Qualidade de vida de vítimas de trauma seis meses após a alta hospitalar

OBJETIVO: O trauma ocupa o terceiro lugar dentre as causas de morte no Brasil. Contudo, seu impacto na qualidade de vida dos sobreviventes tem sido pouco estudado no País. O objetivo do estudo foi avaliar a qualidade de vida de vítimas de trauma atendidas em unidade hospitalar de emergências, seis meses após a alta hospitalar. MÉTODOS: Foram incluídos 35 pacientes de unidade de emergência de hospital universitário de Ribeirão Preto (SP), entre 2005 e 2006. Os pacientes foram entrevistados em seus domicílios, seis meses após terem tido alta hospitalar. Foi aplicado o instrumento World Health Organization Quality of Life, versão breve, para avaliação dos domínios físico, psicológico, relações sociais e meio ambiente. As associações entre os escores dos domínios e as variáveis permanência hospitalar, idade, sexo e Injury Severity Score foram exploradas por modelos de regressão linear. RESULTADOS: Observou-se diminuição significativa na qualidade de vida do grupo estudado, quando comparado a amostras de pessoas normais em estudos nacionais e internacionais, em particular nos domínios físico, psicológico e de meio ambiente. O domínio relações sociais apresentou a maior média de escores, com 69,7 pontos, enquanto o domínio meio ambiente recebeu a menor pontuação (52,4), ambos na escala percentual. As variáveis associadas a domínio físico foram permanência hospitalar (p=0,02), idade (p<0,01) e sexo (p=0,03). Para os demais domínios, a análise não mostrou associação com as variáveis estudadas. CONCLUSÕES: As vítimas de trauma apresentaram diminuição nos escores de qualidade de vida. Embora o aspecto físico tenha sido o mais atingido, há evidências de que os domínios psicológico e de meio ambiente permaneceram distantes das condições ideais esperadas para a população em geral.

Estimate of DMFT index using teeth most affected by dental caries in twelve-year-old children

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.

Atenção domiciliar como mudança do modelo tecnoassistencial

OBJETIVO: Analisar práticas de atenção domiciliar de serviços ambulatoriais e hospitalares e sua constituição como rede substitutiva de cuidado em saúde. PROCEDIMENTOS METODOLÓGICOS: Estudo qualitativo que analisou, com base na metodologia de caso traçador, quatro serviços ambulatoriais de atenção domiciliar da Secretaria Municipal de Saúde e um serviço de um hospital filantrópico do município de Belo Horizonte, MG, entre 2005 e 2007. Foram realizadas entrevistas com gestores e equipes dos serviços de atenção domiciliar, análise de documentos e acompanhamento de casos com entrevistas a pacientes e cuidadores. A análise foi orientada pelas categorias analíticas integração da atenção domiciliar na rede de saúde e modelo tecnoassistencial. ANÁLISE DOS RESULTADOS: A implantação da atenção domiciliar foi precedida por decisão político-institucional tanto com orientação racionalizadora, buscando a diminuição de custos, quanto com vistas à reordenação tecnoassistencial das redes de cuidados. Essas duas orientações encontram-se em disputa e constituem dificuldades para conciliação dos interesses dos diversos atores envolvidos na rede e na criação de espaços compartilhados de gestão. Pôde-se identificar a inovação tecnológica e a autonomia das famílias na implementação dos projetos de cuidado. As equipes mostraram-se coesas, construindo no cotidiano do trabalho novas formas de integrar os diferentes olhares para transformação das práticas em saúde. Foram observados desafios na proposta de integrar os diferentes serviços de caráter substitutivo do cuidado ao limitar a capacidade da atenção domiciliar de mudar o modelo tecnoassistencial. CONCLUSÕES: A atenção domiciliar possui potencial para constituição de uma rede substitutiva ao produzir novos modos de cuidar que atravessam os projetos dos usuários, dos familiares, da rede social e dos trabalhadores da atenção domiciliar. A atenção domiciliar como modalidade substitutiva de atenção à saúde requer sustentabilidade política, conceitual e operacional, bem como reconhecimento dos novos arranjos e articulação das propostas em curso.

Twin Peaks como alegoria daimónica cinematográfica

For a long time the allegorical activity was considered dogmatic and equated with artistic fossilization, archaic religious propensity and lack of creativity. However, Walter Benjamin (1928) and Paul De Man (1969), among other illustrious thinkers, came to its defense, exalting, instead, its cryptic, hybrid and abstract nature, which, incidentally, are the main characteristics of modern art. “Twin Peaks – Fire Walk with Me” (David Lynch, 1992) is a wonderful object of analysis, despite being one of the most misunderstood films in the history of cinema. The fact that its narrative is a prequel to the cult television series “Twin Peaks” and incorporates many of the characters of that show, explicitly denigrating the moral image of the protagonist, Laura Palmer, brought about an intense rejection by the fans of the series, as well as the indifference of the cinephilic community in general. However, one must go deeper, in order to understand Lynch’s brave accomplishment and its artfulness. Indeed, the opus is a powerful cinematic allegory because it contains a double layer of metaphorical meaning, one of them being explicitly metacinematic. Thus, besides assuming itself as a filmic daimonic allegory, occurring in a spiritual universe of Good versus Evil, the film is also an authorial discourse on cinema itself. More specifically, it is an allegory of spectatorship, according to Robert Stam’s definition, where the existence and crossing over to “another side” duplicates the architecture of movie theatres and the psychic processes involved in film viewing.

Tradutores: até que a localização nos separe?

O trabalho específico do tradutor inserido num projecto de localização exige deste competências diferentes das do tradutor técnico ou literário. A definição destas competências distintas é em parte determinada pelos materiais com que uns e outros são confrontados. O presente artigo analisa as diferenças ao nível dos textos de partida e das diversas estratégias utilizadas na produção dos textos de chegada.

Detección precoz de cáncer de cérvix según los discursos de las matronas de atención primaria en Segovia, España

OBJETIVO: Analizar los discursos de las matronas de atención primaria sobre el acceso y la utilización del Programa Preventivo de Cáncer de Cérvix. PROCEDIMIENTOS METODOLÓGICOS: Se desarrolló un estudio cualitativo en un área de baja densidad poblacional, Segovia, España, que cuenta con un alto porcentaje de población rural, entre 2008 y 2009. Se utilizó como técnica la entrevista semi-estructurada. Se realizaron diez entrevistas a las matronas de atención primaria de las 16 Zonas Básicas de Salud. El análisis de la información se basó en las propuestas de la Teoría Fundamentada. ANÁLISIS DE RESULTADOS: El acceso y utilización del Programa Preventivo de Cáncer de Cérvix se relaciona con la utilización de la consulta de la matrona por las mujeres, sus vivencias de los exámenes de citología vaginal y su percepción de riesgo a padecer un cáncer de cuello uterino. La barrera percibida es la distancia para acceder a la consulta de la matrona, y para las mujeres inmigrantes, además son barreras la posibilidad de no disponer de tarjeta sanitaria y desconocer la existencia del Programa. La exclusión social es también considerada una barrera de acceso y utilización. Se identificó como el principal facilitador, la recomendación de los médicos de familia de participar en el Programa. CONCLUSIONES: Las matronas perciben desigualdades de acceso y utilización del Programa Preventivo de Cáncer de Cérvix que se relacionan tanto con características individuales de las mujeres, como con el medio geográfico donde viven y con la propia estructura del Programa. Hay situaciones de vulneración de la equidad en colectivos de mujeres poco representadas a nivel encuestal, como las mujeres inmigrantes y las que residen en zonas rurales.

Effects of early life permethrin exposure on spatial working memory and on monoamine levels in different brain areas of pre-senescent rats

Pesticide exposure during brain development could represent an important risk factor for the onset of neurodegenerative diseases. Previous studies investigated the effect of permethrin (PERM) administered at 34 mg/kg, a dose close to the no observable adverse effect level (NOAEL) from post natal day (PND) 6 to PND 21 in rats. Despite the PERM dose did not elicited overt signs of toxicity (i.e. normal body weight gain curve), it was able to induce striatal neurodegeneration (dopamine and Nurr1 reduction, and lipid peroxidation increase). The present study was designed to characterize the cognitive deficits in the current animal model. When during late adulthood PERM treated rats were tested for spatial working memory performances in a T-maze-rewarded alternation task they took longer to choose for the correct arm in comparison to age matched controls. No differences between groups were found in anxiety-like state, locomotor activity, feeding behavior and spatial orientation task. Our findings showing a selective effect of PERM treatment on the T-maze task point to an involvement of frontal cortico-striatal circuitry rather than to a role for the hippocampus. The predominant disturbances concern the dopamine (DA) depletion in the striatum and, the serotonin (5-HT) and noradrenaline (NE) unbalance together with a hypometabolic state in the medial prefrontal cortex area. In the hippocampus, an increase of NE and a decrease of DA were observed in PERM treated rats as compared to controls. The concentration of the most representative marker for pyrethroid exposure (3-phenoxybenzoic acid) measured in the urine of rodents 12 h after the last treatment was 41.50 µ/L and it was completely eliminated after 96 h.

Expanding our therapeutic options: β-blockers for colon cancer?

Supported by U. Porto/Santander Totta (IJUP) (PP-IJUP2011-320)

Risk perception about zoonoses in immigrants and Italian workers in Northwestern Italy

OBJETIVO: To assess factors associated with a low risk perception of zoonoses and to identify the gaps in knowledge about transmission and prevention of zoonoses in immigrant and Italian workers. MÉTODOS: A cross-sectional study with 175 workers in the agro-livestock and agro-food industry in Piemonte, Italy, was carried out. Data were collected with a semi-structured questionnaire based on knowledge, attitudes and practices (KAP) survey. We calculated proportions and used chi-square tests and odds ratios to assess associations. Eight individual interviews with key informants on immigration and public health in Piemonte were carried out. RESULTADOS: Participants were 82 (47%) Italians and 93 (53%) immigrants. Immigrants were from Romania, Morocco, Albania, India, China, Argentina, Peru, Macedonia, Ivory Coast, Ukraine and Colombia. The study revealed significant differences in risk perception at work (p = 0.001). We found associations between "not having correct knowledge about zoonoses" and the following variables: i. "being immigrant" OR = 4.1 (95%CI 1.7;9.8 p ≤ 0.01); ii. "working in the livestock industry" OR = 2.9 (95%CI 1.2;15.4 p = 0.01); and iii. "being an unqualified worker" OR = 4.4 (95%CI 2.9;15.4 p ≤ 0.01). Another strong association was found between being immigrant and having a low job qualification OR = 6.7 (IC95% 2.9 - 15.4 p ≤ 0.01). Asian immigrants were the group with the highest frequency of risky behaviours and the lowest level of knowledge about zoonoses. CONCLUSÕES: Our results indicate that there were differences in risk perception of zoonoses between the groups participating in our study. These results suggest that immigrant status can be considered a risk factor for having lower risk perception and lower level of knowledge of zoonoses at work. There is a relationship between this specific knowledge of zoonoses and lack of training and instruction among migrant populations. Our results stress the need for developing education programs on zoonoses prevention among the immigrant population in Piemonte, Italy.

Advertising of ultra-processed foods and beverages: children as a vulnerable population

The rapid nutrition transition occurring in Latin America has resulted in a sharp increase of childhood overweight and obesity. Recent evidence has shown that food and beverage advertising has a great influence on children’s eating behavior. This population has become a key target market for the ultra-processed foods and beverages industry, which is marketing products in an aggressive way. Evidence shows that Latin American countries have poor regulation of ultra-processed foods and beverages advertising, where the discourse of self-regulation still prevails over statutory regulations. The following commentary explores how advertising might play an important role in developing unhealthy dietary patterns and obesity in Latin American children, as well as the urgent need for government action and the involvement of civil society to tackle this public health issue.

Estratégia de comunicação da burberry em Portugal: um estudo de caso

Dissertação apresentada à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Gestão Estratégica das Relações Públicas.

Fatores individuais e contextuais associados à má oclusão em crianças brasileiras

OBJETIVO: Avaliar a associação entre a prevalência de má oclusão em crianças aos 12 anos de idade com variáveis individuais e contextuais. MÉTODOS: Foi realizado um estudo transversal analítico com dados da Pesquisa Nacional de Saúde Bucal – SBBrasil 2010. O desfecho estudado foi a má oclusão, categorizada em ausente, definida, severa e muito severa. As variáveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados por meio de modelo multinível, considerando nível de 5% de significância. RESULTADOS: A prevalência de má oclusão severa e muito severa nas crianças com 12 anos de idade não diferiu entre as regiões brasileiras, mas sim entre as cidades (p < 0,001). Crianças do sexo masculino (p = 0,033), de menor renda (p = 0,051), que consultaram o dentista (p = 0,009), com menor satisfação com a boca e os dentes (p < 0,001) e com vergonha de sorrir (p < 0,001) apresentaram má oclusão de maior gravidade. As características das cidades também afetaram a gravidade da má oclusão; cidades com mais famílias com benefício social por 1.000 habitantes, com menores notas do índice de desempenho do sistema de saúde e menor renda per capita foram estatisticamente associadas com a má oclusão. CONCLUSÕES: Associações significativas entre a presença e gravidade da má oclusão foram observadas em nível individual e contextual.

Ultra-processed foods and the nutritional dietary profile in Brazil

OBJECTIVE To assess the impact of consuming ultra-processed foods on the nutritional dietary profile in Brazil.METHODS Cross-sectional study conducted with data from the module on individual food consumption from the 2008-2009 Pesquisa de Orçamentos Familiares (POF – Brazilian Family Budgets Survey). The sample, which represented the section of the Brazilian population aged 10 years or over, involved 32,898 individuals. Food consumption was evaluated by two 24-hour food records. The consumed food items were classified into three groups: natural or minimally processed, including culinary preparations with these foods used as a base; processed; and ultra-processed.RESULTS The average daily energy consumption per capita was 1,866 kcal, with 69.5% being provided by natural or minimally processed foods, 9.0% by processed foods and 21.5% by ultra-processed food. The nutritional profile of the fraction of ultra-processed food consumption showed higher energy density, higher overall fat content, higher saturated and trans fat, higher levels of free sugar and less fiber, protein, sodium and potassium, when compared to the fraction of consumption related to natural or minimally processed foods. Ultra-processed foods presented generally unfavorable characteristics when compared to processed foods. Greater inclusion of ultra-processed foods in the diet resulted in a general deterioration in the dietary nutritional profile. The indicators of the nutritional dietary profile of Brazilians who consumed less ultra-processed foods, with the exception of sodium, are the stratum of the population closer to international recommendations for a healthy diet.CONCLUSIONS The results from this study highlight the damage to health that is arising based on the observed trend in Brazil of replacing traditional meals, based on natural or minimally processed foods, with ultra-processed foods. These results also support the recommendation of avoiding the consumption of these kinds of foods.

Impact of ultra-processed foods on micronutrient content in the Brazilian diet

OBJECTIVE To evaluate the impact of consuming ultra-processed foods on the micronutrient content of the Brazilian population’s diet.METHODS This cross-sectional study was performed using data on individual food consumption from a module of the 2008-2009 Brazilian Household Budget Survey. A representative sample of the Brazilian population aged 10 years or over was assessed (n = 32,898). Food consumption data were collected through two 24-hour food records. Linear regression models were used to assess the association between the nutrient content of the diet and the quintiles of ultra-processed food consumption – crude and adjusted for family incomeper capita.RESULTS Mean daily energy intake per capita was 1,866 kcal, with 69.5% coming from natural or minimally processed foods, 9.0% from processed foods and 21.5% from ultra-processed foods. For sixteen out of the seventeen evaluated micronutrients, their content was lower in the fraction of the diet composed of ultra-processed foods compared with the fraction of the diet composed of natural or minimally processed foods. The content of 10 micronutrients in ultra-processed foods did not reach half the content level observed in the natural or minimally processed foods. The higher consumption of ultra-processed foods was inversely and significantly associated with the content of vitamins B12, vitamin D, vitamin E, niacin, pyridoxine, copper, iron, phosphorus, magnesium, selenium and zinc. The reverse situation was only observed for calcium, thiamin and riboflavin.CONCLUSIONS The findings of this study highlight that reducing the consumption of ultra-processed foods is a natural way to promote healthy eating in Brazil and, therefore, is in line with the recommendations made by the Guia Alimentar para a População Brasileira (Dietary Guidelines for the Brazilian Population) to avoid these foods.

Population health diagnosis with an ecohealth approach

OBJECTIVE To analyze the characteristics of health diagnosis according to the ecohealth approach in rural and urban communities in Mexico.METHODS Health diagnosis were conducted in La Nopalera, from December 2007 to October 2008, and in Atlihuayan, from December 2010 to October 2011. The research was based on three principles of the ecohealth approach: transdisciplinarity, community participation, gender and equity. To collect information, a joint methodology and several techniques were used to stimulate the participation of inhabitants. The diagnostic exercise was carried out in five phases that went from collecting information to prioritization of problems.RESULTS The constitution of the transdisciplinary team, as well as the participation of the population and the principle of gender/equity were differentials between the communities. In the rural community, the active participation of inhabitants and authorities was achieved and the principles of transdisciplinarity and gender/equity were incorporated.CONCLUSIONS With all the difficulties that entails the boost in participation, the incorporation of gender/equity and transdisciplinarity in health diagnosis allowed a holistic public health approach closer to the needs of the population.