RESUMO
Objective: To set cutoff points for the triglyceride and glucose index (TyG) as a marker of insulin resistance (IR) for the pediatric population. Subjects and methods: This was a cross-sectional study with schoolchildren population-based data using data of 377 schoolchildren age 10 to 17 years of both sexes. We studied metabolic variables associated with IR indicators, such as fasting insulin and blood glucose, to calculate the homeostatic model assessment (HOMA-IR), and we studied triglycerides (TG) to determine the TyG index. We obtained TyG cutoff values for IR using the receiver operation characteristic (ROC), with definitions of sensitivity (Sen), specificity (Spe), and area under the ROC curve (AUC), with the HOMA-IR as reference. Results: The cutoff points of the TyG index for IR in adolescents are 7.94 for both sexes, 7.91 for boys, and 7.94 for girls, indicating moderate discriminatory power. When we also considered anthropometric variables of excess weight [TyG-BMI (body mass index)] and visceral fat [TyG-WC (waist circumference)], these indexes reached AUC values higher than 0.72, enhancing their potential use for a good diagnosis. Conclusion: TyG has proven to be a useful instrument for identifying IR in adolescent health screening, with high discrimination capacity when added to anthropometric variables, making it a feasible and inexpensive option.
Assuntos
Doenças Cardiovasculares , Resistência à Insulina , Masculino , Feminino , Humanos , Adolescente , Criança , Glucose , Triglicerídeos , Brasil , Estudos Transversais , Biomarcadores , Glicemia/metabolismoRESUMO
ABSTRACT Objective: To set cutoff points for the triglyceride and glucose index (TyG) as a marker of insulin resistance (IR) for the pediatric population. Subjects and methods: This was a cross-sectional study with schoolchildren population-based data using data of 377 schoolchildren age 10 to 17 years of both sexes. We studied metabolic variables associated with IR indicators, such as fasting insulin and blood glucose, to calculate the homeostatic model assessment (HOMA-IR), and we studied triglycerides (TG) to determine the TyG index. We obtained TyG cutoff values for IR using the receiver operation characteristic (ROC), with definitions of sensitivity (Sen), specificity (Spe), and area under the ROC curve (AUC), with the HOMA-IR as reference. Results: The cutoff points of the TyG index for IR in adolescents are 7.94 for both sexes, 7.91 for boys, and 7.94 for girls, indicating moderate discriminatory power. When we also considered anthropometric variables of excess weight [TyG-BMI (body mass index)] and visceral fat [TyG-WC (waist circumference)], these indexes reached AUC values higher than 0.72, enhancing their potential use for a good diagnosis. Conclusion: TyG has proven to be a useful instrument for identifying IR in adolescent health screening, with high discrimination capacity when added to anthropometric variables, making it a feasible and inexpensive option.
RESUMO
Introduction: Prenatal growth impairment leads to higher preference for palatable foods in comparison to normal prenatal growth subjects, which can contribute to increased body fat mass and a higher risk for developing chronic diseases in small-for-gestational-age (SGA) individuals throughout life. This study aimed to investigate the effect of SGA on feeding behavior in children and adolescents, as well as resting-state connectivity between areas related to reward, self-control, and value determination, such as orbitofrontal cortex (OFC), dorsolateral prefrontal cortex (DL-PFC), amygdala and dorsal striatum (DS). Methods: Caregivers and their offspring were recruited from two independent cohorts in Brazil (PROTAIA) and Canada (MAVAN). Both cohorts included anthropometric measurements, food choice tasks, and resting-state functional magnetic resonance imaging (fMRI) data. Results: In the Brazilian sample (17 ± 0.28 years, n=70), 21.4% of adolescents were classified as SGA. They exhibited lower monetary-related expenditure to buy a snack compared to controls in the food choice test. Decreased functional connectivity (n=40) between left OFC and left DL-PFC; and between right OFC and: left amygdala, right DS, and left DS were observed in the Brazilian SGA participants. Canadian SGA participants (14.9%) had non-significant differences in comparison with controls in a food choice task at 4 years old ( ± 0.01, n=315). At a follow-up brain scan visit (10.21 ± 0.140 years, n=49), SGA participants (28.6%) exhibited higher connectivity between the left OFC and left DL-PFC, also higher connectivity between the left OFC and right DL-PFC. We did not observe significant anthropometric neither nutrients' intake differences between groups in both samples. Conclusions: Resting-state fMRI results showed that SGA individuals had altered connectivity between areas involved in encoding the subjective value for available goods and decision-making in both samples, which can pose them in disadvantage when facing food options daily. Over the years, the cumulative exposure to particular food cues together with the altered behavior towards food, such as food purchasing, as seen in the adolescent cohort, can play a role in the long-term risk for developing chronic non-communicable diseases.
Assuntos
Comportamento Alimentar , Preferências Alimentares , Adolescente , Canadá , Humanos , Fenótipo , RecompensaRESUMO
While classically linked to memory, the hippocampus is also a feeding behavior modulator due to its multiple interconnected pathways with other brain regions and expression of receptors for metabolic hormones. Here we tested whether variations in insulin sensitivity would be correlated with differential brain activation following exposure to palatable food cues, as well as with variations in implicit food memory in a cohort of healthy adolescents, some of whom were born small for gestational age (SGA). Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was positively correlated with activation in the cuneus, and negatively correlated with activation in the middle frontal lobe, superior frontal gyrus and precuneus when presented with palatable food images versus non-food images in healthy adolescents. Additionally, HOMA-IR and insulinemia were higher in participants with impaired food memory. SGA individuals had higher snack caloric density and greater chance for impaired food memory. There was also an interaction between the HOMA-IR and birth weight ratio influencing external eating behavior. We suggest that diminished insulin sensitivity correlates with activation in visual attention areas and inactivation in inhibitory control areas in healthy adolescents. Insulin resistance also associated with less consistency in implicit memory for a consumed meal, which may suggest lower ability to establish a dietary pattern, and can contribute to obesity. Differences in feeding behavior in SGA individuals were associated with insulin sensitivity and hippocampal alterations, suggesting that cognition and hormonal regulation are important components involved in their food intake modifications throughout life.
Assuntos
Resistência à Insulina , Adolescente , Glicemia/metabolismo , Encéfalo/fisiologia , Sinais (Psicologia) , Idade Gestacional , Humanos , Insulina , Refeições , Obesidade/complicaçõesRESUMO
Abstract Objectives: To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs. Source of data: Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019. Summary of data: A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI = 0.25-0.41; I 2 = 92%, p < 0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI = 0.21-0.47; I 2 = 86%, p < 0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI = 0.40-0.64; I 2 = 76%, p < 0.01). Conclusions: Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present.
Resumo Objetivos: Mensurar a prevalência de deficiência de vitamina D (através do metabólito 25-hidroxivitamina D) em pacientes pediátricos em uso de fármacos antiepilépticos. Fonte dos dados: Metanálise de estudos identificados por meio de pesquisa nas bases de dados Pubmed, Embase, LILACS e Cochrane em 19 de fevereiro de 2019. Síntese dos dados: Foram identificados 748 artigos, dos quais 29 mostraram-se relevantes aos objetivos deste estudo. A prevalência de deficiência de vitamina D encontrada foi de 0,32 (IC 95% = 0,25-0,41) (I2 = 92%, p < 0,01). Nas análises por subgrupos, os resultados mais expressivos foram observados no grupo de pacientes em uso de fármacos antiepilépticos indutores do citocromo P450, que apresentou prevalência de 0,33 (IC 95% = 0,21-0,47) (I2 = 86%, p < 0,01). Considerou-se o delineamento dos estudos, no subgrupo de estudos de coorte, com prevalência de 0,52 (IC 95% = 0,40-0,64) (I2 = 76%, p < 0,01). Conclusões: Levando-se em consideração os efeitos deletérios da deficiência de vitamina D na saúde óssea dos sujeitos em uso de fármacos antiepilépticos, sugere-se incluir em seu atendimento, o monitoramento de 25-hidroxivitamina D, suplementação com colecalciferol e tratamento de deficiência quando existente.
Assuntos
Humanos , Criança , Deficiência de Vitamina D/epidemiologia , Vitamina D , Prevalência , Bases de Dados Factuais , Colecalciferol , Suplementos Nutricionais , Anticonvulsivantes/efeitos adversosRESUMO
OBJECTIVES: To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs. SOURCE OF DATA: Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019. SUMMARY OF DATA: A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI=0.25-0.41; I2=92%, p<0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI=0.21-0.47; I2=86%, p<0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI=0.40-0.64; I2=76%, p<0.01). CONCLUSIONS: Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present.
Assuntos
Deficiência de Vitamina D , Anticonvulsivantes/efeitos adversos , Criança , Colecalciferol , Bases de Dados Factuais , Suplementos Nutricionais , Humanos , Prevalência , Vitamina D , Deficiência de Vitamina D/epidemiologiaRESUMO
Objetivo: Discutir o processo de implantação de três Programas de Residência Médica em Medicina de Família e Comunidade (PRM-MFC) em uma capital da Região Sudeste do Brasil na perspectiva da interface dos programas com a organização do sistema de saúde local. Método: Trata-se de um relato de experiência oriundo das vivências dos supervisores dos programas e da equipe técnica do município responsável pela gestão da integração ensino-serviço. Foi produzida uma narrativa significativa aos atores do processo em momento presencial coletivo. Uma matriz SWOT foi elaborada para elencar os fatores que influenciam a implementação dos PRM-MFC na rede de serviços. Resultados: Há três PRM-MFC em atividade no município, todos em estágio inicial de implementação, totalizando nove vagas de R1. Os residentes são beneficiados por uma rede de serviços bem estruturada, diversificada e informatizada, incluindo preceptores sensibilizados e um forte apoio multiprofissional. Contudo, há questões que dificultam esse processo, como a incipiente política de valorização da preceptoria, as insuficiências do modelo de atenção primária existente para a formação médica, as dificuldades na gestão compartilhada do processo e a pouca legitimidade da RM perante a comunidade e os trabalhadores do serviço. Conclusão: Há íntima relação entre o desenvolvimento da rede local de saúde, em particular da APS, com a qualidade do PRM. Assim, é fundamental ter em vista não apenas as questões pedagógicas, mas também todo um conjunto de dispositivos de gestão compartilhada e qualificação da rede de serviços.(AU)
Objective: Discuss the implementation process of three Medical Residency Programs in Family and Community Medicine (PRM-MFC) in a capital city of the Southeast Region of Brazil, in the perspective of the interface of the programs with the organization of the local health system. Method: This is an experience report from the experiences of the program supervisors and the technical team of the municipality responsible for integration of teaching-service. A significant narrative to the actors of the process was produced in a collective presencial moment. A SWOT matrix was developed to list the factors that influence the implementation of PRM-MFC in the health service network. Results: There are three PRM-MFC in activity in the municipality, all in the initial stage of implementation, totaling nine vacancies of R1. Residents are benefited by a well-structured, diversified and computerized service network, including sensitized preceptors and strong multi-professional support. However, there are issues that complicate this process, such as the incipient preceptory valorization policy, the insufficiencies of the existing primary care model for medical training, the difficulties in the shared management of the process, and the lack of legitimacy of RM before the community and service workers. Conclusion: There is an intimate relationship between the development of the local health care network, in particular APS, with the quality of the PRM. Thus, it is essential to look not only at pedagogical issues, but also at the whole set of shared management devices and qualification of the service network.(AU)
Objetivo: Discutir el proceso de implantación de tres Programas de Residencia Médica en Medicina de Familia y Comunidad (PRM-MFC) en una capital de la Región Sudeste de Brasil en la perspectiva de la interfaz de los programas con la organización del sistema de salud local. Método: Se trata de un relato de experiencia oriundo de las vivencias de los supervisores de los programas y del equipo técnico del municipio responsable por la gestión de la integración enseñanza-servicio. Se produjo una narrativa significativa a los actores del proceso en un momento presencial colectivo. Una matriz SWOT fue diseñada para definir los factores que influencian la implementación de los PRM-MFC en la red de servicios. Resultados: Hay tres PRM-MFC en actividad en el municipio, todos en etapa inicial de implementación, totalizando nueve vacantes de R1. Los residentes se benefician de una red de servicios bien estructurada, diversificada e informatizada, incluidos los preceptores sensibilizados y un fuerte apoyo multiprofesional. Sin embargo, hay cuestiones que dificultan este proceso, como la incipiente política de valorización del acompañamiento y orientación del preceptor, las insuficiencias del modelo de atención primaria existente para la formación médica, las dificultades en la gestión compartida del proceso y la poca legitimidad de la RM ante la comunidad y los trabajadores del servicio. Conclusión: Hay una relación íntima entre el desarrollo de la red local de salud, en particular de la APS, con la calidad del PRM. Así, es fundamental tener en cuenta no sólo las cuestiones pedagógicas, sino también todo un conjunto de dispositivos de gestión compartida y calificación de la red de servicios.(AU)
Assuntos
Capacitação de Recursos Humanos em Saúde , Medicina de Família e Comunidade , Política de Saúde , Internato e Residência , BrasilRESUMO
BACKGROUND: The A3669G single nucleotide polymorphism (SNP) of the glucocorticoid receptor (GR) gene NR3C1 is associated with altered tissue sensitivity to glucocorticoids (GCs). GCs modulate the food reward circuitry and are implicated in increased intake of palatable foods, which can lead to the metabolic syndrome and obesity. We hypothesized that presence of the G variant of the A3669G SNP would affect preferences for palatable foods and alter metabolic, behavioural, and neural outcomes. METHODS: One hundred thirty-one adolescents were genotyped for the A3669G polymorphism, underwent anthropometric assessment and nutritional evaluations, and completed behavioural measures. A subsample of 74 subjects was followed for 5 years and performed a brain functional magnetic resonance imaging (fMRI) paradigm to verify brain activity in response to food cues. RESULTS: Sugar and total energy consumption were lower in A3669G G allele variant carriers. On follow-up, this group also had reduced serum insulin concentrations, increased insulin sensitivity, and lower anxiety scores. Because of our unbalanced sample sizes (31/37 participants non-G allele carriers/total), our imaging data analysis failed to find whole brain-corrected significant results in between-group t-tests. CONCLUSION: These results highlight that a genetic variation in the GR gene is associated, at the cellular level, with significant reduction in GC sensitivity, which, at cognitive and behavioural levels, translates to altered food intake and emotional stress response. This genetic variant might play a major role in decreasing risk for metabolic and psychiatric diseases.
Assuntos
Alostase , Regulação do Apetite , Ingestão de Energia , Preferências Alimentares , Polimorfismo de Nucleotídeo Único , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Alelos , Ansiedade/genética , Ansiedade/metabolismo , Ansiedade/psicologia , Brasil , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Estudos de Coortes , Feminino , Estudos de Associação Genética , Humanos , Resistência à Insulina , Estudos Longitudinais , Masculino , Estudos Prospectivos , Estresse Psicológico/genética , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologiaRESUMO
Introduction: Changes in maternal care can affect offspring's thyroid hormone T3 levels. Pups from highly caring mothers have higher levels of thyroid hormone T3. In humans, physical abuse in childhood is related to lower levels of T3 in adolescence. This study aimed at verifying if early-life trauma in rodents is correlated with T3 levels in adulthood. Methods: From the second day of life, litters of Wistar rats were subjected to reduced nesting material (EarlyLife Stress-ELS) or standard care (Controls). In adult life, the animals were chronically exposed to standard diet or standard diet + palatable diet and plasma T3 levels were measured before and after the exposition to diet. Results: Thyroid hormone T3 levels in adult life correlated negatively with the licking and grooming (LG) scores in the ELS group. This correlation disappeared when the animals had the opportunity to choose between two diets chronically. Conclusion: The adverse environment affected maternal behavior and caused marks on the metabolism of the intervention group (T3), which were reverted by chronic palatable food consumption (AU)
Assuntos
Animais , Feminino , Ratos , Sistema Hipotálamo-Hipofisário , Comportamento Materno/fisiologia , Sistema Hipófise-Suprarrenal , Estresse Psicológico/complicações , Glândula Tireoide/metabolismo , Modelos Animais , Gravidez , Ratos Wistar/metabolismoRESUMO
The home prothrombin time/international normalized ratio (PT/INR) self-management could be convenient for patients, enhancing treatment compliance and improving the quality of the oral anticoagulation. However, patient self-management (PSM) of oral anticoagulation may not be feasible for up to half of the patients due to cognitive or educational issues. In the present study, we aimed to evaluate the feasibility of a PSM program in a public health medical center that provides care for low-income patients. We also aimed to determine the accuracy of individual point-of-care devices (CoaguChek XS(®)) during long-term of home manipulation. Patients' time-in-therapeutic range (TTR) and perception of quality of life, were evaluated at scheduled study-visits to the center. Additionally, the accuracy of individual CoaguChek XS(®) was evaluated in comparison to the standard automated coagulometer at scheduled study-visits to the center. Twenty-five patients were included in the PSM program. The median TTR of patients was 75 % before inclusion, 72 % at 3 months, 75 % at 6 months and 100 % at 12 months after the beginning of self-management (P = 0.14).The median DASS scores were 64, 63, 61.5 and 71.5 before inclusion and at 3, 6 and 12 months, respectively (P = 0.09). One hundred paired INR values were obtained. Correlation between INR values delivered by individual CoaguChek XS(®) and the automated coagulometer was 94 % and the mean result bias was 0.07 INR units. The coefficient of correlation and the mean bias between methods was stable during 24 months of follow-up. The present study suggests that PSM is feasible for patients treated in the public health system and that the results delivered by CoaguChek XS(®) have long-term reliability.
Assuntos
Anticoagulantes/uso terapêutico , Serviços de Assistência Domiciliar/normas , Coeficiente Internacional Normatizado , Sistemas Automatizados de Assistência Junto ao Leito/normas , Autocuidado/normas , Administração Oral , Anticoagulantes/administração & dosagem , Monitoramento de Medicamentos/métodos , Estudos de Viabilidade , Humanos , Saúde Pública , Qualidade de Vida , Reprodutibilidade dos TestesRESUMO
Chronic stress increases anxiety and encourages intake of palatable foods as "comfort foods". This effect seems to be mediated by altered function of the hypothalamic-pituitary-adrenal axis. In the current study, litters of Wistar rats were subjected to limited access to nesting material (Early-Life Stress group - ELS) or standard care (Control group) from postnatal day 2 to 9. In adult life, anxiety was assessed using the novelty-suppressed feeding test (NSFT), and acute stress responsivity by measurement of plasma corticosterone and ACTH levels. Preference for palatable foods was monitored by a computerized system (BioDAQ, Research Diets(®)) in rats receiving only regular chow or given the choice of regular and palatable diet for 30 days. ELS-augmented adulthood anxiety in the NSFT (increased latency to eat in a new environment; decreased chow intake upon return to the home cage) and increased corticosterone (but not ACTH) secretion in response to stress. Despite being lighter and consuming less rat chow, ELS animals ate more palatable foods during chronic exposure compared with controls. During preference testing, controls receiving long-term access to palatable diet exhibited reduced preference for the diet relative to controls exposed to regular chow only, whereas ELS rats demonstrated no such reduction in preference after prolonged palatable diet exposure. The increased preference for palatable foods showed by ELS animals may result from a habit of using this type of food to ameliorate anxiety.
Assuntos
Ansiedade/etiologia , Preferências Alimentares/psicologia , Estresse Psicológico/complicações , Gordura Abdominal/anatomia & histologia , Hormônio Adrenocorticotrópico/sangue , Fenômenos Fisiológicos da Nutrição Animal , Animais , Corticosterona/sangue , Dieta , Ingestão de Alimentos/fisiologia , Comportamento Alimentar , Feminino , Sistema Hipotálamo-Hipofisário , Sistema Hipófise-Suprarrenal , Ratos , Ratos Wistar , Restrição FísicaRESUMO
Quando pensamos no bairro do Bom Retiro, São Paulo, possivelmente, uma das primeiras imagens recorrentes que nos vêm á mente é a da Rua José Paulino. Território considerado pelos guias especializados como a rua de compras feminina 'mais famosa' do país; estima-se que pelas suas mais de 350 lojas espalhadas pelos seus longos quarteirões, circulem 70.000 pessoas por dia. Quem é ou o que é o Bom Retiro além das fronteiras da José Paulino foi a pergunta que norteou os quatro meses de nosso caminhar pelas suas cincunvizinhanças. Andando, recuando e voltando a dar passos e mais passos neste espaço é que fomos construindo a nossa metodologia discursiva do espaço. Paradoxalmente, quanto mais nos afastávamos da José Paulino, mais e mais a compreendíamos. 'Além, muito além das fronteiras da José Paulino' é tanto um 'relato de espaço', o ambiente onde as práticas se realizam (CERTEAU, 1994), como o relato de encontros e desencontros entre nós e o outro.
When we think about the neighborhood of Bom Retiro, São Paulo, possibly one of the first recurring images that comes to our minds is that of the José Paulino street. It is considered by specialized guides to be the most famous female-oriented shopping street for women in the country, and the number of visitors to the more than 350 stores spread along its long blocks is estimated at 70.000 people daily. Who is or what is Bom Retiro beyond the frontiers of José Paulino street? That was the question which oriented our walks in the surroundings during four months. By walking, retreating and again taking more and more steps in this territory, we created a sort of discursive methodology for it. Paradoxically, the further away we went from this the street, the more we understood it. 'Beyond, well beyond the frontiers of José Paulino street' is as much a territorial report, the environment where practices occur (Certeau), as a report meetings and failures to meet between us and others.
Assuntos
Humanos , Masculino , Feminino , Cidades/etnologia , Cidades/história , Memória , Mudança Social/história , Espaço PessoalRESUMO
Quando pensamos no bairro do Bom Retiro, São Paulo, possivelmente, uma das primeiras imagens recorrentes que nos vêm á mente é a da Rua José Paulino. Território considerado pelos guias especializados como a rua de compras feminina 'mais famosa' do país; estima-se que pelas suas mais de 350 lojas espalhadas pelos seus longos quarteirões, circulem 70.000 pessoas por dia. Quem é ou o que é o Bom Retiro além das fronteiras da José Paulino foi a pergunta que norteou os quatro meses de nosso caminhar pelas suas cincunvizinhanças. Andando, recuando e voltando a dar passos e mais passos neste espaço é que fomos construindo a nossa metodologia discursiva do espaço. Paradoxalmente, quanto mais nos afastávamos da José Paulino, mais e mais a compreendíamos. 'Além, muito além das fronteiras da José Paulino' é tanto um 'relato de espaço', o ambiente onde as práticas se realizam (CERTEAU, 1994), como o relato de encontros e desencontros entre nós e o outro. (AU)
When we think about the neighborhood of Bom Retiro, São Paulo, possibly one of the first recurring images that comes to our minds is that of the José Paulino street. It is considered by specialized guides to be the most famous female-oriented shopping street for women in the country, and the number of visitors to the more than 350 stores spread along its long blocks is estimated at 70.000 people daily. Who is or what is Bom Retiro beyond the frontiers of José Paulino street? That was the question which oriented our walks in the surroundings during four months. By walking, retreating and again taking more and more steps in this territory, we created a sort of discursive methodology for it. Paradoxically, the further away we went from this the street, the more we understood it. 'Beyond, well beyond the frontiers of José Paulino street' is as much a territorial report, the environment where practices occur (Certeau), as a report meetings and failures to meet between us and others. (AU)
Assuntos
Humanos , Masculino , Feminino , Memória , Cidades/etnologia , Cidades/história , Mudança Social/história , Espaço PessoalRESUMO
Increased coagulation factor levels have been demonstrated to be a risk factor for venous thromboembolism in patients of Caucasian origin. Coagulation factors, hereditary thrombophilia, and ABO blood group were evaluated for venous thrombosis risk in a heterogeneous Brazilian population consisting of 122 women and 53 men, with a median age of 36 years (range 13-63), matched to a control group by age, sex, and ethnicity. Increased levels of factor VIII (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.6-6.0), von Willebrand factor (OR, 2.8; 95% CI, 1.4-5.4), non-O blood group (OR, 2.1; 95% CI, 1.3-3.4), and thrombophilia (OR, 3.4; 95% CI, 1.6-7.1) emerged as independent risk factors for venous thromboembolism. The interaction of high levels of factor IX and factor XI with other independent variables increased the potential for thrombosis synergistically. Therefore, the ability of identifying underlying thrombophilia risk factors in our population was enhanced by the inclusion of these factors in the prothrombotic laboratory workup.
Assuntos
Sistema ABO de Grupos Sanguíneos , Fatores de Coagulação Sanguínea/metabolismo , Trombofilia/sangue , Trombofilia/epidemiologia , Trombose Venosa/sangue , Trombose Venosa/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Fator IX/metabolismo , Fator VII/metabolismo , Fator VIII/metabolismo , Fator X/metabolismo , Fator XI/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Branca/genética , População Branca/estatística & dados numéricos , Adulto Jovem , Fator de von Willebrand/metabolismoRESUMO
OBJECTIVE: To compare the incidence of placental abruption (PA), fetal death and the profile of maternal factors associated with fetal death in pregnancies affected by placental abruption during two different time periods in the same hospital. METHODS: retrospective study between January 1, 1994 and December 31, 1997 and April 1, 2001 and March 31, 2005, including singleton pregnancies with a birth weight higher than 500 g and gestational age of more than 20 weeks. Factors analyzed were maternal age, race, obstetric history, presence of arterial hypertension or premature rupture of membranes, presence of genital bleeding, presence of amniotic fluid contaminated with blood, characteristics of uterine tonus, occurrence of renal insufficiency, postpartum coagulopathy, puerperal anemia, gestational age and weight at birth. RESULTS: there were 7692 births in the 1994-1997 period, placental abruption incidence of 0.78% (60 cases); 8644 births occurred in the 2001-2005 period, placental abruption incidence of 0.59% (51 cases), with no statistical difference. During the 1994-1997 period, proportion of cases without genital bleeding was significantly higher in the group whose fetuses died compared to cases of live born fetuses (57.9% vs 22.0%; p=0.01). During the 2001-2005 period, proportion of cases with uterine hypertonia was significantly higher in the group whose fetuses died compared to cases of live born fetuses (66.7% vs 29.3%; p=0.04). Postpartum maternal complications were more frequent in cases of fetal death during both periods (31.6% vs 4.9%; p=0.009; and 50% vs 5.1%; p=0.001, respectively). CONCLUSION: Placental abruption continues to be a serious obstetric problem, with fatal consequences, especially when the placental abruption area is large. Maternal clinical symptoms are more severe in cases of fetal death.
Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Morte Fetal/epidemiologia , Descolamento Prematuro da Placenta/diagnóstico , Descolamento Prematuro da Placenta/etiologia , Adulto , Brasil/epidemiologia , Feminino , Morte Fetal/etiologia , Idade Gestacional , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Incidência , Recém-Nascido , Idade Materna , Mortalidade Materna , Paridade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de TempoRESUMO
OBJETIVOS: Comparar a incidência de descolamento prematuro da placenta (DPP), de óbito fetal e o perfil dos fatores maternos associados ao óbito fetal em casos acometidos por DPP em dois períodos, num mesmo serviço médico terciário. MÉTODOS: Avaliação retrospectiva dos casos de DPP ocorridos entre 1º de janeiro de 1994 a 31 de dezembro de 1997 (período 94-97) e 1º de abril de 2001 a 31 de março de 2005 (período 01-05), em gestações únicas com peso do recém-nascido superior a 500g e idade gestacional acima da 20ª semana. Foram analisados os fatores: idade materna, cor, antecedentes obstétricos, ocorrência de hipertensão arterial ou ruptura prematura de membranas ovulares, presença de sangramento genital, hemoâmnio, características do tônus uterino, ocorrência de CIVD, insuficiência renal, anemia puerperal, bem como a idade gestacional e peso do RN no parto. RESULTADOS: No período 94-97, foram realizados 7.692 partos e o DPP ocorreu em 0,78 por cento (60 casos), e no período 01-05 foram 8.644 partos com 0,59 por cento (51 casos) de DPP, sem diferença significativa. No período 94-97, a proporção de casos sem sangramento genital foi significativamente maior no grupo que evoluiu com óbito fetal quando comparado aos casos cujo feto nasceu vivo (57,9 por cento vs 22,0 por cento; p=0,01). No período 01-05, a proporção de casos com hipertonia uterina foi significativamente maior no grupo que evoluiu com óbito fetal quando comparado aos casos com recém-nascido nativivo (66,7 por cento vs 29,3 por cento; p=0,04). As complicações maternas no pós-parto foram mais freqüentes nos casos de óbito fetal, em ambos os períodos 94-97 e 01-05 (31,6 por cento vs 4,9 por cento, p=0,009, e, 50,0 por cento vs 5,1 por cento, p=0,001, respectivamente). CONCLUSÃO: O DPP permanece grave problema obstétrico com conseqüências potencialmente fatais, principalmente nos casos com maior área de descolamento da placenta. Maior gravidade do quadro clínico materno é observada...
OBJECTIVE: To compare the incidence of placental abruption (PA), fetal death and the profile of maternal factors associated with fetal death in pregnancies affected by placental abruption during two different time periods in the same hospital. METHODS: retrospective study between January 1, 1994 and December 31, 1997 and April 1, 2001 and March 31, 2005, including singleton pregnancies with a birth weight higher than 500g and gestational age of more than 20 weeks. Factors analyzed were maternal age, race, obstetric history, presence of arterial hypertension or premature rupture of membranes, presence of genital bleeding, presence of amniotic fluid contaminated with blood, characteristics of uterine tonus, occurrence of renal insufficiency, postpartum coagulopathy, puerperal anemia, gestational age and weight at birth. RESULTS: there were7692 births in the 1994-1997 period, placental abruption incidence of 0.78 percent (60 cases); 8644 births occurred in the 2001-2005 period, placental abruption incidence of 0.59 percent (51 cases), with no statistical difference. During the 1994-1997 period, proportion of cases without genital bleeding was significantly higher in the group whose fetuses died compared to cases of live born fetuses (57.9 percent vs 22.0 percent; p=0.01). During the 2001-2005 period, proportion of cases with uterine hypertonia was significantly higher in the group whose fetuses died compared to cases of live born fetuses (66.7 percent vs 29.3 percent; p=0.04). Postpartum maternal complications were more frequent in cases of fetal death during both periods (31.6 percent vs 4.9 percent; p=0.009; and 50 percent vs 5.1 percent; p=0.001, respectively). CONCLUSION: Placental abruption continues to be a serious obstetric problem, with fatal consequences, especially when the placental abruption area is large. Maternal clinical symptoms are more severe in cases of fetal death.
Assuntos
Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Descolamento Prematuro da Placenta/epidemiologia , Morte Fetal/epidemiologia , Descolamento Prematuro da Placenta/diagnóstico , Descolamento Prematuro da Placenta/etiologia , Brasil/epidemiologia , Morte Fetal/etiologia , Idade Gestacional , Hipertensão/complicações , Hipertensão/epidemiologia , Incidência , Idade Materna , Mortalidade Materna , Paridade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de TempoRESUMO
Este estudo visa investigar se a atuação do psicanalista dissidente Wilhelm Reich no cenário científico-cultural da primeira metade do século passado permite associá-lo ao movimento de higiene mental. A fim de cumprirmos tal objetivo, duas direções de pesquisa foram assumidas. A primeira envolveu escritos sobre as origens e as orientações definidoras da moderna saúde pública, do higienismo e, em especial, do movimento de higiene mental. A segunda diz respeito a um levantamento na obra reichiana - artigos, livros, capítulos de livros, cartas e entrevistas - de forma a observar: a) referências diretas ao movimento de higiene mental; b) análises ou relatos de ações do autor vinculadas a esse movimento; c) uso de linguagem característica de tal movimento. Como conclusão, foram formuladas linhas de entendimento sobre a participação de Reich no cenário científico-cultural da primeira metade do século passado, no que tange à associação desse autor com o movimento de higiene mental.
This essay takes two different research directions in order to investigate if the actions of the dissident psychoanalyst Wilhelm Reich, in the cultural-scientific scenario of the first half of the twentieth century, allow us to associate him to the mental hygiene movement. One of the research directions is a review of some writings about the origins and the defining orientations of modern public health care, hygienism and especially the mental hygiene movement. The second one concerns a referring to Reich's work - articles, books, chapters, letters and interviews - aiming to observe: a) direct references to the mental hygiene movement; b) analyses or accounts of the author's actions linked to this movement; c) usages of its characteristic vocabulary. As a conclusion, understanding guidelines about Reich's participation in the cultural-scientific scenario of the first half of the twentieth century, regarding to the mental hygiene movement, were formulated.
Este estudio tiene como objetivo el de investigar si la actuación del psicoanalista disidente Wilhelm Reich en el escenario científico-cultural de la primera mitad del siglo pasado permite asociarle al movimiento de higiene mental. Para cumplir con ese objetivo, la investigación ha tomado dos direcciones: por la primera se ocupa de escritos sobre los orígenes y las orientaciones definidoras de la moderna salud pública, del higienismo y, en especial, del movimiento de higiene mental. Por la segunda se hace una lectura de la obra reichiana - artículos, libros, capítulos de libros, cartas y entrevistas - de manera a observar: a) referencias directas al movimiento de higiene mental; b) análisis o relatos de acciones del autor relacionadas a ese movimiento; c) uso de lenguaje característico del movimiento. Como conclusión, se formularon líneas de entendimiento sobre la participación de Reich en el escenario científico-cultural de la primera mitad del siglo pasado, en lo que respecta a la asociación de ese autor con el movimiento de higiene mental.
Assuntos
Saúde Mental , PsicanáliseRESUMO
Este estudo visa investigar se a atuação do psicanalista dissidente Wilhelm Reich no cenário científico-cultural da primeira metade do século passado permite associá-lo ao movimento de higiene mental. A fim de cumprirmos tal objetivo, duas direções de pesquisa foram assumidas. A primeira envolveu escritos sobre as origens e as orientações definidoras da moderna saúde pública, do higienismo e, em especial, do movimento de higiene mental. A segunda diz respeito a um levantamento na obra reichiana - artigos, livros, capítulos de livros, cartas e entrevistas - de forma a observar: a) referências diretas ao movimento de higiene mental; b) análises ou relatos de ações do autor vinculadas a esse movimento; c) uso de linguagem característica de tal movimento. Como conclusão, foram formuladas linhas de entendimento sobre a participação de Reich no cenário científico-cultural da primeira metade do século passado, no que tange à associação desse autor com o movimento de higiene mental.(AU)
This essay takes two different research directions in order to investigate if the actions of the dissident psychoanalyst Wilhelm Reich, in the cultural-scientific scenario of the first half of the twentieth century, allow us to associate him to the mental hygiene movement. One of the research directions is a review of some writings about the origins and the defining orientations of modern public health care, hygienism and especially the mental hygiene movement. The second one concerns a referring to Reich's work - articles, books, chapters, letters and interviews - aiming to observe: a) direct references to the mental hygiene movement; b) analyses or accounts of the author's actions linked to this movement; c) usages of its characteristic vocabulary. As a conclusion, understanding guidelines about Reich's participation in the cultural-scientific scenario of the first half of the twentieth century, regarding to the mental hygiene movement, were formulated.(AU)
Este estudio tiene como objetivo el de investigar si la actuación del psicoanalista disidente Wilhelm Reich en el escenario científico-cultural de la primera mitad del siglo pasado permite asociarle al movimiento de higiene mental. Para cumplir con ese objetivo, la investigación ha tomado dos direcciones: por la primera se ocupa de escritos sobre los orígenes y las orientaciones definidoras de la moderna salud pública, del higienismo y, en especial, del movimiento de higiene mental. Por la segunda se hace una lectura de la obra reichiana - artículos, libros, capítulos de libros, cartas y entrevistas - de manera a observar: a) referencias directas al movimiento de higiene mental; b) análisis o relatos de acciones del autor relacionadas a ese movimiento; c) uso de lenguaje característico del movimiento. Como conclusión, se formularon líneas de entendimiento sobre la participación de Reich en el escenario científico-cultural de la primera mitad del siglo pasado, en lo que respecta a la asociación de ese autor con el movimiento de higiene mental.(AU)
Assuntos
Psicanálise , Saúde MentalRESUMO
Quando pensamos no bairro do Bom Retiro, no município de São Paulo, possivelmente, uma das primeiras imagens recorrentes que nos vem à mente é a da Rua José Paulino. Território considerado pelos guias especializados como a rua de compras feminina "mais famosa" do país, ou famosa por atrair "sacoleiras de todo o Brasil", conta com mais de 350 lojas espalhadas pelos seus longos quarteirões, estimando-se a circulação de 70.000 pessoas por dia.
Assuntos
Atividades Cotidianas , CulturaRESUMO
Emerging findings have demonstrated the critical role of blood clotting factors in the formation and stabilization of embryonic blood vessels. Whether a similar role is true during post-natal angiogenesis remains to be determined. Here we sought to determine whether the suppression of thrombin generation with anticoagulant drugs at doses routinely used for therapeutic purposes would affect the angiogenesis pattern following hindlimb ischemia in rats. Animals were treated with r-hirudin or enoxaparin within six hours post induction of hindlimb ischemia, whereas two other groups received oral anticoagulation warfarin beginning at day 3 post-ischemia or saline (as control). The revascularization anatomical and functional responses were evaluated 30 days following tissue ischemia. Chronic administration of the drugs resulted in stable anticoagulation in all animals throughout the experiment. Animals that received drugs with fast anticoagulation effects (i.e. r-hirudin and enoxaparin) presented a significant decrease in capillary density and capillary-to-myocyte ratio compared to control animals. These effects were not associated with changes in relative perfusion of the hindlimb at steady state. These anti-angiogenic effects occur in a time-dependent manner, since delayed inhibition of coagulation (>72 hours) presents no adverse effect on the angiogenic response. We conclude that the use of anticoagulant drugs immediately after tissue ischemia induction hampers in vivo angiogenic response in a rodent hindlimb ischemia model.