A Participatory Framework for Plain Language Clinical Management Guideline Development.

BACKGROUND: Clinical management guidelines (CMGs) are decision support tools for patient care used by professionals, patients, and family caregivers. Since clinical experts develop numerous CMGs, their technical language hinders comprehension and access by nonmedical stakeholders. Additionally, the views of affected individuals and their families are often not incorporated into treatment guidelines. We developed an adequate methodology for addressing the needs and preferences of family and professional stakeholders regarding CMGs, a recently developed protocol for managing congenital disorders of glycosylation (CDG), a family of rare metabolic diseases. We used the CDG community and phosphomannomutase 2 (PMM2)-CDG CMGs as a pilot to test and implement our methodology. RESULTS: We listened to 89 PMM2-CDG families and 35 professional stakeholders and quantified their CMG-related needs and preferences through an electronic questionnaire. Most families and professionals rated CMGs as relevant (86.5% and 94.3%, respectively), and valuable (84.3% and 94.3%, respectively) in CDG management. The most identified challenges were the lack of CMG awareness (50.6% of families) and the lack of plain language CMG (39.3% of professionals). Concordantly, among families, the most suggested solution was involving them in CMG development (55.1%), while professionals proposed adapting CMGs to include plain language (71.4%). Based on these results, a participatory framework built upon health literacy principles was created to improve CMG comprehension and accessibility. The outputs are six complementary CMG-related resources differentially adapted to the CDG community's needs and preferences, with a plain language PMM2-CDG CMG as the primary outcome. Additionally, the participants established a distribution plan to ensure wider access to all resources. CONCLUSIONS: This empowering, people-centric methodology accelerates CMG development and accessibility to all stakeholders, ultimately improving the quality of life of individuals living with a specific condition and raising the possibility of application to other clinical guidelines.

Complementary feeding, consumption of industrialized foods and nutritional status of children under 3 years old in Pelotas, Rio Grande do Sul, Brazil, 2016: a descriptive study. / Alimentação complementar, consumo de alimentos industrializados e estado nutricional de crianças menores de 3 anos em Pelotas, Rio Grande do Sul, Brasil, 2016: um estudo descritivo.

OBJECTIVE: to verify how and when complementary feeding (CF) begins, its profile, consumption of processed foods and nutritional status of children aged 1-3 years. METHODS: children enrolled at public schools in Pelotas, RS, Brazil, were evaluated; length/height-for-age and weight-for-age scores, and body mass index (BMI)/age were used, and a structured questionnaire was administered to parents/caregivers; CF was considered early when started before the age of six months; data were presented in a descriptive way. RESULTS: 79 children were evaluated, of whom 13 were overweight and 6 obese; 11 had high weight-for-age; mean age for beginning CF was 5.3 months; when aged <6 months, 43% received gelatin, and 12.7% juice from cartons; when aged 6-24 months, 96.2% received filled biscuits and 91.1% salty snacks. CONCLUSION: CF and consumption of processed foods began early; obesity and overweight were more prevalent than malnutrition.

Alimentação complementar, consumo de alimentos industrializados e estado nutricional de crianças menores de 3 anos em Pelotas, Rio Grande do Sul, Brasil, 2016: um estudo descritivo / Alimentación complementaria, consumo de alimentos industrializados y estado nutricional de niños menores de 3 años en Pelotas, Rio Grande do Sul, Brasil, 2016: un estudio descriptivo / Complementary feeding, consumption of industrialized foods and nutritional status of children under 3 years old in Pelotas, Rio Grande do Sul, Brazil, 2016: a descriptive study

Objetivo: verificar como e quando a alimentação complementar (AC) se inicia, seu perfil, o consumo de industrializados e o estado nutricional de crianças de 1-3 anos. Métodos: foram avaliadas crianças matriculadas em escolas públicas de Pelotas, RS, Brasil; utilizaram-se os indicadores de estatura/idade, peso/idade e índice de massa corporal (IMC)/idade. Um questionário estruturado aplicado aos pais/cuidadores. A AC foi considerada precoce quando iniciada antes dos 6 meses. Os dados foram apresentados de forma descritiva. Resultados: 79 crianças foram avaliadas, 13 apresentaram sobrepeso e 6 obesidade; 11 acusaram peso elevado para a idade. A média para início da AC foi de 5,3 meses. Enquanto menores de 6 meses, 43% receberam gelatina e 12,7% suco de caixinha; quando na idade de 6-24 meses, 96,2% receberam biscoito recheado e 91,1% salgadinho. Conclusão: a AC e o consumo de alimentos industrializados iniciaram-se precocemente; obesidade e sobrepeso foram mais prevalentes que desnutrição.

Objetivo: evaluar como y cuando comienza la alimentación complementaria (AC), su perfil, consumo de alimentos procesados y estado nutricional de niños de 1-3 años. Métodos: se evaluaron niños matriculados en escuelas públicas de Pelotas, RS, Brasil; se utilizaron los índices de longitud/estatura/edad, peso/edad e índice de masa corporal (IMC)/edad, y un cuestionario estructurado aplicado a los padres/cuidadores; la AC fue considerada precoz cuando empezó antes de los seis meses; los datos se presentaron de modo descriptivo. Resultados: 79 niños fueron evaluados, 13 presentaron sobrepeso y 6 obesidad; 11 presentaron peso elevado para la edad; el promedio para el inicio de la AC fue de 5,3 meses; en cuanto a menores de 6 meses, 43% recibieron gelatina y 12,7% jugo de caja; a los 6-24 meses, 96,2% recibieron galletitas rellenas y 91,1% snacks salados. Conclusión: la AC y el consumo de alimentos industrializados comenzaron precozmente; obesidad y sobrepeso fueron más prevalentes que la desnutrición.

Objective: to verify how and when complementary feeding (CF) begins, its profile, consumption of processed foods and nutritional status of children aged 1-3 years. Methods: children enrolled at public schools in Pelotas, RS, Brazil, were evaluated; length/height-for-age and weight-for-age scores, and body mass index (BMI)/age were used, and a structured questionnaire was administered to parents/caregivers; CF was considered early when started before the age of six months; data were presented in a descriptive way. Results: 79 children were evaluated, of whom 13 were overweight and 6 obese; 11 had high weight-for-age; mean age for beginning CF was 5.3 months; when aged <6 months, 43% received gelatin, and 12.7% juice from cartons; when aged 6-24 months, 96.2% received filled biscuits and 91.1% salty snacks. Conclusion: CF and consumption of processed foods began early; obesity and overweight were more prevalent than malnutrition.

Mortality in Brazil according to gender perspective, years 2000 and 2010.

OBJECTIVE: The article assessed the overall mortality in Brazil in 2000 and 2010. METHODS: Data source was the Mortality Information System from Ministry of Health of Brazil. RESULTS: The data show the high rate of mortality among men compared to women between ages of 20 to 59 years and an expressive lower life expectancy by this population. The main groups of death were: external causes; diseases of the circulatory system, diseases of the digestive system, infectious and parasitic diseases, diseases of the respiratory system; mental and behavioral disorders; diseases of the nervous system; endocrine, nutritional and metabolic diseases; neoplasia and diseases of the genitourinary system. CONCLUSION: Unequal gender relations and distinct characteristics of exposure to risk factors can explain this mortality, highlighting the need to bring critical incorporation of relational gender perspective by public health policies.

Mortality in Brazil according to gender perspective, years 2000 and 2010 / Mortalidade no Brasil segundo perspectiva de gênero, anos 2000 e 2010

ABSTRACT: Objective: The article assessed the overall mortality in Brazil in 2000 and 2010. Methods: Data source was the Mortality Information System from Ministry of Health of Brazil. Results: The data show the high rate of mortality among men compared to women between ages of 20 to 59 years and an expressive lower life expectancy by this population. The main groups of death were: external causes; diseases of the circulatory system, diseases of the digestive system, infectious and parasitic diseases, diseases of the respiratory system; mental and behavioral disorders; diseases of the nervous system; endocrine, nutritional and metabolic diseases; neoplasia and diseases of the genitourinary system. Conclusion: Unequal gender relations and distinct characteristics of exposure to risk factors can explain this mortality, highlighting the need to bring critical incorporation of relational gender perspective by public health policies.

RESUMO: Objetivo: O artigo avaliou a mortalidade geral no Brasil em 2000 e 2010. Métodos: A fonte de dados foi o Sistema de Informação sobre Mortalidade do Ministério da Saúde. Resultados: Os dados evidenciam alto índice de mortalidade dos homens em relação às mulheres na faixa etária dos 20 aos 59 anos e uma expectativa de vida expressivamente menor por parte da população masculina. Os principais grupos de morte são: causas externas; doenças do aparelho circulatório; doenças do aparelho digestivo; doenças infecciosas e parasitárias; doenças do aparelho respiratório; transtornos mentais e comportamentais; doenças do sistema nervoso; doenças endócrinas, nutricionais e metabólicas; neoplasias e doenças do aparelho geniturinário. Conclusão. As relações desiguais de gênero e as características distintas de exposição a fatores de risco podem explicar esses índices de mortalidade, realçando a necessidade da incorporação crítica da perspectiva relacional de gênero por parte das políticas públicas de saúde.

Sweet taste of saccharin induces weight gain without increasing caloric intake, not related to insulin-resistance in Wistar rats.

In a previous study, we showed that saccharin can induce weight gain when compared with sucrose in Wistar rats despite similar total caloric intake. We now question whether it could be due to the sweet taste of saccharin per se. We also aimed to address if this weight gain is associated with insulin-resistance and to increases in gut peptides such as leptin and PYY in the fasting state. In a 14 week experiment, 16 male Wistar rats received either saccharin-sweetened yogurt or non-sweetened yogurt daily in addition to chow and water ad lib. We measured daily food intake and weight gain weekly. At the end of the experiment, we evaluated fasting leptin, glucose, insulin, PYY and determined insulin resistance through HOMA-IR. Cumulative weight gain and food intake were evaluated through linear mixed models. Results showed that saccharin induced greater weight gain when compared with non-sweetened control (p = 0.027) despite a similar total caloric intake. There were no differences in HOMA-IR, fasting leptin or PYY levels between groups. We conclude that saccharin sweet taste can induce mild weight gain in Wistar rats without increasing total caloric intake. This weight gain was not related with insulin-resistance nor changes in fasting leptin or PYY in Wistar rats.

Músculo adutor do polegar como ferramenta de avaliação nutricional em pacientes portadores do vírus da imunodeficiência humana / The thickness of the adductor pollicis muscle as a nutrition assessment tool in patients infected with the human immunodeficiency virus

Introdução: Desnutrição é frequente em pacientes portadores do HIV e está associada a pior prognóstico clínico. A espessura do músculo adutor do polegar (EMAP) é uma ferramenta de fácil e rápida aplicação, e parece estar correlacionada com medidas antropométricas. Objetivo: Avaliar a medida da EMAP para diagnosticar desnutrição em pacientes portadores do HIV. Métodos: Estudo transversal realizado em pacientes adultos portadores do HIV, atendidos no serviço de emergência de um hospital. Foram realizadas avaliação antropométrica (circunferência braquial, dobra tricipital, peso atual e altura), avaliação subjetiva global e medida da EMAP. Resultados: Foram incluídos 48 pacientes, com média de idade de 43 ± 11,16 anos, sendo 27 pacientes (56,25%) do sexo feminino. A média da EMAP foi de 9,57 ± 4,71 mm para mão direita e de 8,96 ± 3,52 mm para mão esquerda, sem diferença entre elas (p = 0,615). Coeficientes de correlação positivos (p < 0,01) foram observados somente para a espessura do músculo adutor do polegar esquerda em relação aos parâmetros antropométricos. A EMAP esquerda dos pacientes classificados como bem nutridos, através da avaliação subjetiva global, foi maior em comparação aos classificados como desnutridos (p = 0,02). Valores maiores que 11,13 mm para medida da EMAP direita e 10,08 mm para a esquerda apresentaram sensibilidade de 50% e especificidade de 93,1% e 79,3%, respectivamente, para identificação de eutrofia, segundo análise da curva ROC (AUC = 0,651 e 0,670, respectivamente). Conclusão: A EMAP esquerda pode ser utilizada para identificação do estado nutricional de pacientes portadores do HIV, atendidos em serviços de emergência (AU)

Introduction: Malnutrition is common in HIV-infected patients and is associated with a poor clinical prognosis. The thickness of the adductor pollicis muscle (TAPM) is a fast and easy tool and has a good correlation with anthropometrics measures. Objective: To evaluate the use of TAPM to diagnose malnutrition in HIV-infected patients. Methods: Cross-sectional study with adult HIV-infected patients treated in the emergency department of a hospital. Anthropometric assessment (measurement of arm circumference, triceps skinfold, weight and height), subjective global assessment, and measurement of the TAPM were performed. Results: Forty-eight patients were included. The mean age was 43 ± 11.16 years old and 27 patients (56.25%) were females. The mean TAPM was 9.57 ± 4.71 mm for the right hand and 8.96 ± 3.52 mm for the left hand, with no difference between them (p = 0.615). A positive correlation (p < 0.01) was observed only for the TAPM of the left hand in relation to the anthropometric parameters. The TAPM of the left hand of patients classified as well-nourished by subjective global assessment was higher compared with that of those classified as malnourished (p = 0.02). The ROC curve analysis showed a value of TAPM for the right hand of 11.13 mm and 10.08 mm for the left hand as a cutoff for excluding malnutrition diagnosis. Conclusion: The TAPM for the left hand can be used as anthropometric parameter in the identification of the nutritional status of HIV-infected patients treated in emergency services (AU)

Mortalidade de jovens brasileiros: perfil e tendências no período 2000-2012 / Mortalidad de jóvenes brasileños: perfil y tendencias en el periodo 2000-2012 / Youth mortality in Brazil: profile and trends in the period 2000-2012

OBJETIVO: descrever o perfil e analisar as tendências da mortalidade de jovens (15 a 29 anos de idade) no Brasil, no período 2000-2012. MÉTODOS: estudo ecológico descritivo e de séries temporais, com dados do Sistema de Informações sobre Mortalidade; utilizou-se a regressão de Prais-Winsten para análise de tendências nas taxas de mortalidade. RESULTADOS: registraram-se 958.224 óbitos de jovens no período 2000-2012, 79,6% do sexo masculino; as taxas de mortalidade geral corrigidas foram de 1,6 e 1,5 por 1000 jovens em 2000 e 2012, respectivamente, com tendências estacionárias (-0,34%; intervalo de confiança de 95% [IC95%] -1,05;0,37); observou-se tendência crescente entre homens nas regiões Nordeste (3,08%; IC95% 2,56;3,61) e Sul (0,88%; IC95% 0,09;1,66); em 2012, as causas externas corresponderam a 71,4% do total dos óbitos, 79,2% entre homens e 38,5% entre mulheres. CONCLUSÃO: a mortalidade de jovens foi elevada e estável; causas externas foram as principais causas de morte, em ambos os sexos.

OBJETIVO: describir y analizar las tendencias en mortalidad de jóvenes (15 a 29 años) en Brasil, en el período 2000-2012. MÉTODOS: estudio descriptivo de series temporales, con datos del Sistema de Información de Mortalidad; se utilizó la regresión Prais-Winsten para el análisis de las tendencias en las tasas de mortalidad. RESULTADOS: se registraron 958.224 muertes de jóvenes en el período 2000-2012, 79.6% eran de sexo masculino; las tasas de mortalidad general corregidas fueron de 1.6 y 1.5 por cada 1000 jóvenes en 2000 y 2012, respectivamente, con tendencias estacionarias (-0,34%; IC95% -1,05;0,37); observamos una tendencia ascendente entre hombres en las regiones Nordeste (3,08%; IC95% 2,56;3,61) y Sur (0,88%; IC95% 0,09;1,66); en 2012, las causas externas representaron el 71.4% del total de muertes, 79.2% entre los hombres y 38,5% entre las mujeres. CONCLUSIÓN: la mortalidad de jóvenes fue alta y estable; las causas externas fueron las principales causas de muerte entre jóvenes de ambos sexos.

OBJECTIVE: to describe and analyze youth (15-29 years of age) mortality trends in Brazil between 2000 and 2012. METHODS: this was a descriptive and time series study conducted with Mortality Information System data; Prais-Winsten linear regression was used to analyze mortality rate trends. RESULTS: 958,224 deaths were registered in the period, 79.6% were male; the overall corrected mortality rates were 1.6 and 1.5 per 1,000 inhabitants in 2000 and 2012, respectively; overall mortality rates showed stationary trends in the period (-0.34%; 95%CI -1.05;0.37); increasing trends among men were observed in the Northeast (3.08%; 95%CI 2.56;3.61) and Southern (0.88%; 95%CI 0.09;1.66) regions; in 2012, external causes accounted for 71.4% of deaths, 79.2% among men and 38.5% among women. CONCLUSION: youth mortality rates were high and stable during the study period; external causes were presented as the main causes of death, in both sexes.

[Treatment of childhood injuries and violence in public emergency services]. / Atendimentos por acidentes e violências na infância em serviços de emergências públicas.

This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health's system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child's home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims.

Atendimentos por acidentes e violências na infância em serviços de emergências públicas / Treatment of childhood injuries and violence in public emergency services / Atención por accidentes y violencia contra la infancia en servicios públicos de urgencias

O objetivo deste artigo foi analisar o perfil dos atendimentos de emergência por acidentes e violências envolvendo crianças menores de 10 anos no Brasil no ano de 2011. Foi realizado estudo transversal, descritivo, em 71 serviços de urgência e emergência no âmbito do SUS, localizados no Distrito Federal e em 24 capitais brasileiras. Os dados foram obtidos no sistema de serviços sentinelas de Vigilância de Violências e Acidentes (VIVA Inquérito), do Ministério da Saúde. A maior proporção das lesões (67,4%) ocorreu no ambiente domiciliar. Dentre as injúrias não intencionais, as quedas foram a ocorrência mais frequente (52,4%), seguidas de choque contra objetos/pessoas (21,8%) e lesões no trânsito (10,9%), destacando-se as vítimas na condição de passageiros, e dentre os meios de locomoção da vítima são destaque as bicicletas. As injúrias não intencionais na grande maioria são evitáveis e devem ser adotadas medidas educativas, em especial junto aos pais, educadores, comunidade, profissionais de saúde e educação, alertando para os riscos e adoção de comportamentos seguros em relação ao ambiente doméstico, escola e de lazer. As violências são objeto de notificação obrigatória, e as ações de proteção às vítimas devem ser instituídas prontamente.

This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health’s system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child’s home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims.

El objetivo de este estudio fue analizar el perfil de las consultas de urgencia por causas externas que involucran a niños menores de 10 años en Brasil, 2011. Este estudio transversal, analizando datos de la Violencia de Vigilancia y Accidentes (VIVA), encuesta realizada en 71 servicios de urgencias y emergencias en el Sistema Único de Salud (SUS), con sede en el Distrito Federal y 24 capitales brasileñas. Como resultado de ello el 67,4 % se produjo en el entorno del hogar. Las caídas fueron las más frecuentes (52,4 %), seguidas por la colisión con objetos/personas (21,8%) y las lesiones de tráfico (10,9%). Las lesiones no intencionales en la gran mayoría son evitables y se producen en el hogar y se pueden prevenir. La violencia contra los niños más pequeños son más frecuentemente cometidas por miembros de la familia y están sujetas a notificación obligatoria, destinada a la implantación de medidas de protección a las víctimas.

Emergency room visits due to external causes and alcohol consumption--Capitals and the Federal District, Brazil, 2011.

The study objective was to describe the profile and factors related to alcohol consumption among emergency room visits by external causes. It is a cross-sectional study with data from the Survey of Violence and Injuries in Emergency between September and October 2011, in 24 state capitals and the Federal District. Statistical analysis were performed for all cases treated in selected services, comparing the characteristics of the victims, according to the statement of alcohol consumption. 33,289 visits to emergency rooms by external causes in the population above 18 years of age were included. The prevalence of self-reported statement of alcohol consumption among these services was 14.9% for the 24 capitals and the Federal District, and was significantly higher among visits by violent causes than by accidents. For both accidents and violence the associated causes were victims male, black/brown, less educated, members of specific populations, occurrences on public roads. The results support global discussions on the importance of establishing policies and legal measures to restrict the consumption of alcohol and vehicular direction, control advertising of alcoholic beverages, and laws normalizing the functioning of sales points of alcoholic beverages.

Emergency room visits due to external causes and alcohol consumption - Capitals and the Federal District, Brazil, 2011 / Atendimentos de emergência por causas externas e consumo de bebida alcoólica - Capitais e Distrito Federal, Brasil, 2011

The study objective was to describe the profile and factors related to alcohol consumption among emergency room visits by external causes. It is a cross-sectional study with data from the Survey of Violence and Injuries in Emergency between September and October 2011, in 24 state capitals and the Federal District. Statistical analysis were performed for all cases treated in selected services, comparing the characteristics of the victims, according to the statement of alcohol consumption. 33,289 visits to emergency rooms by external causes in the population above 18 years of age were included. The prevalence of self-reported statement of alcohol consumption among these services was 14.9% for the 24 capitals and the Federal District, and was significantly higher among visits by violent causes than by accidents. For both accidents and violence the associated causes were victims male, black/brown, less educated, members of specific populations, occurrences on public roads. The results support global discussions on the importance of establishing policies and legal measures to restrict the consumption of alcohol and vehicular direction, control advertising of alcoholic beverages, and laws normalizing the functioning of sales points of alcoholic beverages.

Para descrever o perfil e os fatores relacionados ao consumo de bebida alcoólica entre atendimentos de emergência por causas externas, desenvolveu-se estudo transversal com dados obtidos do Inquérito de Violências e Acidentes em Serviços de Urgência e Emergência, em 24 capitais e no Distrito Federal, em 2011. Análises estatísticas foram realizadas para o conjunto de atendimentos, comparando-se as características das vítimas, segundo a declaração de consumo de álcool. Foram incluídos 33.289 atendimentos por causas externas na população ≥ 18 anos de idade. A prevalência da declaração autorreferida de consumo de álcool dentre esses atendimentos foi de 14,9% para as 24 capitais e Distrito Federal, sendo significativamente maior entre os atendimentos por causas violentasem relação aos acidentes. Tanto para os acidentes quanto para as violências as causas associadas foram: vítimas do sexo masculino, pretos/pardos, menor nível de escolaridade, membros de populações específicas, ocorrências em via pública. Os resultados apoiam discussões globais sobre a importância de se estabelecer políticas e medidas legais de restrição no consumo de álcool e direção veicular, controle de propaganda de bebidas alcoólicas e leis normatizando o funcionamento de postos de venda de bebidas alcoólicas.

Gender inequalities in external cause mortality in Brazil, 2010.

OBJECTIVE: To estimate mortality rate by external causes in Brazil. METHODS: Mortality national 2010's data corrected by underreport and adjusted by direct method were evaluated by sex according to age, region of residence, race/skin color, education and conjugal situation. RESULTS: The standardized mortality coefficient of external causes is higher among men (178 per thousand inhabitants) than among women (24 per thousand inhabitants), being higher among young men (20 to 29 years old) in all regions and decreasing with aging. The mortality rate reaches almost nine times higher among men comparably to women, being higher in North and Northeast regions. The death incidence by external causes is higher among men (36.4%) than among women (10.9%), meaning 170% more risk for men. The risk is also higher among the youngest: 6.00 for men and 7.36 for women. The main kind of death by external causes among men is aggressions, followed by transport accidents, the opposite of women. CONCLUSIONS: Besides sex, age is the more important predictive factor of precocious death by external causes, pointing the need of many and various sectors in order to construct new identities of non violence.

Gender inequalities in external cause mortality in Brazil, 2010 / Desigualdades de gênero na mortalidade por causas externas no Brasil, 2010

Objective: To estimate mortality rate by external causes in Brazil. Methods: Mortality national 2010's data corrected by underreport and adjusted by direct method were evaluated by sex according to age, region of residence, race/skin color, education and conjugal situation. Results: The standardized mortality coefficient of external causes is higher among men (178 per thousand inhabitants) than among women (24 per thousand inhabitants), being higher among young men (20 to 29 years old) in all regions and decreasing with aging. The mortality rate reaches almost nine times higher among men comparably to women, being higher in North and Northeast regions. The death incidence by external causes is higher among men (36.4%) than among women (10.9%), meaning 170% more risk for men. The risk is also higher among the youngest: 6.00 for men and 7.36 for women. The main kind of death by external causes among men is aggressions, followed by transport accidents, the opposite of women. Conclusions: Besides sex, age is the more important predictive factor of precocious death by external causes, pointing the need of many and various sectors in order to construct new identities of non violence. .

O artigo tem por objetivo estimar taxas de mortalidade por causas externas no Brasil. Dados de 2010 corrigidos para sub-registro e ajustados por método direto foram avaliados por sexo, segundo idade, região de residência, raça/cor, escolaridade e estado conjugal, usando regressão de Poisson. O coeficiente padronizado de mortalidade por causas externas é muito maior entre homens (178 por cem mil habitantes) do que entre mulheres (24 por cem mil habitantes), sendo maiores entre homens mais jovens (20 a 29 anos) em todas as regiões e diminuindo com a idade. A razão de mortalidade por causas externas chega a ser quase nove vezes maior entre homens comparativamente às mulheres, com valores maiores nas regiões Norte e Nordeste. A incidência é muito maior entre homens (36,4%) do que entre mulheres (10,9%), com risco 170% maior entre homens. O risco também é maior entre os mais jovens: 6,00 para homens e 7,36 para mulheres. Os principais tipos de óbitos por causas externas entre homens são agressões, seguidas por acidentes de transporte terrestre, inverso das mulheres. Além do sexo, a idade foi o fator preditivo mais importante da mortalidade precoce por causas externas, indicando a necessidade de ações multissetoriais na construção de novas identidades de não violência.

Violência contra a mulher: análise das notificações realizadas no setor saúde: Brasil, 2011 / Violence against women: analysis of the reports made in the health sector: Brazil, 2011

A violência contra a mulher é considerada uma questão complexa e multifacetada, que viola os direitos humanos, provocando perdas significativas na saúde física e mental das vítimas. O presente artigo é um estudo descritivo dos dados de notificação de violência doméstica, sexual e/ou outras violências contra mulheres durante o ano de 2011, em unidades de saúde. Foram calculadas a Razão de Prevalência das variáveis selecionadas por faixa etária(20 a 39 anos e 40 a 59 anos) e a análise segundo o tipo de violência praticada. A notificação da violência doméstica ainda é um processo recente, estando em implantação nas unidades da Federação. Os dados aqui analisados revelam o perfil da vítima de violência como sendo mulher adulta jovem (20 a 39 anos), e o agressor predominantemente do sexo masculino, na maioria das vezes, cônjuge, ex-cônjuge, namorado ou ex-namorado. O relato de uso de álcool pelo agressor ocorreu em 51,1% dos casos, e a violência foi de repetição em 54,6% dos casos. A violência mais praticada é a física, por meio de força corporal, seguida da violência psicológica/moral, sexual e tortura. A raça/cor predominante é a parda/preta para a maioria das violências sofridas, exceto para violência psicológica, em que não houve diferença segundo raça/cor. A maioria dos casos evoluiu para alta, enquanto 16,0% demandaram internação. Concluiu-se que a violência contra as mulheres é, na maioria das vezes, praticada pelos parceiros íntimos, e a notificação é um importante instrumento visando ao enfrentamento desses casos, bem como à desigualdade de gênero.

Violence against women is considered a complex and multifaceted issue that violates human rights, causing significant losses in both physical and mental health of victims. This article is a descriptive study of data from reports of domestic, sexual and/or other violence against women during the year 2011, in health care units. Prevalence Ratio were calculated forthe selected age group (20-39 years and 40-59 years), and analyzed according to the type of violence. The reporting of domestic violence is still a new process, still under construction in the Federal States. The data analyzed here reveal the profile of victims of violence against women as a young adult (20-39 years), predominantly male aggressor, most times the spouse, former spouse, boyfriend and ex-boyfriend. The reported use of alcohol by the perpetrator occurred in 51.1% of the cases and violence was repeated in 54.6% of the cases. The most practiced violence is physical, by bodily force, then psychological, moral/sexual violence, and sexual torture. The predominant color is black/brown race for most of the violence suffered, except the psychological violence, where there was no difference regarding race/color. In most cases resulted in discharge, whereas 16.0% required hospitalization. Violence against women is most often practiced by intimate partners and reporting is an important tool aimed at addressing these cases, to eliminate gender inequality.

[Men's health care in the scope of the Family Health Strategy]. / Atenção à saúde dos homens no âmbito da Estratégia Saúde da Família.

The National Policy of Comprehensive Care for Men's Health created the guidelines for the strategies and actions based on comprehensive care, seeking the promotion of health and the prevention of disease duly focused as core issues of the Family Health Strategy (FHS). This article describes the specificities of men's health care in the context of the FHS from the standpoint of the manager, the demands of the men linked to the health units assessed and the practices adopted by the teams. Men's health care was evaluated by interviews with 43 FHS team managers (FHST), systematically selected considering the geographical region, city size and FHS coverage; and by interviewing 86 adult men of the respective FHS coverage area. It was seen that the strategy of the FHST is to address the health-disease process in the family and environmental context. However, in men's health there are still several gaps, from the adaptation of the structure of primary health care through to the motivation and development of actions against the most common health problems of this population group. This situation sometimes limits men's access to health services thereby negating the goal of the Policy.

Atencao a saude dos homens no ambito da Estrategia Saude da Familia / Men's health care in the scope of the Family Health Strategy

A Política Nacional de Atenção Integral à Saúde do Homem orientou a formulação de estratégias e ações fundamentando-se na atenção integral, com vistas à promoção da saúde e à prevenção de agravos, tendo sido focalizadas como eixos fundamentais na Estratégia Saúde da Família (ESF). Este artigo teve por objetivo descrever as especificidades da atenção à saúde dos homens no âmbito da ESF, conforme a visão do gestor, a demanda dos homens adstritos às unidades avaliadas e as práticas desenvolvidas pelas equipes. A atenção à saúde do homem foi avaliada por meio de entrevista a 43 gestores de equipes da ESF (EqSF), sorteadas de forma sistemática contemplando as diferentes regiões, porte dos municípios e cobertura da ESF; e pela entrevista de 86 homens adultos, das respectivas áreas de cobertura da ESF. Observou-se que as EqSF têm como estratégia abordar o processo saúde/doença no contexto familiar e ambiental, no entanto, no que se refere à saúde do homem, ainda há lacunas, desde a adequação da estrutura para o atendimento na atenção básica à motivação e desenvolvimento de ações de promoção contra os agravos mais frequentes nesta população, o que, por vezes, têm dificultado o acesso à saúde, por parte da população masculina, distanciando o alcance do objetivo da Política.

The National Policy of Comprehensive Care for Men's Health created the guidelines for the strategies and actions based on comprehensive care, seeking the promotion of health and the prevention of disease duly focused as core issues of the Family Health Strategy (FHS). This article describes the specificities of men's health care in the context of the FHS from the standpoint of the manager, the demands of the men linked to the health units assessed and the practices adopted by the teams. Men's health care was evaluated by interviews with 43 FHS team managers (FHST), systematically selected considering the geographical region, city size and FHS coverage; and by interviewing 86 adult men of the respective FHS coverage area. It was seen that the strategy of the FHST is to address the health-disease process in the family and environmental context. However, in men's health there are still several gaps, from the adaptation of the structure of primary health care through to the motivation and development of actions against the most common health problems of this population group. This situation sometimes limits men's access to health services thereby negating the goal of the Policy.

Factors associated with exclusive breastfeeding in the Legal Amazon and Northeast regions, Brazil, 2010 / Fatores associados ao Aleitamento Materno Exclusivo na Amazônia Legal e no Nordeste, Brasil, 2010

[{"text": "OBJECTIVE: The objective of this study was to identify the factors associated with exclusive breastfeeding in children aged less than six months from the Brazilian Legal Amazon and Northeast regions. METHODS: The study used data from a survey that assessed prenatal and infant (<1 year) care in 2010. Sociodemographic, prenatal, delivery, and puerperium care factors with p<0.05 in multivariate analysis were associated with exclusive breastfeeding. RESULTS: For both regions, the prevalence of exclusive breastfeeding decreased with age, which was the main variable associated with early weaning. In the Legal Amazon, exclusive breastfeeding prevailed among: mothers aged 35 years or more; mothers living in state capitals; and mothers who breastfed on the first hour of life. In the Northeast, the probability of exclusive breastfeeding was greater for mothers aged 35 years or more. CONCLUSION: The factors associated with exclusive breastfeeding were child's and mother's age in both regions; and residence location and breastfeeding in the first hour of life in the Legal Amazon, suggesting the need of differentiated strategies for the promotion of exclusive breastfeeding. .", "_i": "en"}, {"text": "OBJETIVO: O objetivo foi identificar fatores associados ao aleitamento materno exclusivo em crianças menores de seis meses de idade, residentes na Amazônia Legal e no Nordeste do Brasil, com base nos dados da pesquisa de avaliação da atenção ao pré-natal e aos menores de um ano de idade em 2010. MÉTODOS: Consideraram-se fatores associadas ao aleitamento exclusivo as variáveis sociodemográficos e de assistência ao pré-natal, parto e puerpério que mantiveram p<0,05 em análise multivariada. RESULTADOS: Em ambas as regiões, a prevalência de aleitamento materno exclusivo apresentou declínio com aumento da idade da criança, que se configurou na principal variável associada ao desmame precoce. Na Amazônia Legal, a probabilidade de aleitamento materno exclusivo foi maior para: mães com 35 ou mais anos de idade, mães que residiam nas capitais dos estados e mães que amamentaram na primeira hora de vida da criança. No Nordeste, a probabilidade de aleitamento materno exclusivo também foi maior para mães com 35 ou mais anos de idade. CONCLUSÃO: Os fatores associados ao aleitamento materno exclusivo foram idade da criança e idade da mãe nas duas regiões, localização de moradia e mamada na primeira hora na Amazônia Legal, o que sugere a necessidade de estratégias diferenciadas para a promoção do aleitamento materno. .", "_i": "pt"}]

Perfil das vítimas de violências e acidentes atendidas em serviços de urgência e emergência do Sistema Único de Saúde em capitais brasileiras – 2011 / Profile of victims of violence and accidents treated in public emergency departments in Brazilian state capital cities – 2011

Objetivo: descrever o perfil das vítimas de violências e acidentes atendidas em serviços de emergência do Sistema Único de Saúde em 2011. Métodos: estudo transversal com vítimas de violências e acidentes atendidas em 71 serviços de urgência, situados em 24 capitais brasileiras e no Distrito Federal; os dados foram coletados em turnos sorteados de 12 horas, durante 30 dias consecutivos. Resultados: verificou-se maior proporção dos acidentes (90,4 por cento) em relação às violências (9,6 por cento); predominaram as vítimas do sexo masculino, da faixa etária de 20 a 39 anos, com escolaridade de 9 a 11 anos de estudo, e aqueles de raça/cor parda. Conclusão: pelo perfil dos atendimentos nos serviços de emergência do país, reconhece-se a magnitude das violências e dos acidentes como importante problema de Saúde Pública, identificando-se as vítimas mais vulneráveis.

Objective: to describe the profile of victims of violence and accidents treated in Public Emergency Departments, in 2011. Methods: cross-sectional study with victims treated in 71 emergency departments in 24 Brazilian state capitals and the Federal District. Data were collected from randomly selected 12-hour shifts for 30 consecutive days. Results: the proportion of accidents (90.4 per cent) was higher than that of violence (9.6 per cent). Predominance of mulatto male victims, aged 20 to 39, with 9-11 years of schooling. Conclusion: the profile of patients attended at Public Emergency Departments demonstrates the magnitude of violence and accidents as a major public health problem, as well as identifying the most vulnerable victims.

Saccharin and aspartame, compared with sucrose, induce greater weight gain in adult Wistar rats, at similar total caloric intake levels.

It has been suggested that the use of nonnutritive sweeteners (NNSs) can lead to weight gain, but evidence regarding their real effect in body weight and satiety is still inconclusive. Using a rat model, the present study compares the effect of saccharin and aspartame to sucrose in body weight gain and in caloric intake. Twenty-nine male Wistar rats received plain yogurt sweetened with 20% sucrose, 0.3% sodium saccharin or 0.4% aspartame, in addition to chow and water ad libitum, while physical activity was restrained. Measurements of cumulative body weight gain, total caloric intake, caloric intake of chow and caloric intake of sweetened yogurt were performed weekly for 12 weeks. Results showed that addition of either saccharin or aspartame to yogurt resulted in increased weight gain compared to addition of sucrose, however total caloric intake was similar among groups. In conclusion, greater weight gain was promoted by the use of saccharin or aspartame, compared with sucrose, and this weight gain was unrelated to caloric intake. We speculate that a decrease in energy expenditure or increase in fluid retention might be involved.