Symptoms, CA125 and HE4 for the preoperative prediction of ovarian malignancy in Brazilian women with ovarian masses

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Background: This manuscript evaluates whether specific symptoms, a symptom index (SI), CA125 and HE4 can help identify women with malignant tumors in the group of women with adnexal masses previously diagnosed with ultrasound. Methods: This was a cross-sectional study with data collection between January 2010 and January 2012. We invited 176 women with adnexal masses of suspected ovarian origin, attending the hospital of the Department of Obstetrics and Gynecology of the Unicamp School of Medicine. A control group of 150 healthy women was also enrolled. Symptoms were assessed with a questionnaire tested previously. Women with adnexal masses were interviewed before surgery to avoid recall bias. The Ward Agglomerative Method was used to define symptom clusters. Serum measurements of CA125 and HE4 were made. The Risk of Ovarian Malignancy Algorithm (ROMA) was calculated using standard formulae. Results: Sixty women had ovarian cancer and 116 benign ovarian tumors. Six symptom clusters were formed and three specific symptoms (back pain, leg swelling and able to feel abdominal mass) did not agglomerate. A symptom index (SI) using clusters abdomen, pain and eating was formed. The sensitivity of the SI in discriminating women with malignant from those with benign ovarian tumors was 78.3%, with a specificity of 60.3%. Positive SI was more frequent in women with malignant than in women with benign tumors (OR 5.5; 95% CI 2.7 to 11.3). Elevated CA125 (OR 11.8; 95% CI 5.6 to 24.6) or HE4 (OR 7.6; 95% CI 3.7 to 15.6) or positive ROMA (OR 9.5; 95% CI 4.4 to 20.3) were found in women with malignant tumors compared with women with benign tumors. The AUC-ROC for CA125 was not different from that for HE4 or ROMA. The best specificity and negative predictive values were obtained using CA125 in women with negative SI. Conclusion: Women diagnosed with an adnexal mass could benefit from a short enquiry about presence, frequency and onset of six symptoms, and CA125 measurements. Primary care physicians can be thereby assisted in deciding as to whether or not reference the woman to often busy, congested specialized oncology centers.13Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPESP [2012/15059-8

A atuação do nutricionista na Atenção Básica à Saúde em um grande centro urbano The participation of the nutritionist in Primary Health Care in a large urban center

O nutricionista é um profissional importante na implementação de ações de promoção, tratamento e reabilitação da saúde. Porém, sua participação na Atenção Básica (AB) é reduzida. A cidade de São Paulo vem passando por um processo desigual de urbanização, produzindo novas situações de insegurança alimentar e nutricional. Este trabalho analisará a atuação do nutricionista na AB em um grande centro urbano. Trata-se de estudo de abordagem quantitativa no qual foram utilizados dados populacionais da Secretaria Municipal de Saúde e um questionário semiestruturado aplicado em entrevistas individuais. Encontraram-se 123 nutricionistas atuando na rede Básica de Saúde e 51 em Núcleos de Apoio à Saúde da Família (NASF). Todas as regiões do município apresentaram-se com menor número de nutricionistas quando comparada à recomendação do Conselho Federal de Nutricionistas. Em 57,3% dos NASF do município identificou-se a presença deste profissional. Cada nutricionista de NASF acompanha, em média, 7,1 equipes de saúde da família. As faixas etárias que correspondem à infância são as atendidas com menor frequência pelos nutricionistas das UBS e dos NASF. Comparando-se as atividades desenvolvidas, observa-se a transição de um modelo de assistência primária centrado no atendimento individual para um que prioriza o atendimento em grupo.<br>Nutritionists are important professionals for ensuring the implementation of health promotion, treatment and rehabilitation. However, their participation in primary healthcare from a quantitative standpoint is limited. The city of São Paulo has experienced an uneven urbanization process triggering new problems of insecurity in terms of food and nutrition. This article analyzes the performance of the primary healthcare nutritionist in a large urban center. It is a quantitative study that used data from the Municipal Health Department, population data of São Paulo and a semi-structured questionnaire applied in individual interviews. All regions of the city are found to have fewer nutritionists than the recommendation of the Federal Council of Nutritionists. There are 123 nutritionists in the basic healthcare network and 51 in the Family Health Support Nuclei (FHSN) (57.3%). Each nutritionist from the FHSN accompanies 7.1 family health strategy teams on average. The age groups corresponding to children are less frequently seen by nutritionists. Comparing the activities, the transition from a model of primary health care focused on individual care to a model that prioritizes group care was observed

Post-harvest conservation of organic strawberries coated with cassava starch and chitosan

The strawberry is as non-climacteric fruit, but has a high post-harvest respiration rate, which leads to a rapid deterioration at room temperature. This study aimed to evaluate the application of biodegradable coating on postharvest conservation of organic strawberries, cv. Camarosa, packed in plastic hinged boxes and stored at 10ºC. The treatments consisted of: a) control; b) 2% cassava starch; c) 1% chitosan; and d) 2% cassava starch + 1% chitosan. Physical and chemical characteristics of fruits were evaluated at 3, 6 and 9 days of storage, and microbiological and sensory analyses were carried out at the end of the storage period. The treatments influenced positively the post-harvest quality of organic strawberries. The coating cassava starch + chitosan provided the best results, with less than 6% of loss in fruit mass, lower counts of yeast and psychrophilic microorganisms and the best appearance according to the sensory analysis

Sobrepeso entre adolescentes de escolas particulares de Fortaleza, CE, Brasil Sobrepeso entre adolescentes de escuelas privadas de Fortaleza, CE, Brasil Overweight among adolescents from private schools in Fortaleza, CE, Brazil

O objetivo da pesquisa foi identificar casos de excesso de peso em adolescentes de escolas particulares de Fortaleza - Brasil. Foram investigados 794 estudantes entre 12 e 17 anos de idade, de 12 escolas privadas, nos meses de março-junho e agosto-setembro de 2007. A prevalência de sobrepeso e obesidade foi, respectivamente, de 20% e 4%. O sobrepeso foi maior, e duplicado os casos de obesidade, naqueles que mantinham o hábito de assistir tevê durante as refeições (p= 0, 000). Cerca de 28% dos jovens ativos apresentavam excesso de peso (p < 0, 001). No combate à adiposidade juvenil, cabe a enfermagem, principalmente, realizar as ações preventivas, pois atenuam diversas repercussões patológicas, relacionados com o acúmulo de peso corporal.<br>El objetivo de la investigación fue identificar los casos de sobrepeso en adolescentes de escuelas privadas de Fortaleza-Brasil. Fueron investigados 794 estudiantes entre 12 y 17 años, de 12 escuelas privadas, en los meses de marzo-junio y agosto-septiembre de 2007. La prevalencia de sobrepeso y obsedidad fue de 20% y 4%, respectivamente. La acumulación de peso fue mayor y los casos de obesidad fue dos veces más, en los que tenían la costumbre de asistir a la tele al alimentarse (p= 0, 000). Sobre 28% de los jóvenes que practicaban actividad física regularmente presentaban sobrepeso (p < 0, 001). Para la enfermería luchar contra la obesidad entre adolescentes, son necesarias las acciones preventivas, pues atenuan los diversos efectos patológicos con relación a la acumulación de peso corporal.<br>The purpose of the study was to identify cases of overweight among adolescents in private schools in Fortaleza, Brazil. We investigated 794 students between 12 and 17 years old from 12 private schools, in the months March to June and August-September 2007. The prevalence of overweight and obesity was 20% and 4%, respectively. Among the young people who watch TV while eat, the weight accumulated was higher and the cases of obesity was the double (p = 0, 000). About 28% of people who practiced regular physical activity were overweight (p <0, 001). In the fight against adolescent adiposity, to the nursing is primarily the preventive actions, because attenuate various pathological effects related to the accumulation of body weight

Perda dentária e expectativa da reposição protética: estudo qualitativo Dental loss and prosthetic replacement expectation: qualitative study

Esse estudo qualitativo analisou as repercussões da perda dentária total de usuários do serviço público. Aplicou-se o Oral Health Impact Profile simplificado(OHIP14) a cinquenta voluntários e, após a apuração dos resultados, foram selecionados treze pacientes para entrevistas individuais baseadas em um roteiro com questões abertas. A seleção das pessoas foi de acordo com o grau de percepção do impacto da condição bucal na qualidade de vida, medida pela pontuação OHIP, de forma a incluir a maior variedade de perfis da amostra inicial. Da análise do conteúdo dos depoimentos, verificou-se que a perda dentária total tem forte impacto na vida das pessoas e implica consequências negativas como vergonha, dificuldade em se alimentar, prejuízo ao relacionamento social e sentimento de incompletude. A possibilidade de reposição protética dos dentes gera ansiedade nas pessoas e, embora elas saibam que a utilização das próteses possa representar sacrifícios, a expectativa de retorno ao padrão social geralmente aceito e de recuperação de sua própria imagem rejuvenescida faz valer a pena quaisquer sacrifícios.<br>This qualitative research analyses the repercussions of total dental loss on people's quality of life. The Oral Health Impact Profile short-form (OHIP14) was applied to 50 volunteers, and after analyzing the results, 13 out of those 50, were selected to be individually interviewed in an opened questions script. The criteria to select these 13 people were: perception of the impact of mouth condition on quality of life measured by the score reached on OHIP. We tried to comprise the sample with a good variety, according to the profile of the initial sample. After analyzing people's statements, it was possible to verify that dental loss had strong negative consequences on people's life, like shame, difficulty to eat, impact on social relationship and feeling of not being complete. The possibility of having their teeth replaced generates some anxiety. Although being aware that wearing total prosthesis represents some sacrifices, people considered it worthwhile because the possibility of regaining the social pattern and the self-image is renewed

Surface roughness and hardness of a composite resin: influence of finishing and polishing and immersion methods

This study evaluated the finishing and polishing effect on the surface roughness and hardness of the Filtek Supreme XT, in fluoride solutions. Specimens were prepared (n = 140) with half of the samples finished and polished with Super-Snap® disks. The experimental groups were divided according to the presence or absence of finishing and polishing and immersion solutions (artificial saliva, sodium fluoride solution at 0.05% - manipulated, Fluordent Reach, Oral B, Fluorgard). The specimens remained immersed in artificial saliva for 24 hours and were then subjected to initial analysis (baseline) of surface roughness and Vickers microhardness. Next, they were immersed in different fluoride solutions for 1 min/day, for 60 days. Afterwards, a new surface roughness and microhardness reading was conducted. The data were submitted to a two-way ANOVA and Tukey's test (5% significance level). For the comparison of mean roughness and hardness at baseline and after 60 days, the paired Student t test was used. The results showed that the surface roughness and microhardness of the Filtek Supreme XT were influenced by the finishing and polishing procedure, independently of the immersion methods