Repositório RCAAP

The management of health policies is a very wide field of knowledge as well as complex and therefore, requires that local health authority managers in the position of coordinator in the Programme for the Control of Tuberculosis fully comprehend and act upon policies related to the control of tuberculosis. Objective: To get a sense of the local health authority mangers`, covering the area of SRS/UDIA, understanding of the decentralising process for procedures concerning PNCT in accordance with the evaluation surrounding access to services in Basic Health. Method: A cross-section study using a Primary Care Assessment Tool (PCAT) questionnaire adapted to the concerns of TB in Brazil. Thirty-three managers/coordinators were interviewed. Results: The analysis highlights that 65% of managers consider TB as a priority disease; in relation to the distribution of recourses for 42% of managers, this criterion was not an issue, for 21% this is always based on the needs of the population. Concerning the investment of recourses allocated to TB, 33% referred to this criterion as not being applicable, 18% as always. When it comes to the participation of managers in the discussion and definition of control procedures of TB, 52% always participate, 15% almost always, 36,4% of managers allege that it does not apply and 30% never participate in the definition of resource application for the control of TB. When health care users show signs and symptoms of TB, for 39.4% of managers, these sometimes wait more than 60 minutes to be attended; 18.2% almost never and 15.2% never wait for an hour. According to 84.8% of managers the BHU (Basic Health Unit) always offer pots for the sputum test in order to diagnose TB and for 78% the unit always offer tests for HIV/AIDS. The search for respiratory symptoms for 42% of managers is always and for 18.2% is almost always carried out by professionals. According to 84.8% of managers, health care users when it comes to some form of preventative health control look for a BHU and 81.8% affirm that users when presenting symptoms signs and symptoms of TB look for a BHU. Again 94.7% of managers state that units always offer monthly consultation; 63.2% that patients with TB always manage a doctor`s appointment within 24 hours. These data were submitted for variance analysis. Conclusion: It was found that managers consider the BHU as the principal focus point for health care users searching for preventative or assistance procedures, with the guarantee of easy access to appointments. However, one of the main attributes of the BHU that being first contact, is still not fully operational in that it does not have appropriate investments in the cost of alimentation and transport for patients with TB. Managers have little participation in the application of financial recourses from SUS. The multiplicity of activities have contributed to the low governability in the procedures concerning the control of the disease, concluding that the incorporation of procedures in BH have in fact not been sufficient in increasing the control of TB. When the subject comes to accountability concerning the guarantee of the principals of regionalization and integrity management, it becomes necessary that mangers take ownership of instruments for epidemiological analysis and share information for local and regional planning of control procedures of the disease in BH.

Healthcare-associated infections (HAIs) represent a great risk factor to patient well-being, which in turn brings a significant economic factor onto health services worldwide. Hand hygiene (HH) is considered a high impact measure with the least expense incurred when it comes to controlling infections related to health care, as it avoids the cross transmission of microorganisms. This study aimed to evaluate the effectiveness of the multimodal strategy to improve the HH from the World Health Organization (WHO) in a Brazilian University hospital. This is an ecological study, prospective, pre and post-intervention type, conducted between December 2012 and October 2013. Data were collected by direct observation and employment self-administered instrument to health professionals from seven inpatient units: Adult Intensive Care Unit (AICU), Pediatric Intensive Care Unit (PICU), Kidney Transplant Sector (SECTRAN), Internal Medicine (IM), Clinical Surgery 1 (SC1), Clinical Surgery 2 (SC2), Burn Unit (BU). HAI rates were evaluated, joining the HM and the knowledge and perception of health professionals in relation to IRAS and HM. There were 2.297 hand hygiene opportunities observed. The adherence rate was of 54.86% during the pre-intervention period and 51.02% for post-intervention (p>0.05). The authors did not find any direct relationship between the rates of adherence of hand hygiene with infections related to health care. One of the failures detected in the implementation design, was the fact that feedback of infection rates related to health care did not include that of health care professionals. It is concluded that the implementation of the multimodal strategy to improve the HM the WHO is not necessarily effective.

Introduction: Neural Tube Defects (NTD) is a congenital malformation, witch results from the incomplete closure of the neural tube during the fourth week of embryonic development. It is a complex malformation, the second more frequent in the United States of America. It can be prevented by using folic acid (FA) from pre-conception period until the early months of pregnancy. Mandatory flours enrichment with FA occurs in Brazil since 2002. The aim of this study was to evaluate the impact of this action on NTD occurrence, especially on the meningomyelocele sub type, at the Clinical Hospital of the Federal University of Uberlândia (HC-UFU), a regional reference university hospital. Methods: It was a prevalence study, which evaluated all cases of NTDs hospitalized at the Neonatal Unit of HC-UFU, medical records analyze of eight years before until eight years after flours fortification with FA. There were calculated the prevalence of NTD and specially of meningomyelocele subtype at HC-UFU and at Health Region Triângulo do Norte (MRSTN) in pre and post-FA periods. Also, the prevalence ratios were calculated in the same period, with confidence interval of 95% (p<0,05) . Results: A total of 147 cases of NTDs were studied, 81 in the pre-FA period and 66 in the post-FA. Both groups had similar social demographic characteristics. It was detected decreased prevalence of NTD in the Post-FA Group, even in the Neonatal Unit of HC-UFU as in MRSTN, but without statistical significance. The individualized assessment for meningomyelocele sub type showed reduced prevalence, with statistically significant difference. Conclusion: This study showed a reduction in NTD prevalence in the Neonatal Unit of HC-UFU, after the mandatory fortification of flour with folic acid, especially on meningomyelocele.

Faculdade Patos de Minas

Longevity and population aging are not merely an achievement, but also a challenge, since they cause a series of social problems, especially for the healthcare system. The more age advances, the greater the tendency of health impairments for long-lived people. The femoral fracture is an important example of this reality since it involves other factors that affect negatively on the lives of older people, such as morbidity, reduced functional capacity, psychic disorders, institutionalization and death. The objective of this study was to determine the prevalence of hospital admissions of older people requiring surgery for femoral fracture in the public and private hospital networks in the city of Uberlândia, Minas Gerais. The study included people aged over 60 years living in that city in the fracture date. After a year of hospitalization, by means of sociodemographic and clinical data from medical records, we proceeded to the home visits for applying Questionnaire, the Katz ADL Scale and the Geriatric Depression Scale in participants who agreed to participate. It was found that the most impairments of hip fractures in older people occurs at more advanced ages (80 and over) and in women, and it was also found a higher frequency of ADL dependence in these groups. By multivariate analysis, it was observed significant and positive correlation between disability in basic activities of daily life and variables like age, admission by the the publicly funded health system (SUS); with regard to ADL dependence, it was also found significant correlation with domicile as the place of the traumatic event. The study complied with the objectives proposed in the sense of unraveling the panorama of functional capacity and mortality of the elderly after a year of hospitalization for surgical treatment of hip fractures. The results showed the importance of prevention in minimizing this grave health problem.

Purpose: Application of noninvasive positive airway pressure triggers significant cardiopulmonary interactions. This study aimed to identify the hemodynamic effects arising from the application of bilevel pressure to the airways evaluated by echocardiography. Methods: Randomized, double-blind, controlled study was conducted with 19 healthy participants. Random sequence of three expiratory positive airway pressures (EPAPs) was applied for 5 minutes each. The inspiratory pressure remained constant at 5 cmH2O above the established EPAP. Hemodynamic variables, determined using Doppler echocardiography, a non-invasive ventilator, and a heart monitor were recorded. Results: Comparing baseline data with that collected under various EPAPs of 5, 10, and 15 cmH2O showed reduced aortic velocity time integral (p < 0.001), pulmonary velocity time integral (p = 0.003), mean systolic velocity (p = 0.01), atrial filling (p < 0.001), left atrial volume (p = 0.008), heart rate (p < 0.001), stroke volume (SV - p = 0.006), cardiac output (p < 0.001), and distensibility vena cava (p = 0.01). In addition, increased peripheral oxygen saturation (p =<0.001), tidal volume (p = 0.002), and minute ventilation (p < 0.001) were found. There were important and significant correlations between VS and VTIm (r = 0.76; p < 0.001) and VTIa (r = 0.64; p < 0.001) as well as VTIm and CO (r = 0 61; p < 0.001). Conclusion: The cardiopulmonary and interventricular repercussions by echocardiography, were expressed by reducing the left ventricular preload and increasing the biventricular preload, stroke volume, and cardiac output, ensuring increased tidal volume and blood oxygenation.

Hospital-acquired infection (HAI) rates are measures which should be obtained only to guide infection control practices. However, it is not clear how well they have been actually used by hospital-acquired infection control committees (HAICCs) to achieve this purpose. This study aimed at assessing the characteristics of Hospital-acquired infection control services (HAICS) and HAICC, HAI rates obtained and, especially, their use in the HAI control process in hospitals from a central region of Brazil. Data were prospected using interviews with 44 healthcare professionals working in the HAI control service of 19 hospitals of the region. It was carried out by one of the researchers, who used as instrument a semi-structured questionnaire. Based on data provided by interviewee professionals, HAICSs and HAICCs are relatively well-structured. The major infection rates established relate to surgical site infections (SSI), pulmonary infection related to mechanical ventilation (MV), urinary tract infection (UTI) related to vesical catheter (VC) and primary bloodstream infection (BSI). During activities carried out, data collection, construction of rates and their dissemination took most of the professionals work time. Forty (90.91%) professionals considered that the rates have been useful in controlling HAI and 34 (77.27%) could remember some measure taken by HAICS fundamentally based on obtained rates. However, it is noticeable that mentioned measures were not, necessarily, triggered and sustained by knowledge of the rates. It has been concluded that HAICSs and HAICCs of the study region have a better infrastructure than the known average in Brazil; activities of data collection and rate construction and dissemination are usually carried out as they have been suggested, but time spent on these activities is not clearly justified by the measures they determine.

The aim of this study was to evaluate the efficacy of Power Doppler (PD), by quantifying the Vascular Density (Vascularity Index - VI), as a new predictor clinical tool of pathologic response to neoadjuvant chemotherapy in breast cancer, in order to guide the clinician on the effectiveness of chemotherapy as well as the choice of surgical technique by the surgeon. METHOD: For this prospective observational study, 20 patients were recruited with a histological diagnosis of infiltrating breast carcinoma and an indication for neoadjuvant chemotherapy. The tumor vascular density and largest tumor diameter before treatment, after 2 or 3 cycles of chemotherapy and at the end of treatment were evaluated by ultrasound Power Doppler. These findings were compared, and the association with the pathologic response was analyzed. Fisher s exact test, Wilcoxon-Mann-Whitney test, Spearman s correlation coefficient and Pearson s coefficient were used. The sensitivity, specificity and positive and negative predictive values for the histological response were also calculated. P values < 0.05 were considered statistically significant. RESULTS: VI showed a sensitivity of 88.88%, specificity of 100%, positive predictive value of 100% and negative predictive value of 91.66% for the pathologic response, as well as being strongly associated with it. The variation of VI, in terms of either an increase or decrease after 2 or 3 cycles of chemotherapy, significantly predicted the final histological response. CONCLUSION: By quantifying of the VI, PD showed a strong correlation with and predictive power for the histological response to neoadjuvant chemotherapy.

The aim of research was evaluate the association between postprandial and sleeping arterial blood pressure (BP) variations in the non-diabetic elderly. This observational and crosssectional study evaluated systolic, diastolic, mean and pulse pressures, along with heart rate, in 69 non-diabetic elderly patients. We used Ambulatory BP monitoring for pressure and heart rate measurements. We selected three periods: preprandial (two hours before lunch), postprandial (2 hours after lunch) and sleeping (8 hours). Each period was subdivided into six intervals with their respective means. BP variability rates and heart rate were evaluated according to the studied periods and were calculated using the time-rate index. Comparison of the means and BP variability between the preprandial, postprandial and sleeping periods revealed significant differences. For postprandial and sleeping systolic BP, the variations observed were 113.2±15.3 mmHg and 108.5±13.9 mmHg, respectively, P=0.003. The same significant variations were observed with the other pressures studied (P<0.001), except for pulse pressure. Associations between the postprandial and sleeping period variability rates were obtained for systolic BP (r=0.27; P=0.034; CI: 0.059-0.132), diastolic BP (r=0.35; P=0.005; CI: 0.050-0.112), mean arterial pressure (r=0.46; P<0.001; CI:0.048-0.110), pulse pressure (r=0.20; P=0.128; CI:0.041-0.080) and heart rate (r=0.02; P=0.855; CI:0.023-0.046). Postprandial BP variation had a positive and significant correlation with sleeping BP variation. The presence of this association may become a complementary marker of future cardiovascular events. One need other studies to confirm this hypothesis.

Introduction: Coronary computed tomography angiography (CCTA) allows for noninvasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients. Objective: To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non- LDL cholesterol (NLDLC) levels. Methods: We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after. Results: A total of 97 patients were included, of which 69% were men, mean age 64±12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had nonobstructive (<50%) lesions and 42 (43%) had at least one obstructive ≥50% lesion. NLDLC was similar at baseline between the grups (138±52 mg/dl vs. 135±42 mg/dl vs. 131±44 mg/dl, respectively, p=0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p=0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD. Conclusions: Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

The use of Patient-Reported Outcomes Measures (PROMs), which considers the patient\'s perspective on his/her own health and treatment, has gained importance on clinical practice and research. The Patient-Reported Outcomes Measurement Information System (PROMIS®) revolutionized the area when it started providing precise and valid item banks in different health domains, calibrated by the Item Response Theory (IRT), and used for the evaluation of the impact of different chronic diseases on the patient\'s quality of life. The aim of this study was to translate, cross-culturally adapt and validate the PROMIS® Global Health Item Bank into Portuguese. The Functional Assessment of Chronic Illness Therapy (FACIT) methodology was used to translate and cross-culturally adapt the ten items of the bank. The final version of the assessment tool translated into Portuguese was self-administered in 1010 patients. The statistical analysis conducted were: ceiling and floor effects, internal consistency reliability, test-retest reliability, convergent validity, construct validity through exploratory and confirmatory factor analysis, and item calibration through Samejima\'s Graded Response Model (GRM). Four global items needed to be adjusted after pre-test. The analysis of the psychometric properties showed that the PROMIS® Global Health Item Bank has good reliability Cronbach\'s alpha was 0.83 and intra-class correlation coefficient was 0.89. The correlation between the assessment tool and the physical and psychological domains of the WHOQOL-bref ranged from moderated to strong (rho = 0.478 and 0.571, respectively). The exploratory and confirmatory factor analysis confirmed the validity of the item bank, since they showed a good adjustment to the two dimensional model previously established (Global Physical Health scale: CFI = 0.99, TLI = 0.98, RMSEA = 0.04, SRMR = 0.019; Global Mental Health scale: CFI = 1.00, TLI = 1.00, RMSEA = 0.00, SRMR = 0.011). The Global Physical Health and Global Mental Health scales showed good coverage of the latent trait according to Samejima s Graded Response Model. The PROMIS® Global Health Item Banks translated into Portuguese achieved conceptual, semantic, cultural, and operational equivalences, and demonstrated satisfactory psychometric properties regarding its use in Brazilian patients for clinical practice and research.

The objective of this study was to evaluate the influence of chronic smoking on maternal-fetal hemodynamics through Doppler study of maternal uterine (UtA), fetal umbilical (UmA) and fetal middle cerebral (MCA) arteries compared to pregnant non-smokers. The effect of the degree of nicotine addiction on this hemodynamics was also analyzed. An observational cross-sectional study was conducted in 98 chronic pregnant smokers and 102 pregnant non-smokers without known diseases. Doppler study was performed for measuring pulsatility index (PI) and resistance index (RI) of UtA, UmA and MCA. Fagerström and exhaled carbon monoxide (COex) tests were used to evaluate the degree of nicotine dependence. Comparison of Doppler indexes between the two groups showed that only UtA RI and UmA PI had significant effect (p<0.001 and p=0.032, respectively), with higher values in pregnant smokers than non-smokers, indicating vasoconstriction and increased impedance in the studied vessels. Fagerström analysis showed that smoking had a positive effect for PI (p=0.045) and RI (p=0.007) of MCA, with significantly decreased indexes in smokers with high and very high dependence compared to low and moderate dependence. COex analysis showed elevated Um PI in moderate vs light smokers (p=0.035) whereas MCA RI was higher in light vs heavy smokers (p=0.024), differing from previous data. Chronic smoking interfered negatively on maternal-fetal vascular hemodynamics, as demonstrated by increased impedance in the maternal uterine and fetal umbilical arteries. Moreover, the greatest exposure to tobacco caused vasodilation effect in the fetal middle cerebral artery, demonstrating that higher nicotine dependence, the greater the maternal-fetal hemodynamic changes.

Objective: To assess the Doppler indexes of the ophthalmic artery in pregnant women who have been diagnosed with severe arterial hypertension, as well as to compare these data with a group of pregnant women without hypertension blood pressure and to identify the cut-off points for differentiation between the indexes of both groups. Method: This investigation refers to observational cross-sectional study, which assessed 220 pregnant women with chronic arterial hypertension as well as non-hypertense pregnant women in their second and third trimesters constituting, respectively, the study and the control groups. All patients underwent Doppler evaluation of the ophthalmic artery, with an evaluation of the resistance indexes (RI), pulsatility (PI), and peak ratio (PR). Results: There was a meaningful difference between the averages of the Doppler indexes of the ophthalmic artery between the two groups assessed; showing lower IR and IP values and higher PR in the study group in relation to the control group. It was possible to identify cut-off points for differentiation between the indexes of both groups. Conclusion: There are flow alterations in the ophthalmic arteries of pregnant women with chronic arterial hypertension, represented by signs of moderate vasodilatation and impedance decrease in the orbital territory, the fact which can be extrapolated for the small-caliber vessels of the central nervous system, considering the ophthalmic arteries belong to the central nervous system. The discrimination between the groups, the peak ratio proved to be the best index, due to its higher accuracy (74,54%) among the three tests, with diagnostic sensitivity in the order of 80%, and higher PPV and NPV, 74,9% e 73,9%, respectively, when applied at the cutting level of 0,58.

Objective: Compare the evolution regarding the complications concerning two types of incision (conventional x mini-incision), for saphenectomy in patients that go under myocardial revascularization or otherwise known as coronary artery bypass surgery. Methods: During the period from January 2012 to August 2013, 66 patients were prospectively selected for coronary artery bypass with cardiopulmonary bypass surgery. These were divided into two groups: Conventional and Mini-Incision, with 33 patients in each group chosen in a random fashion and with knowledge of which technique to be used being presented only at the start of the surgery. In the conventional group, the patients received an incision to the lower member of 7 to 10 centimeters. The patients in the Mini-Incision group received an incision to the lower member of 3 to 4 centimeters, both performed without the use of any special material for harvesting the saphenous vein. Results: The groups were similar in terms of clinical data and in the preoperative period. Males made up a greater part of the group with 63.7% and 81.9% in groups C and M, respectively. Among the complications of the analysed surgical areas, edema (p = 0.011), hematoma (p = 0.020), dehiscence (p = 0.012) and infection (p = 0.012), were significantly greater in group C when compared to group M. When the matter comes to the variable in relation to the risk of Surgical Site Infections (SSI), no significant difference was found between the groups. Conclusion: Coronary artery bypass surgery with mini-incision for saphenectomy, demonstrated a lower rate for preoperative complications, such as edema, hematoma, dehiscence and infection, when compared to saphenectomy under conventional incision procedures.

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.