74). A calculator to apply the model is available at https://pedrobrasil.shinyapps.io/INDWELL/. CONCLUSION: The updated risk score enabled the user to make predictions at admission and throughout the weeks, allowing for a prioritized weekly update for clinical pharmacy intervention. The updated model has a moderate and satisfactory performance for infectious disease patients.

How to implement a PEWS in a resource-limited setting: A quantitative analysis of the bedside-PEWS implementation in a hospital in northeast Brazil.

OBJECTIVES: Quantitative analysis of the implementation of the bedside paediatric early warning system (B-PEWS) in a resource-limited setting. The B-PEWS serves to pre-emptively identify hospitalised children who are at risk for cardiopulmonary arrest and subsequently to provide critical care in time. METHODS: We performed a retrospective review through the medical data records of patients after discharge from the paediatric ward of a philanthropic hospital in Brazil. Nurses' performance using the system was measured with various parameters. RESULTS: A total of 499 patients were included, and a total of 8024 scores were checked. During the 21-week research period, the implementation rate increased significantly from 66.5% (SD 26.0) in Period 1 to 93.1% (SD 16.6) in Period 2. The number of scores that resulted in a correct total score went from 7.5% in Period 1 to 32.2% in Period 2, p < 0.001. There was an improvement in the correct choice of age group between the two periods (from 32.2% to 53.4%). There was no difference in the mean admission time of patients in the two periods: in the first period 4.8 days (SD 2.9) and in the second period 4.8 days (SD 4.1). CONCLUSIONS: It is possible to implement a PEWS in resource-limited settings while achieving high implementation rates. However, this is a time- and energy-consuming process. Having an active and involved team that is responsible for implementation is key for a successful implementation. Factors that likely hindered implementation were a large change in workflow for the nursing staff, non-native speakers as main investigators.

Acessibilidade a serviços de saúde por trabalhadores informais do comércio com hipertensão arterial / Accessibility to health services by informal sales workers with arterial hypertension

Estudo exploratório e descritivo de abordagem qualitativa, com objetivo de identificar as facilidades e dificuldades encontradas pelos trabalhadores informais do comércio com hipertensão arterial na acessibilidade aos serviços de saúde. Participaram do estudo 18 trabalhadores informais do comércio com hipertensão arterial que desenvolvem suas atividades laborais no Centro de Abastecimento Vicente Grilo, mercado público situado em Jequié ­ BA. A coleta de dados ocorreu por meio de entrevistas semiestruturadas após aprovação do Comitê de Ética em Pesquisa da Universidade Estadual do Sudoeste da Bahia e realização do estudo piloto. A análise foi realizada de acordo a técnica de análise de conteúdo, modalidade temática. Como resultado, os trabalhadores informais do comércio apontam facilidades e dificuldades na dinâmica de acessibilidade aos serviços de saúde públicos e no sistema de saúde privado, ocorrendo ainda dificuldades de acessibilidade relacionadas a questões de gênero e a falta de tempo para ir aos serviços de saúde, devido a atividades laborais. Quanto às facilidades nos serviços de saúde públicos, apontam-se a proximidade entre a unidade de saúde e o domicílio, o uso de tecnologias relacionais como o acolhimento e a resolutividade dos serviços. No sistema de saúde privado, as facilidades dialogam com a dimensão da qualidade e a rapidez no atendimento. No tocante às dificuldades, nos serviços de saúde públicos, aponta-se a distância entre o local do trabalho e o serviço de atenção básica, presença de filas, demora para a realização do atendimento, ausência de vagas, dificuldade para realização de exames complementares e carência de recursos humanos e materiais. No sistema de saúde privado, as dificuldades dizem respeito à existência de um longo espaço de tempo entre o agendamento e a realização de consultas médicas, além de carência de profissionais médicos. Conclui-se que dificuldades na acessibilidade colocam os trabalhadores informais do comércio com hipertensão arterial em condição de maior vulnerabilidade, sendo necessário o empreendimento de esforços por parte dos formuladores de políticas públicas, gestores e profissionais de saúde, para que os obstáculos à acessibilidade sejam minimizados, com vistas ao tratamento e controle da hipertensão arterial e ao cuidado continuado da saúde desse grupo.

Exploratory and descriptive study with a qualitative approach, aiming to identify the ease and difficulties encountered by informal trade workers with hypertension regarding their accessibility to health services. The sample included 18 informal sales workers with arterial hypertension who work at the Vicente Grilo Supply Center, a public market located in Jequié, Bahia, Brazil. The data was collected through semi- structured interviews after approval by the Research Ethics Committee of the State University of Southwest Bahia and completion of the pilot study. The analysis was performed according to the content analysis technique, with a thematic modality. As a result, informal sales workers point out ease and difficulties in the accessibility to public health services and in the private health system, besides the recurring accessibility problems related to gender issues and the lack of time to go to health services, due to work activities. As far as the ease factors in the public health services are concerned, the proximity between the health unit and their home, as well as the use of relational technologies such as the reception and resolutions of the services are pointed out. In the private health system, the eases dialogue with the dimension of quality and swiftness of care. Regarding the difficulties, in public health services, the workers mention the distance between workplace and primary health care service, the presence of queues, delays in providing care, the lack of vacancies, difficulties to perform complementary exams and the lack of human and material resources. In the private health system, the difficulties are related to the existence of a long period of time between scheduling and conducting medical appointments, as well as the lack of medical professionals. It is concluded that the accessibility difficulties place these informal trade workers with hypertension in a condition of greater vulnerability, requiring the undertaking of efforts by public policy makers, managers and health professionals, so that the obstacles to accessibility can be minimized, with a view to the treatment and control of arterial hypertension and the continued healthcare of this group.

Educação ambiental no processo de territorialização em saúde: apresentação de um método utilizado / Environmental education in the process of territorialization in health: presentation of a method used

RESUMO O objetivo deste artigo foi apresentar um método qualitativo de abordagem da educação ambiental no processo de territorialização em saúde. O percurso metodológico que dá origem a este texto é uma pesquisa-ação cujo estudo é do tipo exploratório e descritivo de abordagem qualitativa por meio do desenvolvimento de oficinas. Foram realizados seis encontros para atender aos objetivos propostos. As atividades foram desenvolvidas por um moderador e contaram com a participação de 60 Agentes Comunitários de Saúde atuantes em um município de pequeno porte do interior e do litoral da Bahia. Os resultados apontam que, no processo de territorialização em saúde, é elementar a incorporação de novas práticas que demonstrem o território além de demarcações geográficas, valorizando a concepção ampliada de ambiente e suas relações com a saúde. Nesse ponto, surge como proposta a reorganização dos processos de trabalho, no sentido de buscar multidisciplinaridade, interdisciplinaridade e participação efetiva no processo de territorialização em saúde à luz da educação ambiental.

ABSTRACT This paper aims to present a method of qualitative approach to environmental education in the process of territorialization in health. The methodological path that gives rise to this text is an action-research whose study is exploratory and descriptive of qualitative approach through the development of workshops. Six meetings were held to meet the proposed objectives. The activities were developed by a moderator and were attended by 60 Community Health Workers working in a small municipality in both the countryside and the coast of Bahia. The results indicate that, in the process of territorialization in health, it is elementary to incorporate new practices that demonstrate the territory beyond geographical demarcations, valuing the broader conception of the environment and its relations with health. In that regard, the proposal that arises is the reorganization of work processes, in the sense of seeking multidisciplinarity, interdisciplinarity and effective participation in the process of territorialization in health, in light of environmental education.

The first observation of the association of Merkel cell polyomavirus and Merkel cell carcinoma in Brazil.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare but aggressive primary cutaneous carcinoma with high mortality rates. The present study intends to delineate the epidemiological profile of patients with MCC seen at the Clinics Hospital of the Medical School at the University of São Paulo, Brazil, and its association with Merkel cell polyomavirus (MCPyV). METHODS: This is a retrospective study. A search was performed in the hospital's medical index for all cases of MCC from January 1994 to December 2012. Among patients with MCC, the available tumoral skin specimens were analyzed with two different techniques of polymerase chain reaction (PCR) (conventional and real-time) for detection of MCPyV DNA. Additionally, paraffin-embedded samples of patients with non-MCC skin cancers were also analyzed. Analyses suitable for categorical data (i.e., x² of Fisher) were used to compare the proportion of patients in each group. RESULTS: Nineteen patients with MCC and 20 patients with non-MCC skin cancers entered the study. All MCC samples available (13) tested positive for the presence of MCPyV DNA; however, in the non-MCC skin cancer samples, the MCPyV DNA was detected in 4 of 20 samples (20%). MCPyV DNA detection rate was higher in patients with MCC than in the other group, and its analysis was statistically significant (P < 0.01). CONCLUSIONS: This study demonstrates the association of MCPyV in Brazilian patients with MCC. However, further studies are necessary to determine the exact involvement of MCPyV in MCC pathogenesis and to define the significance of viral DNA detection in non-MCC skin cancers.

Medicinal plants and natural molecules with in vitro and in vivo activity against rotavirus: A systematic review.

BACKGROUND: Rotaviruses can cause life-threatening health disorders, such as severe dehydrating gastroenteritis and diarrhea in children. Vaccination is the main preventive strategy to reduce rotavirus diarrhea and the severity of episodes, but vaccines are not fully effective and new episodes may occur, even in vaccinated children. The WHO recommends oral rehydration therapy and zinc supplementation for rotavirus-induced diarrhea management. There is little preclinical evidence to support the use of phytotherapeutics in the management of rotaviral infections. PURPOSE: We aim to review the use of medicinal plants and natural molecules in the management of rotavirus infections in experimental studies. METHODS: Articles, published in the English language between 1991 and 2016, were retrieved from PubMed, Scopus and Web of Science using relevant keywords. The scientific literature mainly focusing on plant natural products with therapeutic efficacies against experimental models of rotavirus, were identified and tabulated. In addition, an assessment of the reliability of animal experiments was determined under ``Risk of Bias'' criteria. CHAPTERS: After an initial search and a revision of the inclusion criteria, 41 reports satisfied the objectives of the study. 36 articles were found concerning the anti-rotaviral potential in rotavirus infected cell lines. Among the active secondary metabolites screened for rotavirus inhibition, the polyphenols of flavonoid structure had acquired the highest number of studies in our survey, compared to phenolic acids, stilbenoids, tannins, pectins, terpenoids and flavonoid glycosides. Also, many phytochemicals reduced the efficacy of viral capsid proteins foremost to their elimination and improved the tendency of host-cell inhibiting virus absorption or by prevention of viral replication. Furthermore, five in vivo studies reported that herbs, as well its components, reduced the duration and severity of diarrhea in mice and piglets. The anti-rotavirus efficacy were highlighted based on improvements in reduction on liquid stool, fecal virus shedding, small intestinal histology, levels of inflammation related cytokines and signaling receptors. However, the quality of the experiments in animal studies contained certain types of bias in terms of how they were conducted and reported. CONCLUSION: We identified and summarized studies on medicinal plants and natural molecules having anti-rotavirus activity in order to further future developments of cures for rotavirus gastroenteritis.

Bioética e atendimento a mulheres vítimas de violência sexual: revisão de literatura / Bioethics and care of women victims of sexual violence: a review of literature / Bioética y asistencia a mujeres víctimas de violencia sexual: revisión de literatura

Buscando efetuar revisão de literatura sobre atendimento a mulheres vítimas de violência sexual, realizou-se busca em periódicos indexados nas bases de dados da Biblioteca Virtual de Saúde e Scopus, considerando publicações a partir do ano de 2003. A coleta de dados foi realizada em maio de 2013, utilizando descritores "violência sexual" ("sexual violence"), "assistência" ("assistance"), "serviços de saúde da mulher" ("women's health services"), "aborto" ("abortion") e "gravidez" ("pregnancy"). Foram recuperados quinze artigos, e os resultados foram agrupados em categorias temáticas: aspectos bioéticos relacionados ao acesso de mulheres a serviços de atendimento, e aspectos bioéticos presentes no atendimento. A discussão ocorreu à luz da bioética do risco e proteção, evidenciando que o Estado deve garantir a universalidade do acesso às vítimas de violência sexual e os profissionais de saúde devem estar bioeticamente preparados para esse atendimento.

This article aims to perform a review of literature regarding care of women victims of sexual violence through a search in indexed journals in the Virtual Health Library and Scopus databases, including publications since 2003. Data collection was conducted in May 2013 using the keywords "violência sexual" ["sexual violence"], "assistência" ["assistance"], "serviços de saúde da mulher" ["women" health services"], "aborto" ["abortion"] and "gravidez" ["pregnancy"]. Fifteen publications were retrieved, and the results were grouped into two thematic categories: bioethical issues related to women" access to care services, and bioethical aspects present in treatment. The discussion was based in risk and protection bioethics, showing that the government must ensure universal access for the victims of sexual violence, and that health care professionals should be bioethically prepared for such care.

Procurando realizar una revisión de la literatura sobre la asistencia a mujeres víctimas de violencia sexual, se realizó una búsqueda en revistas indexadas en las bases de datos de la Biblioteca Virtual de Salud y en Scopus, teniendo en cuenta las publicaciones realizadas a partir del año 2003. La recolección de datos tuvo lugar en mayo de 2013, utilizando descriptores como "violencia sexual" ("sexual violence"), "asistencia" ("assistance"), "servicios de salud de la mujer" ("women" health services"), "aborto"("abortion") y "embarazo" ("pregnancy"). Se recuperaron quince artículos y los resultados fueron agrupados en categorías temáticas: aspectos bioéticos relacionados al acceso de mujeres a servicios de protección, evidenciando que el Estado debe garantizar la universalidad del acceso a las víctimas de violencia sexual y que los profesionales de salud deben estar bioéticamente preparados para brindar esta asistencia.

Fatores associados à mortalidade por traumatismo cranioencefálico / Factors associated with the mortality from traumatic brain injury / Factores asociados con la mortalidad en el traumatismo craneoencefálico

Objetivo: analisar os fatores associados à mortalidade por traumatismo cranioencefálico (TCE). Método: estudo transversal realizado com dados de 399 prontuários de vítimas de TCE em um hospital geral do município de Jequié/BA, de 2009 a 2011. Utilizou-se a razão de prevalência (RP) como medida de associação. Os dados foram analisados com o auxílio do SPSS versão 21.0 (SPSS Inc., Chicago, IL.). Realizou-se análise descritiva com os dados apresentados em frequências absoluta e relativa em tabelas, em seguida, apoiando-se na literatura para a discussão. Resultados: os fatores associados à mortalidade por esse tipo de trauma foram: idade, com aumento progressivo da RP conforme maior é a faixa etária; agressão como mecanismo gerador do trauma (RP=2,00; IC95% 1,16-3,46); e os 7 primeiros dias depois de ocorrido o evento (RP=2,09; IC95% 1,19-3,66). Conclusão: a prevalência de óbito em indivíduos internados por TCE aumenta com o avançar da idade, em vítimas de agressão e nos sete primeiros dias depois de ocorrido o evento.(AU)

Objective: to analyze the factors associated with mortality from traumatic brain injury (TBI). Method: crosssectional study, conducted with the data of 399 medical records of TBI victims at a general hospital in the city of Jequié/BA, from 2009 to 2011. The prevalence ratio (PR) was used as measure of association. The data were analyzed with the software SPSS, version 21.0 (SPSS Inc., Chicago, IL.). The descriptive analysis was performed with the data, presented in absolute and relative frequencies, organized in tables and, later, the discussion was made based on the literature. Results: the factors associated with mortality from this type of trauma were: age, with a progressive increase of the PR along with the age's increase; aggression as a mechanism responsible for originating the trauma (PR=2.00; CI95% 1.19-3.46); and the first seven days after the event (PR=2.09; CI95% 1.19-3.66). Conclusion: the death prevalence in individuals hospitalized for TBI increases along with the age, in victims of aggression and in the first seven days after the event.(AU)

Objetivo: analizar los factores asociados con la mortalidad en el traumatismo craneoencefálico (TCE). Método: estudio transversal con datos de 399 registros médicos de víctimas de TCE en un hospital general de la ciudad de Jequié/BA, de 2009 a 2011. Se utilizó la razón de prevalencia (RP) como una medida de asociación. Los datos fueron analizados con el programa SPSS, versión 21.0 (SPSS Inc., Chicago, IL.). Se realizó un análisis descriptivo de los datos presentados en frecuencias absolutas y relativas en las tablas; a continuación, fue hecha la discusión basándose en la literatura. Resultados: los factores asociados con la mortalidad por este tipo de trauma fueron: la edad, con el aumento progresivo de la RP como la edad; agresión como mecanismo generador de trauma (RP=2,00; IC95% 1,16-3,46); y los primeros 7 días después del evento ocurrieron (RP=2,09; IC95% 1,19-3,66). Conclusión: la prevalencia de muerte en pacientes hospitalizados por TCE aumenta con la edad, en las víctimas de agresión y los primeros siete días después de ocurrido el evento.(AU)

Effects of unilateral stereotactic posterior striatotomy on harmaline-induced tremor in rats.

Although long known and the most prevalent movement disorder, pathophysiology of essential tremor (ET) remains controversial. The most accepted hypothesis is that it is caused by a dysfunction of the olivocerebellar system. Vilela Filho et al. [2001; Stereotact Funct Neurosurg 77:149-150], however, reported a patient with unilateral hand ET that was completely relieved after a stroke restricted to the contralateral posterior putamen and suggested that ET could be the clinical manifestation of posterior putamen hyperactivity. The present study was designed to evaluate this hypothesis in the most often used model of ET, harmaline-induced tremor in rats. Fifty-four male Wistar rats were randomly distributed into three groups: experimental (EG), surgical control (SCG), and pharmacological control (PCG) groups. EG animals underwent stereotactic unilateral posterior striatotomy. SCG rats underwent sham lesion at the same target. PCG served exclusively as controls for harmaline effects. All animals received, postoperatively, intraperitoneal harmaline, and the induced tremor was video-recorded for later evaluation by a blind observer. Thirteen animals were excluded from the study. Limb tremor was reduced ipsilaterally to the operation in 20 of 21 rats of EG and in two of nine of SCG, being asymmetric in one of 10 of PCG rats. Comparisons between EG × SCG and EG × PCG were statistically significant, but not between SCG × PCG. Limb tremor reduction was greater in anterior than in posterior paws. Lateral lesions yielded better results than medial lesions. These results suggest that the posterior striatum is involved with harmaline-induced tremor in rats and support the hypothesis presented.

Atualização sobre a abordagem da fisioterapia respiratória nas doenças neuromusculares / Update on the approach of respiratory therapy in patients withneuromuscular diseases

Objetivo: Avaliar o papel da fisioterapia na abordagem das doenças neuromusculares (DNM), com ênfase nos aspectos preventivos e terapêuticos da fisioterapia respiratória. Método: Revisão bibliográfica não sistemática, abrangendo os últimos vinte anos, utilizando as bases de dados MEDLINE e LILACS, através dos seguintes descritores: Doenças neuromusculares, fisioterapia, capacidade vital e insuficiência respiratória. Resultados: Os artigos pesquisados sugerem a necessidade de se estabelecer uma rotina de avaliação periódica da função respiratória a fim de se introduzir medidas fisioterapêuticas pertinentes a cada estágio da doença. O acompanhamento deve incluir provas de função pulmonar, bem como técnicas específicas de fisioterapia respiratória, a fim de se evitar complicações como insuficiência respiratória. Conclusão: O acompanhamento periódico e a introdução de medidas preventivas de fisioterapia têm contribuído para aumentar a sobrevida e melhoraria da qualidade de vida dos pacientes com doenças neuromusculares.

Objective: To assess the role of physiotherapy in approaching neuromuscular disease (NMD), with emphasis on preventive and therapeutic aspects of respiratory therapy. Methods: A nonsystematic literature review covering the past twenty years, using the databases MEDLINE and LILACS through the following descriptors: neuromuscular diseases, physical therapy, vital capacity and respiratory failure. Results: The studies reviewed show the need to establish a routine periodic evaluation of respiratory function in order to introduce physical therapy measures relevant to each stage of the disease. The monitoring should include pulmonary function tests and specific techniques of chest physiotherapy, in order to avoid complications such as respiratory failure. Conclusion: The introduction of regular monitoring and preventive physiotherapy measures have helped to increase survival and improve quality of life of patients with neuromuscular diseases.

Enfermeiras-mães ensinando auto-exame das mamas para suas filhas adolescentes

O estudo tem como objetivo a transmissão do conhecimento de enfermeiras-mães passando suas experiências para suas filhas, tomando como ponto de referência o ensino do auto-exame das mamas. Como objetivo, analisa atitudes positivas transmitidas pelas enfermeiras-mães às suas filhas adolescentes ao ensinar-lhes a fazer o auto-exame das mamas; a investigação, de abordagem qualitativa, se apóia nas contribuições de MICHEL FOUCAULT sobre relações de poder e resistências à este discurso. Como considerações finais ainda um grande número de enfermeiras minimizam a importância do exame de mama deixando de ensinar às suas filhas. Poucas ensinam e acompanham.

Enfermeiras-mães ensinando auto-exame das mamas para suas filhas adolescentes / Nursing mothers-teaching self-breast examination for their teenage daughters

O estudo tem como objetivo a transmissão do conhecimento de enfermeiras-mães passando suas experiências para suas filhas, tomando como ponto de referência o ensino do auto-exame das mamas. Como objetivo, analisa atitudes positivas transmitidas pelas enfermeiras-mães às suas filhas adolescentes ao ensinar-lhes a fazer o auto-exame das mamas; a investigação, de abordagem qualitativa, se apóia nas contribuições de MICHEL FOUCAULT sobre relações de poder e resistências à este discurso. Como considerações finais ainda um grande número de enfermeiras minimizam a importância do exame de mama deixando de ensinar às suas filhas. Poucas ensinam e acompanham.