Meanings and practices of oral health: a qualitative study with mothers of disabled children

The aim of this study was to understand the meanings and oral health practices of ten mothers of disabled children between the ages of zero and three years. The qualitative method was used. The data was collected by means of a semi-structured interview and were recorded, transcribed and analysed using the Thematic Content Analysis. Regarding to the oral health care of the mothers, three reported difficult and traumatising experiences and three did not have much contact with dentists during their childhood. Regarding to the children, the age of their first visit to the dentist varied from three months to two years and six months, and the reason for this appointment for seven children was referral by their doctor or by the Association of Parents and Friends of the Exceptional. Seven mothers reported that they brushed the teeth of their children at least twice a day and only two cited the importance of regular dental appointments. For two mothers, the meaning of oral health was to have a perfect smile and for four others, maintain oral hygiene. Half of the mothers related oral health to general health. All reported that dental caries is related to diet and lack of care regarding to oral hygiene. It was possible to conclude that for this group of mothers, oral health has an important meaning and that oral health practices are based on a healthy diet and brushing. Although mothers of disabled children have presented positive attitudes, in general, the results indicated limited knowledge about oral health. The results showed the importance of considering the point of view of the mothers as data of analysis bringing greater proximity with the reality studied. More qualitative studies should be conducted in order to collaborate with the improvement of the oral condition of disabled children

O movimento pela humanização do parto e nascimento no Brasil: o impacto em Uberlândia segundo a percepção dos enfermeiros / The movement for humanization of birth and birth in Brazil: the impact in Uberlândia according to the perception of nurses

Introdução: O parto é um processo fisiológico natural e na maior parte dos casos não há necessidade de intervenções, exceto nos casos de gravidez de risco. No entando, apesar de a maioria das gestações evoluir naturalmente e sem ricos para a parturiente e a criança, observa-se um numero crescente de intervenções inapropriadas e desnecessárias. Neste sentido o Ministério da Saúde, visando melhorar a qualidade da assistência obstétrica e neonatal, instituiu o Programa de Humanização do Pré-natal e Nascimento (PHPN). Objetivo: Demonstrar a percepção dos Enfermeiros que atuam na rede de saúde do município sobre o impacto do Movimento pela Humanização do Parto e Nascimento em Uberlândia-MG. Metodologia: Trata-se de um estudo observacional, descritivo, de abordagem quali-quantitativa, no qual foram entrevistados 56 Enfermeiros que atuam na rede pública (38) e privada (18) de Uberlândia-MG, com base em um questionário. Ao discurso dos entrevistados foi aplicada a técnica de análise de conteúdo de Bardin (2009). Resultados: Dos 56 entrevistados 44 (78,6%) eram do sexo feminino e 12 (21,4%) do sexo masculino, a média de idade foi de 34,5 anos, com tempo de formação e de atuação de 5 anos. Todos os entrevistados afirmaram conhecer o PHPN, suas instituições incentivam o parto normal (53,5%), há planejamento individual/antecipado sobre onde e por quem o parto será assistido (67,8%), há avaliação de risco no pré-natal/ reavaliação a cada contato/no momento do parto (85,8%). As mulheres tem direito de escolha do local do parto as vezes (57,14%) ou nunca (28,7%); privacidade no local do parto sempre (41%), as vezes(59%); utiliza o partograma sempre (27%), nunca(73%); usa métodos não farmacológicos de alívio da dor sempre (63%), nunca (37%); estimulo a deambulação (27,2%); escolha da posição não supina as vezes (27,2%) nunca (72,8%); estimula o contato pele a pele (100%); amamentação na primeira hora (90%); permite acompanhante durante todo o processo (45,5%). Dos 18 enfermeiros de instituições que prestam assistência ao parto 14(78%) relataram que o enfermeiro obstetra não tem autonomia para assistir o parto. A análise qualitativa dos dados revelaram que os entrevistados demonstraram compreensão adequada da proposta de Ações que Poderiam Melhorar o Modelo Atual de Assistência ao Pré-Natal e Nascimento, evidenciadas em falas como: “Maior comprometimento dos profissionais e dos gestores no cumprimento da legislação vigente Assistência diferenciada, saber ouvir a parturiente reconhecendo suas necessidades emocionais e psicológicas em todo o processo”. Contudo, na percepção deles, até o momento não houve impacto no referido município em decorrência do movimento pela humanização do parto e nascimento, principalmente por resistência dos próprios profissionais, comodismo, falta de capacitação e apoio institucional. Conclusão: Os resultados demonstram que na visão dos enfermeiros não houve impacto na assistência decorrente do PHPN. Evidencia-se que há um longo caminho a percorrer para que as diretrizes e recomendações do programa de humanização do parto e nascimento sejam adotadas pelos profissionais de saúde como parte integrante no processo de trabalho em rede, incluindo a atenção primária e hospitalar

Serious acute respiratory syndrome: a case series in a municipality region of central Brazil

The influenza B virus is more stable than influenza A, with less antigenic drift and consequent immunologic stability, and does not undergo the process of antigenic shift, its participation in epidemics is minimal, being of lesser academic interest. The aim of this work was to describe the occurrence of a series of SARS cases in a municipality in the Central region of Brazil. This is a case series study with a descriptive and quantitative approach of Serious Acute Respiratory Syndrome (SARS) in institutionalized individuals and a health professional from a long-term institution in the municipality where the study was conducted. The variables studied were: age, comorbidities, vaccination status, date of symptoms onset, symptoms, occurrence of death, information regarding provided care (hospital care, exams, and medications). The study was approved by the Research Ethics Committee of the Federal University of Goiás (UFG), under opinion number 2.167.287. Case 1 was diagnosed with influenza B, treated with antibiotic therapy, with no antiviral drugs administered, and culminated in death. Cases 2 and 3 were confirmed as influenza B, being treated with antiviral drugs and discharged due to full recovery. Case 4 was confirmed as influenza B virus by epidemiological link, treated with antiviral drugs and discharged due to full recovery. An early diagnosis, adequate clinical management, transmissible disease research based on the 11 health promotion steps and actions can promote the reduction of morbimortality by influenza type B

Severe cardiac insufficiency secondary to cardiotoxicity with clinical and morpho-functional improvement after optimised clinical treatment: case report

Many therapies used for cancer (pathology whose cases are progressively increasing in the world) such as chemotherapy and radiotherapy have numerous adverse effects, with cardiotoxicity being one of the most important. This can be defined from the detection, by an imaging method, of a reduction of at least 10% in the left ventricular ejection fraction (LVEF), bringing it to a value below 53%. Anthracyclines (such as Doxorubicin), Trastuzumab, and Taxanes (Docetaxel) are among the most associated chemotherapeutics. To emphasize the importance of optimized treatment for heart failure and to review the main updates on the theme of cardiotoxicity. Case report and bibliographic review on the latest updates to the management of cardiotoxicity and associated heart failure. When correctly identifying the main risk factors associated with chemotherapy and the individual to develop myocardial injury, it is possible to perform the monitoring by means of two main predictors: the myocardial tension strength and the biomarkers. In this sense, changes associated with these predictors may allow early intervention through appropriate treatment and, with the advancement of research, even prevention, mainly using the association of Carvedilol with Enalapril. Continuous monitoring and early initiation of drug therapy for heart failure are clearly associated with a lower degree of myocardial injury and a lower rate of complications. In addition, there is still an increasingly promising possibility in relation to preventive drug therapy, however, there is still a lack of studies on this topic

Mudança nos hábitos de vida e cotidiano de pacientes após cirurgia cardíaca em um ambulatório multiprofissional de cirurgia cardíaca / Change in the daily and life habits of patients after cardiac surgery in a multiprofessional cardiac surgery outpatient clinic

As Doenças Cardiovasculares (DCVs) são as principais causas de morbimortalidade e o tratamento muitas vezes são intervenções cirúrgicas. Para prevenir ou reabilitar, é preciso de mudança nas atividades diárias e seus hábitos. Objetivos: identificar o perfil, principais cirurgias e analisar as atividades diárias e laborais dos pacientes antes e após cirurgia. Método: Trata-se de um estudo retrospectivo, transversal. Foi realizada no Hospital de Clínicas de Uberlândia (HCU) e a população alvo foram pacientes que se submeteram a qualquer tipo de cirurgia cardíaca no ano de 2016. Resultados: Analisados 46 prontuários, observou à prevalência do sexo masculino (76%) e a idade média foi 62 anos. Dentre eles prevaleceu Hipertensão Arterial Sistêmica, dislipidemia e diabetes como comorbidades. Das cirurgias cardíacas (67%) foram de revascularização do miocárdio. Observamos que muitos dos hábitos de vida mudaram após o procedimento cirúrgico, mas uma parcela expressiva de paciente não muda seus hábitos de vida que estão diretamente associados às comorbidades. E muitos desses hábitos estão associados à piora dos resultados dos procedimentos e da condição de vida. Hábitos como fumar, beber e se alimentar inadequadamente permanecem mesmo após um procedimento invasivo e de risco. Sendo que se mostra essencial entender o porquê dessa ausência de mudanças em alguns dos pacientes e como o atendimento multiprofissional pode auxiliar nesse processo

A 46,XX testicular disorder of sex development caused by a Wilms’ tumour Factorâ 1 (WT1) pathogenic variant

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146930/1/cge13459_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146930/2/cge13459.pd

The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients

Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systemsand 7.3% from private (out-of-pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.Univ Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilHosp Caridade Sao Vicente Paulo, Jundiai, SP, BrazilInst Med Integral Prof Fernando Figueira IMIP, Recife, PE, BrazilHosp Base FUNFARME & FAMERP, Sao Jose Do Rio Preto, SP, BrazilIMC, Sao Jose Do Rio Preto, SP, BrazilIrmandade Santa Casa Sao Paulo INCT HPV, Fac Ciencias Med Santa Casa Sao Paulo, Sao Paulo, SP, BrazilFundacao Univ Cardiol, Inst Cardiol Rio Grande do Sul, Porto Alegre, RS, BrazilInst Coracao Natal, Natal, RN, BrazilInst Cardiol Dist Fed, Brasilia, DF, BrazilUniv Fed Maranhao HU UFMA, Univ Hosp, Sao Luis, MA, BrazilHosp Evangelico, Cachoeiro De Itapemirim, ES, BrazilHosp Coracao Sergipe, Aracaju, SE, BrazilHosp Nossa Senhora Salete, Inst Cirurgia Cardiovasc ICCV, Cascavel, PR, BrazilHosp Wilson Rosado, Mossoro, RN, BrazilHosp Bosque Saude, Sao Paulo, SP, BrazilHosp Univ Santa Maria, Santa Maria, RS, BrazilHosp Coracao HCor, Sao Paulo, SP, BrazilHosp Coracao IP HCor, Ins Pesquisa, Sao Paulo, SP, BrazilInst Coracao InCor, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilWeb of Scienc

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome