Nutritional Status, Breastfeeding, and Evolution of Infants with Acute Viral Bronchiolitis

Acute viral bronchiolitis is a common respiratory infectious disease of infancy. A prospective study was carried out with 175 infants aged up to six months to evaluate their nutritional and breastfeeding status as possible risk factors for unfavourable evolution of previously-healthy infants from a care hospital. Immunofluorescence test for virus and anthropometric assessment were performed. Outcomes were length of oxygen-use, length of hospital stay, and type of hospital unit needed. Seventy-three percent of the infants were well-nourished, 6% undernourished, 8.6% at a nutritional risk, 10.9% overweight, and 1.7% obese. Eighty-one percent of the undernourished and nutritionally at-risk infants and 72% of the well-nourished, overweight, and obese infants did not receive exclusive breastfeeding. The median length of hospital stay was four days and of oxygen-use was 60 hours. The nutritional status did not affect the clinical course of previously-healthy infants with acute viral brochiolitis. The duration of exclusive breastfeeding, but not type of breastfeeding, was inversely related to the length of oxygen-use and the length of hospital stay. Shorter exclusive breastfeeding was observed in infants who were assigned to a paediatric ward or to an intensive care unit. In conclusion, longer duration of breastfeeding was associated with better clinical outcomes

Translation of the Multiple Sclerosis Quality of Life-54 : Brazilian version

Objective: This study translated the Portuguese version of the Multiple Sclerosis Quality of Life-54 (MSQoL-54) questionnaire. Methods: The original version of 18 items from the MSQoL-54 was translated into Brazilian Portuguese using international guidelines. Two independent translations were completed by Brazilians fluent in English and the results were evaluated and harmonized, concluding version: 1. This version was back-translated by an American living in Brazil and then another analysis was conducted, resulting in version 2. Concluding the translation and harmonization phase, the final version was pre-tested with ten participants from the Reference Centre for Multiple Sclerosis at the Porto Alegre Clinical Hospital in Rio Grande do Sul (RS)-Brazil. Results: The questionnaire was well accepted by the patient’s sample that tested the 18 specific items. They presented no conceptual problems. Conclusion: Patients with multiple sclerosis (MS) felt the questionnaire was easy to understand. We thus attained terms of conceptual equivalence between the original questionnaire and the translation

Interferon-lambda 3 and 4 polymorphisms increase sustained virological responses and regulate innate immunity in antiviral therapy with pegylated interferon-alpha

Sustained virologic response (SVR) in chronic hepatitis C (CHC) treatment denotes that the host genetics controls the immune response and unequivocally contribute to viral clearance or disease severity. In this context, single nucleotide polymorphisms (SNPs) in the locus of interferon lambda 3 and 4 genes (IFNL3/4) have been important genetic markers of responsiveness to CHC as prognostic markers for the pegylated-Interferonalpha/ ribavirin (Peg-IFN-a/RBV). Here, we analyzed 12 SNPs at the IFNL3/4 region in 740 treatment-naïve patients with CHC infected with hepatitis C virus (HCV) genotypes 1, 2, or 3 treated with Peg-IFN-a/RBV. Individually, rs12979860-CC, rs8109886-CC, or rs8099917-TT were predictive markers of SVR, while rs12979860-CC demonstrated the stronger effect. Besides, the genotypic combination of these three predictors’ genotypes, CC/CC/TT, increased the rate of SVR. Serum levels of cytokines and gene expression analysis on the genes IFNL3, IFNL4, IFNA1, and some of the IFN-stimulated genes (ISGs) were measured in a subgroup of 24 treated patients and 24 healthy volunteers. An antagonist effect was highlighted between the expression of IFNL3/4 and IFNA1 mRNA among patients. Besides, a prominent production of the proinflammatory chemokines CCL4 and CXCL10 was observed at a 12-week treatment follow-up. Lower serum levels of these chemokines were detected in patients with an rs12979860-CC genotype associated with the better treatment outcome. Also, lower expression levels of the IFI6, IFI16, IRF9 genes were observed among rs12979860-CC individuals. In conclusion, a combination of the genotypes at the IFNL3/4 locus can act as a better marker for the prognosis for virological responses in an admixed Brazilian population presenting the modulating effect over innate immunity and inflammation that are controlling the outcome of the viral infection, but also other infectious diseases

Tratamento medicamentoso do infarto agudo do miocárdio no Hospital de Clínicas de Porto Alegre

OBJECTIVE: To determine the prescription rates of thrombolytics, aspirin, betaadrenergic antagonists and angiotensin-converting-enzyme inhibitors during the acutephase of the infarction, and to determine the prescription rates of aspirin, betaadrenergic antagonists, and angiotensin-converting-enzyme inhibitors for secondaryprophylaxis.MATERIALS AND METHODS: The prescription rates were determined by reviewing the medical records of all patients whose diagnosis of acute myocardial infarctionwas made at Hospital de Clínicas de Porto Alegre from January 1996 to February 1997.RESULTS: We identified 100 patients, with a mean age of 63 ± 13 years, 58% men and 89% white. The drug prescription rates in the acute phase were: 41% forthrombolytics, 97% for aspirin, 81% for beta-adrenergic antagonists and 38% for angiotensin-converting-enzyme inhibitors. The secondary prophylaxis prescriptionrates were: 71% for aspirin, 68% for beta-adrenergic antagonists and 45% for angiotensin-converting-enzyme inhibitors.CONCLUSION: The prescripition rates forthe drugs listed above are still bellow the ideal ranges, although they are comparable to the rates reported in the medicalliterature.OBJETIVO: Determinar a taxa de prescrição de trombolíticos, aspirina, betabloqueadores e inibidores da enzima conversora da angiotensina na fase aguda doinfarto e, no caso dos três últimos fármacos citados, na profilaxia secundária do infarto agudo do miocárdio.MATERIAIS E MÉTODOS: As taxas de prescrição foram determinadas mediante revisão de prontuários de todos os pacientes que estiveram internados com odiagnóstico de infarto agudo do miocárdio no Hospital de Clínicas de Porto Alegre entre janeiro de 1996 e fevereiro de 1997.RESULTADOS: Foram identificados 100 pacientes, com uma idade média de 63 ± 13 anos, 58% homens e 89% brancos. As taxas de prescrição dos fármacos nafase aguda foram: 41% para trombolíticos, 97% para aspirina, 81% para betabloqueadores e 38% para inibidores da enzima conversora. As taxas de prescriçãona profilaxia secundária foram: 71% para aspirina, 68% para beta-bloqueadores e 45% para inibidores da enzima conversora.CONCLUSÃO: As taxas de prescrição dos fármacos acima citados ainda encontramse abaixo dos valores ideais, apesar de serem comparáveis às taxas relatadas na literatura

A population-based study of tuberculosis incidence among rheumatic disease patients under anti-tnf treatment

Introduction Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. The advent of immunobiologic therapy with TNF inhibitors agents, has been associated with a significant increase in incident cases of tuberculosis in this population. Objective To estimate the incidence of tuberculosis in patients receiving TNF inhibitors therapy for rheumatic diseases. As secondary objectives, we sought to evaluate mortality and the clinical impact of screening for latent tuberculosis infection. Methods This retrospective study included patients with rheumatic diseases of Public Health System from the Brazilian state, a high TB incidence area, who received prescriptions of TNF inhibitors agents between 2006 and 2016. Results A total of 5853 rheumatic disease patients were included. Patients were predominantly women (68.7%) aged 49.5 (± 14.7) years old. Forty-three cases of TB were found (2.86 cases per 1000 person-years; 18 times higher than in the general population). Adalimumab and certolizumab users presented a higher risk for TB development compared to etanercept users (RR: 3.11, 95%CI 1.16–8.35; 7.47, 95%CI 1.39–40.0, respectively). In a subgroup of patients, screening for latent tuberculosis infection was performed in 86% of patients, and 30.2% had a positive tuberculin skin test. Despite latent TB treatment, TB was diagnosed in 2 out of 74 (2.7%) patients. Overall, TB diagnosis did not increase mortality. Conclusion In this population-based study of rheumatic disease patients from a high incident area, TNF inhibitor exposure was associated with an 18-time increased TB incidence. Adalimumab and certolizumab were associated with greater and earlier TB diagnosis compared to etanercept

Kingdon’s multiple stream model used to analyze health policies : applicability, contribution and limits

O presente trabalho teve como objetivos identifcar as produções científcas sobre análise de políticas de saúde que utilizaram o modelo dos múltiplos fuxos de Kingdon e examinar as contribuições e os limites do modelo no estudo das políticas públicas de saúde, no contexto do SUS. Realizou-se uma revisão integrativa de publicações disponíveis nas bases de dados ProQuest, Portal de Periódicos e Banco de Teses e Dissertações da Capes e Scientifc Elec- tronic Library Online, com uso das palavras-chave Kingdon Model, multiple streams model (modelo dos múltiplos fuxos) e políticas públicas de saúde. Os critérios de inclusão foram: estudos completos em português e inglês, disponíveis on-line nas bases de dados; e análises de políticas públicas de saúde com uso do modelo Kingdon em experiências nacio- nais ou internacionais. Foram excluídos estudos de revisão e relatos de experiência. Foram levantados 4 teses de doutorado, 6 artigos e 2 dissertações de mestrado, publicados entre 1994 a 2009. O modelo de Kingdon mostrou-se aplicável a análises de políticas de saúde em diferentes sistemas políticos nacional e internacional, em períodos prolongados de tempo e na atuação dos governos. As contribuições desse modelo de análise para o SUS incluem: a) a incorpo- ração da ambiguidade nas decisões; b) a valorização da consistência das ideias contidas nas propostas; c) a análise das diferentes interpretações sobre os problemas complexos da saúde brasileira pelos tomadores de decisão. Dentre os limites, aponte-se a ênfase na atuação dos atores em detrimento do marco institucional que delimita suas decisões.This study aimed to identify the scientifc produc- tion on health policy analysis that use Kingdon’s model of multiple streams, and to examine the model’s contributions and limits in the study of public health policies, in the SUS context. An inte- grative review of publications using the keywords Model Kingdon, multiple streams model “modelo de múltiplos fuxos” and health public policy was made at the following databases: ProQuest, Portal de Periódicos and Banco de Teses e Dissertações (from CAPES) and Scientific Electronic Library Online. Inclusion criteria were: complete studies in Portuguese and English, available online in the databases; analysis of public health policies using the Kingdon model in national or international ex- periences. Review studies and experience reports were excluded. We identifed 4 doctoral thesis, 6 articles and 2 master dissertations published from 1994 to 2009. The Kingdon’s model proved to be ap- plicable for analysis of health policies in different national and international political systems, in long periods of time and in the practice of governments. The contributions of this model for SUS analysis include: a – the incorporation of ambiguity in the decisions; b –appreciation of the consistency of the ideas contained in the proposals; c – an analysis of di- fferent interpretations of decision makers about the complex problems of Brazilian health. Concerning its limits, we point out its emphasis in the action of actors at the expense of the institutional framework that delineates their decisions

Nutritional Status, Breastfeeding, and Evolution of Infants with Acute Viral Bronchiolitis

Acute viral bronchiolitis is a common respiratory infectious disease of infancy. A prospective study was carried out with 175 infants aged up to six months to evaluate their nutritional and breastfeeding status as possible risk factors for unfavourable evolution of previously-healthy infants from a care hospital. Immunofluorescence test for virus and anthropometric assessment were performed. Outcomes were length of oxygen-use, length of hospital stay, and type of hospital unit needed. Seventy-three percent of the infants were well-nourished, 6% undernourished, 8.6% at a nutritional risk, 10.9% overweight, and 1.7% obese. Eighty-one percent of the undernourished and nutritionally at-risk infants and 72% of the well-nourished, overweight, and obese infants did not receive exclusive breastfeeding. The median length of hospital stay was four days and of oxygen-use was 60 hours. The nutritional status did not affect the clinical course of previously-healthy infants with acute viral brochiolitis. The duration of exclusive breastfeeding, but not type of breastfeeding, was inversely related to the length of oxygen-use and the length of hospital stay. Shorter exclusive breastfeeding was observed in infants who were assigned to a paediatric ward or to an intensive care unit. In conclusion, longer duration of breastfeeding was associated with better clinical outcomes

Absortância solar e desempenho térmico de tintas frias para uso no envelope construtivo

Materials with low absorptance and high emittance are known as cool materials. When used on the building envelope these materials decrease building surface temperatures, reducing energy demand in conditioned buildings and making more comfortable non conditioned buildings. In this work, cool and standard paints for exterior walls and roofs were comparatively evaluated through their absorptance and emittance properties, as well as the thermal performance evaluation with surface temperature measurements. Cool paints were selected from available products in the Brazilian and international market, as well as standard paints with the same color, totaling 15 samples. Results indicated that cool paints with low near-infrared absorption, but with the same color of standard ones have lower solar absorptance. Surface temperature measurements for samples exposed to the sun confirmed that coatings solar absorptance directly affects the thermal performance of painted surfaces, which corroborates that as lower is the surface solar absorptance, lower is the building envelope temperature. It was observed that the potential to use cool paints on buildings results from the decrease in the near-infrared solar absorptance, with the possibility to use paints with darker colors, but with better thermal performance when compared with standard paints with the same color.Materiais que apresentam baixas absortâncias e altas emissividades são conhecidos como materiais refletivos ou frios. Esses materiais, quando usados como revestimento no envelope construtivo permitem a redução de temperaturas superficiais nos edifícios, minimizando a necessidade de energia para refrigeração em edificações artificialmente condicionadas e tornando mais confortáveis edificações não condicionadas. Neste trabalho, tintas frias e convencionais para pintura externa de paredes e coberturas são avaliadas comparativamente através da caracterização de suas absortâncias e emissividades, assim como o desempenho térmico das mesmas a partir de medições de temperaturas superficiais. Foram selecionadas tintas frias para pintura de paredes e coberturas a partir de produtos disponíveis no mercado nacional e internacional, assim como tintas convencionais de cores correspondentes, totalizando 15 amostras. Os resultados indicaram que tintas frias com baixa absorção no infravermelho-próximo, porém de cor e tonalidade iguais às tintas convencionais, resultam em tintas com menores absortâncias solares. As temperaturas superficiais das amostras expostas ao sol evidenciaram que a absortância solar das tintas afeta diretamente o desempenho térmico das superfícies pintadas, comprovando que quanto mais baixa é a absortância solar da superfície, menor a temperatura do envelope construtivo. Observou-se que o grande potencial de uso das tintas frias em edificações é resultado da diminuição da absortância solar na região do infravermelho, com a possibilidade de se utilizar cores de tonalidade mais escura, porém com melhor desempenho térmico quando comparadas com tintas convencionais de cor e tonalidade semelhante

Los ayuntamientos y la promoción de la accesibilidad arquitetónica

Background: Architectural barriers have a significant impact on the daily activities of people with reduced mobility. Objectives: To understand the weaknesses and/or opportunities in the responses of local authorities to eliminate the architectural barriers for people with reduced mobility in their social and residential context. Methodology: A descriptive, exploratory study was conducted with a sample of 21 parish council presidents from two municipalities using an accidental non-probabilistic sampling method. Results: In this sample, 76.2% of parish council presidents do not know how many people with disabilities live in their parish. The elimination of architectural barriers focused on accessible sidewalks and pedestrian routes (80%), pedestrian crossings (75%), access to public parks and gardens (70%), and access to cemeteries and markets (70%). Other equipment, even educational ones, represent less than 50%. Conclusion: Some public spaces still have architectural barriers. There is little cooperation between health professionals and society to promote accessibility.Enquadramento: As barreiras arquitetónicas assumem um peso importante na prossecução das atividades de vida diária para pessoas com mobilidade condicionada. Objetivos: Compreender as fragilidades e/ou potencialidades das respostas das autarquias locais para abolir barreiras arquitetónicas para pessoas com mobilidade condicionada quando inseridas no seu contexto social e habitacional. Metodologia: Estudo descritivo, exploratório, com uma amostra de 21 presidentes de junta de dois municípios, a partir de uma amostragem não probabilística acidental. Resultados: Da amostra, 76,2% presidentes de junta não sabem quantas pessoas com deficiência vivem na sua freguesia. A eliminação de barreiras arquitetónicas incidiu sobre passeios e percursos pedonais acessíveis (80%), passadeiras (75%), acesso a parques e jardins públicos (70%) e a cemitérios e mercado (70%). Os restantes equipamentos, mesmo os educacionais, têm representações abaixo de 50%. Conclusão: Subsistem espaços de uso público com barreiras arquitetónicas. Existe pouca articulação entre profissionais de saúde e a sociedade para a promoção da acessibilidade.Marco contextual: Las barreras arquitectónicas asumen un peso importante en la realización de las actividades de la vida diaria de las personas con movilidad reducida. Objetivos: Comprender las fragilidades y/o potencialidades de las respuestas de los ayuntamientos locales para abolir barreras arquitectónicas para personas con movilidad condicionada cuando se encuentran en su contexto social y habitacional. Metodología: Estudio descriptivo, exploratorio, con una muestra de 21 presidentes de junta de dos municipios, a partir de un muestreo no probabilístico accidental. Resultados: De la muestra, el 76,2% de los presidentes de junta no sabe cuántas personas con discapacidad viven en su barrio. La eliminación de barreras arquitectónicas incidió sobre paseos y zonas peatonales accesibles (80%), pasos de peatones (75%), acceso a parques y jardines públicos (70%) y a cementerios y mercados (70%). Los restantes equipamientos, incluso los educacionales, tienen representaciones por debajo del 50%. Conclusión: Subsisten espacios de uso público con barreras arquitectónicas. Hay poca articulación entre los profesionales de la salud y la sociedad para promover la accesibilidad.info:eu-repo/semantics/publishedVersio