Promoção em saúde nas escolas: Um caminho para redução de morbimortalidade por causas externas

Trabalho apresentado no 31º SEURS - Seminário de Extensão Universitária da Região Sul, realizado em Florianópolis, SC, no período de 04 a 07 de agosto de 2013 - Universidade Federal de Santa Catarina.A atividade de Extensão intitulada “PROMOÇÃO EM SAÚDE NAS ESCOLAS: Um caminho para redução de morbimortalidade por causas externas” tem como objetivo desenvolver em uma escola pública do município de Uruguaiana - RS, uma proposta de intervenção no âmbito do Programa Saúde e Prevenção na Escola para redução das morbidades e mortalidade ocasionadas pelas causas externas em uma população jovem. Este Projeto de extensão acontece em dois momentos distintos. Num primeiro momento realizou-se o levantamento dos dados epidemiológicos do município de Uruguaiana sobre causas externas, através da análise documental retrospectiva, a partir da coleta de informações nas fichas de atendimento ambulatorial, tendo como local de coleta dos dados uma unidade de Urgência e Emergência de um hospital, relativo ao período de janeiro a junho de 2012, com aprovação do Comitê de Ética em Pesquisa (CEP) UNIPAMPA, parecer CAAE nº 04010912.9.0000.5323. Dentro deste contexto, a primeira fase do projeto apontou 3.144 vítimas de causas externas, sendo 2.053 homens (65,30%) e 1.091 mulheres (34,70%). Quanto aos motivos de atendimentos relacionados às causas externas o evento que mais acometeu a população em estudo foram às quedas, os acidentes de trânsito e as agressões físicas, conforme evidenciado na tabela 1

A randomised phase I study of etrolizumab (rhuMAb β7) in moderate to severe ulcerative colitis.

ObjectiveEtrolizumab (rhuMAb β7, anti-β7, PRO145223) is a humanised monoclonal antibody targeting the β7 subunit of the heterodimeric integrins α4β7 and αEβ7, which are implicated in leucocyte migration and retention in ulcerative colitis (UC). This randomised phase I study evaluated the safety and pharmacology of etrolizumab in patients with moderate to severe UC.DesignIn the single ascending dose (SAD) stage, etrolizumab (0.3, 1.0, 3.0, 10 mg/kg intravenous, 3.0 mg/kg subcutaneous (SC) or placebo) was administered 4:1 (n=25) in each cohort. In the multiple dose (MD) stage, new patients received monthly etrolizumab (0.5 mg/kg SC (n=4), 1.5 mg/kg SC (n=5), 3.0 mg/kg SC (n=4), 4.0 mg/kg intravenous (n=5)) or placebo (n=5). The pharmacokinetics was studied and Mayo Clinic Score evaluated at baseline, day 29 (SAD), and days 43 and 71 (MD).ResultsIn the SAD stage, there were no dose limiting toxicities, infusion or injection site reactions. Two impaired wound healing serious adverse events occurred in two patients receiving etrolizumab. In the MD stage, there were no dose limiting toxicities, and no infusion or injection site reactions. Headache was the most common adverse event, occurring more often in etrolizumab patients. Antietrolizumab antibodies were detected in two subjects. The duration of β7 receptor full occupancy was dose related. A clinical response was observed in 12/18 patients, and clinical remission in 3/18 patients treated with etrolizumab in the MD stage, compared with 4/5 and 1/5 placebo patients, respectively.ConclusionEtrolizumab is well tolerated in moderate to severe UC. Further investigation is warranted

Cuidados de enfermagem ao paciente adulto: prevenção de lesões cutaneomucosas e segurança do paciente

Aim: to identify nursing care for skin and mucosal lesions prevention in hospitalized adult patients and possible difficulties encountered by professionals to promote these actions. Method: A descriptive, exploratory qualitative study conducted in 2014 with interview of 118 active nurses in clinical and surgical inpatient units, intensive care unit and emergency room of a hospital in Southern Brazil. Results: three categories emerged: the meaning of patient safety; patient safety and the prevention of mucocutaneous injuries; the difficulties to promote patient safety and prevention of skin and mucosal lesions. Conclusions: the care provided for the prevention of skin and mucosal lesions mostly agree with what the literature recommends. However, patient safety meaning is limited to preventing tumbles and pressure ulcersObjetivo: verificar los cuidados de enfermería en la prevención de lesiones en la piel y mucosa de pacientes adultos y las posibles dificultades profesionales en la promoción de estas acciones. Método: Estudio cualitativo, descriptivo y exploratório realizado en 2014 con 118 enfermeras que trabajan en unidades de hospitalización clínica y quirúrgica, unidades de cuidados intensivos y servicio de urgencia de un hospital de Río Grande del Sur. Resultados: Emergieron tres categorías: el significado de la seguridad del paciente; seguridad del paciente y la prevención de lesiones mucocutáneas; las dificultades para promover la seguridad y prevención de lesiones en la piel y las mucosas del paciente. Conclusiones: la atención para la prevención de lesiones en la piel y las mucosas está en acuerdo con lo que recomienda la literatura. Sin embargo, la seguridad del paciente se limita a la prevención de caídas y úlceras por presión.http://dx.doi.org/10.5902/2179769216310Objetivo: identificar os cuidados de enfermagem para a prevenção das lesões cutaneomucosas em pacientes adultos hospitalizados e possíveis dificuldades encontradas pelos profissionais para promover estas ações. Método: estudo descritivo e exploratório, de abordagem qualitativa, realizado em 2014, com a entrevista de 118 profissionais de enfermagem atuantes nas unidades de internação clínica e cirúrgica, unidade de terapia intensiva e pronto socorro, de um hospital do Rio Grande do Sul. Resultados: emergiram três categorias: o significado da segurança do paciente; a segurança do paciente e a prevenção de lesões cutaneomucosas; as dificuldades para a promoção da segurança do paciente e prevenção de lesões cutaneomucosas. Conclusões: os cuidados realizados para a prevenção de lesões cutaneomucosas em sua maioria estão de acordo com o que a literatura preconiza. Contudo, o significado de segurança do paciente está restrito aos cuidados com a prevenção de quedas e a prevenção das úlceras por pressão

Caracterização das mulheres agredidas em uma zona urbana localizada em uma região de fronteira

Aim: to know the profile of battered women in a west border region of Rio Grande do Sul, Brazil. Method: quantitative descriptive research, developed in Emergency Care, with 68 victims in the period January to June, 2013. The collection was through the records of the Outpatient chips, analyzed by the Statistical Package for Social Sciences. Results: the most prevalent age was between 20 and 29 years, most of the records were not in the offending agent, followed by the spouse. The reasons were the attendance of physical aggression. Among morbidities sharp injuries stood out, followed by a referral to intensive therapy and one death. Conclusions: we emphasize the importance of improving the search for cases of violence against women, customer service network, pay attention to the realization of the records and point out the incipience of studies in frontier areas.Objetivo: conocer el perfil de las mujeres agredidas en una zona urbana situada en una región de frontera del estado del Rio Grande do Sul, Brasil. Método: investigación cuantitativa, descriptiva, desarrollada en el Atendimiento de Urgencia, con 68 víctimas en el período de enero/junio de 2013. La recopilación fue mediante registros de fichas de atención ambulatoria, analizados por el programa StatisticPackagefor Social Sciences. Resultados: la edad con mayor predominio fue entre 20 y 29 años, la mayoría de los registros no constaban el sujeto agresor, seguidas de cónyuge. Los motivos de atendimiento fueron las agresiones de orden física. Entre las morbilidades se destacan las lesiones cortantes, seguidas de un direccionamiento a la terapia intensiva y un fallecimiento. Conclusiones: se destaca la importancia de mejorar la búsqueda de casos de violencia contra la mujer, el servicio de atendimiento, la realización de registros, además de señalar estudios iniciales en áreas de fronteras.Objetivo: conhecer o perfil das mulheres agredidas em uma zona urbana localizada em uma região de fronteira do estado do Rio Grande do Sul, Brasil. Método: pesquisa quantitativa, descritiva, desenvolvida em Pronto Socorro, com 68 vítimas no período de janeiro a junho de 2013. A coleta foi por meio dos registros das fichas ambulatoriais, analisadas pelo programa StatisticPackage for Social Sciences. Resultados: a faixa etária com maior prevalência foi entre 20 e 29 anos, na maioria dos registros não constavam o agente agressor, seguidas do cônjuge. Os motivos de atendimento foram as agressões de ordem física. Entre as morbidades destacaram-se as lesões cortantes, seguidas de um encaminhamento à terapia intensiva e um óbito. Conclusões: ressalta-se a importância de aprimorar a busca dos casos de violência contra a mulher, da rede de atendimento, da realização dos registros,além de apontar a incipiência de estudos em áreas de fronteiras

Association Between Response to Etrolizumab and Expression of Integrin αE and Granzyme A in Colon Biopsies of Patients With Ulcerative Colitis

Background & AimsEtrolizumab is a humanized monoclonal antibody against the β7 integrin subunit that has shown efficacy vs placebo in patients with moderate to severely active ulcerative colitis (UC). Patients with colon tissues that expressed high levels of the integrin αE gene (ITGAE) appeared to have the best response. We compared differences in colonic expression of ITGAE and other genes between patients who achieved clinical remission with etrolizumab vs those who did.MethodsWe performed a retrospective analysis of data collected from 110 patients with UC who participated in a phase 2 placebo-controlled trial of etrolizumab, as well as from 21 patients with UC or without inflammatory bowel disease (controls) enrolled in an observational study at a separate site. Colon biopsies were collected from patients in both studies and analyzed by immunohistochemistry and gene expression profiling. Mononuclear cells were isolated and analyzed by flow cytometry. We identified biomarkers associated with response to etrolizumab. In the placebo-controlled trial, clinical remission was defined as total Mayo Clinic Score ≤2, with no individual subscore >1, and mucosal healing was defined as endoscopic score ≤1.ResultsColon tissues collected at baseline from patients who had a clinical response to etrolizumab expressed higher levels of T-cell−associated genes than patients who did not respond (P < .05). Colonic CD4+ integrin αE+ cells from patients with UC expressed higher levels of granzyme A messenger RNA (GZMA mRNA) than CD4+ αE− cells (P < .0001); granzyme A and integrin αE protein were detected in the same cells. Of patients receiving 100 mg etrolizumab, a higher proportion of those with high levels of GZMA mRNA (41%) or ITGAE mRNA (38%) than those with low levels of GZMA (6%) or ITGAE mRNA (13%) achieved clinical remission (P < .05) and mucosal healing (41% GZMAhigh vs 19% GZMAlow and 44% ITGAEhigh vs 19% ITGAElow). Compared with ITGAElow and GZMAlow patients, patients with ITGAEhigh and GZMAhigh had higher baseline numbers of epithelial crypt-associated integrin αE+ cells (P < .01 for both), but a smaller number of crypt-associated integrin αE+ cells after etrolizumab treatment (P < .05 for both). After 10 weeks of etrolizumab treatment, expression of genes associated with T-cell activation and genes encoding inflammatory cytokines decreased by 40%−80% from baseline (P < .05) in patients with colon tissues expressing high levels of GZMA at baseline.ConclusionsLevels of GZMA and ITGAE mRNAs in colon tissues can identify patients with UC who are most likely to benefit from etrolizumab; expression levels decrease with etrolizumab administration in biomarkerhigh patients. Larger, prospective studies of markers are needed to assess their clinical value

Non-Invasive Mapping of the Gastrointestinal Microbiota Identifies Children with Inflammatory Bowel Disease

Background: Pediatric inflammatory bowel disease (IBD) is challenging to diagnose because of the non-specificity of symptoms; an unequivocal diagnosis can only be made using colonoscopy, which clinicians are reluctant to recommend for children. Diagnosis of pediatric IBD is therefore frequently delayed, leading to inappropriate treatment plans and poor outcomes. We investigated the use of 16S rRNA sequencing of fecal samples and new analytical methods to assess differences in the microbiota of children with IBD and other gastrointestinal disorders. Methodology/Principal Findings: We applied synthetic learning in microbial ecology (SLiME) analysis to 16S sequencing data obtained from i) published surveys of microbiota diversity in IBD and ii) fecal samples from 91 children and young adults who were treated in the gastroenterology program of Children’s Hospital (Boston, USA). The developed method accurately distinguished control samples from those of patients with IBD; the area under the receiver-operating-characteristic curve (AUC) value was 0.83 (corresponding to 80.3% sensitivity and 69.7% specificity at a set threshold). The accuracy was maintained among data sets collected by different sampling and sequencing methods. The method identified taxa associated with disease states and distinguished patients with Crohn’s disease from those with ulcerative colitis with reasonable accuracy. The findings were validated using samples from an additional group of 68 patients; the validation test identified patients with IBD with an AUC value of 0.84 (e.g. 92% sensitivity, 58.5% specificity). Conclusions/Significance: Microbiome-based diagnostics can distinguish pediatric patients with IBD from patients with similar symptoms. Although this test can not replace endoscopy and histological examination as diagnostic tools, classification based on microbial diversity is an effective complementary technique for IBD detection in pediatric patients.Natural Sciences and Engineering Research Council of Canada (Award NSERC PGS D)National Institutes of Health (U.S.) (1-R21-A1084032-01A1

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children