Repositório RCAAP

Cardiac hypertrophy is a major mechanism by which the heart compensates for chronic conditions of overload, is a feature of hypertension. Carvedilol is a not seletive alpha and beta adrenergic blocker which acts on cardiac hypertrophy (HC) with hypotensive effects. The present stydy has the objective to verify the effects of carvedilol on HC of SHR rats. We used 14 each: SHR and Wistar rats. Animals were divided into two subgroups with seven animals: SHR-Drug (SHR-M), SHR-control (SHR-C) Normal-Drug (N-M) and Normal-Control (N-C). SHR-M and N-M received 5mg/kg of carvedilol by gavage while controls received only water for 4 weeks. We compared the body weight (BW), blood pressure (BP) and heart rate (HR) at the beginning and at end of the experiment. and, finally, heart and left ventricular weight (LV). We measured the cardiac hypertrophy estimating the heart and left ventricular weight, transverse diameter of ventricular cardiomyocytes and collagen. Student t test, ANOVA and Kruskal Wallis were used in statistical analyse. The BW increased in all groups, the final weight of SHR-C body weight was lower than the N-C. BP was not reduced by carvedilol; BP of SHR-C was higher than N-C. Total weight of the heart has not decreased, the LV weight was greater in SHR-C when compared to the N-C and in SHR-M when compared to N-M. The transverse diameter of cardiomyocytes was greater in SHR-F and SHR-C. The amount of collagen remained unchanged. In conclusion, in SHR, carvedilol is not able to reduce BP, HR, heart weight and left ventricular weight. The LV weight was greater in SHR. The transverse diameter of cardiomyocytes was greater in SHR and remained unchanged with carvedilol that does not alter the left venricular amount of collagen in those animals.

Introduction: Patients with psychoactive substance (PAS) dependence may co-present other mental and behavioral disorders (MBD), and such comorbidities may alter the symptoms and interfere with proper diagnosis, treatment and prognosis of each disease. Objectives: We aimed to assess the frequency of MBD comorbidities in patients dependent on PAS attending Centers for Psychosocial Care alcohol and other drugs (CAPS-ad), and their feelings about their own use of these substances. Furthermore, we aimed to compare socio-demographic data, conditions related to childhood and clinical features between those patients with and without comorbidities. Method: We consecutively analyzed adult patients from April to September, 2010, in two CAPS-ad in Uberlândia MG, excluding those who were under the influence of PAS, with withdrawal symptoms or with dementia. Patients were divided according to the abstinence length: < 1 week (Group 1), 1 to 4 weeks (Group 2) and > 4 weeks (Group 3). For diagnosing comorbidities we used the symptoms checklist of ICD-10 and collected information from medical records. We used a structured questionnaire to collect the analyzed data. Results: Among the 188 evaluated patients, 62.8% were diagnosed with a MBD comorbidity, which were more frequent (p < 0.05) in Group 1 (72%) than in Group 3 (54.2%), and what differed them was the greater frequency of depressive disorders and other anxiety disorders in the first (61.3% and 34.6% respectively); both groups were similar to Group 2 (61.0%). Patients with comorbidities, more often than those without them, respectively, suffered abuse in childhood (67.8% and 42.8%), had perceived that presented another MBD (84.7% and 37.1%) and psychological disorders (79.7% and 44.3%) in addition to CD, made use of psychotropic medications (81.4% and 37.1%) and previous treatments for CD (88.1% and 70.0%), had injuries due to external causes (84.8% and 68.6%), were involved in fights or assaults (71.2% and 50.0%), attempted suicide (45.8% and 15.8%) and were in controlled environments throughout life (72.9% and 57.1%). Sociodemographic features were similar between patients with or without comorbidities, and also between those with different periods of abstinence. Most patients (59.4%) had negative feelings about their own use of PAS. Conclusion: Two thirds of the patients had a MBD comorbidity diagnosis, which was more frequent among those with shorter periods of abstinence, which shows that sometime of abstinence should be awaited before these diagnoses are given as final. Presence of comorbidities was associated with worse clinical conditions and no differences were found regarding socio-demographic data between the patients with or without comorbidities. Among all, there was a predominance of negative feelings over their own use of PAS.

Introduction: Nephrectomy (Nx) for living kidney donation has been supported by studies that report few long-term clinical implications for donors. But the parameters used for donor evaluation are the same as those used for the general population. Hence, it is necessary to review the adequacy of those values and assess obese donors, since the incidence of obesity is increasing worldwide. Objective: To evaluate the impact of the ponderal changes and the values used as references for normal renal function of kidney donors. Methods: The study is a series of cases, with 48 living kidney donors who underwent uninefrectomy, between 1983 and 2006. Anthropometric data, systemic arterial pressure, glomerular filtration rate estimated (eGFR) by creatinine clearance and 24h proteinuria were assessed. Results: 52.08% of the sample showed eGFR between 60 and 89 ml/min and only 4.2% presented eGFR ≥ 120ml/min. It can be inferred that 77.1% were subject to hyperfiltration, if we consider as the normal value for a single kidney 50% of 120 ml/min, used for the population with two kidneys. Proteinuria was observed in 22.9% of the sample and, using the same reasoning as above and taking as reference 75mg/24h, 64.6% showed high levels of proteinuria. At the time of Nx, 10.4% of the sample was obese and has evolved with the increase of the obesity rate to 31.3%. The group also showed an increase in mean BMI. Obese patients had higher values of eGFR and systolic arterial pressure. Individuals with higher levels of proteinuria also showed higher ponderal values. Conclusion: Using the values of eGFR and proteinuria for the single kidney, hyperfiltration and proteinuria were, respectively, 18.3 and 2.8 times higher when compared to rates obtained by using the parameters applied for the general population. After donation, it was found an increase of body mass index (BMI) and obesity in the sample. Therefore, obesity appears to be associated with higher hyperfiltration, systolic arterial hypertension and subsequent proteinuria. Those findings justify a strict ponderal control for that population in order to avoid an overlapping of factors leading to renal injury.

Preterm birth is a worldwide public health problem by presenting an increased overall rate, high rate of morbidity and mortality of newborns with a high probability of sequelae, and generates a burden on family and at society. Mothers of preterm infants may develop psychological stress, anxiety and depression, and possible impaired of quality of life (QOL). This study aimed at assessing and comparing the QOL of mothers of VLBW (very low birth weight) preterms infants with mothers of healthy full terms and evaluates the impact of symptoms of maternal depression and chronic comorbidities of the VLBW preterm infants in the QOL of these mothers. This is a cross-sectional study was held from November 2009 to November 2010, in the Clinics of Hospital of Federal University of Uberlandia after approval by the Ethics Committee in Research of Federal University of Uberlandia. Study group consisted of 152 mothers of VLBW preterm infants with gestational age <34sem and birth weight <1.500 g. The control group consisted of 152 mothers of at healthy full terms with birth weight >2.500 g. The WHOQOL-bref and the Beck Depression Inventory (BDI) were completed in four periods after childbirth: the mother s discharge, 3m, 6m and 12m. The scores of the instruments, the demographic and clinical variables were compared between the two groups over time by ANOVA, Tukey, Chi square and Kruskal-Wallis tests and Spearman correlation. Demographic characteristics were similar between the two groups (p> 0.05) except for the number of visits to prenatal care, cesarean delivery and the presence of maternal diseases that predominated in the group of mothers of VLBW preterm infants. At the time of discharge from hospital, the WHOQOL-bref scores of mothers of VLBW preterm infants were lower (p <0.05) than those of the control group, especially in the physical (61.88 versus 69.63) and psychological (66.44 versus 73.31) domains. Six months after delivery, the mean of the scores of the mothers of preterm infants was higher than that of mothers of healthy full terms in the physical (71.81 versus 62.94) and psychological (71.75 versus 64.31) domains, but was lower in total score of WHOQOL-bref (61.47 versus 74.53). Mothers of preterm infants reported a poorer "health perception" than mothers of healthy full terms (p <0.05) at the time of discharge from hospital and three months after childbirth. Higher BDI scores were observed in the study group especially at the time of discharge from hospital (p <0.05). There was no significant difference between groups in other domains of WHOQOL- bref, or in other periods. At the time of discharge from hospital and three months later, the presence of peri-intraventricular hemorrhage and hydrocephalus negatively correlated with the physical and psychological domains and with the physical and environment domains, respectively. It is concluded that mothers of preterm infants of very low birth weight show impaired QOL compared to mothers of healthy full terms at the time of discharge from hospital and six months postpartum, particularly in the physical and psychological domains. This group also tends to presents higher intensity of depressive symptoms at the time of discharge. Mothers of preterm infants with peri-intraventricular hemorrhage or hydrocephalus are particularly vulnerable to the negative impact on quality of life at the time of discharge and three months later, respectively.

For a chronic and disabling disease such as leprosy it is necessary to identify and monitor the patient and the proposed actions to prevent disabilities. This study aimed to conduct a census of impairment and disabilities in leprosy patients enrolled in a National Reference Center of Uberlândia and evaluate the effectiveness of guided self-care plan for set up by a physiotherapist/occupational therapist. For the census held a retrospective study of medical records of 506 leprosy patients in the period 2001 to 2010, analyzing the variables: sex, age, occupation, clinical, operational classification, degree of disability (DD), type of impairment/disability by site and affected nerves. In the prospective study were applied a screening of activity limitation and safety awareness (SALSA), including score Salsa (SS) and score safety awareness (SA); Participation Scale (PS) and eyes, hands and feet score (EHF) in 63 patients for monitoring after 3 months. In 506 patients, there were a higher prevalence of males, multibacillary (MB) and borderline-tuberculoid (BT) clinical form. More than 50% had at least one impairment, despite 15% had grade 2 disability (GI=2). The sites most affected were the feet 51.8% and hands 30.4%; and impairments/disabilities were anesthesia and/or hypoesthesia followed by ulcers. The nerve average affected was 3.6 in MB and 2.7 in PB, predominating the ulnar and posterior tibial nerves. In 63 patients, the mean score were: PS=9.1, SS=37.2, SA=1.6 and EHF=1.9. After interventions occurred reduction of the mean scores of SS (31) and EHF (1.5) and increased of SA (3). Stigmatizing and crippling disabilities that are not classified in the table the grading disability and should be included as well as the nose as a body site of disabilities that keeps the stigma of the disease, allowing to plan a specific attention to leprosy with the aim of reintegration and combating social stigma. The SALSA provided a standardized measure of activity limitation and allowed us to outline a plan of self-care oriented and external interventions that helped the patient to perform tasks of daily life. The inclusion of this instruments in the routine associated with the evaluation of grading disability in order to define management protocols, providing screening and referral of patients to sectors specific health units within the network of attention to the condition chronic that is leprosy. Thus, it is expected to promote a rehabilitation of the patient in order to improve health conditions for this specific population.

Objectives: To identify aspects associated with alcohol use in adolescent students. Methods: A total of 638 students aged between 13 and 17 years were assessed. They were randomly selected from the enrollment records of 13 urban and rural public schools of the city of Uberlândia, MG, Brazil, from November 2009 to August 2010. Students subsequently completed the Alcohol Use Disorders Identification Test (AUDIT) and a questionnaire about sociodemographic, personal and family data. Results: Previous alcohol use was more frequent (p<0.05) among girls (86.6%) than boys (79.1%) in the urban area; among adolescents of the central urban (84.8%) or suburban area (81.9%) than the rural area (65.4%) and among adolescents whose parents drank alcohol (89.4% vs 71.0%). Among boys and girls, 57.5% and 62.0% began to drink alcohol at the age of 13 respectively, 26.1% and 20.5% drank alcohol at the level of risk/harm/probable dependence, an active sexual life was more frequent (p<0.05) among those who had already used alcohol (55.5% and 35.8%) than those who did not use it (29.0% and 8.9%), and 24.5% and 18% did not always use condoms after alcohol use. Of all adolescents, 97.7% had already managed to buy alcoholic beverages and 25.4% believed that there was no risk involved with alcohol use. Considering advertisements for alcoholic beverages as appealing was more frequent (p<0.05) among students who had already drunk alcohol (44.3% vs 32.2%). Conclusions: The following aspects were observed: 1) alarming early alcohol use, especially in the urban area, 2) influence caused by parental alcohol use, 3) influence of alcohol on adolescents sexual life, 4) the fact that adolescents can easily buy alcoholic beverages, 5) lack of knowledge about the risks of alcohol use, and 6) greater appeal of advertisements for alcoholic beverages among those who had already drunk alcohol.

Background: Population aging is a worldwide phenomenon leding to a rising demand for elderly long-term institutions (LTI). The institutionalization sets out the changes that might affect the seniors nutritional state, which prevalence is associated to a higher risk of morbidity and mortality. Objective: To evaluate the nutritional status of elderly LTI residents registered at the Secretariat of Social Development of Uberlândia-MG, and characterize all the LPI evaluated. Design: This is a cross-sectional study conducted in the LTI of Uberlândia - MG, from October to December 2010, with elderly people (60 years or older), both sexes, who agreed to participate in the study and in the conditions of anthropometric measures. Socio-demographic data were collected to verify the group's profile. To assess the seniors nutritional status, the full version of MNA was used. The anthropometric evaluation was performed in order to complete the items of anthropometric assessment of MNA, like: weight, height, arm circumference and calf. To describe and characterize the LTI, data were collected and recorded in a specific form by interviewing the institution s authorities. Results: From the 209 elderly residents during the data collection period, 196 underwent nutritional assessment. Most of the women were between 80-89 years (34%), widows (50.7%), without children (45.4%) and had 1 to 10 years of institutionalization (66%). It was verified that 68.2% of the subjects were literate and 31.1% were using more than three drugs a day. It was observed that 82.6% of the participants had some nutritional problem, and between the undernourished, 91.4% had neuropsychological problems. Conclusions: The MNA was presented as an efficient method for assessing the nutritional status of this population, suggesting a high frequency of nutritional risk. The characteristics of LTI may contribute to the nutritional status found. Analytical studies could help to elucidate the factors determining the nutritional status of elderly people and the relationships with their LTI.

Introduction: in several developing countries, the endemicity patterns of hepatitis A (HA) have changed from high to intermediate and from intermediate to low, as a result of improvements in sanitation and hygiene conditions. Adolescents and adults without immunity are vulnerable to this infection, when the disease is more severe than when acquired during childhood. Objectives: to determine the seroprevalence of immunity against hepatitis A virus (HAV) among public school students of two cities located in the state of Minas Gerais, in the Southeastern region of Brazil, and to associate it with their conditions socioeconomic and environmental. Methods: antibodies anti-HAV seroprevalence was determinate (ELISA method) in 487 students, aged 7-18 years. Students were enrolled in public schools in the cities of Uberlândia (604,013 inhabitants) and Limeira do Oeste (6,890 inhabitants), and were divided according to sex and age. Their socioeconomic and environmental data also were collected. Results: total anti-HAV was positive in 62/304 (20.4%) students in Uberlândia, with a higher frequency (p=0.05) among those in peripheral schools (38/150; 25.3%) than others in central schools (24/154; 15.6%), and in 24/183 (13.1%) students in Limeira do Oeste. Seroprevalence increased with age and was similar between boys and girls. The multivariate analysis showed no statistically significant correlation between seropositivity and socioeconomic and environmental conditions. Conclusions: the low seroprevalences of immunity against HA found in the population evaluated reveal the need to implement vaccination strategies against this infection.

Universidade Federal de Uberlândia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Eosinophilic Esophagitis (EoE) is a pathological clinical emerging disease, whose recognition has nearly three decades. It is defined as a chronic inflammatory disorder, immune mediated characterized by primary esophageal symptoms of upper gastrointestinal tract dysfunction, associated with an increase of eosinophils intra-epithelial lymphocytes in esophageal mucosa, in number exceeding fifteen eosinophils by large field of increase, in more than a fragment of biopsy obtained during the examination of digestive endoscopy. The prevalence and incidence of EoE in Brazil is unknown. Describing the clinical, endoscopic, histological aspects, epidemiological and evaluate awareness allergic foods and inhalants of patients in the pediatric age group, was the goal or object of this research, with prior diagnosis of EoE, 35 of them were evaluated in the period from January 2010 to January 2011. Responsible for patients filled a form with questions and patients performed tests for evaluation of IgE and not IgE allergic awareness mediated foods and a test to assess immediate allergic awareness through inhalants, with skin prick test (SPT) and atopic patch test (APT) . Most epidemiological, clinical, histological characteristics was similar to those observed in world literature, except the upper endoscopy for diagnosis of EoE perception in patients studied, reported on 97.2% of endoscopic examinations carried out and confirmed by histological examination. Sensitization feeding evaluated through the APT and SPT was 46%, lower than the observed in the literature, being expressive the presence of awareness inhalants, observed in 66% of the patients evaluated. The foods most frequently involved in awareness observed in the tests performed were the cow's milk, soybeans, fish and chicken meat. A group of eight patients (22.8%), awareness has not submitted any of the allergens tested, showing characteristics in relation to sex, presence of atopic dermatitis associated examination of pHmetria of 24 hours normal findings of clinical and endoscopic with difference statistically significant in relation to the group aware.

The quality of health communication is associated to better treatment adherence and greater degree of patient satisfaction. There are few studies on the assessment of the communication abilities of health professionals who assist children and adolescents. The Housestaff Communication Survey (HCS) is an instrument that evaluates the perception of the importance of 16 specific pediatric sills, the confidence for performing them and the institutional support offered. Objectives: Translate into Portuguese, culturally adapt it to Brazilian society and validate the Portuguese version of the HCS instrument, evaluate the importance of communication abilities, the confidence for communication and the institutional support offered to the respondents regarding their professional training and the development of communication abilities. Methods: The HCS questionnaire was translated into Portuguese, adapted culturally and its Portuguese version was validated, according to the guidelines recommended in the literature. The final Portuguese version was answered by medical students, pediatric residents and pediatricians of a university hospital. Face validity, internal consistency reliability, test-retest reproducibility and the missing data were assessed. Results: The final version was answered by 182 of the 200 eligible participants (response rate of 91%). The Cronbach's alpha reliability coefficient of the entire group was 0.929 for the scale of importance and 0.892 for the scale of confidence. The intraclass correlation coefficient was 0.796 for the scale of importance and 0.792 for the scale of confidence on test-retest. Twenty-five items were not answered (0.3%). Ninety-five percent of participants reported that effective communication with their patients is a priority and 94.5% indicated they had no previous participation in a program to improve their communication skills with patients. All the 16 items of the communication skills studied were rated as high or very high in importance. Concerning the scale of confidence, half or fewer of the participants indicated they felt rather or very confident about more advanced skills : speaking with children about serious illness, discuss end-of-life issues with patients and families, dealing with the difficult patient or parent, ability to respond to patients‟ emotions and giving bad news to patient and family. In the evaluation of the scales by subgroup, pediatricians were found to be more confident than students, and older respondents expressed greater confidence for performing the different communication items. The institutional support and incentives to the promotion of good physician-patient communication was found to be adequate for 62%. Conclusions: The translation in stages ensured an adequate Portuguese version both in the linguistic and technical aspects. The psychometric properties were adequate and similar to those in the original questionnaire. This instrument can be used for the assessment of the teaching of communication abilities in pediatrics and to identify the most difficult subjects that should be addressed as a priority in medical education.

Most intra-abdominal infections such as acute appendicitis require surgical intervention. The use of antimicrobials, however, is essential in the treatment complementation and reduction of surgical site infection (SSI). The present study aims to make a critical analysis of the use of antimicrobials use, anatomopathological stage and surgical site infection after appendectomy. It were analyzed the demographic data, antimicrobial scheme chosen, the beginning of antimicrobial, usage time and evolution as the SSI associated with the anatomopathological stage of resected appendices. 233 patients were evaluated between 14 years and 78 years with male predominance (135 / 57.94%) and in the third decade of life (72 / 30.90%). In 139 patients (59.65%) surgical time was up to two hours with a predominance of Phlegmonous Acute Appendicitis (91 / 39.05%) and Necrotizing Acute Appendicitis (88 / 37.76%). The antimicrobial scheme most used was a combination of Ampicillin/Sulbactam totalizing 127 (54.50%) patients. Most patients had the start of the antimicrobial scheme in anesthetic induction (212 /90.94%). Regarding the usage time of antimicrobials, the prevalence was of less than 24 hours of use (122 / 52.36%) and 16 (6.87%) presented SSI. Based on the anatomopathological classification on nonnecrotic appendices, 145 (62.23%) patients should have used a single antimicrobial dose or at maximum for 24 hours. Of patients with non-necrotic appendix, only 60 (41.37%) used one dose; 15 (10.34%) used 2 to 4 doses and 70 (48.29%) used more than four doses of antimicrobial. In 16 (6.87%) patients considered with normal appendix were used more than four doses of antimicrobials. In the analysis of the SIRI SSI in perspective, no patient presented with SIRI 0 SSI (4 / 5.79%) patients presented with an SIRI SSI (9 / 5.88%) patients had 2 SIRI SSI and (1 / 12.5) 3 SIRI SSI presented. Based on anatomopathological association (necrotic and non-necrotic) of resected appendices for clinical suspicion of acute appendicitis and the use of antimicrobials, we can conclude: there was unnecessary use of more than one dose of antimicrobials in patients with uncomplicated appendicitis.

Introduction: Diabetic individuals who are smokers have higher risks of cardiovascular disease, premature death, and microvascular complications. The present study aims to evaluate the degree of nicotine dependence and the prevalence of symptoms of anxiety and depression in smokers with type 2 diabetes mellitus (T2D). Methods: Each of the T2D smoking patients treated at the Endocrinology Clinic of the Hospital de Clinicas, Federal University of Uberlândia, was matched with two controls. Thus, three study groups were formed: 46 T2D smokers (DS), 46 T2D non-smokers (D), and 46 smokers without diabetes (S), totaling 138 participants. The presence of symptoms of anxiety and depression was determined based on the Hospital Anxiety and Depression (HAD) scale, and the Fagerström Test for Nicotine Dependence was used to evaluate the degree of nicotine dependence. Results: The prevalence of high nicotine dependence among smokers with and without T2D was 39.1% and 37.1%, respectively (p = 0.999). There was no significant difference in the proportion of individuals with symptoms of anxiety in the DS group (50%) compared to group D (39.1%) or S (63%) (p = 0.072). The same was observed for symptoms of depression in groups DS, D, and S (30.4%, 39.1%, and 32.6%, respectively, p = 0.657). The consumption of anxiolytics in the DS group (19.6%) was higher than in group D (2.2%) (p = 0.028). Among male patients, the diabetic smokers had a higher prevalence of anxiety symptoms (19.6%) than non-smokers (2.9%) (p = 0.003). The prevalence of symptoms of anxiety and depression among nicotine addicts (54.6% and 37.1%, respectively) and non-addicts (57.7% and 28.1%, respectively) was similar. Conclusions: The prevalence of depression and anxiety among diabetic and non-diabetic smokers and diabetic non-smokers is similar, although the consumption of anxiolytics among diabetic smokers is significantly higher than diabetic nonsmokers. Diabetic male smokers have more symptoms of anxiety than non-smokers with diabetes. There is no difference in the prevalence of nicotine dependence among diabetics and non-diabetics. The presence of anxiety or depression symptoms is similar between individuals who are dependent and not dependent on nicotine.

Asthma is a disease with high morbidity and mortality and is the major chronic respiratory disease of children and adolescents. In Brazil there is a prevalence of asthma from 16.1 to 27.2% and it represents the third cause of hospitalization by the Sistema Único de Saúde SUS (Unified Health System). It is not only a complex disease but also difficult to diagnose especially in children, because it is observed characteristic patterns of wheezing at this age. This study has aimed to describe the clinical features and verify the allergen sensitization profile of the skin prick test (SPT) in patients with asthma who were followed in Programa de Controle de Asma de Catalão-GO - Pro-asma - (Asthma Control Program of Catalão-GO) due to the high prevalence and the need for studies in the pediatric population in Brazil. The purpose is to have a better understanding of the disease and especially the way it behaves regarding the patterns of wheezing and atopy which have been observed in recent decades in childhood asthma. A clinical questionnaire has been prepared and applied to the SPT for the major aeroallergens. In a total of 301 study participants, 57% were male and had a median age of 74 months. In 80% of cases, at least one first-degree relative was atopic, 88% had clinical symptoms of rhinitis and passive smoking was found in 29% of the patients homes. The most prevalent aeroallergen was the mite and the sensitization to at least one aeroallergen was of 63%. In the analysis of the sensitization by age group, there was predominance of sensitization asthma in patients over 5 years old and non-sensitization asthma between 2 and 5 years old, with p<0,0001. It was also observed that as time passed, it took older patients more time to get the diagnosis and to initiate the treatment, also with p <0,0001. Therefore, the Pro-asma (Pro-asthma) patients were divided into two large groups: with sensitization and without sensitization. It was shown that the higher prevalence of non-atopic asthma at the age of 5 below coincides with large cohort studies of asthma in childhood. It may show that at this age group, recurrent wheezing can be transient, with no loss of lung function and without features of atopy. It is suggested that asthma may have different patterns according to age, changing the prognosis and severity of the disease.

Disabling chronic neurological diseases such as cerebral palsy (CP), myelomeningocele (MM), Down syndrome (DS) and autistic disorder (AD) are still prevalent in childhood and limit various aspects of child development. Although there is a major negative impact on the health related quality of life (HRQL) of the mothers of affected children, so far no comparative studies have been performed to tell whether these diseases compromise the mothers HRQL in a different way, and whether there is an association of demographic characteristics with HRQL. The intention of this study is to evaluate the HRQL of mothers of children and adolescents with CP, MM, DS and AD, comparing them to each other and to the group of mothers of healthy children and adolescents and to look at the demographic characteristics of mothers of children and adolescents with disabling neurological diseases and their association with HRQL. One hundred and thirty-seven mothers with children and adolescents with CP, MM, DS and AD and 208 mothers with healthy children and adolescents participated. All the mothers answered the Medical Outcomes Study 36- Item Short Form Health Survey (SF-36) and protocol with demographic information. The Alfa Cronbach coefficient was calculated to determine the reliability of the instrument. The demographic variables and the SF-36 scores of mothers of children and adolescents with disabling neurological diseases were compared to the healthy group together or separately according to their child`s diagnosis (Mann-Whitney, Kruskal-Wallis or Chi-Square tests). The SF-36 scores achieved by the mothers of the group with disabling neurological diseases were compared to the demographic variables (Kruskal-Wallis or Mann-Whitney tests) and correlated to the age of mothers, number of children and family income (Spearman correlation coefficient). Mothers in the group with disabling neurological diseases had lower scores than healthy group (p<0.05) in most domains, when compared together or separately according to their child`s diagnosis. There was no significant difference in the HRQL among the mothers of children and adolescents with CP, MM, DS and AD. Mothers of children and adolescents with disabling neurological diseases presented a lower frequency of continued employment, a higher frequency of stable marital unions and higher family income compared to the healthy group. Older mothers or widows had lower scores in the physical dimension of SF-36 (p<0.05). Concluding, mothers of children and adolescents with CP, MM, DS and AD presented multidimensional impairment in HRQL, compared to the mothers of healthy children and adolescents, but this negative impact was not different from the groups of mothers of children and adolescents with disabling neurological diseases. The negative impact on HRQL was greater in the physical dimension among older mothers or widows.

National curricular guidelines suggest a shift in healthcare model with the use of patient-centered practices and flexible physician behavior that meets patients\' preferences. This change requires appropriate evaluation of medical students\', physicians\' and patients\' attitudes with valid and reliable instruments. The objective of this study was to translate, culturally adapt and validate the Patient-Practitioner Orientation Scale (PPOS) to Portuguese spoken in Brazil. The PPOS is a measure of individual attitudes regarding medical/disease or patient-oriented practices. This instrument was translated according to international guidelines of translation. Two translated versions, a back-translation and author\'s observations were assessed by five reviewers through modified Delphi and the pre-final version of the PPOS was obtained. This pre-final version was then assessed by the author of the scale and pre-tested with 37 participants (12 resident physicians, 13 medical students and 12 patients). Pre-test results were analyzed by three evaluators (doctors) and two researchers to produce a final version of the Brazilian version of the PPOS - the EOMP. This final version was approved by the scale author and by a language coordinator. The EOMP was then applied to 360 participants (120 resident physicians, 120 medical students and 120 patients). We verified data quality (lost data, floor and ceiling effects), test-retest reliability (intraclass correlation reliability), internal consistency reliability (Cronbach\'s alpha coefficient) and construct validity (explanatory factor analysis with principal component analysis, two factors extraction, Oblimin rotation and Kaiser criterion; confirmatory factor analysis with maximum likelihood method and goodness-of-fit indexes: X2/df, RMSEA, SRMR, GFI, AGFI, NNFI and CFI). During independent review process (modified Delphi), only two items (04 and 17) did not reach a minimum of 80% agreement among the reviewers or produce answer stability throughout the different testing sessions. During pre-testing, seven items (38.9%) were modified according to pre-established criteria. The rate of lost data was 0.28%. Floor effect was observed in most of items answered by patients. Ceiling effect was detected in most of items answered by residents, students and patients. Internal consistency reliability (Cronbach s alpha = 0.605) and test-retest reliability (intraclass correlation coefficient = 0.670) were considered to be adequate. In the two-factor principal component analysis (a priori criteria), one item (item 09) did not achieve a loading factor higher than 0.3, one item (item 15) was considered factorially complex and two items (items 02 and 14) were inconsistent with a priori factors (explanatory factor analysis). A confirmatory factor analysis provided an acceptable adjustment for the observed variables (X2/df = 2.33; GFI= 0.91; AGFI= 0.89; CFI= 0.84; NFI= 0.75; NNFI= 0.81; RMSEA= 0.062 (p= 0.016) e SRMR= 0.065). These results show that the EOMP has adequate reliability and acceptable validity. This scale may be useful in evaluating physicians\', medical students\' and patients\' attitudes in Brazil.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

To evaluate the patterns of the ophthalmic artery Doppler velocimetry in pregnant women with gestational diabetes mellitus (GDM), comparing them with those found in normal pregnant women. This is an observational study that examined the ophthalmic artery Doppler indices in two groups: one consisting of 40 pregnant women diagnosed with GDM and the other for 40 normal pregnant women, treated at the Hospital Clinics of the Federal University of Uberlândia. The study was approved by the Ethics Committee and Research institution under the number 293/10. The patients underwent Doppler ultrasound of the ophthalmic artery from 27 weeks. The variables analyzed were: pulsatility index (PI), resistance index (RI), peak velocity ratio (PVR), peak systolic velocity (PSV) and end distolic velocity (EDV). To analyze the normality of the samples was used Lillefors test and Student st- tests and Mann-Whitney test to compare means and medians, as data normality. The significance level used was of 95%. The mean age of pregnant women with GDM was 30,0 ± 5,5 years and pregnant women at 24,2 ± 5,5 years. The mean gestational ages were 33,7 ± 2,7 weeks and 33, 9 ± 2,7 weeks in groups of GDM and normal pregnant women. There was no significant difference between the mean gestational age between the two groups analyzed (p = 0,701). The median and mean values with standard deviation of the variables of the ophthalmic artery Doppler group GDM and normal pregnant women were: PI = 1,68 ± 0,60 / 1,64 ± 0,46 (p = 0,695); RI = 0,75 / 0,75 (p = 0,980); RPV = 0,54 ± 0,11 / 0,50 ± 0,11 (p=0,117); PVS(cm/s)= 33,05 / 31,91 (p=0,721) e EDV(cm/s)= 6,24 / 7,89 (p=0,485). Twenty-six patients (65%) underwent mapping of the retina with normal results. There were no significant changes in flow patterns of ophthalmic arteries in the group of pregnant women with GDM, showing that the time of exposure to the disease during pregnancy was short to cause significant vascular disorders within central.

Objective: The purpose of this paper is to analyze the pre-gestational diabetes can modify the defaults maternal ophthalmic artery Doppler velocimetry. Methods: This prospective observational study that examined the ophthalmic artery Doppler 30 pregnant women with pre-gestational diabetes according to the criteria of the American Diabetes Association (ADA) and compared with data from a control group of 40 normal pregnant women. Inclusion criteria were pregnant women above 18 years with a diagnosis of diabetes mellitus type I, II, or secondary, with a gestational age greater than or equal to 20 weeks. We excluded patients with heart disease, and hypertensive smokers. All patients underwent obstetrical ultrasound examination, focusing on Doppler examination of the ophthalmic artery. The following variables were measured in the ophthalmic artery, resistance index (RI), pulsatility index (PI), peak velocity ratio (RPV), peak systolic velocity (PSV) and end diastolic velocity (EDV). Statistical analysis was performed calculating the average, median and standard deviation (SD) of variables and applying Student\'s t test and Mann-Whitney test as normality of the sample. The significance level was 95%. Results: The diabetic women had a mean age of 28 years (SD 8.5) and mean gestational age 30 weeks (SD 2.8). The average or median and SD of the indexes of the study group were: RI = 0.75, PI = 1.83 (SD 0.34); RPV = 0.53 (SD 0.01), PSV = 31.92; VDF = 7.89. When comparing the mean between the study group and normal group of patients showed an increase of PSV and EDV in the diabetic group compared to the normal group, with significant results (p = 0.020 and p = 0.005 respectively). The other Doppler indices did not differ significantly between the two groups. Conclusion: In this study it was observed that the ophthalmic artery Doppler signals identified orbital hyperperfusion in diabetic pregnant women, by high values of peak systolic velocity and end diastolic velocity in relation to pregnant women.