The importance of simulation in team training on obstetric emergencies: results of the first phase of the national plan for continuous medical training

As emergências obstétricas são eventos raros e inesperados. O modelo tradicional para a formação médica nestes eventos críticos apresenta limitações óbvias. Dada a variedade de competências técnicas e o ambiente de alto risco em que são aplicadas, a obstetrícia é uma especialidade que se adequa totalmente ao treino através de técnicas ou tecnologias aplicadas à Medicina ou Obstetrícia. Este modelo de aprendizagem constitui uma oportunidade para aprender e treinar competências técnicas simples e complexas, bem como a oportunidade para ensaiar e aprender com os erros, sem riscos para os doentes. Assim, elaborámos um estudo com o objectivo de avaliar a percepção dos formandos relativamente a quais os factores associados à falibilidade humana antes e após a formação clínica com simulação; comparar o nível de confiança para a resolução de situações emergentes obstétricas entre internos e especialistas com mais de 5 anos de experiência, antes e após uma acção formativa em gestão de eventos críticos de Obstetrícia; determinar o valor atribuído pelos formandos à simulação como instrumento formativo em cuidados emergentes. Nesta fase do programa, correspondente às 3 primeiras sessões formativas em gestão de eventos críticos de Obstetrícia, participaram 31 médicos. Após a acção formativa, verificaram-se alterações na percepção dos formandos relativamente a quais os factores associados à falibilidade humana, no nível de confiança para a resolução de situações emergentes obstétricas e no valor atribuído pelos formandos à simulação como recurso pedagógico

Body adiposity index to analyze the percentage of fat in young men aged between 7 and 17 years

BACKGROUND: The body adiposity index (BAI), uses anthropometry to estimate percent body fat (%F). However, previous studies have shown that the BAI has limited accuracy for children and adolescents. OBJECTIVE: We propose to develop and validate an adjusted BAI for use in male children and adolescents from 7 to 17 years of age. METHODS: The sample consisted of 141 physically active male children and adolescents (age: 12.5 ± 2.14). The %F was determined by X-ray dual energy absorptometry equipment (DXA) as the standard method and by BAI, using an equation that uses height and hip circumference. Arithmetic modeling was used to adjust the structure of the BAI mathematical model. RESULTS: The BAI arithmetic adjustment was successful, resulting in the mathematical model named in the present study of adjusted body adiposity index (BAIADJ ). BAI and BAIADJ correlated with DXA (r ≤ .70, p  .05). CONCLUSION: The adjusted model of the body adiposity index proves to be an effective tool for the analysis of the fat percentage in young males. In addition, it demonstrated significant degrees of agreement and validity in relation to DXA

How Are Adolescents Sleeping? Adolescent Sleep Patterns and Sociodemographic Differences in 24 European and North American Countries.

PURPOSE:Insufficient and poor sleep patterns are common among adolescents worldwide. Up to now, the evidence on adolescent sleep has been mostly informed by country-specific studies that used different measures and age groups, making direct comparisons difficult. Cross-national data on adolescent sleep that could inform nations and international discussions are lacking. We examined the sleep patterns of adolescents across 24 countries and by gender, age, and affluence groups. METHODS:We obtained sleep data on 165,793 adolescents (mean age 13.5 years; 50.5% girls) in 24 European and North American countries from the recent cross-sectional Health Behaviour in School-aged Children surveys (2013-2014 and 2017-2018). For each country, we calculated the age-standardized mean in sleep duration, timing, and consistency and the proportions meeting sleep recommendations on school and nonschool days from self-reported bedtimes and wake times. We conducted stratified analyses by gender, age, and family affluence group. RESULTS:Adolescent sleep patterns varied cross-nationally. The average sleep duration ranged between 7:47 and 9:07 hours on school days and between 9:31 and 10:22 hours on nonschool days, and the proportion of adolescents meeting sleep recommendations ranged between 32% and 86% on school days and between 79% and 92% on nonschool days. Sleep patterns by gender and affluence groups were largely similar, but older adolescents slept less and went to bed later on school days than younger adolescents in all countries. CONCLUSIONS:The sleep patterns of adolescents vary across countries and sociodemographic groups. Insufficient sleep on school days is common in many countries. Public health and policy efforts to promote healthy adolescent sleep are encouraged

Cytochrome-P450 enzymes and autoimmunity: expansion of the relationship and introduction of free radicals as the link

The Cytochrome-P-450 enzymes (CYP) are among the most important xenobiotic-metabolizing enzymes, which produce reactive oxygen species (ROS) as the result of metabolizing xenobiotics

Knowledge and behaviors regarding salt intake in Mozambique

Background/objectives: Health education and regulatory measures may contribute to lower population salt intake. Therefore, we aimed to describe knowledge and behaviors related to salt intake in Mozambique. Subjects/methods: A cross-sectional evaluation of a representative sample of the population aged 15–64 years (n = 3116) was conducted in 2014/2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance, including a 12-question module for evaluation of dietary salt. Results: Three dimensions were identified in the questionnaire, named “self-reported salt intake”, “knowledge of health effects of salt intake”, and “behaviors for control of salt intake”. A total of 7.4% of the participants perceived that they consumed too much/far too much salt and 25.9% reported adding salt/salty seasoning often/always to prepared foods. The proportion considering that it was not important to decrease the salt contents of their diet was 8%, and 16.9% were not aware that high salt intake could be deleterious for health. Prevalences of lack of behaviors for reducing salt intake ranged from 74.9% for not limiting consumption of processed foods, to 95% for not buying low salt alternatives. There were few differences according to socio-demographic variables, but awareness of hypertension was, in general, associated with better knowledge and less frequent behaviors likely to contribute to a high salt intake. Conclusions: Most Mozambicans were aware that high salt intake can cause health problems, but the self-reported salt intake and behaviors for its control show an ample margin for improvement. This study provides evidence to guide population level salt-reducing policies

Allele-Specific Impairment of GJB2 Expression by GJB6 Deletion del(GJB6-D13S1854)

Mutations in the GJB2 gene, which encodes connexin 26, are a frequent cause of congenital non-syndromic sensorineural hearing loss. Two large deletions, del(GJB6-D13S1830) and del(GJB6-D13S1854), which truncate GJB6 (connexin 30), cause hearing loss in individuals homozygous, or compound heterozygous for these deletions or one such deletion and a mutation in GJB2. Recently, we have demonstrated that the del(GJB6-D13S1830) deletion contributes to hearing loss due to an allele-specific lack of GJB2 mRNA expression and not as a result of digenic inheritance, as was postulated earlier. In the current study we investigated the smaller del(GJB6-D13S1854) deletion, which disrupts the expression of GJB2 at the transcriptional level in a manner similar to the more common del(GJB6-D13S1830) deletion. Interestingly, in the presence of this deletion, GJB2 expression remains minimally but reproducibly present. The relative allele-specific expression of GJB2 was assessed by reverse-transcriptase PCR and restriction digestions in three probands who were compound heterozygous for a GJB2 mutation and del(GJB6-D13S1854). Each individual carried a different sequence variant in GJB2. All three individuals expressed the mutated GJB2 allele in trans with del(GJB6-D13S1854), but expression of the GJB2 allele in cis with the deletion was almost absent. Our study clearly corroborates the hypothesis that the del(GJB6-D13S1854), similar to the larger and more common del(GJB6-D13S1830), removes (a) putative cis-regulatory element(s) upstream of GJB6 and narrows down the region of location

Perspectives on the chemical etiology of breast cancer.

Multiple factors, known and unknown, contribute to human breast cancer. Hereditary, hormonal, and reproductive factors are associated with risk of breast cancer. Environmental agents, including chemical carcinogens, are modifiable risk factors to which over 70% of breast cancers have been attributed. Polymorphisms of drug-metabolizing enzymes may influence risk of breast cancer from environmental chemicals, dietary agents, and endogenous steroids. The environmental factors discussed in this review include pollutants, occupational exposures, tobacco smoke, alcohol, and diet. Aromatic amines are discussed as potential mammary carcinogens, with a focus on heterocyclic amine food pyrolysis products. These compounds are excreted into the urine after consumption of meals containing cooked meats and have recently been detected in the breast milk of lactating women

Leprosy among Patient Contacts: A Multilevel Study of Risk Factors

Leprosy is an infectious disease that can lead to physical disabilities, social stigma, and great hardship. Transmitted from person to person, it is still endemic in developing countries, like Brazil and India. Effective treatment has been available since 1960, but early diagnosis of the disease remains the most effective way to stop the transmission chain and avoid late diagnoses and subsequent disabilities. Knowledge of the risk factors for leprosy can facilitate early detection; therefore, our study aimed to investigate the factors presented by leprosy patients and their contacts, who are considered at highest risk of contracting the disease. We studied 6,158 contacts of 1,201 patients under surveillance from 1987 to 2007 in a Public Health Care Center in the City of Rio de Janeiro, Brazil. We evaluated the ways patient and contact demographics and epidemiological characteristics were associated with the detection of leprosy. Statistical analyses took into account both individual and group characteristics and their interrelationships. The main characteristics facilitating the contraction of leprosy among contacts were shown to be consanguinity and household association. Conversely, the bacillary load index of leprosy patients was the principle factor leading to disease among their contacts