Qualidade da atenção ao parto em maternidades do Rio de Janeiro

OBJECTIVE: To evaluate the quality of birth care based on the World Health Organization guidelines. METHODS: A case-control study was carried out in a public and a private maternity hospitals contracted by the Brazilian Health System in the city of Rio de Janeiro, Brazil, from October 1998 to March 1999. The sample comprised 461 women in the public maternity hospital (230 vaginal deliveries and 231 Cesarean sections) and 448 women in the private one (224 vaginal deliveries and 224 Cesarean sections). Data was collected through interviews with puerperal women and review of medical records. A summarization score of quality of delivery care was constructed. RESULTS: There was low frequency of practices that should be encouraged, such as having an accompanying person (1% in the private hospital for both vaginal delivery and C-sections), freedom of movements throughout labor (9.6% of C-sections in the public hospital and 9.9% of vaginal deliveries in the private hospital) and breastfeeding in the delivery room (6.9% of C-sections in the public hospital and 8.0% of C-sections in the private hospital). There was a high frequency of known harmful practices such as enema administration (38.4%); routine pubic shaving; routine intravenous infusion (88.8%); routine use of oxytocin (64.4%), strict bed rest throughout labor (90.1%) and routine supine position in labor (98.7%) in vaginal deliveries. The best summarizing scores were seen in the public maternity hospital. CONCLUSIONS: The two maternity hospitals have a high frequency of interventions during birth care. In spite of providing care to higher risk pregnant women, the public maternity hospital has a less interventionist profile than the private one. Procedures carried out on a routine basis should be pondered based on evidence of their benefits.OBJETIVO: Avaliar a qualidade da atenção durante o processo de trabalho de parto de acordo com normas da Organização Mundial de Saúde. MÉTODOS: Trata-se de estudo do tipo caso-controle, realizado em duas maternidades: pública e conveniada com o Sistema Único de Saúde, no Município do Rio de Janeiro. A amostra foi composta por 461 mulheres na maternidade pública (230 partos vaginais e 231 cesáreas) e por 448 mulheres na maternidade conveniada (224 partos vaginais e 224 cesáreas). De outubro de 1998 a março de 1999, foram realizadas entrevistas com puérperas e revisão de prontuários. Foi construído escore sumarizador da qualidade do atendimento. RESULTADOS: Observou-se baixa freqüência de algumas práticas que devem ser encorajadas, como presença de acompanhante (1% na maternidade conveniada, em ambos os tipos de parto), deambulação durante o trabalho de parto (9,6% das cesáreas na maternidade pública e 9,9% dos partos vaginais na conveniada) e aleitamento na sala de parto (6,9% das cesáreas na maternidade pública e 8,0% das cesáreas na conveniada). Práticas comprovadamente danosas e que devem ser eliminadas como uso de enema (38,4%), tricotomia, hidratação venosa de rotina (88,8%), uso rotineiro de ocitocina (64,4%), restrição ao leito durante o trabalho de parto (90,1%) e posição de litotomia (98,7%) para parto vaginal apresentaram alta freqüência. Os melhores resultados do escore sumarizador foram obtidos na maternidade pública. CONCLUSÕES: As duas maternidades apresentam freqüência elevada de intervenções durante a assistência ao parto. A maternidade pública, apesar de atender clientela com maior risco gestacional, apresenta perfil menos intervencionista que maternidade conveniada. Procedimentos realizados de maneira rotineira merecem ser discutidos à luz de evidências de seus benefícios

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

indications os the use of metformin in anvulatory patients.

Entre os agravantes relacionados à infertilidade feminina, estes possuem alta probabilidade de serem provocados por complicações da anovulação, em especial, à Síndrome do Ovário Policístico (SOP), também conhecida como Síndrome da Anovulação Crônica Hiperandrogênica Sabe-se que esta síndrome está, também, relacionada ao aumento da resistência à insulina, condição característica de portadores de Diabetes Mellitus tipo 2, além do quadro de hiperandrogenismo. Nesse contexto, observou-se por meio dos estudos, que o uso terapêutico do fármaco Metformina nessas pacientes provocou melhorias nas concentrações glicêmicas, além da diminuição de androgênios circulantes e foliculares, juntamente com efeitos benéficos indiretos para os oócitos em desenvolvimento. Dessa forma, o uso alternativo do fármaco citado em pacientes portadoras de SOP, apresenta elevado potencial na indução da ovulação, visto que aumenta a sensibilidade à insulina e reduz níveis hormonais, resultando em ciclos ovulatórios e regulares. Com o presente trabalho, objetivou-se, portanto, discutir a eficácia da terapêutica alternativa com Metformina em portadoras de SOP, uma vez que esse medicamento é um agente anti-hiperglicêmico que melhora a tolerância à glicose em pacientes com Diabetes Mellitus tipo 2. Entende- se, portanto, que o uso alternativo da Metformina em portadoras de SOP anovulatórias demonstra efeitos benéficos e possível retorno da ovulação.Among the aggravating related to female infertility, these are highly likely to be caused by complications of anovulation, in particular, the Polycystic Ovarian Syndrome (PCOS), also known as anovulation Chronicle Syndrome hyperandrogenism. It is known that this syndrome is also associated with increased insulin resistance, characteristic condition of patients with type 2 diabetes mellitus, in addition to hyperandrogenism condition. In this context, it was found through studies that the therapeutic use of drug Metformin in these patients led to improvements in glucose concentrations, besides the decrease of circulating and follicular androgen, together with indirect beneficial effect on the oocytes under development. Thus, the alternative use of said drug in patients with PCOS has a high potential for induction of ovulation, by increasing insulin sensitivity and reducing hormonal levels, and resulting in regular ovulatory cycles. With this study, we aimed, therefore, discuss the effectiveness of alternative therapy with metformin in women with PCOS, as this drug is an anti-hyperglycemic agent which improves glucose tolerance in patients with diabetes mellitus type 2. Therefore, the alternate use of metformin in anovulatory women with PCOS shows beneficial effects and possible return of ovulation

Parto cesáreo: quem o deseja? Em quais circunstâncias?

O Brasil apresenta altos índices de cesáreas. Este estudo investigou a existência de uma "cultura de cesárea", ou preferência por este tipo de parto, através de uma amostra de 909 puérperas (454 vaginais e 455 cesáreos) em duas maternidades do Município do Rio de Janeiro, onde entrevistas e revisão de prontuários foram realizados entre setembro de 1998 e março de 1999. Perguntou-se às mulheres se queriam que seu parto fosse cesáreo e a maioria absoluta (75,5%) respondeu "não", as razões principais sendo: "recuperação mais difícil e lenta no parto cesáreo" (39,2%) e "dor e sofrimento maior depois da cesárea" (26,8%). Apenas 17% das mulheres solicitaram cesárea e, destas, cerca de 75% o fizeram durante o trabalho de parto/parto. Análise mostrou que quanto maior o intervalo de tempo entre a admissão no hospital e o parto, mais freqüente é a solicitação. A maioria das mulheres, nas maternidades estudadas, não quer e não pede cesárea; ou seja, não existe uma ?cultura? feminina que valorize a cesárea como preferência. Além do desejo da laqueadura, as circunstâncias concretas da assistência no pré-parto/parto parecem influenciar no pedido da mulher

Traducción y adaptación del Children with Special Health Care Needs Screener al portugués de Brasil

Submitted by Regiane Silva ([email protected]) on 2018-08-14T19:12:47Z No. of bitstreams: 1 Tradução e adaptação do Children with Special Health Care.pdf: 175484 bytes, checksum: 65fb90a169893d6d1e04de5b42011f81 (MD5)Approved for entry into archive by Regiane Silva ([email protected]) on 2018-08-15T19:16:56Z (GMT) No. of bitstreams: 1 Tradução e adaptação do Children with Special Health Care.pdf: 175484 bytes, checksum: 65fb90a169893d6d1e04de5b42011f81 (MD5)Made available in DSpace on 2018-08-15T19:16:56Z (GMT). No. of bitstreams: 1 Tradução e adaptação do Children with Special Health Care.pdf: 175484 bytes, checksum: 65fb90a169893d6d1e04de5b42011f81 (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.Universidade Federal de Santa Maria, Santa Maria, RS, Brasil.Universidade Federal do Rio de Janeiro. Escola de Enfermagem Anna Nery. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.O estudo teve como objetivo elaborar a versão brasileira do instrumento Children with Special Health Care Needs Screener, avaliar a consistência interna e a concordância interobservador. Seguiram-se as etapas de tradução, retrotradução, comissão de revisão e pré-teste. Participaram 140 familiares de crianças de 0-12 anos em dois serviços de saúde, no Sul do Brasil. Estatística kappa e alfa de Cronbach avaliaram confiabilidade. Na avaliação de clareza, com profissionais de saúde, 80% consideraram as questões muito claras. A prevalência de crianças com necessidades especiais de saúde foi 36%. O tempo médio de aplicação foi 3,5 minutos. Contatou-se dificuldade de compreensão na questão dois. O instrumento apresentou consistência interna satisfatória e concordância perfeita. Ressalta-se que a utilização em pesquisas futuras permitirá complementar as análises psicométricas da adequação para o contexto brasileiro, contribuindo para a definição do perfil epidemiológico desse grupo infantil de forma padronizada no cenário da saúde pública brasileira.This study aimed to elaborate the Brazilian version of the Children with Special Health Care Needs Screener to assess internal consistency and inter-observer agreement. The stages included translation, back-translation, expert committee review, and pretest. Participation included 140 family members of children 0-12 years of age at health services in southern Brazil. Reliability was assessed with kappa statistic and Cronbach's alpha. In the assessment of clarity with health professionals, 80% rated the questions very clear. Prevalence of children with special health needs was 36%. Mean time for applying the instrument was 3.5 minutes. The process identified difficulties in understanding question number two. The instrument showed satisfactory internal consistency and perfect agreement. Future research should add to the psychometric analyses of the instrument's adequacy for the Brazilian context, thereby contributing to a standardized definition of this young age group's epidemiological profile within the public health scenario in Brazil.El estudio tuvo como objetivo elaborar la versión brasileña del instrumento Children with Special Health Care Needs Screener para evaluar su consistencia interna y concordancia inter-observador. Se siguieron las etapas de traducción, retrotraducción, ejecución de la revisión y pre-test. Participaron 140 familiares de niños de 0-12 años en dos servicios de salud, en el Sur de Brasil. La estadística kappa y alfa de Cronbach evaluaron la fiabilidad. En la evaluación de la claridad, con profesionales de salud, un 80% consideraron las cuestiones muy claras. La prevalencia de niños con necesidades especiales de salud fue un 36%. El tiempo medio de aplicación fue 3,5 minutos. Se constató dificultad de comprensión en la cuestión dos. El instrumento presentó una consistencia interna satisfactoria y una concordancia perfecta. Se resalta que la utilización en investigaciones futuras permitirá complementar los análisis psicométricos de la adecuación al contexto brasileño, contribuyendo a la definición del perfil epidemiológico de ese grupo infantil, de forma estandarizada, en el escenario de la salud pública brasileña