Nutritional transition of school children from low income families of a northeastern urban area, Brazil

Background: Evaluating child growth is, in practice, performed by measuring the development of a child's weight, height, and body composition in comparison to averages observed among a reference population. Objective: To describe the nutritional status of children of low income families who live in urban region in northeastern Brazil. Methods: This study is a population case series with a transversal and observational design. The study population consisted of 257 children, aged 5 to 10 years, who were enrolled in a public school to children of low income families. We used the cutoff point for short stature of -2 Z scores for age, and underweight, overweight, and obese were classified as the 5th, 85th, and 95th percentiles, respectively, of the body mass index (BMI) for age, with both classifications in accordance with the Center for Disease Control and Prevention (CDC 2000). Comparisons by gender were performed for the measures of the central tendency and the frequency of diagnoses, in addition to the tendency of the evolution of BMI by age. Results: The prevalence of short stature was 3.5% (95% CI: 1.9-6.5). In the evaluation of BMI for age, the prevalences found for underweight, overweight, and obese were 5.8% (95% CI: 3.6-9.4), 4.7% (95% CI: 2.7-8.0), and 2.3% (95% CI: 1.1-5.0), respectively. We found a significant trend in the reduction of BMI with the increase in age. Conclusions: According to CDC references, the prevalences of underweight and short stature were higher than expected and for the overweight and obesity were lower than expected, indicating that the nutritional transition had still not reached, as commonly is described, these low income children from the urban outskirts of the Northeast region.

Obstructive acute abdomen due to intestinal intussusception in adolescent

Introduction: Intestinal intussusception is a rare disease out of childhood. It is represented by an invagination of a bowel into the lumen of the adjacent segment. Case Report: This article reports a case of 14 year-old patient presenting intestinal obstruction caused by an intussusception at the level of the terminal ileum. A surgical resection of the invaginated segment was done and the histopathological study disclosed no evidence of malignancy. Discussion: In children, it is usually idiopathic, but among adolescents and adults it is often related to anatomic lesions, some of them neoplastic with high risk of malignancy. Preoperative diagnosis of intestinal intussusception is difficult due to its nonspecific and subacute symptoms. Computed tomography and ultrassonography can confirm the intussusception through characteristic images. Conclusion: Intestinal intussusception in adolescents is a rare and often misdiagnosed disease, deserving special attention from surgeons and general doctors.

Sleep disorders in climacteric women

Introduction: This paper examines the various factors that contribute to the occurrence of sleep alterations during peri and post climacteric and thus produce significant imperil to women's quality of life. Among the probable causes of insomnia or sleep disorders associated to climacteric stand out the occurrence of vasomotor symptoms, depressive state and respiratory distress during sleep, such as sleep apnea, along with chronic pain, although psychosocial factors related to the climacteric bear major influence on such clinical status. Method: The bibliographic analysis was carried out using several electronic data base namely: Cochrane, Medline, Embase, Bni Plus, Biological Abstracts, Psycinfo, Web Of Science, Sigle, Dissertation Abstracts and ZETOC published in English, Spanish and Poruguese. The key terms used were: sleep, REM sleep, slow wave sleep polysomnography; electroencephalogram; sleep disturbances; disturbances of sleep onset and maintenance; excessive somnolence disturbances; climacteric; menopause; depression; neurobiology; biologic models; circadian rhythm; mental health and epidemiology. Case studies and letters to the editor were excluded. The summaries of the identified studies found in the data base were analyzed and assessed, and the data analyzed separately according to the subjective or objective criteria for data collection. Results: The climacteric transition constitutes a period of major risk for the development of depressive, vasomotor and insomnia symptoms although not caused solely by hypoestrogenism. The diagnostic methods used in the study of sleep disorders range from subjective assessment by means of response to specific questionnaires to the objective analysis of actigraphic or polissonographic daytime and nocturnal reports. Polissonographic studies of the whole night, performed at the laboratory, are the golden method of choice for diagnostic of sleep disorders. Studies point to the high prevalence of sleep disorders in the climacteric, especially insomnia, apnea and periodic movement of legs and also to the fact that this phase of life presents decrease in the quality of sleep. Women in peri and post climacteric show higher sleep latency and difficulty in its maintenance and refer being less satisfied with its quality even when compared to those who are not climacteric. Exception made to the vasomotor symptomatology, the other climacteric complaints such as mood disturbances, libido alterations, cognitive deficit, articular pain and sleep disorders are markedly associated to psychosocial factors, lifestyle and especially to women's perception of what the climacteric means to their lives. Conclusion: The analysis of the available studies revealed a proneness to deterioration of quality of life of climacteric women markedly in the sleep disturbances, depressed mood and anxiety domains and should not to be basically attributed to the climacteric. It is necessary that the professionals consider the need of assessment of such pathologies as complex phenomena and the literature lacks studies contemplating such dimensions.

Bioethics and Mental Health: The Rights of Patients With a Disorder

Bioethics can be included in the context of psychiatric patients' recovery of dignity and rights, creating a therapeutic interface of social rehabilitation, respect and closeness between professionals and the treated persons. The completion of the analysis of the facts occurred by reviewing 22 articles dated between 1999-2011, from a prior reading, selecting the ones that mention bioethics and mental health. Before the Psychiatric Reform, often, a lack of commitment to the mentally ill was noticed, isolating the patient from a social life. Before the Psychiatric Reform, often, a lack of commitment to the mentally ill was noticed by isolating the patient from a social life. After the Reform, the person with mental illness began to receive a more attentive care. It can be concluded that the Reform tried to bring life to those who had no respect and attention, these patients who needed to be included in a social and urban interaction.

Combined oral contraceptives and increasing cardiovascular risk: thromboembolism and hypertension

Background: Hormonal contraceptive pills are the most used reversible method for familiar planning in Brazil. The combined pill, with synthetic analogs of estrogen and progestin, is employed by 25% of Brazilian female population. Its use provokes an increase of blood pressure levels, takes patient to a hipercoagulability state and predisposes her to thromboembolic events. Purposes: We aimed to describe mechanisms of hypercoagulability promoted by oral combined contraceptives, to analyze the relative risk of cardiovascular events within users and to list the most common circulatory pathologies in these patients. Methods: Three virtual medical databases were surveyed (Pubmed/Medline, BVS/LILACS and Scielo). Twelve studies were selected: clinical trials, case reports and articles of indexed medical periodic originally published in Portuguese and English about synthetic hormones, oral contraception, coagulation disorders and cardiovascular morbimortality. Results: Synthetic estrogen promotes an increase of some clotting factors' levels (VII, VIII, IX, X, XII, XIII and fibrinogen), such as a reduction of their inhibitors (S protein and antithrombin). Because of this, etinilestradiol is the component most related to venous thrombosis and ischemic diseases of brain and heart. It also improves the releasing of hepatic angiotensinogen, taking to a increase of blood pressure levels. Conclusions: The prescription of oral combined contraceptives needs criteria, notably due to adverse effects of etinilestradiol. It is recommended to avoid the administration of these drugs for patients elder than 35 year-old or with risk factors. For these patients, the use of progestagen-only pills seems to be safer.

Structuring depressive discourse: A descriptive narrative process

This study aimed to evaluate the importance of a descriptive narrative process of the significance involved in a depressive phenomenon. The research population consisted of 324 adult and adolescent patients of both genders, located in the central area of the city of Paraiba, for clinical and psychological health care. For surveyed patients, suffering and or psychological pain were the most common complaints. A sample of 159 patients was taken, including male and female adolescents and adults. Data were collected through a narrative interview. Shutz' procedure was used for information analysis. The obtained data offered the opportunity to review concepts, discuss life history and listen to narrative positioning episodes of manifested depression. The narratives were considered to be a determinant factor to consider inherent conflicts.

Depression in children and adolescents: family narratives in Brazilian primary attention

Background: The incidence of depression in children and adolescents still increasing and this disorder is now a major public health challenge worldwide. The Psychiatric Reform suggested an end to the fragmented and inefficient service by proposing integrated and quality care. In this context, family narratives are a way to recognize vulnerabilities and provide psychopathology prevention in primary care. Methods: Two medical databases (LILACS and SciELO) were surveyed and 14 texts published between 2004 and 2011 were selected and reviewed. Results and discussion: Children and adolescents are nowadays exposed to several stressing factors, in addition to natural vulnerabilities of this age group. Prevention is associated with a qualified hearing of family narratives in primary care and healthcare professionals should be able to perceive said and unsaid elements across the speech. Conclusion: In spite of the advances about children and adolescents mental health, some procedures must be adapted to achieve an efficient mental health policy though analyzing family discourse.

Non-functionant urinary bladder paraganglioma

Introduction: Paragangliomas are rare tumors origined on chromaffin-cells of neural crest and can be located from skull base to pelvis, on sympathetic or parasympathetic paraganglia. They account on less than 0,06% of all urinary bladder tumors, with only few hundreds of cases reported in literature since the first record by Zimmermmann in 1953. Case Report: A 63 year-old woman referring irritative urinary symptoms was submitted to an ultrassonography that disclosed an irregular-shaped nodulation on her bladder. CT confirmed the existence of a nodulation on bladder's anterior wall. Patient had normal levels of urinary catecholamins and Vanilmandelic acid. Tumor was excised and posterior immunohistochemical study revealed it was a paraganglioma. Nowadays, ten months after surgery, patient stills healthy and disease-free. Discussion: Paragangliomas can be classified as functionant or non-functionant, according to its production of cathecolamins, which can cause the same symptom complex of pheocromocytomas. About 10-15% of bladder paragangliomas are malignant, and potential metastasis are more common to lymph nodes, lungs and bones. 131-MIBG iodine cyntilography is the most sensitive method for diagnosis and surgery (transurethral resection or cystectomy) is the best choice for treatment.

Green Line Peace Forum (Beirut: Lo spazio del dialogo nella città spartiacque tra Occidente ed Oriente)

Come al giorno dʼoggi si verifica lʼintegrazione (o più spesso lʼemarginazione) della cultura islamica, dalle caratteristiche così differenti e lontane dalla cultura occidentale, con la società contemporanea nella quale viviamo? Riflettendo sulla risposta a tale quesito, alla luce delle conoscenze intraprese durante lʼesperienza erasmus, ho pensato a quale fosse il contesto migliore nel quale investigare e tentare una connessione tra queste due culture. Ho quindi individuato alcune città “modello” per quanto riguarda la convivenza di differenti religioni, crogiuoli di diverse etnie e culture, con una storia radicata di interculturalità: in particolare Sarajevo, Tirana e Beirut. La scelta di allontanarmi da un contesto europeo od addirittura italiano è stata dettata da ragioni storiche e di apertura mentale: in quelle città da anni, forse secoli si verifica la convivenza di differenti confessioni, spesso allʼinterno dello stesso quartiere.

Cooperation after war: International development in Bosnia, 1995 to 1999

This paper discusses how predispositions, incentives, the number and heterogeneity of participants, and leadership (Faerman et al. 2001) jointly influenced the international effort to develop Bosnia and Herzegovina. International coalitions, task forces, and advisory groups are increasingly charged with implementing reforms following civil conflict. This requires a complex web of interorganizational relationships among NGOS, donors and host nations at both global and ‘ground’ levels. To better understand development assistance, attention must be paid to the relationships between these varied players. We find that four factors influenced relationships between policy, donor, and implementing organizations; and those strained relationships, in turn, affected development success. The paper draws on interviews, conducted in Bosnia, with 43 development professionals, observation of development meetings in Tuzla and Sarajevo, and review of related documents from international development programs.

Linguistic Stylistics

Marina Katnic-Bakarsic. Linguistic Stylistics The practical, i.e. educational, objective of this research was to produce lectures on linguistic stylistics for the students of Sarajevo University, while the theoretical one was to produce a monograph on the subject. This monograph, which can also be used as a university textbook, includes twenty-nine chapters, an index of topics, a bibliography and a list of sources. The theoretical postulates are followed by examples from texts in various functional styles in Bosnian, Croatian, Serbian, and in some cases Russian or English. Linguo-stylistic problems were investigated from both the structuralist and post-structuralist points of view. Linguistic stylistics is therefore understood as a discipline which studies expressive, stylistically marked language units on all language levels, functional-stylistic language variation and various aspects of intertextuality and metatext. The author introduces a notion of stylistic competence. The stylistic competence of a speaker is directly proportional to his/her knowledge of different varieties of language (i.e. subcodes) and to the successful switching from one subcode to another. Stylistic creativity is a special segment of stylistic competence as a feature of individual style. A new classification of functional styles has also been introduced. This includes six primary styles (scientific, colloquial, administrative, publicistic, journalistic and literary-artistic) and five secondary styles (oratorical, the style of advertisements and commercials, that of comics, that of essays and that of screenplays). A special place is given to the analysis of the style of hypertext and hypermedia, which can be understood only within the post-structuralist theory of text deconstruction and intertextuality. The project also analysed some new topics, including reregistration in literary texts, gender and style of dialogue, and citations as metatextual signals and their role in different types of text. The results therefore offer a new approach to the study of linguistic stylistics both in Bosnia and Herzegovina and in the field in general.

Muslim Literature in Serbo-Croat in Relation to the Serbian and Croatian Literatures

Mr. Tutnjevic set out to define the position of the Muslim community within the overall framework of literature in Serbo-Croat, particularly in terms of its relation to the Serbian and Croatian Literatures, on the basis of an extensive comparative study of primary and secondary sources relating to the most important Muslim writers in Serbo-Croat. Carried out against the background of an unprecedented civil war between these national groups, his research focused rather on the encounters between them on the historical and literary stages. He concludes that the Muslim national community was established and developed on a foundation of Slavic self-consciousness and oriental influences. The constantly changing relative weights of the influence of these two factors on the community shaped the specific nature of its literature as well as its place in the cultural environment of its neighbouring national communities, and Muslim literary traditions are inseparably linked with the total literature in Serbo-Croat. A real Muslim literature first emerged at the end of the nineteenth century and virtually all authors writing about this at the time emphasised its educational character and its importance for the process of national identification. At the same time there were visible results of the self-awareness process in which Muslim authors affiliated with Serbian or Croatian literary tradition, sometimes even substituting one with another. During the period between the two world wars Muslim literature reached maturity and while Muslim authors generally focused on their national milieu in terms of subject matter, their forms of expression and their understanding of the function of literature showed the same preoccupation as other Yugoslav authors of the period. When the ideological and class-related concept of society replaced the national character of literature after 1945, Muslim writers found themselves in the same position as writers from other ethnic groups. As in earlier times, writers sought to present themselves to as wide a market as possible and would provide grounds for consideration as Serbian or Croatian writers, sometimes even explicitly presenting themselves as such. Most of the writers of this period are described at times as Yugoslav, at others as Bosnian-Herzegovina, and at still others as Serbian, Croatian or Muslim. Mr. Tutnjevic quotes, for example, the case of Camil Sijaric, a Muslim from Sandzak who also wrote in Sarajevo and falls within the boundaries of Bosnian-Herzegovnian literature, but is also described as a Muslim, Montenegrin and Serbian writer, together with a number of other such examples. An understanding of this process provides the basis for a completely new perception of the intertwining of Serbian, Croatian and Muslim literary traditions, without the earlier visible prejudice on all three sides.

Zur Geschichte der jüdischen Handschriften-Illustration

von David Kaufmann

Una guerra todas las guerras : El viaje a la barbarie de Juan Goytisolo

En Cuaderno de Sarajevo, Juan Goytisolo reconstruye un escenario de guerra que trasciende el referente: aquel "viaje hacia la barbarie"-como reza el subtítulo- recupera múltiples voces, escenas, personajes fácilmente reconocibles en cualquier enfrentamiento bélico de la historia. El lector entiende que no es una obra de ficción: autor y narrador se confunden en el nombre de Goytisolo; su profesión, su vida personal, sus afectos, sus imágenes (se incluye una serie de fotografías que muestran al autor en el escenario descrito) son puestos en primer plano como parte fundamental de la construcción de un género -el de la crónica- que exige anclar en la realidad. Es, sin embargo, el mundo de Sarajevo un mundo que se construye en clave ficcional: un mundo parecido a la realidad efectiva, pero alternativo al mundo objetivo. Así se representa el escenario como si fuera la repetición caótica de muchos otros: la Guerra Civil española, la indiferencia de las instituciones internacionales, las distancias étnicas, políticas y económicas de ayer y hoy son algunos de los referentes que el autor utiliza para construir una memoria colectiva, intemporal, única y universal, que nos permite viajar -movernos, proyectarnos, avanzar- en la inmovilidad, la iteración y el retroceso.

Una guerra todas las guerras : El viaje a la barbarie de Juan Goytisolo

En Cuaderno de Sarajevo, Juan Goytisolo reconstruye un escenario de guerra que trasciende el referente: aquel "viaje hacia la barbarie"-como reza el subtítulo- recupera múltiples voces, escenas, personajes fácilmente reconocibles en cualquier enfrentamiento bélico de la historia. El lector entiende que no es una obra de ficción: autor y narrador se confunden en el nombre de Goytisolo; su profesión, su vida personal, sus afectos, sus imágenes (se incluye una serie de fotografías que muestran al autor en el escenario descrito) son puestos en primer plano como parte fundamental de la construcción de un género -el de la crónica- que exige anclar en la realidad. Es, sin embargo, el mundo de Sarajevo un mundo que se construye en clave ficcional: un mundo parecido a la realidad efectiva, pero alternativo al mundo objetivo. Así se representa el escenario como si fuera la repetición caótica de muchos otros: la Guerra Civil española, la indiferencia de las instituciones internacionales, las distancias étnicas, políticas y económicas de ayer y hoy son algunos de los referentes que el autor utiliza para construir una memoria colectiva, intemporal, única y universal, que nos permite viajar -movernos, proyectarnos, avanzar- en la inmovilidad, la iteración y el retroceso.