Brazilian Workshop Model To Train Investigators In Chronic Graft-versus-host Disease Clinical Trials According To The 2005-2006 National Institutes Of Health Recommendations

Background: The lack of standardization of clinical diagnostic criteria, classification and severity scores of chronic graft-versus-host disease led the National Institutes of Health to propose consensus criteria for the purpose of clinical trials. Method: Here we describe a one-day workshop model conducted by the Chronic Graft-versus-Host Disease Brazil-Seattle Consortium Study Group to train investigators interested in participating in multicenter clinical trials in Brazil. Workshop participants included eight transplant physicians, one dermatologist, two dentists, three physical therapists and one psychologist from five institutions. Workshop participants evaluated nine patients with varying degrees of severity of mucocutaneous lesions and other manifestations of the disease followed by a training session to review and discuss the issues encountered with the evaluation and scoring of patients and in the methods used to evaluate grip strength and the 2-minute walk test. Results: Most participants had difficulties in rating the percentage of each type of mucocutaneous lesion and thought 20 minutes was insufficient to evaluate and record the scores of each patient using the National Institutes of Health criteria and other cutaneous assessments. Several specific areas of difficulties encountered by the evaluators were: 1) determining the percentage of erythema in movable and non-movable sclerosis, 2) whether to score all cutaneous findings in a particular area or just the dominant lesion; 3) clarification of the definition of poikiloderma in chronic graft-versus-host disease; 4) discrepant interpretation of the mouth score and 5) clarification on the methodology used for the evaluation of grip strength and the 2-minute walk tests. Conclusions: Results of this workshop support the need to train investigators participating in clinical trials on chronic graft-versus-host disease.335358366Cutler, C., Antin, J.H., Chronic graft-versus-host disease (2006) Curr Opin Oncol, 18 (2), pp. 126-131Lee, S.J., Vogelsang, G., Flowers, M.E., Chronic graft-versus-host disease (2003) Biol Blood Marrow Transplant, 9 (4), pp. 215-233. , Comment in: Biol Blood Marrow Transplant. 2003;9(8):540Filipovich, A.H., Weisdorf, D., Pavletic, S., Socie, G., Wingard, J.R., Lee, S.J., National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report (2005) Biol Blood Marrow Transplant, 11 (12), pp. 945-956Pavletic, S.Z., Martin, P., Lee, S.J., Mitchell, S., Jacobsohn, D., Cowen, E.W., Turner, M.L., Vogelsang, G.B., Measuring therapeutic response in chronic graft-versus-host disease: National Institutes of Health consensus development project on criteria for clinical trials in chronic graftversus-host disease: IV (2006) Biol Blood Marrow Transplant, 12 (3), pp. 252-266. , Response Criteria Working GroupMartin, P.J., Weisdorf, D., Przepiorka, D., Hirschfeld, S., Farrell, A., Rizzo, J.D., Foley, R., Lee, S.J., National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: VI. Design of Clinical Trials Working Group report (2006) Biol Blood Marrow Transplant, 12 (5), pp. 491-505. , Design of Clinical Trials Working GroupBouzas, L.F., Silva, M.M., Tavares, R.C., Moreira, M.C., Correa, M.E., Funke, V.A., Diretrizes para o diagnóstico, classificação, profilaxia e tratamento da doença enxerto contra hospedeiro crônica (2010) Hemoter Rev Bras Hematol, 32 (SUPPL. 1), pp. 22-39Vigorito, A.C., Miranda, E.C.M., Bouzas, L.F., Moreira, R.C., Silva, M.M., Tavares, R.C.B.S., Feasibility of NIH consensus criteria for chronic graft-versus-host disease (GVHD): Establishing a Successful Efforts in Brazil-Seattle collaborative multicenter consortium (2010) 2010 BMT Tandem Meetings, 16, pp. S47. , In:, Orlando, Florida. Biology of Blood and Marrow Transplantation. New York: ElsevierVigorito, A.C., Miranda, E.C., Bouzas, L.F., Moreira, R.C., Silva, M.M., Tavares, R.C., Feasibility of NIH consensus criteria for chronic graftversus-host disease (GVHD): Establishing a Successful Efforts in Brazil-Seattle collaborative multicenter consortium (2010) 2010 BMT Tandem Meetings, 16, pp. S47. , In:, Orlando, Florida. Biology of Blood and Marrow Transplantation. New York: ElsevierAlborghetti, M.R., Corrêa, M.E., Adam, R.L., Metze, K., Coracin, F.L., de Souza, C.A., Late effects of chronic graft-vs.-host disease in minor salivary glands (2005) J Oral Pathol Med., 34 (8), pp. 486-493Hymes, S.R., Turner, M.L., Champlin, R.E., Couriel, D.R., Cutaneous manifestations of chronic graft-versus-host disease (2006) Biol Blood Marrow Transplant, 12 (11), pp. 1101-1113Rationale and Design of the Chronic GVHD Cohort Study: Improving Outcomes Assessment in Chronic GVHD (2011) Biol Blood Marrow Transplant, 17 (8), pp. 1114-1120. , The Chronic GVHD ConsortiumGreinix, H.T., Pohlreich, D., Maalouf, J., Soukup, P., Supper, V., Kalhs, P., A Single-Center Pilot Validation Study of a New Chronic GVHD Skin Scoring System (2007) Biol Blood Marrow Transplant, 13 (6), pp. 715-723Arai, S., Jagasia, M., Storer, B., Chai, X., Pidala, J., Cutler, C., Global and organ-specific chronic graft-versus-host disease severity according to the 2005 NIH Consensus Criteria Blood, , In press online in, doi:10.1182/blood-2011-03-344390Inamoto, Y., Chai, X., Kurland, B.F., On behalf of the Chronic GVHD Consortium: Validation of Measurement Scales in Ocular Graft-versus-host Disease (2011) Ophthalmology, , in pressMitchell, S.A., Jacobsohn, D., Powers, K.E., A Multicenter Pilot Evaluation of the National Institutes of Health Chronic Graftversus-Host Disease (cGVHD) Therapeutic Response Measures Feasibility, Interrater Reliability, and Minimum Detectable Change Biol Blood Marrow Transplant, , In press: doi:10.1016/ j.bbmt.2011.04.002Vogelsang, G.B., Wolff, D., Altomonte, V., Farmer, E., Morison, W.L., Corio, R., Treatment of chronic graft-versus-host disease with ultraviolet irradiation and psoralen (PUVA) (1996) Bone Marrow Transplant, 17 (6), pp. 1061-1067Volc-Platzer, B., Hönigsmann, H., Hinterberger, W., Wolff, K., Photochemotherapy Improves chronic cutaneous graft-versushost disease (1990) J Am Acad Dermatol., 23 (2 PART. 1), pp. 220-22

Conhecimento sobre aleitamento materno de puérperas atendidas em dois hospitais de Viçosa, Minas Gerais Knowledge about maternal nursing of mothers attended at two hospitals in the city of Viçosa, Minas Gerais, Brazil

Este estudo teve como objetivo investigar o conhecimento de puérperas sobre o aleitamento materno. Foram entrevistadas 266 puérperas atendidas em dois hospitais da cidade de Viçosa, MG. A amostra caracterizou-se por mulheres na faixa etária de 13 a 48 anos, das quais 58,3% residiam em Viçosa. A maioria delas tinha o 1º grau incompleto. Segundo a pesquisa, 32,7% das mães receberam informação sobre amamentação antes do parto e 14,3% delas foram orientadas no pré-natal. Apesar de 99,2% das entrevistadas manifestaram a necessidade de a criança ser amamentada, 54,8% não conheciam outra função do leite além da alimentar. A sucção foi lembrada por apenas 1,5% das puérperas como fator que aumenta a produção de leite, e 61,0% delas não conheciam a maneira correta de a criança abocanhar o mamilo. Quanto ao problema do ingurgitamento mamário, 57,0% não sabiam como resolvê-lo. Com relação às leis de proteção à nutriz trabalhadora, 84,6% as desconheciam. Concluiu-se que o baixo nível de conhecimento, por parte das puérperas, sobre questões fundamentais para o sucesso da amamentação reafirmam a importância do incentivo e da orientação para o aleitamento durante o pré-natal.<br>This study had the objective of investigating the mothers knowledge about maternal nursing. Two hundred and sixty-six mothers attended at two hospitals in the city of Viçosa, state of Minas Gerais, where interviewed.The sample was characterized by women in the age group from 13 to 48 years old, and 58,3% of them lived in Viçosa. The majority of them had not finished elementary school. From the total of mothers interviewed, 32.7% had received information on breast-feeding before the childbirth, and 14.3% of them were oriented in the prenatal period. Although of 99.2% of the mothers considered that the child should be breastfed, 54.8% did not know another function of milk besides feeding. The suction was remembered by only 1.5% of the mothers as a factor which increases the production of milk, and 61.0% of them did not know the child's correct way to seize the breast nipple with the mouth. Regarding the problem of mammary engorgement, 57.0% did not know how to solve it. Concerning the laws that favor the lactating workers, 84.6% ignored them. The mothers low level of knowledge about fundamental subjects for the breast-feeding success reaffirms the importance of the incentive and of the orientation towards nursing during the prenatal period