Recovery of Proteases and Protease Inhibitors from Ganoderma spp. Cultivated in Amazonian Lignocellulose Wastes.

BACKGROUND: Ganoderma spp. are a great source of bioactive molecules. The production and recovery of bioactive molecules vary according to strain, growth substrate, and extraction solution. Variations in protease and their inhibitors in basidiomata from a commercial strain (G. lingzhi) and an Amazonian isolate (Ganoderma sp.) cultivated in Amazonian lignocellulosic wastes and extracted with different solutions are plausible and were investigated in our study. METHODS: Basidiomata from cultivation in substrates based on açaí seed, guaruba-cedro sawdust and three lots of marupá sawdust were submitted to extraction in water, Tris-HCl, and sodium phosphate. Protein content, proteases, and protease inhibitors were estimated through different assays. The samples were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Fourier transform infrared spectroscopy with attenuated total reflectance (FTIR-ATR). RESULTS: Tris-HCl provided higher protein extraction from Ganoderma sp. and higher caseinolytic, gelatinolytic, and fibrinolytic activity for G. lingzhi cultivated in açaí. Water extracts of Ganoderma sp., in general, exhibited higher trypsin and papain inhibitor activities compared to G. lingzhi. Extracts in Tris-HCl and sodium phosphate showed more intense protein bands in SDS-- PAGE, highlighting bands of molecular weights around 100, 50, and 30 kDa. FTIR spectra showed patterns for proteins in all extracts, with variation in transmittance according to substrate and extractor. CONCLUSION: Water extract from Amazonian Ganoderma sp. cultivated in marupá wastes are promising as a source of protease inhibitors, while the Tris-HCL extract of G. lingzhi from açaí cultivation stands out as a source of proteases with fibrinolytic, caseinolytic, and gelatinolytic activities.

Social vulnerability and cardiovascular risk factors in adolescents.

BACKGROUND: Social vulnerability can influence in the development of cardiovascular risk factors in adolescents (CRF). For this reason, the objective of our study was to evaluate the presence of CRF in adolescents, according to social vulnerability. METHODS: This is a cross-sectional study with 517 adolescents of both sexes, from 10 to 19 years of age, classified into 2 groups by social vulnerability, according to socioeconomic characteristics collected by means of questionnaires, where adolescents who did not have access to drinking water, sewage network, and adequate per capita income were classified as vulnerable. Anthropometric, biochemical, and blood pressure data were evaluated. Level of physical activity was assessed by an adapted questionnaire, and food intake was assessed by a 3-day food record. Independent T, Mann-Whitney, and χ2 tests were used, according to the scale of measurement of the variables, on the statistical program SPSS, version 25, at a significance level of 5%. RESULTS: Adolescents had median age of 14 (11 to 15) years; 58.4% were female; 32.4% were overweight, and 52.4% were physically inactive in leisure. Mean consumption of ultra-processed food was observed to account for 45.0% of calorie intake. Adolescents classified as vulnerable had lower weight, body mass index, waist circumference, hip circumference, and neck circumference when compared to non-vulnerable adolescents. Both groups had cholesterol concentrations above the normal level. Non-vulnerable adolescents had higher triglyceride concentrations, higher alcohol consumption, and lower fiber intake compared to vulnerable adolescents. CONCLUSIONS: Adolescents with social vulnerability are less likely to have cardiovascular risk factors.

Ophthalmic Manifestations Among Patients Surviving COVID-19.

Background and Aim: To identify ocular findings related to SARS-CoV-2 infection in patients after the resolution of COVID-19 using complete ocular examinations and optical coherence tomography (OCT). Methods: In this cross-sectional study, conducted from May 30 to October 30, 2020, patients who recovered from various stages COVID-19 underwent eye examination and multimodal retinal imaging (Retinographies and Spectral-OCT). Results: We included 50 patients, 29 (58%) males, median age of 46.5 [standard deviation 15.8]. Of these, 42% (21) had mild, 18% (9) had severe and 40% (20) had critical disease. The median time interquartile range (IQR) between symptom onset and ocular examination was 55 days [IQR 39-71]. Seven patients (14%) reported ophthalmic symptoms, transitory low visual acuity (6%) and retroocular pain (8%). On OCT, one patient without comorbidities had sectoral retinal pallor suggestive of acute retinal ischaemia and oedema of the retina's inner layers and atrophy. All findings progressively and spontaneously improved months after resolution of COVID-19. Conclusion: Patients with COVID-19 present findings compatible with the general population depending on age and comorbidities; nevertheless, acute retinal findings associated with the disease may be present, such as caused either by the direct effects of retinal SARS-CoV-2 infection, by indirect effects of the cytokine storm or by the pro-thrombotic state associated with COVID-19. Therefore, retinal involvement in patients with COVID-19 remains subject to considerable discussion and study.

Effect of Hypoenergetic Diet Combined With Pumpkin Seed Flour Consumption on Obese Women

Abstract Background Dietary treatment containing fiber-rich foods may contribute to lowering weight in obese women. Objective To investigate the effect of a hypoenergetic diet combined with pumpkin seed flour (PSF) consumption on diet quality, anthropometric indices, and glucose and lipid metabolism in obese women. Methods We conducted a randomized, double-blind, placebo-controlled, 90-day clinical trial with obese women, distributed into the following two groups: hypoenergetic diet + placebo (PG) and hypoenergetic diet + pumpkin seed flour (PSFG). A total of 100 participants were included in the PSFG (n = 47) and PG (n = 53). We evaluated neck circumference (NC); waist to height ratio; conicity index; fat mass (FM); lipid profile; blood concentrations of glucose and insulin; homeostatic model assessment for insulin resistance (HOMA-IR); quantitative insulin sensitivity check index (QUICKI); and blood pressure at baseline, 30, 60, and 90 days. Dietary analysis was determined by differences between diet quality indices before and after prescribing the experimental diet. Chi-squared, Student's t-tests and analysis for repeated measures were used, and values were considered significant at p < 0.05. Results The dietary pattern improved after 90 days in both groups. The PSFG presented lower NC (p < 0.001), FM (p = 0.010), triglycerides (TG) (p = 0.025), insulin (p = 0.003), and HOMA-IR (p = 0.018). The PG presented a lower diastolic blood pressure (p = 0.004) and low-density lipoprotein cholesterol (LDL-c) (p = 0.056). Conclusion A hypoenergetic diet combined with PSF consumption contributes to lowering NC, FM, HOMA-IR, TG, and insulin concentrations.

Cytotoxic and mutagenic effects of the food additive tartrazine on eukaryotic cells.

BACKGROUND: Among the food additives used in the food industry, food dyes are considered the most toxic. For instance, tartrazine (TRZ) is a food colorant commercially available with conflicting data regarding its cytotoxic, genotoxic, and mutagenic effects. Therefore, this study aimed to evaluate the cytotoxic and mutagenic potential of TRZ using different eukaryotic cells (in vitro). METHODS: This study employed 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT), brine shrimp lethality, Allium cepa and Saccharomyces cerevisiae tests. Different concentrations of TRZ and different exposure times were used in this study. RESULTS: The results demonstrate that TRZ induced a concentration-dependent toxic effect on the test systems. It also exerted cytotoxicity in fibroblasts and human gastric cells. In addition, TRZ showed mutagenic effects on the A. cepa test system. However, its toxicogenic effects may not relate to the oxidizing activity, which was confirmed by the S. cerevisiae test model. CONCLUSION: Taken together, TRZ exerted toxicogenic effects on the test systems. Therefore, it may be harmful to health, especially its prolonged use may trigger carcinogenesis.

Extracts from jatobá (Hymenaea courbaril L.) peel and seeds: Antioxidant and antimicrobial activities and synergistic effect of extract combinations.

In this work, the in vitro antioxidant and antimicrobial potential of hydroalcoholic extracts from the peel and seeds of jatobá fruit and the synergistic effect of their combination against pathogenic bacteria were evaluated. The 80% ethanol fruit seed extract showed a greater antioxidant potential and higher total phenolic content (5135.61 mg GAE 100 g dry residue-1) than the maximum value obtained from peel extract using 50% ethanol (2614.74 1 mg GAE 100 g dry residue-1). Moreover, 70% and 80% ethanol seed extracts inhibited most bacteria, especially Pseudomonas aeruginosa, with the lowest values of minimum inhibitory concentration (1.0 and 8.0 mg mL-1), when compared with extracts from peel. Combining the 70% ethanol extracts from peels and seeds reduced their inhibitory concentration by about 4 to 32 times against Bacillus cereus, Bacillus subtilis, Enterococcus faecalis, Staphylococcus aureus, P. aeruginosa and Salmonella enteritidis, when compared to each extract alone. Extracts from the peel and seeds of the jatobá fruit showed potential as natural antioxidants and antimicrobials.

Intoxicações por alimentos e bebidas e ocorrência das doenças de transmissão hídrica e alimentar no Brasil / Food and drink poisoning and occurrence of waterborne and foodborne diseases in Brazil

O presente estudo teve como objetivo fazer um levantamento do perfil epidemiológico das notificações por intoxicação e das doenças de transmissão hídrica e alimentar (DTHA) no Brasil, entre 2016 a 2021. Trata-se de um estudo documental com análises quantitativas e descritivas dos dados coletados no Sistema de Informação de Agravos de Notificação - SINAN e Ministério da Saúde. Os resultados mostraram uma diminuição no número de notificações ao longo dos anos, apesar do grande número encontrado em 2017 e 2018. O perfil dos intoxicados entre 2016-2021, foi de indivíduos do sexo masculino (58,3%), com faixa etária 20-59 anos (60,5%) e cor parda (46,6%). Já quanto aos principais agentes etiológicos relacionados aos surtos de DTHA no período analisado, destacou-se a bactéria Escherichia coli (7,9%). A investigação dos dados disponibilizados acerca das intoxicações e DTHA se faz necessária para verificação e monitorização sobre os casos que ocorrem anualmente no Brasil e no mundo.

The present study aimed to investigate the epidemiological profile of notifications for intoxication and water and foodborne diseases (WFD) in Brazil, between 2016 and 2021. This was a documentary, quantitative, descriptive study with data collected from the Notifiable Diseases Information System - SINAN and Ministry of Health. The results showed a decrease in the number of notifications over the years, despite the high number found in 2017 and 2018. The profile of people intoxicated between 2016 and 2021 was male (58.3%), aged 20-59 years (60.5%) and brown (46.6%). As for the main etiological agents related to WFD outbreaks in the analyzed period, the bacterium Escherichia coli (7.9%) stood out. The investigation of available data on intoxications and WFD is necessary for verification and monitoring of cases that occur annually in Brazil and in the world.

Physiological quality of crambe seeds (Crambe abyssinica Hochst, Brassicaceae) produced under different water regimes / Qualidade fisiológica de sementes de crambe (Crambe abyssinica Hochst, Brassicaceae) produzidas sob diferentes regimes hídricos

The physiological quality of the seeds is an aspect of great relevance for the establishment of a culture. However, plant management conditions during seed production can influence its quality. Given the above, the objective was to evaluate the physiological quality of crambe seeds from plants submitted to different water regimes. The experimental design used was in randomized blocks, composed of five water conditions in the soil, based on field capacity (100, 85, 70, 55 and 40%) that consisted of treatments, with four replications. After harvesting, the seeds were sent to the seed laboratory, processed and then evaluated for water content, germination and vigor. Crambe plants grown in soil water conditions between 59 to 61% of the field capacity produce seeds of better physiological quality, demonstrated by the performance in the germination and vigor tests.

A qualidade fisiológica das sementes é um aspecto de grande relevância para o estabelecimento de uma cultura. No entanto, as condições de manejo das plantas durante a produção de sementes podem influenciar na sua qualidade. Diante do exposto, objetivou-se avaliar a qualidade fisiológica de sementes de crambe oriundas de plantas submetidas a diferentes regimes hídricos. O delineamento experimental utilizado foi em blocos casualizados, composto por cinco condições de água no solo, baseadas na capacidade de campo (100, 85, 70, 55 e 40%) que consistiram nos tratamentos, com quatro repetições. Após a colheita, as sementes foram encaminhadas ao laboratório de sementes, beneficiadas e em seguida, avaliadas quanto ao teor de água, germinação e vigor. Plantas de crambe cultivadas em condições de água no solo entre 59 a 61% da capacidade de campo produzem sementes de melhor qualidade fisiológica, demonstrado pelo desempenho nos testes de germinação e vigor.

Retinal findings in hospitalised patients with severe COVID-19.

AIM: To identify retinal findings using dilated eye examination, which are possibly related to SARS-CoV-2 infection in hospitalised patients with confirmed severe COVID-19. METHODS: In this cross-sectional study, hospitalised patients with confirmed severe COVID-19 in a single referral centre for the treatment of COVID-19, in Santo André, São Paulo Metropolitan Area, Brazil, underwent dilated eye examination of both eyes performed by a retina specialist. Findings were recorded using a portable digital fundus camera. Retinographies were analysed by two retina specialists. Medical records were reviewed for assessment of patient demographics, baseline comorbidities and clinical data. RESULTS: There were a total of 18 patients, nine (50%) male, median IQR age of 62.5 (12) years. Ten of the 18 patients (55.6%; 95% CI 33.7 to 75.4) had abnormalities on dilated eye examination. The main findings were flame-shaped haemorrhages (N=4; 22.2%; 95% CI 9.0 to 45.2) and ischaemic pattern lesions (cotton wool spots and retinal sectorial pallor) (N=4; 22.2%; 95% CI 9.0 to 45.2), with one patient having both cotton wool spots and flame-shaped haemorrhages. CONCLUSION: These findings suggest that patients with severe COVID-19 have acute vascular lesions of the inner retina including flame-shaped haemorrhages and cotton wool spots. Further studies controlling for confounding factors are necessary to properly assess these findings so as to increase the understanding of COVID-19 pathophysiology and to identify new therapies.

Meditation for adults with non-specific low back pain: a systematic review and meta-analysis.

OBJECTIVES: We aim to determine the effectiveness of meditation for adults with non-specific low back pain. METHODS: We searched PubMed, EMBASE, PEDro, Scopus, Web of Science, Cochrane Library, and PsycINFO databases for randomized controlled trials that investigated the effectiveness of meditation in adults with non-specific low back pain. Two reviewers rated risk of bias using the PEDro scale and the certainty of the evidence using the GRADE approach. Primary outcomes were pain intensity and disability. RESULTS: We included eight trials with a total of 1,234 participants. Moderate-certainty evidence shows that meditation is better than usual care for disability at short-term (SMD = -0.22; 95% CI = -0.42 to -0.02). We also found that meditation is better than usual care for pain intensity at long-term (SMD = -0.28; 95% CI = -0.54 to -0.02). There is no significant difference for pain intensity between meditation and minimal intervention or usual care at short and intermediate-term. We did not find differences between meditation and minimal intervention for disability at intermediate-term or usual care in any follow-up period. CONCLUSIONS: We found small effect sizes and moderate-certainty evidence that meditation is slightly better than minimal intervention in the short-term for disability. Low-certainty of evidence suggests that meditation is slightly better than usual care for pain in the long-term. Meditation appears to be safe with most trials reporting no serious adverse events.

A percepção sobre o acesso avançado em uma unidade unidade-escola de atenção básica à saúde / Perception of advanced access in a basic health care unit

Resumo: Introdução: Uma das diretrizes da atenção básica à saúde (ABS) no Brasil é o primeiro contato da pessoa no sistema de saúde. O acesso ou a acessibilidade é um atributo essencial da APS que teve avaliação ruim em pesquisas brasileiras. O sistema de agendamento certamente influencia o acesso nas unidades de saúde, e o modelo por acesso avançado (AA) tem sido implantado no Brasil, e vem obtendo melhores resultados que modelos tradicionais de agendamento. Objetivo: Este estudo teve como objetivo compreender a percepção de profissionais que atuam em uma unidade básica de saúde de Uberlândia, em Minas Gerais - MG (Centro de Saúde Escola Jaraguá (Cejar)), sobre a implementação do AA. Método: Trata-se de um estudo qualitativo que utilizou o grupo focal e a análise de conteúdo. Resultado: Foram delimitadas as seguintes categoriais temáticas: Desafios desafios na consolidação da APS e investimento em equipes mínimas; Tensionamentos tensionamentos quanto ao aumento na demanda de atendimentos individuais e sobrecarga de trabalho; Educação educação e saúde: intersecções necessárias entre ensino, serviço, gestão e comunidade. Conclusão: O Cejar apresentou particularidades com a implementação do AA por ser uma unidade de ensino, por não ter Estratégia de Saúde da Família (ESF) consolidada e pela sobrecarga de trabalho advinda com dessa agenda, o que pode contribuir para o planejamento de outras equipes que tenham interesse pelo AA.

Abstract Introduction: One of the guidelines of Primary Health Care (PHC) in Brazil is the person's user's first contact with the health system. Access or accessibility is an essential attribute of PHC that has been poorly assessed in Brazilian surveys. The appointment scheduling system certainly influences access in health units, and the model for advanced access (AA) has been implemented in Brazil, and has been achievinggetting better results than traditional scheduling models. Objective: The objective of the presentthis study is to understand the perception of professionals who work in a basic health unit in Uberlândia-MG (Centro de Saúde Escola Jaraguá) about the implementation of AA. Method: It is a qualitative study that used the focus group methodology and content analysis. Result: The following thematic categories were delimited: Challenges in the consolidation of PHC and investment in minimal teams; Tensions regarding the increasedin the demand for individual careassistance and work overload; Education and health: necessary intersections between teaching, service, management and community. Conclusion: It was concluded that CEJAR presented specific characteristicsparticularities with the implementation of AA as it isfor being a teaching unit, doesfor not haveing a consolidated Family Health Strategy (FHS) and due to thefor the work overload resulting from this scheduleagenda, which can contribute to the planning of other teams that are interested in AA.

Avaliação de guidelines para atenção pós-parto na Atenção Primária: revisão sistemática / Guidelines evaluation for postpartum attention in Primary Care: systematic review

Resumo Introdução O cuidado após o parto, denominado de pós-natal, pós-parto ou puerpério, é um importante período para desenvolvimento de estratégias de atenção à saúde das mulheres para redução da morbimortalidade. Com o aumento de publicações de diretrizes clínicas, há preocupações quanto à qualidade delas. Objetivo Avaliar a qualidade de guidelines sobre a atenção às mulheres no pós-parto na Atenção Primária à Saúde. Método Revisão sistemática de guidelines publicados entre 2008 e 2017, nas bases de dados Lilacs e PubMed, e página da internet do National Guideline Clearinghouse, National Institute for Health and Care Excellence e Google®. A ferramenta Appraisal of Guidelines for Research and Evaluation II foi utilizada para avaliação da qualidade dos guidelines nos domínios: escopo e finalidade; envolvimento das partes interessadas (stakeholders); rigor do desenvolvimento; clareza e apresentação; aplicabilidade; e independência editorial. Resultados Foram analisados dez guidelines que apresentaram escore médio geral de avaliação de 77%, com melhor avaliação para "escopo e finalidade" (92%) e pior para "aplicabilidade" (57%). Conclusão Os guidelines apresentaram boa qualidade geral com necessidade de melhorar sua elaboração no domínio aplicabilidade.

Abstract Background Postpartum care, known as postnatal care, postpartum or puerperium, is an important period for the development of health care strategies for women aiming to reduce morbidity and mortality. With the increase of publications of clinical guidelines, there are concerns about their quality. Objective To evaluate guidelines quality on women postpartum care in Primary Health Care. Method Systematic review of guidelines published between 2008 and 2017, in Lilacs and PubMed databases, and the National Guideline Clearing House, National Institute for Health and Care Excellence and Google®. Appraisal of Guidelines for Research and Evaluation II tool was used to assess the quality of the guidelines as to: scope and purpose; stakeholders involvement; accuracy of development; transparency and presentation; applicability; and editorial independence. Results Ten 10 guidelines that presented a general average score of 77%, with a better evaluation for "scope and purpose" (92%) and worse for "applicability" (57%) were analyzed. Conclusion The guidelines presented good overall quality, however, they need to improve their elaboration regarding applicability.

Recomendações para o cuidado pós-parto às mulheres na Atenção Primária: revisão sistemática / Recommendations for postpartum women care in the Primary Care: systematic review

Objetivo: Comparar as recomendações de guidelines sobre a atenção às mulheres no pós-parto na Atenção Primária à Saúde. Desenvolvimento: Revisão sistemática de guidelines com busca nas bases de dados Lilacs e PubMed, e páginas da internet do National Guideline Clearinghouse, National Institute for Health and Care Excellence e Google®, considerando como critérios de inclusão: tratar de recomendações sobre cuidados pós-parto de rotina e/ou complicações decorrentes do pós-parto; contemplar responsabilidades da Atenção Primária à Saúde; ser publicado de 2008 a 2017; estar disponível em texto completo; nos idiomas inglês, espanhol ou português. Foram analisados 9 guidelines, em que apenas três trataram de cuidados gerais no pós-parto, sendo os demais sobre temas específicos, como depressão pós-parto e contracepção. Apenas um guideline era direcionado para países de baixa renda. As recomendações trataram sobre organização do cuidado, saúde mental, saúde física, aleitamento materno, atividade educativa/grupo de apoio, sinais e sintomas de violência doméstica e métodos contraceptivos. O escopo de recomendações foi baseado, de modo geral, em baixo nível de evidência, com maior foco em saúde física e mental, e incipiente abordagem sobre violência doméstica. Conclusão: Os guidelines apresentaram recomendações amplas que abrangem a atenção às mulheres no pós-parto. Há necessidade de maior investimento em pesquisas sobre o tema para aumentar o nível das evidências, e incentivo para elaboração de guidelines em países de baixa renda.

Objective: To compare the recommendations of guidelines on postpartum women care in Primary Health Care. Development: Systematic review of guidelines in the Lilacs and Pub Med databases, the websites National Guideline Clearinghouse, National Institute for Health and Care Excellence e and Google®, with the following inclusion criteria: to address recommendations for routine postpartum care and/ or postpartum complications; to contemplate Primary Health Care responsibilities; to be published from 2008 to 2017; to be available in full text; in English, Spanish or Portuguese. A total of 9 guidelines were analyzed, in which only three treated general care in the postpartum period, with the others on specific topics, such as postpartum depression and contraception. Only one guideline was aimed at low- income countries. The recommendations addressed the care organization, mental health, physical health, breastfeeding, educational activity or support group, signs and symptoms of domestic violence, and contraceptive methods. The scope of recommendations was generally based on a low level of evidence, with a greater focus on physical and mental health, and an incipient approach to domestic violence. Conclusion: The guidelines presented broad recommendations covering care for postpartum women. There is a need for greater investment in research on the subject to increase the level of evidence, and encouragement for developing guidelines in low-income countries.

Perfil epidemiológico de gestantes de alto risco / Epidemiological profile of high risk pregnant women

Introdução: Mundialmente, a saúde materna e neonatal tem sido motivo de preocupação e estudos, e no Brasil é considerada prioridade .Objetivo: traçar o perfil de gestantes de alto risco, segundo variáveis demográficas, socioeconômicas, histórico de saúde e assistência prénatal. Método: transversal, observacional, descritivo, no período de janeiro a julho de 2017 com 314 gestantes de alto risco, dados coletados por meio de questionário estruturado e analisados por frequência absoluta e relativa. O estudo foi aprovado pelo Comitê de Ética em Pesquisa Envolvendo Seres Humanos da Unicentro. Resultados: 66,9% tinham de 20 a 34 anos; 48,4% eram brancas; 89,2% possuiam companheiro; 47,1% tinham escolaridade entre 5 e 9 anos; 54,5% eram desempregadas/do lar; 42% possuiam renda de 2 salários mínimos; 46,2% portavam doenças crônicas não transmissíveis; 56,1% referam rara procura pelos serviços de saúde; 28% eram primigestas; 33,4% tiveram reincidência de alto risco; 48,4% não realizava planejamento familiar; 58,8% referiram gestações não planejadas; 36,7% tinham índice de massa corporal gestacional de obesidade; 19,3% tiveram Pré eclâmpsia; 78% não tinham acompanhamento da atenção primária; 76,1% não participaram de educação em saúde. Conclusão: o perfil revela que população feminina necessita de ações não somente no período gestacional, mas de promoção à saúde da mulher.

Introduction: Worldwide, maternal and neonatal health has been a cause for concern and research and in Brazil it is considered a priority. Objective: to profile high-risk pregnant women considering demographic, socioeconomic, health history and prenatal care variables. Method: cross-sectional, observational, descriptive study, from January to July 2017 with 314 high-risk pregnant women, data collected through structured questionnaire and analyzed for absolute and relative frequency. The study was approved by the Research Ethics Committee Involving Humans. Results: 20 to 34 years (66.9%); white (48.4%); with partner (89.2%); education between 5 and 9 years old (47.1%); unemployed/ housewife (54.5%); income of 2 minimum wages (42%); with chronic noncommunicable diseases (46.2%); rare demand for health services (56.1%); first-born (28%); high risk recurrence (33.4%); without family planning (48.4%) unplanned pregnancies (58.8%); gestational body mass index of obesity (36.7%); pregnancy-specific hypertensive disease (19.3%); unaccompanied by primary care (78%); did not participate in health education (76.1%). Conclusion: the profile reveals that the female population needs actions not only during pregnancy, but also to promote women's health.

Residência de Medicina de Família e Comunidade em uma Unidade Básica de Saúde Tradicional / Family and Community Medicine Residency in a Basic Unit of Tradional Health

Introdução: As Unidades Básicas de Saúde (UBS) desempenham papel central na garantia à população à serviços de saúde. Dotar estas unidades de condições para um atendimento de qualidade é um desafio. Relato: Residentes do primeiro ano de Medicina de Família e Comunidade (MFC)da Universidade Federal de Uberlândia foram direcionados em março de 2018 para uma UBS tradicional (constituída por clínico, pediatra e ginecologista). A partir da contratação de preceptoras especialistas em MFC, formou ­se outra equipe, de estratégia básica, composta por elas e residentes. Foi feita territorialização e a distribuição de micro áreas para cada residente e construídas planilhas com dados dos pacientes. Assim, foi possível conhecer o perfil da população, implementando diversas ações: grupos, visitas domiciliares, organização da agenda por meio do "acesso avançado". Reuniões com esta equipe propiciaram espaço de educação permanente e formulação de Projetos Terapêuticos Singulares A população demonstrou satisfação com as mudanças por meio da Ouvidoria de Saúde. Quantitativamente, os atendimentos aumentaram 17%, sendo que o clínico representou 86% do total desse aumento e houve 40% menos exames laboratoriais solicitados Discussão e considerações finais: A Residência de MFC ofereceu condições para alcançar melhorias no acesso e qualidade dos serviços ofertados pela UBS. A experiência foi bem­ sucedida e deveria ser estimulada em outros cenários da Atenção Básica. Propõe­ se que as esferas governamentais incentivem a seleção de especialistas em MFC para atuarem na APS e promovam transições de UBS tradicionais para equipes com a Estratégia de Saúde da Família.

Introduction: As the Basic Health Units (BHU) play a central role in guaranteeing the population to health services. Providing these units with conditions for quality care is a challenge. Report: Residents of the first year of Family and Community Medicine (MFC) at the Federal University of Uberlandia were directed in March 2018 to a traditional BHU (consisting of a clinician, pediatrician and gynecologist). As a result of the hiring of MFC specialist tutors, another basic strategy team was formed, composed of them and residents. Territorializing and the distribution of micro areas to each resident were carried out and spreadsheets were built with patient data. Thus, it was possible to know the profile of the population, implementing several actions: groups, home visits, organization of the agenda through "advanced access". Meetings with this team provided space for permanent education and formulation of Unique Therapeutic Projects. The population showed satisfaction with the changes through the Health Ombudsman. Quantitatively, the attendances increased by 17%, with the clinician representing 86% of the total of this increase and there were 40% less laboratory tests requested. Discussion and final remarks: The MFC Residency offers advanced access services and quality services offered by UBS. A. It has been studied in other AB scenarios. It is proposed that the rules encourage the selection of MFC services for Primary Health Care and promote transitions from BHU to the Family Health Strategy (FHS).

Strengthening and weakening factors for breastfeeding from the perspective of the nursing mother and her family.

OBJECTIVE: To describe the strengthening and weakening factors for breastfeeding. METHOD: This is a descriptive multiple case qualitative study, conducted in Curitiba, Parana, with members of 17 families with children between 6 and 12 months old, through semi-structured interview and construction of genograms, analyzed by the strategy of cross case synthesis. RESULTS: 28 people participated in the study. Strengthening factors for breastfeeding were: the desire to breastfeed; child with facility for breastfeeding; mother with time available to the child; previous breastfeeding experience and family history of breastfeeding; the support and encouragement to breastfeed. Weakening factors were: negative expectations; the myth of weak milk; child's disease; maternal illness; negative experiences of the mother; the absence of family history of breastfeeding; lack of a support network. CONCLUSION: Breastfeeding is a family and social phenomenon. Therefore, practices that go beyond the mother-baby dyad are necessary. The care process should include the social and subjective dimension, strengthening the support network of nursing mothers, in order to obtain more satisfactory professional practices that promote breastfeeding.

Vivência da família na transição ecológica do prematuro da UTIN ao domicílio, com vistas ao desenvolvimento infantil / Family experience in the ecological transition of premature infants from the NICU to the home, with a view to child development

Resumo: Introdução: É crescente o número de nascimentos prematuros no mundo, sendo importante considerar o impacto desse acontecimento sobre a criança e sua família. Assim, a prematuridade configura-se como uma condição de vulnerabilidade para o desenvolvimento infantil. Além disso, a família do prematuro vivencia sentimentos de insegurança, estresse e angústia desde o nascimento, que ficam exacerbados no momento da transição da Unidade de Terapia Intensiva Neonatal para o domicílio. Objetivo: Descrever a vivência da família na transição ecológica do prematuro da Unidade de Terapia Intensiva Neonatal ao domicílio, com vistas ao desenvolvimento infantil. Método: Trata-se de um estudo de casos múltiplos embasado no referencial metodológico de Yin, realizado junto a 9 famílias, constituído por 15 familiares em dois hospitais em um município do Estado do Paraná, e depois dada continuidade no domicílio. A coleta de evidências ocorreu entre abril de 2018 a janeiro de 2019; utilizou-se o método de inserção ecológica em que foram realizadas entrevistas, genograma, ecomapa, notas metodológicas e dados da carteira de saúde da criança. Para a organização dos dados, utilizou-se o software MAXQDA®. Os dados foram analisados segundo combinação de padrão e síntese de casos cruzados, à luz dos marcos teóricos conceituais do Modelo Bioecológico de Bronfenbrenner e das necessidades essenciais das crianças de Brazelton e Greenspan. Resultados: Foi elaborado a proposição de uma matriz conceitual para análise do desenvolvimento infantil de prematuros diante das necessidades essenciais. Assim, compreende-se que a prematuridade afeta a família a partir das características pessoais e demandas de cuidado ao prematuro, modificando as expectativas, interações e vínculos estabelecidos. A descontinuidade dos processos proximais no contexto neonatal e a continuidade dos processos proximais em casa geram tensão, ansiedade, incerteza e expectativa, implicando maior necessidade de apoio da família e atenção dos profissionais de saúde. O microssistema familiar é considerado como determinante para garantir que as necessidades irredutíveis do prematuro sejam atendidas com qualidade. Portanto, é preciso incluir de fato a família como partícipe das ações de saúde em todos os níveis assistenciais, com vistas ao desenvolvimento de autonomia, responsabilidade e confiança da família, e seu adequado engajamento em atividades e papéis decorrentes das interações com os demais contextos. O tempo inclui eventos não esperados relacionados à prematuridade, gera mudanças no curso de vida familiar, a partir do momento que é afastado o risco de perda devido melhora do quadro clínico do prematuro, a concretização em ser pai e mãe torna-se mais pautável, os familiares refazem planos futuros, com oportunidade para novos aprendizados a fim de favorecer o desenvolvimento do filho. Conclusões: Confirma-se, portanto, a tese de que a compreensão da vivência da família na transição ecológica de crianças prematuras, egressas de Unidade de Terapia Intensiva Neonatal, segundo o modelo bioecológico, assim, pode direcionar o cuidado de enfermagem para fortalecer as famílias na promoção do desenvolvimento infantil. Além disso, o instrumento analítico elaborado pode subsidiar equipes de saúde a propor ações de intervenção específicas a esse contingente populacional, além da articulação de políticas públicas para primeira infância, sobretudo das que apresentam maior vulnerabilidade.

Abstract: Introduction: The number of premature births in the world is increasing, and it is important to consider the impact of this event on the child and his family. Thus, prematurity is a condition of vulnerability for child development. In addition, the preterm's family experiences feelings of insecurity, stress and anguish since birth, which are exacerbated when the Neonatal Intensive Care Unit transitions to the home. Objective: To describe the family's experience in the ecological transition of the premature infant from the Neonatal Intensive Care Unit to the home, with a view to child development. Method: This is a multiple case study based on Yin's methodological framework, carried out with 9 families, consisting of 15 family members in two hospitals in a municipality in the State of Paraná, and then continued at home. Evidence was collected between April 2018 and January 2019; the ecological insertion method was used, in which interviews, genogram, ecomap, methodological notes and data from the child's health card were carried out. For the organization of the data, the MAXQDA® software was used. The data were analyzed according to a combination of pattern and synthesis of crossed cases, in the light of the conceptual theoretical frameworks of the Bronfenbrenner Bioecological Model and the essential needs of the children of Brazelton and Greenspan. Results: The proposition of a conceptual matrix for the analysis of child development of preterm infants was prepared in view of essential needs. Thus, it is understood that prematurity affects the family from the personal characteristics and demands of care for the premature, changing the expectations, interactions and bonds established. The discontinuity of proximal processes in the neonatal context and the continuity of proximal processes at home generate tension, anxiety, uncertainty and expectation, implying a greater need for family support and attention from health professionals. The family microsystem is considered as a determinant to ensure that the irreducible needs of the premature are met with quality. Therefore, it is necessary to actually include the family as a participant in health actions at all levels of care, with a view to developing the family's autonomy, responsibility and trust, and their appropriate engagement in activities and roles resulting from interactions with other contexts. Time includes unexpected events related to prematurity, changes in the course of family life, as soon as the risk of loss due to the improvement of the premature infant's clinical condition is removed, the realization of being a father and mother becomes more reasonable, family members redo future plans, with an opportunity for new learnings in order to favor the child's development. Conclusions: It is confirmed, therefore, the thesis that the understanding of the family's experience in the ecological transition of premature children, discharged from the Neonatal Intensive Care Unit, according to the bioecological model, thus, can direct nursing care to strengthen families promoting child development. In addition, the analytical instrument developed can support health teams to propose specific intervention actions to this population, in addition to the articulation of public policies for early childhood, especially those that are most vulnerable.

Mothers of angels: (re)living the death of the child as a coping strategy / Madres de ángeles: (re)vivenciar la muerte de un hijo como estrategia de enfrentamiento / Mães de anjos: (re)vivenciando a morte do filho como estratégia de enfrentamento

Abstract Objective: To describe the experiences lived by mothers facing the death of their children. Method: A qualitative, exploratory and descriptive research conducted in Guarapuava-PR, with six participants of the "Marias" group that brings together mothers who lost their children and share their experiences to spontaneously help other women in the process of mourning. Data collection took place from May to August 2017, through a focus group. The speeches were organized by the Iramuteq® software and analyzed according to Creswell. Results: Age ranged from 28 to 40 years old, and most participants were married and catholic. The categories express the need to strengthen bonds and to create ways in which women can express themselves; the importance of the social network to accommodate mourning; the relevance of ethical and humanized care; and group identity as an element to promote resilience. Conclusion and Implications for practice: Describing the potentialities and weaknesses in the process of loss and grief enables a qualifying and humanizing care, overcoming care gaps, stimulating the creation of creative and dialogical spaces in maternal care. These results may guide the professional approach by considering the sociocultural context and the risk factors experienced by the mothers, by supporting the development of resilient skills and enabling a humanized and individualized care.

Resumen Objetivo: Describir las experiencias vivenciadas por las madres frente a la muerte de sus hijos. Método: Investigación descriptiva, exploratoria y cualitativa realizada en Guarapuava-PR, con seis participantes del grupo "Marías" que reúne a madres que perdieron a sus hijos y comparten sus vivencias además de ayudar a otras mujeres espontáneamente en el proceso de duelo. Los datos se recolectaron entre mayo y agosto de 2017, por medio de un grupo focal. Las conversaciones se organizaron por medio del software Iramuteq® y se analizaron según Creswell. Resultados: La edad varió entre 28 y 40 años, y la mayoría de las participantes estaban casadas y eran católicas. Las categorías expresan la necesidad de fortalecer vínculos y de crear medios con los que las mujeres puedan expresarse; la importancia de la red social para sobrellevar el duelo; la relevancia de una atención ética y humanizada y la identidad grupal como elemento promotor de la resiliencia. Conclusión e Implicaciones para la práctica: Describir las potencialidades y debilidades en el proceso de pérdida y duelo permite calificar y humanizar el cuidado, superando las lagunas asistenciales y estimulando la creación de espacios creativos y de diálogo en el cuidado materno. Estos resultados pueden orientar el enfoque profesional al considerar el contexto sociocultural y los factores de riesgo que experimentan las madres, apoyando el desarrollo de habilidades resilientes y haciendo posible un cuidado humanizado e individualizado.

Resumo Objetivo: Descrever as experiências vivenciadas pelas mães frente à morte do filho. Método: Pesquisa descritiva exploratória qualitativa realizada em Guarapuava-PR, junto a seis participantes do grupo "Marias" que reúne mães que perderam seus filhos e compartilham suas vivências além de ajudar outras mulheres espontaneamente no processo de luto. A coleta de dados ocorreu de maio e agosto/2017, por meio de grupo focal. As falas foram organizadas pelo software Iramuteq® e analisada segundo Creswell. Resultados: Idade variou entre 28 a 40 anos, maioria casadas e católicas. As categorias expressam a necessidade fortalecer vínculos e criar meios em que possam se expressar; importância da rede social para acolher o luto; relevância do atendimento ético e humanizado e a identidade grupal como elemento promotor da resiliência. Conclusão e Implicações para a prática: Descrever as potencialidades e fragilidades no processo de perda e luto possibilita qualificar e humanizar o cuidado, com a superação de lacunas assistenciais estimulando a criação de espaços criativos e dialógicos no acolhimento materno. Estes resultados podem orientar a abordagem profissional ao considerar o contexto cultural, social e fatores de risco em que as mães vivenciam, ao apoiar o desenvolvimento de habilidades resilientes e possibilitando um cuidado humanizado e individualizado.

Strengthening and weakening factors for breastfeeding from the perspective of the nursing mother and her family / Fortalecedores y debilitadores de la lactancia bajo la óptica de la lactante y su familia / Fortalecedores e fragilizadores da amamentação na ótica da nutriz e de sua família

Abstract Objective: To describe the strengthening and weakening factors for breastfeeding. Method: This is a descriptive multiple case qualitative study, conducted in Curitiba, Parana, with members of 17 families with children between 6 and 12 months old, through semi-structured interview and construction of genograms, analyzed by the strategy of cross case synthesis. Results: 28 people participated in the study. Strengthening factors for breastfeeding were: the desire to breastfeed; child with facility for breastfeeding; mother with time available to the child; previous breastfeeding experience and family history of breastfeeding; the support and encouragement to breastfeed. Weakening factors were: negative expectations; the myth of weak milk; child's disease; maternal illness; negative experiences of the mother; the absence of family history of breastfeeding; lack of a support network. Conclusion: Breastfeeding is a family and social phenomenon. Therefore, practices that go beyond the mother-baby dyad are necessary. The care process should include the social and subjective dimension, strengthening the support network of nursing mothers, in order to obtain more satisfactory professional practices that promote breastfeeding.

Resumen Objetivo: Describir los elementos fortalecedores y debilitadores de la lactancia. Método: Investigación con abordaje cualitativo del tipo estudio de casos múltiples con carácter descriptivo, llevado a cabo en el municipio de Curitiba, Paraná, con miembros de 17 familias compuestas de niños de 6 a 12 meses, mediante entrevista semiestructurada y construcción de genograma, analizados por la estrategia de síntesis de casos cruzados. Resultados: Participaron en el estudio 28 miembros. Fueron fortalecedores de la lactancia: el deseo de amamantar; niño con facilidad para mamar; madre con disponibilidad de tiempo para el niño; experiencia previa de la lactante y antecedentes familiares de lactancia; el apoyo y el incentivo para amamantar. Los debilitadores de la lactancia fueron: expectativas negativas; el mito de la leche flaca; la enfermedad del niño; las afecciones maternas; vivencias negativas de la madre; la ausencia de antecedentes familiares de lactancia; la ausencia de apoyo y soporte de la red. Conclusión: Amamantar es un fenómeno familiar y social, por lo que son necesarias prácticas promovedoras que extrapolen el binomio madre-bebé. En el proceso de cuidar se debe buscar la involucración de la dimensión social y subjetiva, mediante el fortalecimiento de la red de apoyo a las lactantes, a fin de lograrse prácticas profesionales más satisfactorias y promovedoras de la lactancia.

Resumo Objetivo: Descrever os elementos fortalecedores e fragilizadores da amamentação. Método: Pesquisa com abordagem qualitativa do tipo estudo de casos múltiplos com caráter descritivo, realizado no município de Curitiba, Paraná, com membros de 17 famílias compostas de crianças de 6 a 12 meses, por meio de entrevista semiestruturada e construção de genograma, analisados pela estratégia de síntese de casos cruzados. Resultados: Participaram do estudo 28 membros. Foram fortalecedores da amamentação: a vontade de amamentar; criança com facilidade para mamar; mãe com disponibilidade de tempo para a criança; experiência anterior da nutriz e antecedentes familiares de amamentação; o apoio e o incentivo para amamentar. Os fragilizadores da amamentação foram: expectativas negativas; o mito do leite fraco; a doença da criança; as afecções maternas; vivências negativas da mãe; a ausência de antecedentes familiares de amamentação; a falta de apoio e suporte da rede. Conclusão: Amamentar é um fenômeno familiar e social, portanto são necessárias práticas promotoras que extrapolem o binômio mãe-bebê. No processo de cuidar deve-se buscar o envolvimento da dimensão social e subjetiva, por meio do fortalecimento da rede de apoio das nutrizes, a fim de obterem-se práticas profissionais mais satisfatórias e promotoras da amamentação.

H1N1: perfil clínico-epidemiológico de pacientes atendidos em um hospital / H1N1: clinical and epidemiological profile of patients treated in a hospital

Objetivo: Avaliar casos de suspeita de gripe H1N1, bem como comparar aspectos epidemiológicos e clínicos dos pacientes com gripe H1N1 confirmada em relação àqueles não confirmados; analisar os critérios de gravidade clínica com relação à confirmação (ou não) da gripe H1N1 e seu desfecho (mortalidade); e criar um banco de dados para fins de comparação com a literatura nacional e mundial. Métodos: Estudo retrospectivo de coorte transversal realizado no período sazonal (outono e inverno) no ano de 2016. Foram analisados os prontuários, acessíveis e completos, de pacientes com suspeita clínica de H1N1, além daqueles com resultados definidos na sorologia. A partir dos dados coletados, foi elaborada tabela de análise epidemiológica, com informações clínicas, laboratoriais e sorológicas. Resultados: Destacam-se a média das faixas etárias mais acometidas de 48 anos, além dos sintomas mais comuns que foram dispneia, tosse e mialgia; as comorbidades foram hipertensão arterial sistêmica, cardiopatias, diabetes e doença pulmonar obstrutiva crônica. Conclusão: Este trabalho contribuiu com a caracterização do perfil epidemiológico regional e auxiliou na definição de indicadores de diagnóstico e gravidade, além de agregar à literatura conteúdos de caráter relevante. Este estudo está registrado como CAAE 58664016.2.0000.5515 na Plataforma Brasil. (AU)

Objective: To evaluate cases of suspected H1N1 flu, as well as to compare epidemiological and clinical aspects of patients with confirmed H1N1 influenza to those who were not confirmed; to analyze the criteria of clinical severity regarding the confirmation (or not) of H1N1 influenza, and its outcome (mortality); and to create a database to be compared with the national and world literature. Methods: This is a cross-sectional retrospective cohort study, carried out in the seasonal period ( fall/winter) of 2016. Accessible and complete medical records of patients with clinical suspicion of H1N1 were analyzed along with those with defined serology results. Based on the collected data, a table of epidemiological analysis was elaborated with clinical, laboratory and serological information. Results: The mean age of the most affected age groups was 48 years; the most common symptoms were dyspnea, cough and myalgia; and the comorbidities were systemic arterial hypertension, cardiopathies, diabetes, and chronic obstructive pulmonary disease. Conclusion: This work contributed to the characterization of the regional epidemiological profile, and helped in the definition of indicators of diagnosis and severity, besides adding relevant content to the literature. This study is registered as CAAE 58664016.2.0000.5515 at Plataforma Brasil. (AU)