Exercício de intensidade moderada durante a gravidez é seguro para o feto? Ensaio clínico aberto

To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks. Methods A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20-minute periods (resting, treadmill walking, and postexercise recovery). Results The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p <0.001), with bradycardia occurring in 56% of the fetuses in the first 10minutes of exercise, and in 47% after 20minutes. Bradycardia was not detected in the other phases. The mean STV and HV were 7.9, 17.0, and 8.0 milliseconds ( p <0.001) and 7.6, 10.8 and 7.6 bpm ( p =0.002) in the resting, walking and recovery phases, respectively. The mean number of fetal movements in 1 hour was 29.9, 22.2 and 45.5, respectively, in the 3 periods ( p <0.001). In overweight/obese women, the mean FHR was lower ( p =0.02). Following the logistic regression analysis, two variables remained significantly associated with bradycardia: maternal fitness in the 28 (th) week of pregnancy (protective effect) and maternal weight (increased risk). Conclusion In healthy fetuses, physical exercise proved to be safe, since, although FHR and AFM decreased during treadmill walking, an increase in SVT and LTV was observed419531538CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE APOIO À PESQUISA DO ESTADO DA PARAÍBA - FAPESQUniversal 480761/2008-6PPSUS2009Determinar o efeito da caminhada em esteira sobre a frequencia cardiaca materna (FCM) e parametros cardiotocograficos (batimentos cardiofetais basais [BCFs], movimentos ativos fetais [MAFs], numero de aceleracoes e desaceleracoes e variabilidade de curta [STV] e longa [LTV] duracAo da frequencia cardiaca fetal) em gestantes na 36 (a) semana. Metodos Foi realizado um ensaio clinico nAo randomizado e aberto com 88 gestantes saudaveis submetidas a caminhada de moderada intensidade na esteira e a cardiotocografia computadoriza em 3 momentos de 20 minutos (antes, durante e apos a caminhada). Resultados A media dos BCFs diminuiu durante a caminhada, retornando a niveis previos (antes: 137 bpm; durante: 98 bpm; apos: 140 bpm; p <0,001), com bradicardia ocorrendo em 56% dos fetos nos primeiros 10 minutos do exercicio, e em 47% apos 20 minutos. A bradicardia fetal nAo foi observada em outros momentos (antes ou depois). As medias da STV e da LTV foram 7,9, 17,0 e 8,0 milissegundos ( p <0,001) e 7,6, 10,7 e 7,6 bpm ( p =0,002) antes, durante e apos a caminhada, respectivamente. A media dos numeros dos MAFs em 1 hora foi 29,9, 22,2 e 45,5, respectivamente, nos tres momentos ( p <0,001). Nas mulheres com sobrepeso/obesidade, a media da FCM foi menor ( p =0,02). Apos a analise de regressAo logistica, duas variaveis permaneceram significativamente associadas a bradicardia: aptidAo maternal na 28 (a) semana de gravidez (efeito protetor) e peso materno (aumento do risco). ConclusAo Em fetos saudaveis, o exercicio fisico mostrou-se seguro, uma vez que, embora os BCFs e os MAFs diminuam durante a caminhada na esteira, foi observado um aumento da SVT e da LT

Viscum album mother tinctures: Harvest conditions and host trees influence the plant metabolome and the glycolytic pathway of breast cancer cells.

Viscum album is a semi-parasitic plant used for over one hundred years in complementary cancer therapy. The main commercial drugs used in cancer patients' treatment are derived from the aqueous V. album extracts, whose cytotoxic potential is mostly attributed to the aqueous soluble antitumoral metabolites. On the counterpart, ethanol solvents must be used to obtain V. album mother tinctures. This methodology permits better solubilization of phenolic compounds, among others, which present antitumoral bioactivity. Recently, the metabolomics approach revealed the influence of the host tree on the V. album subspecies differentiation. To increase the scientific information about the chemical differences related to the host trees and to clarify the seasonal influences, in this study, the metabolome of 50 V. album mother tinctures from three subspecies (abietis, album, austriacum) and five host trees (Malus domestica, Quercus sp., Ulmus carpinifolia, Pinus sylvestris, Abies alba) was evaluated using summer and winter plant harvests. The in vitro cytotoxic activities were investigated in breast cancer cells (MDA-MB-231) and immortalized normal human keratinocytes (HaCaT). The summer V. album mother tinctures presented higher cytotoxic activity than winter ones. Among the summer samples, those prepared with V. album subsp. album were more cytotoxic than V. album subsp. abietis and subsp. V. album subsp. austriacum. The V. album harvested from Quercus petraea and Abies alba inhibited the key-glycolytic enzymes: hexokinase (HK), phosphofructokinase (PFK), pyruvate kinase (PK). This activity was related to a reduction in glucose uptake and lactate production, which were host-tree-time-dose-dependent. The untargeted metabolomic approach was able to discriminate the mother tinctures according to respective botanical classes and harvest season. A total of 188 metabolites were annotated under positive and negative modes. Fourteen compounds were responsible for the samples differentiation, and, to the best of our knowledge, eight were described in the Viscum album species for the first time. Our study shows the interruption of the Warburg effect as a novel antitumoral mechanism triggered by V. album mother tinctures, which is related to their metabolite profile. These results bring scientific evidence that encourages the use of V. album mother tinctures as a natural product for cancer therapy

Assistance for customers with sexually transmitted diseases at pharmacies in the Federal District, Brazil : an intervention study

Pesquisa para investigar práticas, características dos trabalhadores e avaliar efetividade de intervenção educativa foi desenvolvida em setenta farmácias de Brasília e Taguatinga, Brasil, distribuídas em dois grupos; metade das farmácias participou de treinamento sobre DST. Realizou-se 411 visitas de pesquisadores simulando sintomas de DST, que resultaram em: encaminhamento ao médico em cerca de 30% dos atendimentos; indicação de medicamentos em mais de 70% dos atendimentos, embora nas entrevistas apenas 16,4% afirmaram fazê-lo; nenhum tratamento indicado era adequado segundo abordagem sindrômica; recomendações preventivas e tratamento de parceiros foram pouco freqüentes; farmacêuticos recomendaram ida ao médico mais do que balconistas e estes indicaram medicamentos mais do que farmacêuticos. O conhecimento dos trabalhadores sobre DST foi considerado superficial. Após intervenção educativa nenhum dos indicadores apresentou melhora significativa em ambos os grupos. As constatações apontam a necessidade de regulamentação e de intervenção para divulgação de práticas educativas para controle de doenças como as DST e para o uso racional de medicamentos nas farmácias. ___________________________________________________________________________________________________________________ ABSTRACTA quantitative survey was conducted to analyze the type of assistance provided by pharmacy employees for cases of STDs. Simulated customer visits and interviews were conducted in 70 pharmacies in Brasilia and Taguatinga, Brazil, randomly assigned to two groups, one of which participated in educational activities on STDs. There were 411 simulated client visits to the pharmacies, with the following results: recommendation to seek medical care in 30% of cases, while in 70% of cases the pharmacy employees themselves recommended some drug treatment (although only 16.4% admitted to such practice). None of these suggested treatments was appropriate, based on the syndromic approach. Recommendations for prevention and treatment of partners were rare. Pharmacists recommended consulting a physician more frequently than attendants, and the latter recommended medicines more frequently than the former. Pharmacy workers had only superficial knowledge of STDs. After an educational intervention, none of the indicators showed a significant improvement in either group. The observations point to the need for regulation and intervention to publicize educational practices for the control of diseases like STDs and for the rational use of medicines in pharmacies

Vitamin C and Sepsis

Vitamin C is a supplement used orally by several people globally. It may help in many other conditions, like sepsis, which is caused by an infection that leads to an imbalanced immune response involving pro (e.g., TNF-α, IL-1, IL-2, IL-6) and anti-inflammatory (e.g., IL-10, IL-4, IL-7) cytokines. Ascorbic acid is an antioxidant and acts against reactive oxygen species. At the same time, this vitamin influences cellular immune signaling, avoiding exacerbated transcription of pro-inflammatory cytokines. Very high intravenous doses have already shown to be beneficial in septic patients. Some clinical trials are still running to evaluate the real impact of vitamin C in this condition. To the moment, the combination of low-dose corticosteroids, high-dose parenteral ascorbate, and thiamine seems to be the most effective supportive treatment that could help septic patients recover

System management and internal control: an analysis of the accounting firms in Belo Horizonte / MG and the metropolitan area from the Taxonomy of Kaplan and Cooper

O objetivo deste estudo foi analisar o nível de gerenciamento e controle interno dos escritórios de contabilidade a partir da tipologia de quatro estágios desenvolvida por Kaplan e de Cooper (1998) para projetar sistemas gerenciais. Na metodologia, adotou-se o estudo descritivo, por meio de pesquisa de campo do tipo survey e de natureza quantitativa. A pesquisa foi realizada em 112 escritórios de contabilidade situados na cidade de Belo Horizonte/MG e região metropolitana, registrados no Conselho Regional de Contabilidade (CRC/MG). Na análise de dados, utilizou-se a técnica bivariada para as questões referentes ao sistema integrado e ao controle interno e a técnica multivariada, utilizando-se do método Stepwise, para classificar os escritórios entre os quatro níveis de estágios de gerenciamento. Os resultados obtidos permitiram identificar o nível de integração entre as áreas sobre os aspectos de qualidade de dados, emissão de relatórios e controles operacionais e estratégicos, constatando-se o grau de utilização de controle interno e sistemas integrados.This study examines the level of management and internal controls of accounting firms from the four-stage typology developed by Kaplan and Cooper (1998) to project management systems. In the methodology, we adopted the descriptive study, using field research on the type and quantitative survey. The research was conducted in 112 accounting firms located in the city of Belo Horizonte / MG and the metropolitan area, recorded in the Regional Accounting Council (CRC / MG). In data analysis, we used the technique for bivariate issues and the integrated internal control and the multivariate technique, using the stepwise method to rank the offices of the four levels of stage management. The results allowed to identify the level of integration between departments on aspects of data quality, reporting and strategic and operational controls, verifying the degree of utilization of internal control and integrated systems

Modelagem de processos com o BPMN para a melhoria de processos acadêmicos do IFS / Process modeling with BPMN for IFS academic process improvement

Em uma organização, para que seus processos sejam bem definidos e facilmente visualizados por todos os membros, a utilização da modelagem  de processos é essencial. Neste contexto, a modelagem de processos e o uso de uma notação permite com que os processos sejam mapeados e assim aprimorados. Este trabalho apresenta um estudo de caso referente à  aplicação da metodologia Business Process Management para modelagem dos processos de matrícula e trancamento de matrícula do Instituto Federal  de Sergipe - campus Lagarto. A partir do mapeamento e análise dos processos atuais foram propostas melhorias que resultaram na automatização de atividades e no melhor entendimento dos processos. 

Quality of Life of Mothers of Brazilian Children with Congenital Zika Virus Syndrome and Associated Factors

Objective: To evaluate the quality of life of mothers of Brazilian children with congenital Zika virus syndrome (CZS) and associated factors. Material and Methods: This cross-sectional study assessed the quality of life (QoL) of 65 mothers of children diagnosed with CZS using the WHOQOL-bref questionnaire. Information related to mothers and children's characteristics and aspects of QoL (physical, psychological, social and environment domains) was collected. Data were presented using descriptive and inferential statistics. Associations between independent variables and quality of life outcome were carried out through bivariate analyses, adopting a 5% significance level. Results: The “physical” domain showed the highest score (65.98 ± 17.62), while the “environment” domain showed the lowest score (48.55 ± 14.75). The quality of life for the physical domain was associated with maternal schooling and child's sex, while the psychological domain was associated with family income and child's sucking difficulty. Conclusion: Socioeconomic characteristics and comorbidities were associated with mothers' QoL. Knowledge of QoL determinants and their impact on different dimensions of life can serve as a guide for interventions aimed at improving the QoL of this population

TESTE RÁPIDO MOLECULAR PARA TUBERCULOSE: DA COLETA AO INÍCIO DO TRATAMENTO

Objetivo: determinar el tiempo transcurrido desde que se recolecta el material para la pruebamolecular rápida hasta que se inicia el tratamiento contra la tuberculosis en unidades queenviaron muestras para su procesamiento en Unidades Centralizadoras.Método: estudio epidemiológico y analítico desarrollado en dos Unidades Básicas de Saludde Belém-Pará. Se recolectaron datos referentes a 296 casos nuevos con confirmación delaboratorio, diagnosticados entre diciembre de 2014 y diciembre de 2015. En el análisisse utilizó la prueba U de Mann-Whitney, con un valor p≤ 0,05 para la correlación entre lasvariables.Resultados: no se registró ninguna diferencia estadísticamente significativa en el tiempo deemisión de los resultados de los exámenes entre las Unidades Centralizadoras y las Unidadesque enviaron exámenes para su procesamiento. En relación con el inicio del tratamiento, sí seregistró una diferencia de tiempos entre las Unidades Centralizadoras y las Unidades Básicas.Conclusión: centralizar el procesamiento de la Prueba Molecular para Detección Rápidade la Tuberculosis no interfiere en el tiempo de diagnóstico ni en el tratamiento, inclusoconsiderando el envío de muestras entre servicios.Objetivo: identificar o tempo decorrido entre a coleta do material para teste rápido molecular e o início do tratamento para tuberculose em unidades que encaminharam amostras para processamento em Unidades centralizadoras.Método: estudo epidemiológico analítico desenvolvido em duas Unidades Básicas de Saúde em Belém-Pará. Foram coletados dados referentes a 296 casos novos com confirmação laboratorial, diagnosticados de dezembro de 2014 a dezembro de 2015. Na análise, utilizou-se o Teste U de Mann-Whitney, p-valor ≤ 0,05 para a correlação entre as variáveis.Resultados: não houve diferença estatisticamente significativa no tempo de liberação dos resultados de exames em Unidades Centralizadoras e Unidades que encaminharam exames para processamento. Quanto ao início do tratamento, houve diferença no tempo entre as unidades centralizadoras e as de abrangência.Conclusão: a centralização do processamento do Teste Rápido Molecular não interfere no tempo para diagnóstico e tratamento da tuberculose, mesmo com o encaminhamento das amostras entre os serviços.Objective: To identify the time elapsed between the collection of material for rapid moleculartesting and the start of treatment for tuberculosis in units that forwarded samples forprocessing in centralizing units.Method: An analytical epidemiological study carried out in two Basic Health Units in Belém-Pará. Data was collected referring to 296 new laboratory confirmed cases diagnosed fromDecember 2014 to December 2015. In the analysis, the Mann-Whitney’s U test, p-value ≤0.05, was used for the correlation between variables.Results: There was no statistically significant difference in the time of release of the test resultsin the Centralizing Units and the Units that sent exams for processing. As for the start oftreatment, there was a difference in time between the centralizing units and the coverageunits.Conclusion: The centralization of the processing of the Rapid Molecular Test does not interferewith the time for diagnosis and treatment of tuberculosis, even with the forwarding of samplesbetween services

Shorter delay to treatment by integrated diagnostic services and NGO-provided support among breast cancer patients in two Brazilian referral centres

Background: The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies.Design and Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals.Results: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of &gt;90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p&lt;0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p&lt;0.050).Conclusion: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic- histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow

Physical activity patterns in pregnant women attending the family health program of Campina Grande - PB

INTRODUÇÃO: A atividade física realizada durante a gestação vem sendo discutida devido aos seus efeitos benéficos tanto para a saúde materna como para o crescimento fetal e desfechos gestacionais, porém ainda são escassos estudos sobre o padrão de atividade física neste período. OBJETIVO: Avaliar o padrão de atividade física entre gestantes atendidas pela estratégia Saúde da Família (ESF) do município de Campina Grande/PB. MÉTODOS:Foi acompanhada uma coorte observacional de gestantes (n=118), a partir da 16ª semana gestacional, durante os anos de 2005 a 2006. A cada quatro semanas eram aferidas as condições clínicas, socioeconômicas e obstétricas, incluindo a aplicação de um questionário específico sobre atividade física na 16ª, 24ª e 32ª semanas gestacionais. A avaliação foi feita a partir da somatória do equivalente metabólico (METs) e as atividades cotidianas foram divididas em quatro grupos: atividades laboral, doméstica e caminhada, além de inatividade. As gestantes foram classificadas de acordo com o padrão de atividade física realizado em: sedentárias, praticantes de atividades física leve, moderada e vigorosa. Os dados foram analisados no programa Epi Info 3.4.1. RESULTADOS: As características socioeconômicas da coorte estudada indicaram majoritariamente gestantes de baixo poder aquisitivo, baixa escolaridade e baixo percentual de mulheres economicamente ativas. O padrão de atividade física observado foi baixo desde o primeiro trimestre gestacional, oscilando entre o leve e o sedentário, e foi diminuindo com o evoluir da gravidez, com 100% das gestantes alcançando o padrão sedentário na 32ª semana. Em relação aos grupos de atividades, observou-se um predomínio de atividades domésticas, seguidas pelas atividades de lazer. CONCLUSÃO:Na coorte estudada verificou-se um padrão de atividade física inadequado desde o início da gestação, agravando-se no terceiro trimestre gestacional.INTRODUCTION: The benefits of physical activity during pregnancy on fetal growth, maternal health and pregnancy outcomes have been debated; however, studies on the physical activity patterns during this period are still scarce. OBJECTIVE: To evaluate the physical activity patterns of pregnant women attending the Family Health Strategy at the municipality of Campina Grande, PB. METHODS:A cohort of 118 pregnant women was followed from 2005 to 2006. Follow up started on the 16th gestational week and continued at every four weeks to assess clinical conditions and collect obstetric and socio-economic information. A specific questionnaire on physical activity was applied on the 16th, 24th and 32nd gestational weeks, which was estimated through the weekly sum of the metabolic equivalent (MET). Daily activities were classified in four groups: labor, household, walking, and inactivity. According to the physical activity pattern, women were classified as sedentary, or performing light, moderate or vigorous activity. The data set was analyzed in Epi Info 3.4.1 RESULTS: The socioeconomic characteristics of the cohort described a population of low levels of income and education. The physical activity pattern observed since the first gestational trimester was low, ranging from light to sedentary and it decreased along pregnancy. On the 32nd gestational week 100% of the women were sedentary. Regarding physical activity groups, women spent more time on household activities followed by recreational activities. CONCLUSION:The physical activity pattern observed was inadequate form the beginning of pregnancy and it worsened in the third gestational trimester.CNP