Efetividade da higienização de brinquedos infantis na redução microbiana: revisão sistemática da literatura

Objective: It is to assess the effectiveness of the sanitation of infant toys, when compared to no intervention in the reduction of the microbial load of the toys, in different environments where the care of children exists. Method: It is a systematic review of the literature from 2003 to 2013, held through the bases of data SciELO, LILACS, IBECS, MEDLINE, EMBASE, Scopus, PUBMED and through dissertation and theses banks of USP, UNESP and UNICAMP digital libraries. The obtained data were tabulated and submitted to the analysis of subgroups, which was done descriptively. Results: In total, 7762 researches were raises, which after evaluation of the reviewers, resulted in 12 studies relevant to the theme. Predominant were the comparative researches of the microbial loads before and after the intervention of the sanitation of the toys, and the methods of sanitation were much varied. Conclusion: Several sanitation methods were consideres effective, however the heterogeneity of methods didn´t make possible the identification of the best evidence, showing the need of larger investigation for the elaboration of sanitation strategies of infant toys.Objetivo: Avaliar a efetividade de estratégias de higienização de brinquedos infantis, quando comparadas a nenhuma intervenção na redução da carga microbiana dos brinquedos, em diferentes ambientes onde há o cuidado de crianças. Método: Revisão sistemática da literatura de 2003 a 2013, realizada nas bases de dados SciELO, Lilacs, IBECS, MEDLINE, Embase, Scopus, PubMed e bancos de dissertações e teses das bibliotecas digitais da USP, Unesp e Unicamp. Os dados foram tabulados e submetidos a análise de subgrupos de forma descritiva. Resultados: Foram levantados 7762 trabalhos, que após avaliação dos revisores, resultaram em 12 pesquisas relevantes ao tema. Predominantemente estudos comparativos de cargas microbianas, com grande variabilidade metodológica, trazendo propostas de higienização diversas. Conclusão: Várias estratégias de higienização foram consideradas eficazes, porém a heterogeneidade de métodos não possibilitou a identificação da melhor evidência, mostrando a necessidade de maior investigação do tema para a elaboração de estratégias de higienização de brinquedos infantis

Evaluación del uso de collar cervical de inmovilización después de la descompresión y fusion cervical por acceso anterior: Revisión sistemática

This study aims to evaluate safety and effectiveness of the use of orthesis in postoperative degenerative disorders of the cervical spine. Although widely used, there are not defined criteria for the use of cervical collars, and their importance on cervical arthrodesis. A systematic literature review was undertaken and a multicentre controlled clinical trial comprising 32 specialized services, with a total of 257 patients who met the inclusion criteria of the review. Clinical and radiographic outcomes were compared in post surgical patients that used or not rigid cervical collar during 6 to 12 weeks after surgery. The evidence available on literature, although weak, suggests that cervical collar decreases the clinical scores in first weeks after surgery. Furthermore, it does not alter the rate of fusion when used concomitantly with plaque and screws through anterior access in cervical degenerative diseases on a single anatomical level.Este estudio tiene como objetivo evaluar la eficacia y seguridad de la utilización de ortesis después de la cirugía de trastornos degenerativos de la columna cervical. Aunque ampliamente utilizado, no existen criterios para la aplicación de collares cervicales y su importancia en la artrodesis cervical. Se realizó una revisión sistemática de la literatura y un estudio multicéntrico controlado, compuesto de 32 departamentos, con un total de 257 pacientes que cumplieron los criterios de inclusión de la revisión. Se compararon los resultados clínicos y radiográficos de pacientes, en un solo nivel anatómico, que usaron o no el collar cervical duro durante 6 a 12 semanas después de la cirugía. La evidencia disponible en la literatura, aunque débil, sugiere que el uso del collar cervical reduce las puntuaciones clínicas en las primeras semanas después de la cirugía. Además, no altera la tasa de fusión cuando se utiliza de forma concomitante con la placa y tornillos colocados por acceso anterior en la enfermedad degenerativa cervical en un solo nivel anatómico.Este estudo tem como objetivo avaliar a efetividade e a segurança do uso de órteses no pós-operatório de afecções degenerativas da coluna cervical. Apesar de amplamente utilizados, não existem critérios definidos para a aplicação de colares cervicais e sua relevância na artrodese cervical. Foi realizada uma revisão sistemática da literatura, além de um estudo multicêntrico controlado, composto por 32 serviços, com um total de 257 pacientes que satisfizeram os critérios de inclusão da revisão. Foram comparados desfechos clínicos e radiográficos de pacientes operados em um único nível anatômico que fizeram uso ou não de colar cervical rígido por 6 a 12 semanas após a cirurgia. As evidências disponíveis na literatura, apesar de fracas, sugerem que o uso do colar cervical diminui os escores clínicos nas primeiras semanas após o procedimento cirúrgico. Além disto, não altera a taxa de fusão quando utilizado concomitantemente à placa e aos parafusos por acesso anterior, em doenças degenerativas cervicais em um único nível anatômico.Santa Casa da Misericórdia de SantosUniversidade Estadual PaulistaHospital do Servidor Público Estadual Francisco Morato de OliveiraUniversidade Federal de São Paulo (UNIFESP)UNIFESP, ISS, SantosSciEL

Laronidase for treating mucopolysaccharidosis type I

Mucopolysaccharidoses are a group of inherited metabolic diseases caused by the absence or deficiency of the lysosomal enzymes that are needed for breaking down glycosaminoglycans (GAGs). Over time, GAGs collect in cells, blood and connective tissues, and increased amounts are excreted in the urine. The result is permanent and includes progressive cell damage that affects the individual's appearance, physical abilities, organ and system functioning and, in certain cases, mental development. Enzyme replacement therapies are currently in use or are being tested for at least three different subtypes (I, II and VI). The aim of the present study was to evaluate the effectiveness and safety of laronidase for treating mucopolysaccharidosis type I. A systematic review of the literature was conducted. A computerized electronic search was then conducted using the CENTRAL, Pubmed, EMBASE, and LILACS databases, to identify any randomized controlled trials. The last date of the search was June 2006. There was no possibility of combining the results, because only one study was included. In the pivotal placebo-controlled trial conducted over a 26-week period, there was a reduction in the urinary excretion of GAGs among treated patients. Regarding adverse events, there were no laronidase-related serious adverse events or deaths. Laronidase seems to be a promising agent for treating mucopolysaccharidosis type I, as shown by the reduction in the urinary excretion of GAGs and the associated improvements in vital capacity and in the performance of defined physical tasks.Univ Fed Sao Paulo, Ctr Cochrane Brasil, Sao Paulo, SP, BrazilNYU, Sch Med, Neurogenet Lab, New York, NY USAUniv Fed Sao Paulo, Ctr Cochrane Brasil, Sao Paulo, SP, BrazilWeb of Scienc

Interventions to promote the wearing of hearing protection

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2006 and previously updated in 2009.Noise-induced hearing loss can be prevented by eliminating or lowering noise exposure levels. Where the source of the noise cannot be eliminated, workers have to rely on hearing protection equipment. Several trials have been conducted to study the effectiveness of interventions to influence the wearing of hearing protection. To evaluate the effectiveness of interventions to enhance the wearing of hearing protection among persons regularly exposed to high noise levels. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 April 2011. We included studies if they had a randomised design, if they were among noise exposed (> 80 dB(A)) persons, if they included an intervention to promote the wearing of hearing protection (compared to another intervention or no intervention), and if the outcome measured was the amount of use of hearing protection or a proxy measure thereof. Two authors selected relevant trials, assessed risk of bias and extracted data. Seven studies, involving 4670 participants, were included.A computer-based intervention lasting 30 minutes, tailored to the risk of an individual worker, was not found to be more effective than a video providing general information among workers, around 80% of whom already used hearing protection.A four-year school-based hearing loss prevention programme found that the intervention group was twice as likely to wear some kind of hearing protection as the control group that received a baseline hearing test and two additional tests at years two and three.We conducted two meta-analyses for the comparisons 'tailored strategy (the use of communication or other types of interventions that are specific to an individual or a group and aim to change behaviour) versus non-tailored strategy' and 'tailored strategy versus a commercial video on the use of hearing protection' to look at mean percentage use of hearing protective devices (HPDs), that showed improvement in the mean use of HPDs for the tailored group. A meta-analysis of the comparison 'mixed interventions' (classroom instruction, distribution of HPDs, mailings, noise level assessments and audiometric testing) versus control (audiometric testing alone) also showed improvement in self reported use of HPDs when shooting firearms.Tailored education showed an improvement in HPD use of 8.3% versus targeted education (6.1%). The evidence found in this review shows that some interventions improve the mean use of hearing protection devices compared to non-intervention. Future trials should have standard outcomes and interventions to allow the combining of results in meta-analysis.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES