Atuação das equipes da atenção primária na identificação precoce do câncer infanto-juvenil

Identificar o conhecimento de profissionais da atenção primária sobre a identificação precoce do câncer infanto-juvenil e descrever o desempenho das equipes de saúde antes da realização de treinamentos para identificação precoce do câncer infanto-juvenil. Método: Os dados foram obtidos por um questionário e grupo focal com 30 profissionais de uma Unidade de Saúde da Família, e analisados por temas geradores. Resultados: Os profissionais possuem conhecimentos sobre a identificação do câncer infanto-juvenil, e, demandam conhecer mais sobre os sinais e sintomas para identificação precoce, e a prestação de uma assistência sistematizada. Conclusão: Torna-se fundamental estimular a qualificação dos profissionais da atenção primária para a identificação precoce e o fortalecimento de uma rede de assistência que proporcione atendimento integral e a redução no retardo do diagnóstico de câncer infanto-juvenil

Morbimortalidade perinatal associada à infecção clamidiana: uma revisão sistemática

Universidade Federal do Rio Grande do Norte

Programas de exercícios físicos e níveis de biomarcadores inflamatórios em mulheres com distúrbios metabólicos: uma revisão sistemática

Uma grande quantidade de informações dá suporte à relação existente entre inatividade física e processos inflamatórios latentes em distúrbios metabólicos. O objetivo deste trabalho foi acessar criticamente o corpo de evidências existentes na literatura sobre a associação entre programas de exercícios físicos e os níveis de biomarcadores inflamatórios em mulheres entre 18 e 82 anos de idade. Foram realizadas buscas bibliográficas sistemáticas usando as bases de dados PubMed Medline, Cochrane Central Register of Controlled Trials, Web of Science, LILACS e SciELO de publicações entre janeiro de 1993 e janeiro de 2012 usando os seguintes termos: inflamação, citocinas, exercícios, treinamento físico, treinamento aeróbico, treinamento cardiovascular, treinamento de força, treinamento contra resistência, treinamento intervalado, reabilitação cardíaca e gerenciamento/modificação terapêutica de estilo de vida. Do total de estudos incluídos na revisão, três deles reportaram mudanças não significativas nos níveis de biomarcadores inflamatórios, um estudo documentou um aumento nos biomarcadores e 12 estudos reportaram decréscimos nos níveis de biomarcadores inflamatórios associados com exercício. Características secundárias do estilo de vida, como trabalho físico extenuante e fumo, afetaram os níveis de biomarcadores inflamatórios. Intervenções integrativas incluindo dieta, exercício aeróbico moderado (60% a 80% da frequência cardíaca máxima ou 50% a 60% do VO2Máx), treinamento contra resistência em circuito (8 a 10 exercícios, 8 a 12 repetições), aconselhamento e educação voltados para a saúde, usados conjuntamente, se apresentaram como possíveis estratégias efetivas na melhoria nos níveis de biomarcadores inflamatórios em mulheres

Exercícios respiratórios para asma: revisão sistemática com metanálise

Introdução: A asma se tornou um problema de saúde pública devido aos seus grandes custos em cuidados de saúde. Os exercícios respiratórios constituem uma intervenção não farmacológica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes países no tratamento de pacientes asmáticos. Objetivo: Avaliar a eficácia dos exercícios respiratórios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, número de exacerbações agudas, episódios de hospitalização, mensurações fisiológicas (função pulmonar e capacidade funcional), número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, avaliação subjetiva do paciente em relação à intervenção. Método: Revisão sistemática de estudos controlados randomizados com metanálise realizada em parceria com a Colaboração Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, além de busca manual em revistas da área e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de referências dos estudos selecionados e registros de ensaios clínicos também foram consultados. A seleção dos estudos e a avaliação do risco de viés dos estudos incluídos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para análise dos dados, no qual o modelo de efeito fixo foi utilizado. As variáveis contínuas foram expressas como diferença de média ponderada com um intervalo de confiança de 95%. A heterogeneidade dos resultados dos estudos incluídos foi realizada por meio da análise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar significância estatística. O Índice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um nível substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes estão atualmente incluídos na revisão. Os seguintes desfechos foram mensurados pelos estudos incluídos: qualidade de vida, sintomas da asma, número de exacerbações agudas e função pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e número de exacerbações agudas. Seis dos onze estudos que avaliaram função pulmonar mostraram uma diferença significativa favorável aos exercícios respiratórios. Não houve relato de efeitos adversos. Devido à heterogeneidade substancial encontrada entre os estudos, metanálise foi possível apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferença significativa favorável aos exercícios respiratórios. A avaliação do risco de viés foi prejudicada devido ao relato incompleto de aspectos metodológicos pela maioria dos estudos incluídos. Conclusão: Embora os resultados encontrados pelos estudos incluídos demonstraram individualmente que os exercícios respiratórios podem ser importantes no tratamento da asma, não há evidência conclusiva nesta revisão para suportar ou refutar a eficácia desta intervenção no tratamento de pacientes asmáticos. Este fato foi devido às diferenças metodológicas entre os estudos incluídos e à ausência de relato de aspectos metodológicos por parte da maioria dos estudos incluídos. Não há dados disponíveis em relação aos efeitos dos exercícios respiratórios nos seguintes desfechos: episódios de hospitalização, número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, e avaliação subjetiva do paciente em relação à intervenção

Treinamento muscular inspiratório para asma: revisão sistemática com metanálise

In asthmatic, the lung hyperinflation leaves the inspiratory muscle at a suboptimal position in length-tension relationship, reducing the capacity of to generate tension. The increase in transversal section area of the inspiratory muscles could reverse or delay the deterioration of inspiratory muscle function. Objective: To evaluate the evidence for the efficacy of inspiratory muscle training (IMT) with an external resistive device in patients with asthma. Methods: A systematic review with meta-analysis was carried out. The sources researched were the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov and reference lists of articles. All databases were searched from their inception up to November 2012 and there was no restriction on the language of publication. Randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion. Two reviewers independently selected articles for inclusion, evaluated risk of bias in studies and extracted data. Results: A total of five studies involving 113 asthmatic patients were included. Three clinical trials were produced by the same group. The included studies showed a significant increase in maximal inspiratory pressure (MD 13.34 cmH2O, 95% CI 4.70 to 21.98), although the confidence intervals were wide. There was no statistically significant difference between the IMT group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnea and use of beta2-agonist. There were no studies describing exacerbation events that required a course of oral and inhaled corticosteroids or emergency department visits, inspiratory muscle endurance, hospital admissions and days of work or school. Conclusions: There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma, once the evidence was limited by the small number of studies included, number of participants in them together with the risk of bias. More well conducted randomized controlled trials are needed, such trials should investigate respiratory muscle strength, exacerbation rate, lung function, symptoms, hospital admissions, use of medications and days off work or school. IMT should also be assessed in the context of more severe asthma

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática

Introduction: Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. Objectives: To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. Methods: We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013). We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Results: Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were xvi described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Conclusion: Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation

Efeitos do tratamento com Hidrogel na cicatrização de úlceras venosas de membros inferiores: revisão sistemática

Chronic venous disease (CVD) is evident among the chronic diseases and affects the elderly population and primarily is responsible for leg ulcers in this population. The use of dressings in the care of a venous ulcer is a fundamental part of the treatment for healing, however, evidence to assist in choosing the best dressing is scarce. The main objective of this study was to evaluate the effectiveness of treatment with hydrogel in the healing of venous ulcers using search methods, synthesis of information and statistical research through a systematic review and meta-analysis. Randomized controlled trials were selected in the following databases: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Beyond these databases three websites were consulted to identify ongoing studies: ClinicalTrials.gov, OMS ICTRP e ISRCTN. The primary outcomes were analyzed: complete wound healing, incidence of wound infection and the secondary were: changes in ulcer size, time to ulcer healing, recurrence of ulcer, quality of life of participants, pain and costs of treatment. Four studies are currently included in the review with a total of 250 participants. The use of hydrogel appears to be superior to conventional dressing, gauze soaked in saline, for the healing of venous leg ulcers; 16/30 patients showed complete healing of ulcers (RR 5,33, 95%CI [1,73,16,42]). The alginate gel was shown to be more effective when compared to the hydrogel dressing in reduction of the wound area; 61,2% (± 26,2%) with alginate e 19,4% (± 24,3%) with hydrogel at the end of four weeks of treatment. Manuka honey has shown to be similar to the hydrogel dressings in percentage of area reduction. This review demonstrated that there is no evidence available about the effectiveness of the hydrogel compared to other types of dressings on the healing of venous leg ulcers of the lower limbs, thus demonstrating the need of future studies to assist health professionals in choosing the correct dressing.

Avaliação sistemática de abordagens de derivação de produto

Product derivation tools are responsible for automating the development process of software product lines. The configuration knowledge, which is responsible for mapping the problem space to the solution space, plays a fundamental role on product derivation approaches. Each product derivation approach adopts different strategies and techniques to manage the existing variabilities in code assets. There is a lack of empirical studies to analyze these different approaches. This dissertation has the aim of comparing systematically automatic product derivation approaches through of the development of two different empirical studies. The studies are analyzed under two perspectives: (i) qualitative that analyzes the characteristics of approaches using specific criteria; and (ii) quantitative that quantifies specific properties of product derivation artifacts produced for the different approaches. A set of criteria and metrics are also being proposed with the aim of providing support to the qualitative and quantitative analysis. Two software product lines from the web and mobile application domains are targets of our study

Uma abordagem sistemática para implementação, gerenciamento e customização de testes de linhas de produto de software

Through the adoption of the software product line (SPL) approach, several benefits are achieved when compared to the conventional development processes that are based on creating a single software system at a time. The process of developing a SPL differs from traditional software construction, since it has two essential phases: the domain engineering - when common and variables elements of the SPL are defined and implemented; and the application engineering - when one or more applications (specific products) are derived from the reuse of artifacts created in the domain engineering. The test activity is also fundamental and aims to detect defects in the artifacts produced in SPL development. However, the characteristics of an SPL bring new challenges to this activity that must be considered. Several approaches have been recently proposed for the testing process of product lines, but they have been shown limited and have only provided general guidelines. In addition, there is also a lack of tools to support the variability management and customization of automated case tests for SPLs. In this context, this dissertation has the goal of proposing a systematic approach to software product line testing. The approach offers: (i) automated SPL test strategies to be applied in the domain and application engineering, (ii) explicit guidelines to support the implementation and reuse of automated test cases at the unit, integration and system levels in domain and application engineering; and (iii) tooling support for automating the variability management and customization of test cases. The approach is evaluated through its application in a software product line for web systems. The results of this work have shown that the proposed approach can help the developers to deal with the challenges imposed by the characteristics of SPLs during the testing process

Sistemática integrativa de Cichlasoma orientale Kullander 1983 e Crenicichla menezesi Ploeg 1991 (Teleostei: Cichlidae) das bacias hidrográficas do Nordeste do Brasil

Understanding the historical and ecological relationships which are influent in current biological diversity is one of the most challenging tasks of evolutionary biology. Recent systematics emphasizes the need of integrative approaches to delimit different lineages and species. The northeastern Brazil, mostly placed in Caatinga biome, is characterized by a semi-arid weather, low precipitation and seasonal behavior of rivers. This region is regarded lacking as ichthyological knowledge and one of the most threatened by anthropic activities. Further, will be affected by a massive water diverpsion work that will transfer waters from São Francisco basin, to other major four basins: Jaguaribe, Apodi-Mossoró, Piranhas-Açu and Paraiba do Norte. Loss of diversity and richness, hibridizitation, community interactions changes, population homogenization, changes in water quality and flow regime, are examples of environmental impacts already related with similar works. The present study aims to investigate morphological and molecular variation of Cichlasoma orientale Kullander 1983 and Crenicichla menezesi Ploeg 1991, two cichlid species present in northeastern Brazil basins. Further, the study aims to evaluate the influence of geomorphological and climatic processes in this variation, and point some possible impacts of the artificial connectivity which can be brought by São Francisco interbasin water transfer to their population dynamics. Geometric morphometrics and phylogeographical analysis were used to investigate the populations from three different hydrological regions. Our results showed a significant morphological variation of populations from basins that are involved in the São Franscisco s diversion project, not related to an ancient separation between populations, emphasizing morphological variation which could represent a set of plastic responses to the variable hydrological regime in Northeastern Brazil. The role of plastical responses in naturally variable habitats as well as the potential disturbs that could be brought by the interbasin water transfer works are discussed here. Further, our molecular data allowed us to make inferences about species distribution and their taxonomy, and identification of a potential new species of Crenicichla for São Francisco river basin. Our data also allowed to identify some shared haplotypes for both species, which could be related to lineage sorting scenarios or recent gene flow between populations. However a strong structure in most of the pairwise comparisons between populations for both species was revealed. Climatic events such as Atlantic forest regression during the Pleistocene, sea level fluctuations and dispersion by paleorivers in the mouth of Apodi-Mossoró river, and neotectonic events regulating the connection between drainages are likely to have had a contribution for the actual lineages distribution in northeastern Brazil. Further, analysis of molecular variation (AMOVA and SAMOVA) showed that the actual basin s isolation is an important factor to molecular variation, in spite of the signal of recent contact between some basins. Different genetic diversity patterns between species could be related to multiple historic events of colonization, basins landscapes or biological differences. The present study represents the first effort of integrative systematics involving fish species of northeastern Brazil, and showed important morphological and molecular patterns which could be irrecoverably affected by the artificial connection that might be caused by the São Francisco interbasin water transfer