Repositório RCAAP

Type 1 diabetes mellitus (DM1) is a metabolic disorder characterized by high blood glucose levels resulting from insulin secretion defects. Hyperglycemia stimulates an increased production of renal renin and consequently, due the tissue action effects of Angiotensin II, there is an important mediator of the DN pathophysiological changes. Pharmacological inhibition of the renin-angiotensin-aldosterone system (RAAS) has been widely studied and is proving to be an ally to DN treatment. There is evidence that mast cells, originally cells involved in allergic reactions, release a number of mediators and cytokines that are also related to DN. Wistar rats were divided into six groups: control (C) - without DM; Sham (S) without DM with dummy treatment; Diabetic control (CD) with DM; Enalapril (EN) diabetics treated with enalapril; Losartan (LO) diabetics treated with losartan; Aliskiren (AL) diabetics treated with aliskiren. After 90 days of treatment, animals were placed in metabolic cages during 24 hours for urine collection and later, blood collection for biochemical analysis and renal function. Then the kidneys were removed for morphological and histochemical studies and the animals were euthanized. Post-induction and final glycemia in diabetic animals were significantly higher than the values presented by non-diabetic animals. There were no significant changes in sodium and potassium plasma levels, but all diabetic animals showed increased plasma urea and increased kidney weight and body weight ratio (except AL) compared to C and S groups. The cortical collagen percentage was higher in CD group when compared to C and S groups, and EN group compared to S group. RAAS blockers prevented or minimized parameters changes such as areas of the renal corpuscle (EN), renal glomerulus (EN) and capsular space, also GFR (AL) and AUE (EN). Treatment with AL prevented the increase in the number of intact, degranulated and total mast cells, alteration observed in the kidneys of diabetic animals. It was found that treatment with RAAS blockers preserve renal function (AL) and reduces AUE (EN) in diabetics by minimizing some glomerular structural changes induced by DM, in addition to reducing (AL) the mast cells number in renal parenchyma, suggesting that these cells may be involved in the pathogenesis of DN.

Apart from causing therapeutic injury and unnecessary toxicity to the patient, the frequent use of inappropriate antimicrobials generates increased costs and has a great impact on bacterial resistance. Many interventions demonstrate success in adapting the duration of intravenous antibiotic therapy, but few studies have been conducted in developing countries. The aim of this study was to evaluate the effectiveness of an intervention in the induction of early discontinuation of intravenous antimicrobial therapy and/or its switch to oral therapy. The study employed a before-after intervention design. The intervention consisted of displaying a message in the computerized prescription on the third day of intravenous antimicrobial therapy and suspension of the prescription on the fifth day of intravenous antimicrobial therapy. A total of 465 patients were followed during the control period (CP), October/November 2013, and 440 in the intervention period (IP), August/September 2014. The intravenous therapy was switched to oral therapy for 11 (2.4%) patients during the CP and 25 (5.7%) in the IP (p = 0.011), and was discontinued for 82 (17.6%) patients during the CP and 106 (24.1%) in the IP (p = 0.017). During the IP there was a significant increase of patients who had their antimicrobial treatment discontinued before the seventh day of intravenous treatment, 37.40% (49/131) in the IP and 16.13% (15/93) in the CP (p = 0.0005). The duration of intravenous antimicrobial therapy decreased by one day, but it was not significant (p = 0.136). It is concluded that the proposed intervention is effective in promoting the early discontinuation of intravenous antimicrobial treatment and/or switch to oral therapy. As long as a computerized system for prescription already exists, it is easy and inexpensive to be implemented, especially in hospitals in developing countries.

In despite of type I latex allergy being well documented, it is not yet under controll. It is an object of interest for different medicine departments by the pottencial risk of severe reactions and the lack of diagnostics exams. The aims of this study were to identify the frequency of latex allergy type I, the factors associated with this and search for predictors of a positivity of specific latex Immunoglobulin E (IgE) antibody. It was a cross-sectional study of three hundred ninety health workers at Hospital de Clínicas de Uberlândia da Universidade Federal de Uberlândia- HCU-UFU. The assessment was from February to October 2013, after the received approval from the Research Ethics Committee of the Universidade Federal de Uberlândia (CEP). It was applicated a questionnaire for all the participants, and those who had symptoms to latex were obtained serum samples for test of specific IgE antibody to latex by immunocap assay. The questionnaire had variables sociodemographic including work activities, associated factors and symptoms. The healthworkers were separated according to clinical history: symptomatics and assymptomatics to latex. In the symptomatic group was dominant: the female gender, history of allergic reactions, use of antiallergic drugs and number of previous surgeries. The symptomatics were then classified according to the results of specific IgE to latex in positive and negative groups. Years of work in the health system, number of hours wearing gloves, job title and department did not show risk factors. The most related symptoms were hands and itchy nose. Between IgE positive and IgE negative groups the Spearman test (RS) and odds ratio (OR) was significant for the sum of hand symptoms equal 6 and for the sum of systemic symptoms equal 7, and for frequency of symptoms mostly diary. This study concluded that the number of symptoms, for hands or systemic, hereafter the frequency of them could be predictors of a positivity result to specific latex IgE antibody test. It is probable that false negatives occurred in the symptomatic group because of a limitation of sensibility of the test. This supports the need for improvement in diagnostic tests for this disease. The use of questionnaire could be useful in screening health workers with low cost.

The objective of the present study was to assess the prevalence of autoimmune thyroid disease (ATD) and thyroid dysfunction (TD) in patients with systemic lupus erythematosus (SLE). Seventy-nine SLE patients (American College of Rheumatology criteria) and 159 control patients with no diagnosis of autoimmune diseases (except for ATD) were consecutively evaluated with respect to changes in laboratory results of thyroid function and the presence of ATD. ATD was detected in 11.4 % of the SLE patients and in 13.8 % of the control patients (p= 0.747), whereas TD was detected in 25.3 % and 9.4 % (p= 0.002), hypothyroidism was detected in 21.5 % and 6.9 % (p= 0.002), and hyperthyroidism was detected in 3.8 % and 2.5 % (p= 0.426) of the SLE and control patients, respectively. No relation was observed between SLE disease activity and ATD or TD. The mean duration of SLE was higher in patients with TD (p= 0.036). Mild hypothyroidism was more frequent in the SLE patients with anti-Smith (anti-SM) antibodies (p= 0.029), and TD was more common in patients with discoid lupus (p= 0.020). In contrast, moderate/severe hypothyroidism was less frequent in SLE patients with malar rash (p= 0.038) and more frequent in those with lupus nephritis (p= 0.041). Because hypothyroidism was more frequent in the SLE patients and given the high frequency of ATD in both groups, the authors suggest that TSH and anti-thyroid antibody levels be assessed in SLE patients.

Studies have shown that some diseases are highly prevalent in shift workers, such as nutritional, metabolic, gastrointestinal, psychological and sleep disorders. In addition, it has been documented a high occurrence of various symptoms among these workers, such as pain, insomnia, sleepiness, heartburn, fatigue, weight gain, weight loss and irritability. Therefore, we hypothesized that shift workers consume more medications than people who work on regular times. The aim of this study was to evaluate the use of medications between workers who work in different shifts. A total of 1,099 shift workers of a Brazilian poultry processing agribusiness who had not been previously reported chronic diseases were included in the study. All volunteers worked 10 hours daily in one of the following shifts: early morning, day, evening and night shift. A questionnaire was used to assess sociodemographic characteristics, medical history and lifestyle habits (patterns of sleep, physical activity and tobacco use). The use of medication - including self-medication was evaluated by self-reported daily habitual use. It was also measured the waist circumference, weight and height, and the body mass index (BMI) was calculated. Of the total, 67% of workers reported to consume any medication every day. The most consumed daily medication classes were: analgesics (45.9%), muscle relaxants (44.2%), hormones (17.3%), antacids (15.3%), non-steroidal anti-inflammatory (8,1% ) and hypnotics (2.6%). The prevalence of self-medication was higher between evening workers (54.8%), followed by early morning (51.9%), night (51.5%) and day workers (34.3%) (p <0.001). Night shift workers had, in relation to workers from other shifts: lower median of total sleep hours (p <0.001), higher frequency of workers with inadequate sleep pattern (p <0.001), higher median of waist circumference (p = 0.004), higher frequency of smokers (p = 0.002) and a higher frequency of sedentary (p = 0.006). Multivariate logistic regression analysis indicated that night shift is positively associated to the use of muscle relaxants (OR = 1.39, 95% CI 1.03-2.07, p = 0.034) and hypnotics (OR = 1.45 , 95% CI 1.55-2.08, p = 0.003); work in the early morning shift is positively associated to the use of muscle relaxants (OR = 1.40, 95% CI 1.02-1.93, p = 0.037), poor sleep pattern is positively associated to the use of muscle relaxants (OR = 1.60, 95% CI 1.59-1.99; p = 0.032) and hypnotics (OR = 1.55, 95% CI 1.56-2.06; p = 0.003); being female is positively associated to the consumption of analgesics (OR = 2.80, 95% CI 2.11-3.73, p = 0.001), muscle relaxants (OR = 1.93, 95% CI 1.44-2,59, p = 0.001), hormones (OR = 4.50, 95% CI 14.01-737.2, p = 0.001) and antacids (OR = 2.58, 95% CI: 1.61-4.12, p = 0.001); and being obese is positively associated to the consumption of muscle relaxants (OR = 1.51, 95% CI 1.07-2.13, p = 0.019). These results demonstrate that shift workers have a high consumption of medications, and the self-medication practice and consumption muscle relaxants, hormones, antacids and hypnotics were dependent on the shift work. These results pointed to the need to carry out intervention programs related to improvement of the health quality and proper use of medications in these workers.

INTRODUCTION: Nutrients present site-specific digestion and absorption. After bowel resection, the clinical manifestations, including protein-energy malnutrition, are influenced by the resected segment, extent of resection and the functional capacity of the remaining segments. The prescribed nutritional therapy should be individualized and specialized, considering characteristics of the remaining intestinal segments, nutritional status and clinical time. The study aims were to analyze in medical records the description of the characteristics of resection of intestinal segments and nutritional management implemented for patients undergoing to bowel resection. MATERIALS AND METHODS: A non-concurrent cohort study using semi-structured and specific form. Medical records of 55 patients undergoing to bowel resection in 2007/August at 2012/July period, and evolved to death, were analyzed. RESULTS: Among the records analyzed, most were male (n=30 patients, 54.6%), mean age 60.2±17.8 years, who underwent only one bowel resection (n=45, 81.8 and the main causal factor was vascular ischemia mesenteric (n=17). The description of the resected bowel segment was not performed for 31 patients (56.4%). The description length of small intestine resected was performed in ten patients exclusively by the team of pathology. Description of the remaining length of the small intestine (n = 10) were classified as short bowel syndrome (n = 9) or intestinal failure (n = 4) syndrome. The assessment of nutritional status was performed for 33 patients (60%), 1.7 ± 0.7 different methods associated form being used. The assessment of nutritional status identified malnutrition (n = 15, 68.2% of reviews) and was significantly. For the nine patients diagnosed with Short Bowel Syndrome, three (75%) received as the first dietary prescription parenteral nutrition and enteral nutrition received polymer (25%). Exclusive oral diet was given to malnourished patients undergoing to bowel resection. Twenty-eight patients (50.1% of the sample) received ministry diet after conducting enterectomies, 23 patients (41.8%) fasted on average by 3.2 days in the postoperative period and four patients (7.3 %) died in the immediate postoperative period. Sepsis and septic shock were the main cause of death (n = 30). The average period since the last or only bowel resection until death was 76.5 ± 194.4 days. CONCLUSION: The no description of resected and remaining intestinal segments was frequent and may have contributed to the development / worsening of malnutrition among the patients undergoing to bowel resection, which evolved to death.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Objective: To determine the association between systolic blood pressure (SBP) values at the start and end of a hemodialysis (HD) session in intradialytic hypertension (IDH) patients. Methods: This study evaluated the systolic blood pressure patterns in 154 chronic kidney disease patients; among these patients, 18 were identified as having intradialytic hypertension. After patient selection, four consecutive hemodialysis sessions were prospectively evaluated for each patient, totaling 72 sessions. SBP, diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and heart rate (HR) were measured at 30, 60, 90, 120, 150, 180, 210, and 240 minutes. PP was calculated using the formula PP= SBP - DBP. The results for each pressure represent the arithmetic mean of the 72 sessions analyzed at the previously specified times. Results: A linear relationship was revealed between the systolic blood pressure levels measured after 30 minutes and those obtained after 240 minutes of HD (r=0.742, p=0.001). This association became stronger at 90 minutes (r=0.937; p <0.001), indicating that for intradialytic hypertension patients, systolic blood pressure values at the start of HD were correlated to systolic blood pressure values at the end of the session. Conclusion: For intradialytic hypertension patients, values obtained at the end of HD are correlated with the initial values. This information could facilitate planning and earlier treatment.

The pelvic floor muscles (PFM) are responsible for supporting the pelvic viscera and for promote urinary and fecal continence. Several studies observed the consequences of the perineal trauma during childbirth on the PFM, but there is lack of research in order to evaluate these muscles during pregnancy, so, although the physiological changes of pregnancy is known, there is not enough data on how these changes influence the PFM function. Therefore, this study aims to evaluate the functions of PFM during pregnancy and compare with nulliparous pelvic floor (PF) function. It is a cross-sectional study, observational, comparative, conducted between April and July 2015.The study population consisted of 141 women: 36 nulliparous (C group), 31 primiparous on first trimester pregnancy (1T group), 42 on second trimester (2T group) and 32 on third (3T group). The PF was evaluate by measuring the size of the genital hiatus (HG) and the perineal body (CP) and measuring the strength of the muscles through the bi-digital palpation (Pb), perineometry (Pe) and dynamometry (Din). The Levene test was used to check homogeneity of the samples regarding age, the Kruskal-Wallis test (ANOVA non-parametric) was applied on the variables to assess significant differences in the groups (C, 1T, 2T and 3T) and U test of Mann-Whitney for paired comparison. For correlation of the variables, we calculated the correlation coefficient by Spearman\'s Rank. The level of significance was establish at 0.05. Regarding the HG and CP variables, when comparing the groups, the lowest values were observed in C group (HG = 1.75cm and CP = 2.5cm) and increased in 3T group (HG = 2.25 cm and CP = 3, 5cm). Concerning the strength variables (Pb, Pe and Din) the initial study hypothesis was confirmed, with the group of nulliparous higher (Pb = 3.2; Pe = 45.6 cmH2O and Din = 1.2 kgf) of strength compared to the third trimester primiparous group (Pb = 2.1; Pe = 17.3 cmH2O and Din = 0.7 kgf). The correlation between the HG, CP and the strength measurements, demonstrated that the variable HG was not found and the CP was negatively correlated with Pe and Din (r = - 0.219 and r = - 0.228). Already comparing Pb variables, Pe and Din, it was possible to establish a positive correlation (Pb x Pe (r = 0.757); Pe x Din (r = 0.755) and Pb x Din (r = 0.564). For variables HG and CP, the highest numbers in 3T group were expected due to changes during pregnancy. The highest values for Pb, Pe and Din found in C group can also be explained when compared to lower values in 3T group, also for sustained changes by pregnant women. The positive correlation between the strength of assessment methods (Pb, Pe and Din) proven by this study, strengthened our results and concluded that there is a significant difference in PFM strength between primiparous on third trimester of pregnancy and nulliparous, suggesting pregnancy as a risk factor for reduction of the PFM strength.

Concentrations of leptin - a hormone that contributes importantly to the central regulation of food intake - seem to be influenced by the shift work schedule. Soluble leptin receptors (OB-Re) are the major leptin-binding protein in blood and can affect leptin transport in the brain. As the daily concentrations of OB-Re have not been described in shift workers, we hypothesized that OB-Re concentrations and the free leptin index (FLI) do not vary throughout the day in shift workers as they do in day workers. To evaluate the daily profiles of OB-Re and FLI in shift and day workers, two shift-working groups (early morning and night shifts) and one group of day-shift workers were studied. They completed sleep, nutritional and metabolic assessments. Venous blood samples were collected every 4 hours over 24 hours to measure leptin and OB-Re levels. FLI was calculated by the ratio of free leptin to OB-Re levels. The Mixed-model ANOVAs indicated that OB-Re showed a significant main effect of shift, with the day workers showing higher OB-Re levels than the early morning (p=0,001) and night (p=0,004) groups. No effect of time or interaction between time x shift was observed in OB-Re. No main effect of shift, time or interaction between shift x time was observed for FLI (p>0.05). No significant differences were observed in mean 24-hours concentrations of Ob-Re and FLI between shift and day workers (p>0.05). We conclude that the concentration of OB-Re is altered by working on atypical schedules (early morning and night shifts) compared to day shifts.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Cryptococcus is a yeast-like fungus, capsuled, which has the ability to infect and cause disease in a wide variety of hosts; is the causative agent of cryptococcosis, systemic disease, subacute or chronic, occurring before the AIDS epidemic was sporadic and usually associated with patients with low cellular immunity. Two species are the main pathogenic to humans: C. neoformans and C. gattii; generally C. neoformans cause disease in immunocompromised individuals, manifested as a disease in immunocompetent individuals generally have as C. gattii agent. The laboratory diagnosis of cryptococcosis is usually performed by microbiological examinations (direct and culture research) in various clinical specimens and also by serological methods (latex reaction). Molecular techniques may also be used, but still have limited application in clinical diagnostics. Treatment is with amphotericin B in the induction phase and with fluconazole in the phases of consolidation and maintenance. The objectives of this study were to investigate the phenotypic and molecular characteristics and determine the antifungal susceptibility of Cryptococcus neoformans isolated from samples from patients treated at Uberlândia Clinical Hospital in the 2004-2013 period; and also examine the demographic characteristics of the patients. The phenotypic characteristics have been studied through the use of conventional biochemical tests, such as melanin production and urease and sensitivity to canavanine; to have the molecular characteristics, conventional PCR reactions and research have been used in the URA-5 gene by PCR-RFLP. The antifungal susceptibility was performed either by disk diffusion technique and the dilution technique broth through VITEK® 2 system. The demographic characteristics of patients suffering from cryptococcosis were studied by analyzing the records. Between 41 samples were stored Cryptococcus identified as C. neoformans. During molecular analysis it was found that 40 were C. neoformans var. grubii (VNI) and one was C. gattii (VGI). All strains were mating type α. All isolates were susceptible to antifungals front tested by automated method of broth microdilution (Vitek® 2, Biomerieux). Patients affected by cryptococcosis were mostly men 31-40 years old, coming from urban areas. The meningoencephalitis was the predominant form of the disease; most were immunocompromised, AIDS being the predominant underlying disease. Most of them receive appropriate treatment according to the proposed guidelines; however, 58% of patients progressed to death.

The Acute Myocardial Infarction (AMI) is a vascular disease that generally results from the aterosclerotic process with thrombotic occlusion of the coronaries. This acute situation unbalances the offer and consumption of oxygen, leading to a necrosis of the tissue. Due to the higher number of AMI survivors, we tend to be more concerned about clinical care, what motivates the search for methods that enable an objective and quantitative assessment of the quality of life, anxiety and depression. These factors must be particularly focused during medium and long-term treatments. We also need to compare the various types of treatment presently used in post-infarction, especially the percutaneal or surgical revascularization and the clinical treatment, with the aim of choosing the ones which are more efficient and present more correlation with a better quality of life, with lower levels of anxiety and depression. The purpose of this study is to evaluate the quality of life, anxiety and depression in patients after acute myocardial infarction (AMI), through the application of Mac New QLMI, IDATE and BDI questionnaires, respectively, and confront them to risk factors and the kind of treatment established before the recruitment. We evaluated 59 patients, being 46 (78%) males and 13 (22%) females, with an average age of 57,70 +/- 6,96, selected from the medical file of the Clinics Hospital of the Federal University of Uberlândia, MG. All of them presented an AMI episode before the evaluation started. The questionnaires were firstly applied in August 2003, and reapplied in August 2004. The results were analyzed through descriptive techniques, using also the Pearson and the Spearman correlation coefficients. The results demonstrate that: a) there was a reduction in anxiety and depression levels added to a worsening in life quality between the two evaluations; b) stress and tobaccoism positively correlated with the existence of depression; c) the arterial hypertension and the medicamental treatment showed correlations with a higher anxiety only in the first evaluation; d) the worsening in life quality was correlated with tobaccoism, in the first evaluation, and with the presence of dislipidemy, after twelve months; e) depression showed significant correlation with the black race and widowhood. These results showed the necessity of accompanying these patients through special rehabilitation programs, with multidisciplinary scope and with protocols, established trough a clinical approach, but always followed by an evaluation of life quality, anxiety and depression, which deserve special attention from the team.

Hip fractures occur frequently in the aged and have a considerable impact on health-related quality of life (HRQOL) of the elderly affected. This study aimed to assess the psychometric properties of the Brazilian version of the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) in elderly with hip fractures and the HRQOL of this population over 4 months following fracture. Forty five elderly (60% female) aged between 62 and 92 years (mean= 74.4; SD=8.81) answered the SF-36. Patient scores at baseline, 1 and 4 months after surgery (ou hospital discharge), were compared to 135 controls (mean age=72.3;SD=6.92), and according to fracture type (femoral neck or trochanteric). Psychometric qualities assessed were: on floor and ceiling effect, item internal consistency, internal consistency reliability, reprodutibility, discriminant validity, item discriminant validity, convergent validity, divergent validity, criterion validity, concurrent validity, construct validity and minimallyl important difference. All psychometric properties assessed were deemed adequate as a whole. Patients scores at baseline were lower (p<0.05) than the controls for vitality, mental health and social aspects domains. Similarly, patients scored lower at 4 months after surgery (p<0.05) than controls, except for the general state of health domain, and also lower at baseline, except for pain, general state of health, social aspects, mental health and vitality domains. No significant difference was observed amongst scores according to type of fracture. Brazilian version of the SF-36 demonstrated good reliability, validity and responsiveness as applied to patients with hip fracture. Independent of type of hip fracture, elderly patients presented significant compromise in their quality of life, at one and four months after hip fracture, both in physical and psychosocial aspects, while experiencing partial recovery only within the fourth month.

Cancer in children and adolescents can compromise the health and well being of both patients and their family members. Over time, exposure to pain, suffering and the likelihood of death become sources of emotional, family and social instability, particularly for the parents who tend to be directly responsible for their children s care. The objective of the present study were to assess health related quality of life (HRQL) of caregivers of children and adolescents with cancer using a generic instrument 36-item Short Form Health Survey Questionnaire (SF-36) and to verify the psychometric properties of this instrument. The SF-36 was completed by 73 caregivers (mean age =38.4 years; SD=8.5) of children and adolescents with cancer (mean age =10.4 years; SD=3.7). The scores achieved for SF-36 domains were compared to scores of caregivers who had no chronic diseases (mean age=37.2 years; SD=9.1) who cared for healthy children and adolescents (control group), according to cancer type (central nervous system, leukemias and solid tumors), treatment phase and presence of chronic disease or mood disorder in caregivers. The psychometric properties (data quality, reliability and validity) of the SF-36 were verified. The reliability (Chronbach s alpha coefficient> 0.5) and the discriminant validity proved acceptable for all domains of the questionnaire. The scores achieved by caregivers of children and adolescents with cancer were significantly lower than scores of the control group (p<0.05) on both physical and mental components. Mood disorder in caregivers correlated with physical and mental function compromise as well as presence of chronic disease for functional capacity only (p<0.05). There was no significant difference amongst scores achieved according to cancer type or treatment phase. The Brazilian version of the SF-36 is valid for assessing health related quality of life (HRQL) of caregivers of children and adolescents with cancer. These caregivers present a significant negative impact on both physical and psychosocial function.

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Several studies found a higher prevalence of Autoimmune Thyroid Disease (AITD) in patients with Chronic Urticaria (CU). This relationship may be due to the possible autoimmune etiology in up to half of the cases of Chronic Idiopathic Urticaria (CIU). However the frequency of AITD ranged from 1.14% to 28.6%. The study began by determining whether there is an association between AITD and CU, in a population seen at the same clinic. We compare the frequency of anti-thyroid antibodies and thyroid dysfunction in 49 patients with CIU (group 1) and 112 controls (Group 2). In order to support the result found, we studied the prevalence of CIU in 60 patients with AITD (group 3), compared with 29 patients who had non-immune thyroid disease (NAITD) (group 4). We did not find a statistical difference for the presence of anti-thyroid antibodies or thyroid dysfunction between groups 1 and 2. The same occurred for the presence of CIU among groups 3 and 4. In our study it was not possible to demonstrate a relationship between AITD and CIU, which means that different populations may present a higher or lower degree of association between these illnesses.

The intrafamiliar violence against children and teenagers is a public health problem that injures the right to life and dignity, causing serious physical, psychological and moral losses. The Programa de Saúde da Família (Family Health Program), PSF, is an important vehicle for the in locus comprehension of this phenomena, and it s an integrated part of a social support network. The objective of the study was to evaluate the knowledge and behavior of the professionals of PSF and Programa de Agentes Comunitários de Saúde (Health Communitarian Agents Program), PACS, about the intrafamiliar violence against children and teenagers. Interviews were conducted with the professionals that acted directly in the 34 teams of PSF e 3 PACS from the Secretaria Municipal de Saúde de Uberlândia (Uberlândia Municipal Department of Health), from April to October 2005. There were two versions of questionnaires: one with the term denounce in the questions and the other in which this term has been switched by notification . Most of the 233 interviewed professionals were female (187; 80%), most were between 18 and 39 years old (167; 71,7%) and most worked in the programs for more than one year (164; 70%). Many (138; 59,2%) said they had read or studied about violence in childhood and teenage, principally in newspapers and magazines (66; 47,8%). Between the participations (123) in classes or lectures mentioned by 114 (48,9%) professionals, only 16 (13%) occurred during graduation. About the definition of intrafamiliar violence against children and teenagers, explicit acts such as disrespect and aggression were easily included (193; 82,8%), and the parents (89; 38,2%) were the most mentioned as aggressors. The most identified classes of violence were the physical (215; 92,2%) and psychological (163; 69,9%). From the total, 106 (45,5%) considered themselves able to attend or recognize this phenomena. When the question was about the reason for such aptitude, the personal knowledge was the most cited criteria (71; 89,9%). In one of the 14 hypothetical situations presented, the violence has not been recognized by some (8; 3,4%) and the children was considered guilty for such act (27; 11,6%). While working in PSF and PACS, 142 (60,9%) professionals faced actual situations, most commonly related to negligence (39; 27,5%) and to the combination of physical and psychological violence (36; 25,4%). Nonetheless, most (83; 58,4%) did not notify or denounced any case. The fear for retaliation was the most cited reason (71; 30,4%) for not notifying. Among the professionals that answered the questionnaire with the term denounce (115; 49,3%), only 16 (13,9%) denounced all the cases; among the ones that answered the other version term notification (118; 50,6%), 52 (44%) didn t notify any case. The Tutelary Council was considered (141; 60,5%) the most adequate institution to receive the notifications, however a great part (193; 82,8%) was unknown of the obligatoriness of such conduct. Most (99%) expressed interest in receiving information about the subject, pointing systematic meetings and lectures (142; 60,9%) as the best means for obtaining knowledge. It was concluded that the configuration of the Equipes de Saúde da Família (Family Health Teams), ESF, in Uberlândia, specially follows the biomedical pattern of health attention, disrespecting the integrality, basic principle of PSF and Sistema Único de Saúde (Unique Health System), SUS. Most professionals are women, with a preponderance of young adults, reinforcing the tendency to feminization in health work market, and the destination of early graduated to the public system. There is few theorycal subsides for the identification of the intrafamiliar violence, once there is a lacuna in the knowledge and formation of the health professionals. They find difficulties in delimitating what is or is not violence, and the classes are not strictly defined and structured. Even though, many of them considered themselves able to recognize and attend potential situations, guided by personal criteria. The notification, as a resource of intervention, is not included in their technical procedure. Although most know the institution they should notify the cases of suspicion or confirmation of such violence, when facing reality, they don t do so, finding difficulties about the legal destinations and not assuming their paper of protectors of childhood and teenage. The fear for retaliation, the misconception of lack of need and the misinformation about what institution to communicate the cases are the most important factors for not notifying. The words denounce or notification did not influence the answers about the conduct towards the violence situations. Anyway, the need for a process of capacitation is urgent, once there is the risk of violence reproduction in its institutional form.

One of the greatest problems that humanity faces today is the violence phenomenom, is in most people s lives and, together with the accidents, represents one of the main injuries to health resulting from outside causes. This study shows epidemiological and clinical aspects of violence, using the medical handbooks data from the Hospital de Clínicas de Uberlândia (HCU); from the expertise reports of bodily harm and of autopsies of Posto Médico Legal (PML) and service reports of the Organização-não Governamental SOS Mulher Ação Família (ONG SOS Mulher). It prevailed physical agressions in the HCU medical supports (98.2%) and PML (96%), and psycological violence (36.2%) in the ONG SOS Mulher. The services were more frequent during the weekend, as much as those performed in HCU (36%) as the services in PML (38%), and in the ONG SOS Mulher, mainly on Mondays (24.3%). In the HCU and the PML, the medical supports were common in the period between 6pm until 12am (36.5% and 42.3%, respectively). The victims were 18 to 39 years of age (77.5% and 76.2%, respectively HCU and PML); those with services in HCU (49.4%) and PML (34,9%) declared themselves mainly singles, and in the ONG SOS Mulher, joined together (50.3%), more than half (50,9%) hasn´t finished elementary school; their professions/occupations were mainly housewives (40.2%) of those with services in the PML, and domestics (30.5%) in the ONG SOS Mulher and these lived in their own property (55.2%). Among the aggressors, 87.8% were between 20 and 49 years of age, 57.7% haven t concluded elementary and junior high; most had little professional qualification, were joined together/ex-joined together (50.2%) of the victims attended in the ONG SOS Mulher and husbands/ex-husbands those with services in HCU (51.5%) and of those with services in the PML (30.4%). According to the reports from the women taken care in the ONG SOS Mulher, 86.3% of the aggressors were stylists, 20.7% drug addicts and 10.3% practised games of chance. According to victims, the main reason to continue living with the aggressor after the suffered violence was the hope that the conjugal relationship would improve (33.8%). The victims taken care of in the HCU and the PML, presented mainly wounds (62.3% and 74.8%, respectively), that they had reached especially, head/neck (39.1%) according to given data of the HCU, and upper limbs (35.1%) as the findings of the PML. The deaths mainly had resulted from the use of cold steel weapons (36.4% and 44.0%, respectively HCU and PML) and firearms (36.4% and 20.0%, respectively HCU and PML). One concludes that the violence against women is frequent and a health problem; the medical supports occur mainly weekends and the nocturnal period. The victims are young, with little scholarity and little professional qualification and habits in their own property. The profile of the aggressors resemble to the one of the victims, generally, being their own companions, the addictions and the jealousy are the main reasons for the aggressions that occur mainly inside their homes, and the hope that the conjugal relationship improves, makes the victims remain in the violent relationship. The injuries deriving from the aggressions are wounds, especially in the head/neck and the upper limbs. The deaths are not rare. They occur mainly by the use of cold steel arms and firearms.