DÉFICITS NA MEMÓRIA DE TRABALHO EM IDOSOS COM DEPRESSÃO MAIOR:: UMA REVISÃO SISTEMÁTICA

Geriatric depression is related with cognitive impairments, but how this is connected to specific Working Memory deficits is still unknown. Hence, the aim of this study is to systematically review the literature about the associations between Working Memory impairments and major depression in the elderly. Thus we performed a systematic review, considering published articles in major international databases between 2000 and 2011. After exclusion criteria, 17 articles were fully reviewed. There is evidence that there is indeed an association between depression in elderly and Working Memory impairments. In addition, some articles found that such deficits are sustained even after mood symptoms remission.Alguns estudos observaram declínio neuropsicológico em idosos deprimidos, todavia nem todos os aspectos da cognição estariam envolvidos. Particularmente a Memória de Trabalho (MT) seria uma das funções mais afetadas. Portanto o objetivo deste artigo é apresentar quais são as evidências sobre prejuízos na MT em idosos portadores de depressão maior. Através de uma revisão sistemática de artigos publicados entre 2000-2011 nas bases de dados Medline, PsycINFO, Cochrane, Scielo, Lilacs e Web of Science (ISI), publicados em inglês, português e espanhol, buscou-se as seguintes palavras chaves: working memory, depression and elderly or elder or aginig or aged or ageing. Após análise, seguindo critérios de inclusão e exclusão, foram analisados 17 artigos. A maioria destes evidenciando prejuízos significativos da MT em participantes depressivos. Prejuízos que parecem permanecer mesmo após a remissão dos sintomas.&nbsp

Contributions for the Brazilian hearing health policy assessment

OBJETIVO: Realizar o levantamento do quantitativo dos procedimentos relacionados à adaptação de aparelho de amplificação sonora individual (AASI) incluídos na Tabela do Sistema Único de Saúde (Tabela SUS). MÉTODOS: Os dados sobre os procedimentos relacionados à adaptação de AASI incluídos na Tabela SUS foram levantados no site www.datasus.gov.br. Após o levantamento desses dados, foi realizada a organização e a análise descritiva da produção dos atendimentos ambulatoriais registrados pelos serviços de saúde auditiva do Brasil, durante o período de novembro de 2004 a julho de 2010. Os dados foram analisados estatisticamente. RESULTADOS: Quanto aos procedimentos relacionados à dispensação de AASI no território nacional no âmbito da saúde auditiva, em 2006, a terapia fonoaudiológica ultrapassou o quantitativo obtido pela adaptação de AASI e, o acompanhamento fonoaudiológico, por sua vez, foi pouco realizado no país. Os AASI com tecnologias B e C vem sendo mais adaptados do que os AASI de tecnologia A e a realização de medida com microfone sonda ou acoplador de 2cc na adaptação dos AASI é pouco realizada em comparação ao ganho funcional. CONCLUSÃO: Houve grandes avanços na atenção ao deficiente auditivo no país, mas é necessário aprimorar o acompanhamento dos usuários de AASI, e revisar procedimentos como medidas com microfone sonda e tecnologias dos AASI.PURPOSE: To quantity the procedures related to hearing aid fitting included in Hearing Health Care National Policy (Tabela SUS). METHODS: Data about fitting procedures included in Tabela SUS were gathered in the website www.datasus.gov.br. After data collection, it was conducted the organization and descriptive analysis of the production of ambulatory consults registered by hearing health services in Brazil, during the period from November 2004 to July 2010. Data were statistically analyzed. RESULTS: Regarding procedures related to dispensing hearing aids in national territory, in 2006, speech-language therapy exceeded the amount obtained by hearing aid fitting, and audiological follow-up was little frequent. Hearing aids with technologies B and C have been adapted more than hearing aids with technology A, and the use of measures with a real-ear measurement or 2cc coupler in the adaptation of hearing aids is uncommon, in comparison to functional gain measures. CONCLUSION: There has been great progresses in the area of hearing impaired attention in the country, but it is necessary to improve the audiological follow-up to hearing aid users, and to review procedures such as the real-ear measurement and technologies of hearing aids

Questionário para monitoramento do desenvolvimento auditivo e de linguagem no primeiro ano de vida

Purpose: To validate a monitoring questionnaire about hearing and language development applied by community health agents in the first year of life. Methods: Seventy six community health agents, previously trained on infant hearing health, administered a questionnaire to the families of 304 children with ages from 0 to 1 year. The questionnaire contains questions regarding hearing and language development and, for all age groups, the question “Does your child hear well?” was presented. The validity of the questionnaire was assessed by analyzing false positive and false negative rates of the identified children. A double-blind study was conducted so that all children assessed by the questionnaire were submitted to hearing evaluation performed by audiologists. Results: Four children (1.32%) were diagnosed with sensorineural hearing loss (two unilateral), and 69 (22.7%) with conductive hearing loss. The monitoring questionnaire showed specificity of 96% and sensitivity of 67%, with a false-negative rate of 33% for not identifying the unilateral hearing loss, and a false-positive rate of 4%. Conclusion: The questionnaire used has shown to be feasible and relevant to actions of the community health agents of the Family Health Strategy program, with high specificity and moderate sensitivity. The use of the validated instrument should be considered to complement Newborn Hearing Screening Programs, in order to identify late onset or acquired hearing loss.Validar um questionário de monitoramento do desenvolvimento da função auditiva e de linguagem, \ud aplicado por agentes comunitários de saúde no primeiro ano de vida. Métodos: Setenta e seis agentes comunitários \ud de saúde, capacitados previamente em saúde auditiva infantil, aplicaram o questionário às famílias de 304 crianças \ud de 0 a 1 ano de idade. O questionário constitui-se de questões sobre o desenvolvimento da função auditiva e da \ud linguagem, sendo que para todas as faixas etárias possui a questão “Seu filho ouve bem?”. A validade do questionário foi averiguada por meio da análise das taxas de falso-positivo e falso-negativo das crianças investigadas \ud por ele. Para tanto, foi utilizado um estudo duplo-cego em que todas as crianças investigadas pelo questionário \ud foram submetidas à avaliação audiológica realizada por fonoaudiólogos. Resultados: Foram diagnosticadas \ud quatro crianças (1,32%) com perda auditiva sensorioneural, sendo duas unilaterais e 69 crianças (22,7%) com \ud perda auditiva condutiva. O questionário de acompanhamento demonstrou especificidade de 96% e sensibilidade \ud de 67%, com taxa de falso-negativo de 33%, por não identificar as perdas auditivas unilaterais, e falso-positivo de \ud 4%. Conclusão: A utilização do questionário proposto mostrou-se viável e pertinente às ações desenvolvidas pelos \ud agentes comunitários de saúde da Estratégia de Saúde da Família, demonstrando alta especificidade e moderada \ud sensibilidade. A utilização do instrumento validado deve ser considerada como forma complementar aos Programas \ud de Triagem Auditiva Neonatal, a fim de identificar as alterações auditivas de caráter adquirido ou de início tardio.CNPq 403719/2004-6CNPq 403719/2004

A experiência da maternidade na gestação

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Incidence of ventilator-associated pneumonia in an intensive care unit Incidência de pneumonia associada à ventilação mecânica em uma Unidade de Terapia Intensiva

Objetivo: Identificar a incidência de pneumonia associada à ventilação mecânica (PAV) em usuários hospitalizados em uma unidade de terapia intensiva. Método: Trata-se de um estudo transversal, documental e retrospectivo. Os dados foram coletados através de busca nas fichas do Serviço de Controle de Infecções Relacionadas à Assistência à Saúde no período de agosto de 2014 a março de 2015 após aprovação no Comitê de Ética em Pesquisa da UFFS com CAEE 45124915100005564. Tabulados no programa Excel e analisados através de estatística descritiva e analítica, com o auxílio do software SPSS 20.0. Resultados: Evidenciaram incidência de 29% de Pneumonia Associada à Ventilação Mecânica, com destaque para o Staphylococcuss no aspirado traqueal e mortalidade de 44%. Conclusão: Revelou índices compatíveis com dados de outros estudos e com o preconizado pela ANVISA. No entanto, sugestiona capacitação aos profissionais envolvidos no cuidado. Descritores: UTI, Enfermagem, Pneumonia Associada a Ventilação Mecânica

Observando adolescentes e adultas na interação mãe-bebê

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Particularidades e semelhanças entre as expectativas de gestantes adolescentes e adultas em relação ao bebê e futuro da criança

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The brain-derived neurotrophic factor (BDNF) gene Val66Met polymorphism affects memory performance in older adults

Objective: Memory impairment is an important contributor to the reduction in quality of life experienced by older adults, and genetic risk factors seem to contribute to variance in age-related cognitive decline. Brain-derived neurotrophic factor (BDNF) is an important nerve growth factor linked with development and neural plasticity. The Val66Met polymorphism in the BDNF gene has been associated with impaired episodic memory in adults, but whether this functional variant plays a role in cognitive aging remains unclear. The purpose of this study was to investigate the effects of the BDNF Val66Met polymorphism on memory performance in a sample of elderly adults. Methods: Eighty-seven subjects aged 4 55 years were recruited using a community-based convenience sampling strategy in Porto Alegre, Brazil. The logical memory subset of the Wechsler Memory Scale-Revised was used to assess immediate verbal recall (IVR), delayed verbal recall (DVR), and memory retention rate. Results: BDNF Met allele carriers had lower DVR scores (p = 0.004) and a decline in memory retention (p = 0.017) when compared to Val/Val homozygotes. However, we found no significant differences in IVR between the two groups (p = 0.088). Conclusion: These results support the hypothesis of the BDNF Val66Met polymorphism as a risk factor associated with cognitive impairment, corroborating previous findings in young and older adults

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide