Correlação entre achados colposcópicos e diagnóstico histológico segundo a Classificação Colposcópica da Federação Internacional de Patologia Cervical e Colposcopia de 2002

Objetivo: Avaliar a acurácia da colposcopia utilizando a Classificação Colposcópica Internacional de 2002. Métodos: 3040 pacientes de população geral foram rastreadas para patologia cervical através de exame citopatológico, captura híbrida para HPV de alto risco e inspeção cervical. As colposcopias que resultaram em biópsia (n=468) executadas no rastreamento e acompanhamento destas pacientes foram gravadas, revistas por dois colposcopistas cegados e incluídas para análise. Resultados: Os observadores apresentaram excelente concordância (Kappa=0.843) no relato dos achados pela nova nomenclatura. A colposcopia apresentou sensibilidade de 86% e especificidade de 30.3% em diferenciar colo normal de colo anormal (LSIL, HSIL ou carcinoma); quando a colposcopia objetivava diferenciar colo normal ou LSIL de HSIL ou carcinoma, apresentou sensibilidade de 61.1% e especificidade de 94.4%. Os achados colposcópicos classificados como “maiores” pela nova classificação apresentaram valores preditivos positivos elevados para HSIL. Presença do achado colposcópico na zona de transformação e tamanho da lesão estavam associados a HSIL. Bordas externas definidas, associação de múltiplos achados distintos e presença de zona iodo negativa não estavam relacionados à gravidade das lesões. Conclusão: A colposcopia utilizando a Classificação Internacional de 2002 mostra-se um bom método de rastreamento, mas como método diagnóstico apresenta falhas, não podendo substituir a avaliação histológica. A categorização em achados colposcópicos “maiores” e “menores” apresentada pela nova classificação é adequada. Na realização da colposcopia, é importante também que a lesão seja situada em relação à zona de transformação e que seu tamanho seja indicado, já que estes foram fatores associados a lesões de alto grau.

Hipertensão arterial e fatores de risco em servidores atendidos pelo departamento de assistência da Universidade Federal do Rio Grande do Norte

Systemic arterial hypertension is a multifactorial disease that contributes to the country´s high cardiovascular morbi-mortality rates. Considering that hypertension affects individuals in their most productive age while facing work and living risk factors, it is important to investigate its occurrence and predisposing factors in different occupational segments. The objective of this study was to identify the prevalence of hypertension among workers attended to in a medical service of a public university, their hypertension levels, the risk factors present, and their knowledge of the factors that influence the arterial pressure. The epidemiologic study was conducted in the Health Department of the Federal University of Rio Grande do Norte with 102 workers that sought care in the medical clinic during the months of March to May 2009. Data were collected by means of a questionnaire and measurements of systolic and diastolic arterial pressure (SAP and DAP) that were classified in stages according to the Brazilian Society of Hypertension and the degree of risk for cardiovascular events according to the criteria of the Brazilian Society for Cardiology. Data were analyzed using descriptive statistics. The workers were, on average, 54 years of age; the majority (67%) was male and had primary or middle educational level; they worked mainly in supplemental units and deanship offices conducting different functions such as security guards, administrative assistants, health auxiliaries and constructions workers; 48 (47%) of the workers identified themselves as hypertensive for 8 years on average, with the majority executing hard labor and administrative functions. Among the workers with hypertension, the number of the pressure levels classified as pre-hypertensive, stage I and II were: (12% in the SAP and 20% in the DAP); (16% in the SAP and 9% in the DAP); and (15% in the SAP and 5% in the DAP), respectively. The workers that did not identify themselves as hypertensive presented classifications with greater frequencies were: normal (16% in the SAP and 30% in the DAP); and pre-hypertensive (21% in the SAP and 16% in the DAP). The risk factors identified in more than 50% of the workers were: tobacco smoking, alcohol consumption and indices of being overweight, although physical activities are also present. Of the 48 workers diagnosed as hypertensive, those that had 5 risk factors present and limitrophic pressure levels (12%), in stage I hypertension (16%) and stage II hypertension (15¨%) were categorized as being in high risk for vascular events. The number of workers that indicated they had knowledge of the factors that influence their hypertension was less than 39% for each factor. It is concluded that there is a high prevalence of systemic arterial hypertension in the university workers, even amongst those already under treatment. They constitute a population at risk considering their age group, their work functions, and their inadequate life habits. Health care of these hypertensive workers that seek attention in the Health Department is an important aspect of the internal workers health policy in the institution. Educational interventions are recommended for the improvement of quality of life and of work in these workers

Ações de profissionais relativas ao banco de leite humano : uma perspectiva de mudança

This is an exploratory and descriptive study that aimed to investigate the actions of professionals in the context of breastfeeding, on the assumption that the actions taken by employees working together to postpartum and newborn are not competing to effect the distribution of pasteurized human milk so that it meets the needs of infants who depend on it. Thus, the study aimed to analyze the actions of medical and nursing staff of the distribution of pasteurized human milk to the newly born. The investigation was developed by action research in a federal hospital, located in the capital the state of Rio Grande do Norte, Brazil, reference assistance to women during pregnancy, childbirth and postpartum high risk in 2010. Study participants were fifty-five professionals chosen from the following inclusion criteria: to act in the NICU or rooming, being a pediatrician and / or neonatologists, nurses and technical nursing. According to the methodology of action research a questionnaire was applied, techniques in focus groups and courses were developed, and, finally, action evaluation. The project was submitted to the Ethics Committee at the Federal University of Rio Grande do Norte and approved with no protocol 448/2009. The problems identified in the responses issued by the social research were grouped into categories according to the similarity between them. The answer to the question of the survey - How is the need for pasteurized human milk for the newborns in neonatal intensive care unit and rooming identified? - Brought subsidies for action planning and implementation of strategies for change in the practice of professionals working in rooming and ICU. Thus, the study has relevance in social care and, when at the local level, will compete for the distribution pasteurized human milk to take effect as best as possible, as recommended by the Ministry of Health. It is also conceived that, in a macro view of society, it could contribute to minimizing the health problem that involves the child population

Percepção de riscos ambientais de populações vulneráveis a inundações e deslizamentos de dunas em Natal-RN

In urban, flooding and landslides are among the troubles that most bring human and material loss. Therefore, this study objected to perform an analysis on the risk perception on the population living in social environmental vulnerable places in order to understand what is the way this population realize the risks they are exposed to and what are the outbrave strategies the develop. The first analyzed area was Complexo Passo da Pátria for the flooding risk problematic and then the Cidade Nova neighborhood threatened by the dunes slides. The areas locate, respectively, in the West and East zones of Natal-RN. Using an interview screenplay adapted from risk perception researches from different brazilian cities, it was collected primarily data on the variables: perception, evaluation and choice, safety threshold, adjustment, decision and participation. Due to the studied areas characteristics the qualitative approach adjusted itself to the difficulties for accessing the areas. The studied places characterize for its insecure situation like selling/using drugs, robbery and murder among others. Due to this situation the interviewed individuals were the ones that could be found more accessibly and available in the moment and the interviews were made in the community leader presence of each area. Through the discourse of the respondents analysis it was able to conclude that the interviewed population is exposed to a high vulnerability grade and risks. However it was identified substantial differences between the perception and risks of Complexo Passo da Pátria and bairro Cidade Nova, because in the first area the intervied ones can recognize the high risk they are exposed to in a more emphatic way to the interviewed ones for the Cidade Nova neighborhood. Furthermore, there is a heavy dissatisfaction for the population of the two places about the city hall positions relating to the present problems in the studied areas. It was also identified the strategy development of acquaintanceship with the risk in the research places beyond a feeling of belonging and affection between the dwellers and the places, yet it was more evident for Complexo Passo da Pátria. Though this analysis it was possible to understand and perceptions and the behavior of the individuals or social groups facing the risks as acceptance and rejection of determined risks beyond adaptation measures of living together with the persistence presence of risks. Therefore, qualitative nature researches emphasizing the perception approach are in the fundamental importance in the studies about risks making it possible to offer aids to the urban planning and management in the implement of effective preventive measures and compatible with the population aims

Caracterização das quedas de pacientes segundo notificação em boletins de eventos adversos

Este estudo foi desenvolvido com o objetivo de caracterizar as quedas de pacientes internados ocorridas em hospital terciário. Foram analisados 826 Boletins de Notificação de Eventos Adversos, de um período de 30 meses, que registraram 0,30 quedas por 1000 pacientes/dia. Quedas do leito foram mais frequentes (55%), com maior prevalência na enfermaria de neurologia. Maior frequência de quedas foi verificada no período noturno (63,7%), nos primeiros cinco dias da admissão (61,7%), nos pacientes de sexo masculino (57,5%) e na faixa etária maior de 60 anos (50%). Nos casos de quedas do leito, os diagnósticos relacionaram-se a doenças infecciosas e parasitárias (18,2%), doenças do sistema nervoso (18,2%) e doenças do aparelho circulatório (13,7%). Nas quedas da própria altura, os diagnósticos relacionaram-se a neoplasias (19,4%) e doenças do aparelho geniturinário (16,1%). A caracterização desses eventos adversos auxilia no reconhecimento dos grupos de maior risco e na elaboração de propostas preventivas.

PSA and androgen-related gene (AR, CYP17, and CYP19) polymorphisms and the risk of adenocarcinoma at prostate biopsy

The aim of the present study was to examine the impact of polymorphisms in prostate-specific antigen (PSA) and androgen-related genes (AR, CYP17, and CYP19) on prostate cancer (PCa) risk in selected high-risk patients who underwent prostate biopsy. Blood samples and prostate tissues were obtained for DNA analysis. Single-nucleotide polymorphisms in the 50-untranslated regions (UTRs) of the PSA (substitution A > G at position -158) and CYP17 (substitution T > C at 50-UTR) genes were detected by polymerase chain reaction (PCR)-restriction fragment length polymorphism assays. The CAG and TTTA repeats in the AR and CYP19 genes, respectively, were genotyped by PCR-based GeneScan analysis. Patients with the GG genotype of the PSA gene had a higher risk of PCa than those with the AG or AA genotype (OR = 3.79, p = 0.00138). The AA genotype was associated with lower PSA levels (6.44 +/- 1.64 ng/mL) compared with genotypes having at least one G allele (10.44 +/- 10.06 ng/mL) (p = 0.0687, 95% CI - 0.3146 to 8.315, unpaired t-test). The multivariate analysis confirmed the association between PSA levels and PSA genotypes (AA vs. AG+GG; chi(2) = 0.0482) and CYP19 (short alleles homozygous vs. at least one long allele; chi(2) = 0.0110) genotypes. Genetic instability at the AR locus leading to somatic mosaicism was detected in one PCa patient by comparing the length of AR CAG repeats in matched peripheral blood and prostate biopsy cores. Taken together, these findings suggest that the PSA genotype should be a clinically relevant biomarker to predict the PCa risk.

A function to predict the risk for death in the neonatal sepsis

This was a prospective study of 43 septic neonates at the NICU of the School of Medicine of Botucatu, São Paulo State University. Clinical and laboratory data of sepsis were analyzed based on outcome divided into two groups, survival and death. We calculated the discriminatory power of the relevant variables for the diagnosis of sepsis in each group, and using software for Discriminant Analysis, a function was proposed. There were 43 septic cases with 31 survivals and 12 deaths. The variables that had the highest discriminatory power were: n(o) of compromised systems, the SNAP, FiO2, and (A-a)O2. The study of these and others variables, such as birth weight, n(o) of risk factors, and pH using a Linear Discriminant Function(LDF) allowed us to identify the high-risk neonates for death with a low error rate (8.33%). The LDF was: F = 0.00043 (birth weight) + 0.30367 (n(o) of risk factors) - 0.1171 (n(o) of compromised systems) + 0.33223 (SNAP) + 2.27972 (pH) - 14.96511 (FiO2) + 0.01814 ((A-a)O2). If F > 22.77 there was high risk of death. This study suggests that the LDF at the onset of sepsis is useful for the early identification of the high-risk neonates that need special clinical and laboratory surveillance.

Fatores associados à vacinação contra influenza em idosos em município do Sudeste do Brasil

OBJETIVO: Mesmo gratuita e disponível no Brasil desde 1999, a cobertura vacinal contra a influenza ainda é inadequada em diversos municípios do País. O objetivo da pesquisa foi estimar a cobertura vacinal e identificar fatores relacionados à vacinação contra a influenza em idosos. MÉTODOS: Realizou-se inquérito domiciliar em amostra aleatória sistemática (N=365) da população urbana maior de 60 anos em Botucatu, São Paulo. Foi aplicado modelo de regressão logística múltipla, cuja variável dependente foi ter sido vacinado em 2002. Foram testadas no modelo as covariáveis: sexo, idade, socioeconômicas (renda per capita, número de pessoas por cômodo, escolaridade, estado civil, ocupação, tempo de moradia), antecedentes mórbidos, de internação, hábito de fumar, sintomas respiratórios nos últimos 15 dias e atividades comunitárias (trabalho voluntário, atividades no bairro, igreja). RESULTADOS: Registrou-se cobertura vacinal de 63,2% (IC 95%: 58,3-68,2). Foi observado menor percentual de vacinados entre os idosos na faixa etária de 60 a 64 anos. As variáveis que se mostraram associadas à vacinação e permaneceram no modelo final foram: idade (OR=1,09 por ano; IC 95%: 1,06-1,13); hipertensão arterial (OR=1,92; IC 95%: 1,18-3,13); inserção em atividades na comunidade (OR=1,63; IC 95%: 1,01-2,65). A vacinação em portadores de doenças crônicas não atingiu níveis adequados conforme esperado para este grupo de risco, com exceção dos hipertensos. A participação em atividades comunitárias e sociais foi relacionada com o estado vacinal. CONCLUSÕES: Condições socioeconômicas, hábitos e idade não restringiram o acesso à campanha vacinal. Por outro lado, campanhas específicas, endereçadas a indivíduos da faixa de 60 a 64 anos, podem ampliar a cobertura da vacinação.

Consumo abusivo e dependência de álcool em população adulta no Estado de São Paulo, Brasil

OBJETIVO: Descrever as prevalências de consumo abusivo e dependência de álcool em população adulta de 20 a 59 anos no Estado de São Paulo, e suas associações com variáveis demográficas e socioeconômicas. MÉTODOS: Inquérito domiciliar do tipo transversal (ISA-SP), em quatro áreas do Estado de São Paulo: a) Região Sudoeste da Grande São Paulo, constituída pelos Municípios de Taboão da Serra, Itapecerica da Serra e Embu; b) Distrito do Butantã, no Município de São Paulo; c) Município de Campinas e; d) Município de Botucatu. Foi considerado consumo abusivo de álcool a ingestão em dia típico de 30 gramas ou mais de etanol para os homens, e 24 gramas ou mais para as mulheres. A dependência de álcool foi caracterizada pelo questionário CAGE. Análises bivariadas e multivariadas dos dados foram realizadas a partir de Modelos de Regressão de Poisson. Todas as análises foram estratificadas por sexo. RESULTADOS: em 1.646 adultos entrevistados, a prevalência de consumo abusivo de álcool foi de 52,9% no sexo masculino e 26,8% no sexo feminino. Quanto à dependência de álcool, foram observadas duas ou mais respostas positivas no teste CAGE em 14,8% dos homens e em 5,4% das mulheres que relataram consumir álcool. Isto corresponde a uma prevalência populacional de dependência de 10,4% nos homens e 2,6% nas mulheres. O consumo abusivo de álcool no sexo masculino apresentou associação inversa à faixa etária e associação direta à escolaridade e ao tabagismo. No sexo feminino, observou-se associação direta do consumo abusivo de álcool com a escolaridade e o tabagismo, e com as situações conjugais sem companheiro. A dependência de álcool no sexo masculino associou-se a não exercer atividade de trabalho e à baixa escolaridade. No sexo feminino não houve associação do CAGE com nenhuma das variáveis estudadas. CONCLUSÕES: Pela alta prevalência de consumidores e dependentes, é essencial a identificação dos segmentos sociodemográficos mais vulneráveis ao consumo abusivo e dependência de álcool. As associações entre a dependência/abuso e não estar exercendo atividade de trabalho, no sexo masculino, e a maior prevalência em mulheres de escolaridade universitária, sugerem componentes para programas de intervenção e controle.

High Incidence of Enterotoxin D Producing Staphylococcus spp. in Brazilian Cow's Raw Milk and Its Relation with Coagulase and Thermonuclease Enzymes

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth and dental trauma prevention

A high prevalence of dental trauma exists and its effects on function and esthetics deserve the attention of general dentists. The aim of this study was to assess the level of general dental practitioners' (GDPs) knowledge about guidelines for dental avulsion and its prevention using a questionnaire. The 21-item questionnaire was distributed among 264 GDPs and the survey was realized between August-November 2006. The data obtained were statistically analyzed using descriptive analysis and Pearson's Chi-square test to determine associations between knowledge regarding emergency treatment and dentists from public or private dental schools and years of experience. The results showed that the participants exhibited appropriate knowledge concerning procedures in cases of tooth avulsion and its prevention. The number of correct answers was low in relation to recommended treatment at the site of injury. Storage medium, preparation of the alveolus and splint time for receiving the avulsed tooth received a high number of correct answers. One statistically significant association between years of experience and recommended treatment at the site of the injury in the case an avulsed tooth (KH2 = 9.384, P = 0.009). In conclusion, this survey showed appropriate knowledge of dental avulsion management and its prevention among the surveyed dentists. The findings also showed that communication between dentists and the population is deficient, especially concerning practitioners of high risk and contact sports.

Interactions between genetic predisposition and environmental toxicants for development of lung cancer

Significant interindividual variations in health outcome may be caused by the inheritance of variant polymorphic genes, such as CYP2D6 and CYP2E1 for activation, and GSTM1 and GSTT1 for detoxification of chemicals. However. mechanistic studies linking the inheritance of predisposing genes with genotoxic effects towards cancer have yet to be systematically conducted. We have studied 54 lung cancer patients and 50 matched normal controls, who have been cigarette smokers, to elucidate the role of polymorphic genes in cancer. Our data indicates that the inheritance of unfavorable CYP2D6, CYP2E1, and GSTT1 genes is strongly correlated with the smoking-related lung cancer. For heavy cigarette smokers (> 30 pack-years), the smoking habit is the strongest predictor of lung cancer risk irrespective of the inheritance of unfavorable metabolizing genes. For moderate to light smokers (< 30 pack-years), the genetic predisposition plays on important role For the risk (odds ratio = 3.46; 95% CL = 0.46-40.2). Using a subgroup of the study population, we observed that cigarette smokers having the defective GST genes have significantly more chromosome aberrations as determined by the fluorescence-in-situ-hybridization (FISH) technique than smokers with the normal GST genes (P < 0.001). In conclusion, our study provides data to indicate that individuals who have inherited unfavorable metabolizing genes have increased body burden of toxicants to cause increased genetic damage and to have increased risk for cancer. Studies like ours can be used to understand the basis for interindividual variations in cancer outcome, to identify high risk individuals and to assess health risk. (C) 1997 Wiley Liss, Inc.

Long-term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Second Primary Tumors in Patients with Head and Neck Cancer

This is a review on second primary tumors in patients with head and neck cancer. These patients have a high risk of developing other cancers simultaneously or subsequently. The incidence of multiple primary tumors in this population can be as high as 27%. Recurrences are the most common cause of treatment failure within the first 2 years of follow-up. After the third year the diagnosis of a second primary tumor becomes the most important cause of morbimortality in head and neck cancer patients, especially in those treated for cancers early diagnosed. Most second primary tumors occur in the upper aerodigestive tract (40%-59%), lung (31%-37.5%), and esophagus (9%-44%). Patients who develop second primary tumor have a significant reduction of survival expectancy.

Programa de controle de surto de escorpião Tityus serrulatus, Lutz e Mello 1922, no município de Aparecida, SP (Scorpiones, Buthidae).

A scorpion control program was proposed for the town of Aparecida (SP), an endemic region of Tityus serrulatus. Clusters of scorpions in urban and rural areas, environmental degradation of the town's outskirts and new scorpion procreation and dispersal habitats were studied. In addition, infrastructure problems such as the disposal and collection of residential and municipal refuse, sanitation (sewage and storm sewer), condition of vacant lots and constructions in the urban area were evaluated. After an epidemiological study, educational measures such as the distribution of pamphlets, cleaning group work, visits to residences and cooperation from High School teachers and students were also suggested. Chemical control was indicated in high-risk sites, especially those of near-school buildings. Furthermore, the use of natural predators was also mentioned within the present sanitation regulations for urban areas. The authors assert that these procedures must be integrated and continued uninterruptedly for several years. They also suggest a collaborative work with those responsible for the dengue eradication program, as well as the institution of the scorpion study week, which would greatly contribute to the education of the population, to preventive programs and to scorpion control.