Avaliação de testes diagnósticos na rotura prematura de membranas.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Tocoginecologia, Curso de Medicina, Florianópolis, 199

Validação de uma escala de ansiedade para procedimentos diagnósticos prénatais

OBJECTIVE: To perform a cross-cultural adaptation of the Prenatal Diagnostic Procedures Anxiety Scale questionnaire for application in the Brazilian cultural context. METHODS: The translation and back translation processes followed internationally accepted criteria. A committee of experts evaluated the semantic, idiomatic, experimental and conceptual equivalence, proposing a pre-final version that was applied in 10.0% of the final sample. Afterwards, the final version was approved for the psychometric analysis. At that stage, 55 pregnant women participated which responded to the proposed Brazilian version before taking an ultrasound examination at a public hospital in Santa Catarina, in the year of 2017. The Edinburgh Postnatal Depression Scale was used as an external reliability parameter. The internal consistency of the instrument was obtained by Cronbach’s alpha. Validation was performed by exploratory factorial analysis with extraction of principal components by the Kaiser-Guttman method and Varimax rotation. RESULTS: The Cronbach’s alpha value of the total instrument was 0.886, and only the percentage of variance from item 2 (0.183) was not significant. The Kaiser-Guttman criterion defined three factors responsible for explaining 78.5% of the variance, as well as the Scree plot. Extraction of the main components by the Varimax method presented values from 0.713 to 0.926, with only item 2 being allocated in the third component. CONCLUSIONS: The Brazilian version is reliable and valid for use in the diagnosis of anxiety related to the performance of ultrasound procedures in prenatal care. Due to the lack of correlation with the rest of the construct, it is suggested that item 2 be removed from the final version.OBJETIVO: Proceder à adaptação transcultural do questionário Prenatal Diagnostic Procedures Anxiety Scale para aplicação no contexto cultural brasileiro. MÉTODOS: Os processos de tradução e retrotradução seguiram critérios aceitos internacionalmente. Um comitê de especialistas avaliou as equivalências semântica, idiomática, experimental e conceitual, propondo uma versão pré-final que foi aplicada em 10,0% da amostra final. Em seguida, foi aprovada a versão final para a análise psicométrica. Nessa etapa participaram 55 gestantes que responderam à versão brasileira proposta antes de realizarem um exame ultrassonográfico em um hospital público de Santa Catarina, no ano de 2017. A Edinburgh Postnatal Depression Scale foi utilizada como parâmetro de confiabilidade externa. A consistência interna do instrumento foi obtida pelo alfa de Cronbach. A validação foi realizada por análise fatorial exploratória com extração de componentes principais pelo método de Kaiser-Guttman e rotação Varimax. RESULTADOS: O alfa de Cronbach do instrumento total foi 0,886, e apenas o percentual de variância do item 2 (0,183) não foi significativo. O critério de Kaiser-Guttman definiu três fatores responsáveis por explicar 78,5% da variância, assim como o gráfico de Escarpa. A extração dos componentes principais pelo método Varimax apresentou valores de 0,713 a 0,926, sendo apenas o item 2 alocado no terceiro componente. CONCLUSÕES: A versão brasileira é confiável e válida para uso no diagnóstico de ansiedade relacionada à realização de procedimentos ultrassonográficos no pré-natal. Devido à falta de correlação com o restante do construto, sugere-se a retirada do item 2 da versão final

A utilização do mbt para levantamento das dificuldades conceituais em mecânica apresentada por alunos de graduação do CEUNES / The use of mbt to survey the conceptual difficulties in mechanics presented by undergraduate students of CEUNES

A forma de ensinar e avaliar física pouco se alterou nos últimos anos; ainda se dá ênfase à resolução mecanizada de problemas de Física básica, em vez de uma discussão conceitual mais profunda dos conceitos físicos. Uma consequência direta disto é que, na maioria das vezes, os alunos permanecem com concepções espontâneas e pré-conceitos errôneos trazidos do ensino médio e de sua própria experiência pessoal. Este trabalho foi realizado com a intenção de identificar as dificuldades conceituais em alguns tópicos da mecânica Newtoniana, em alunos ingressantes e do segundo período dos cursos de licenciatura, engenharia, ciências biológicas e ciência da computação do CEUNES/UFES. O intuito é caracterizar o grau de entendimento conceitual dos alunos e obter informações que evidenciem as dificuldades conceituais enfrentadas por eles. Foi usado o teste conceitual Mechanics Baseline Test como método de avaliação. Os resultados demonstram que todos os participantes apresentam dificuldades conceituais em vários tópicos da mecânica Newtoniana, tais como: velocidade, aceleração, força, conservação da energia e do momento linear, além de grandes dificuldades de se analisar gráficos e diagramas. Existem fortes indícios de que tais dificuldades estão relacionadas com as concepções espontâneas adquiridas cotidianamente e que persistem mesmo após o curso de física introdutória de mecânica na universidade. Além disso, verificamos que tais concepções  espontâneas podem ser investigadas através da utilização dos testes conceituais, tais como o Mechanics Baseline Test, e os resultados podem ser importantes na implementação de ações mitigadoras no ensino de física, uma vez que o professor poderá verificar em quais tópicos seus alunos apresentam maior dificuldade conceitual

Prevalence and Associated Factors of Dental Trauma in Six-Year-Old School-Children

Objective: To estimate the prevalence and associated factors of dental trauma in 6-year-old school children in the city of Palhoça, Brazil. Material and Methods: Cross-sectional study nested in a cohort study. It involved a representative sample of school children born in 2009, residing in the municipality and regularly enrolled in public and private schools (n = 1,102). Clinical data were obtained through oral exams. To evaluate the incisal overjet, the distance in millimeters was measured horizontally from the labial surface of the lower central incisor to the labial surface of the upper incisor. Bivariate analyses were performed using the Chi-square test, with a p-value <0.05 considered statistically significant. Multivariate analyses using Poisson Regression were performed to identify independent associations between the prevalence and the independent variables studied. Results: Prevalence of dental trauma was 4.2% (95% CI 3.0-5.4). Dental trauma was statistically associated with studying in a private school (PR = 1.03; 95% CI 1.01-1.06) (p=0.016) and with inadequate lip coverage (PR = 1.08; 95% CI 1.01-1.14) (p=0.016). Conclusion: The prevalence of 4.2% of dental trauma in six-year-old children, associated with inadequate and greater lip coverage in children from private schools should be taken into account, since most teeth at this stage are newly erupted

Prevalence and Associated Factors of Dental Trauma in Six-Year-Old School-Children

Objective: To estimate the prevalence and associated factors of dental trauma in 6-year-old school children in the city of Palhoça, Brazil. Material and Methods: Cross-sectional study nested in a cohort study. It involved a representative sample of school children born in 2009, residing in the municipality and regularly enrolled in public and private schools (n = 1,102). Clinical data were obtained through oral exams. To evaluate the incisal overjet, the distance in millimeters was measured horizontally from the labial surface of the lower central incisor to the labial surface of the upper incisor. Bivariate analyses were performed using the Chi-square test, with a p-value <0.05 considered statistically significant. Multivariate analyses using Poisson Regression were performed to identify independent associations between the prevalence and the independent variables studied. Results: Prevalence of dental trauma was 4.2% (95% CI 3.0-5.4). Dental trauma was statistically associated with studying in a private school (PR = 1.03; 95% CI 1.01-1.06) (p=0.016) and with inadequate lip coverage (PR = 1.08; 95% CI 1.01-1.14) (p=0.016). Conclusion: The prevalence of 4.2% of dental trauma in six-year-old children, associated with inadequate and greater lip coverage in children from private schools should be taken into account, since most teeth at this stage are newly erupted

Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Quality of Prenatal Care Questionnaire (QPCQ)

OBJECTIVE: To translate and to observe the psychometric measures of the Brazilian version of the Quality of Prenatal Care Questionnaire. METHODS: The translation protocol followed the standards of the International Society for Pharmacoeconomics and Outcomes Research. Descriptive statistics were performed to identify characteristics of 280 literate postpartum women in a public hospital. We examined the internal consistency using Cronbach’s alfa. To determine the test-retest reproducibility and the instrument’s stability, we performed the intraclass correlation coefficient and Bland and Altman plot between two applications. We investigated the item’s properties using the item response theory. RESULTS: The overall Cronbach’s alpha index was 0.975. The intraclass correlation coefficient was 0.995 (95%CI 0.993–0.996) and a uniform distribution was visualized at the Bland and Altman plot. The item response theory identified the discriminatory power and the difficulty level of the instrument and of each item. The instrument showed acute angulation of the expected total score, and good concentrate information and good standard error curves, preserving the latent construct and its original items. CONCLUSIONS: This analysis concluded that the Brazilian version of the Quality of Prenatal Care Questionnaire is a high-quality, reliable and valid questionnaire to determine the quality of prenatal care among Brazilian women. The questionnaire is suitable for the cultural context represented

CT-based diagnosis of bronchial stenosis after lung transplantation

Introduction: Among all types of transplant complications, that related to airway anastomosis, such as stenosis is still uncertain¹². Starting by the difficulty in diagnosis, such as the low precision of bronchoscopy, high cost and invasive test. This article purpose a precise and non-invasive diagnostic method of bronchial stenosis after lung transplantation based on three measures got from a reconstruction of thorax computerized tomography (CT) using a software called TeraRecon. Objective: The anastomosis index (AI), ratio of the area of the bronchial cross-section at the site of the anastomosis to the arithmetic mean of the cross-sectional areas 5 mm upstream and 5 mm downstream, obtained from reconstruction of a thorax CT has direct correlation with the bronchoscopic and clinical diagnosis of bronchial stenosis. Methods: Were obtained all cases of clinical and bronchoscopic diagnosed bronchial stenosis after lung  transplantation at Heart Institute of University of São Paulo, between 2003 and 2016 (n=8). Another 8 patients, without any signs of stenosis, were selected to the control group. After that, the closest CT from the diagnostic was obtained and reconstructed using the software Terarecon, which is capable to find the exact area of any point of a cylindrical structure chosen by the operator. Then, three areas were obtained: 5mm before, at the anastomosis and 5mm after. Were calculated the Anastomosis Index (AI), which is the ratio between the area of anastomosis, and the arithmetic average of the areas 5mm before and 5mm after the anastomosis. After that, the data was confronted to variation of best FEV1 from transplantation to chosen CT and the FEV1 closest to the chosen CT. Results: As expected, in patients without bronchial stenosis, the area of the bronchi cross- section decreases linearly as it moves from proximal to distal in the bronchial tree, the AI in these cases tends to 1. Whereas, when there is no decay linear, that is, there is bronchial stenosis at the anastomosis, the AI was less than 1. There was a significant difference between AI in stenosis group (n=8, M = 0.387, SD = 0.151) and control group (n=8, M = 0.850, SD = 0.091). t(16)= -7.893 p < 0.001. This findings were supported by mean reduction of FEV1 in 17.71% and median 19.81% on stenosis group and mean reduction of 5.45%, and median 5.35% on control group. Besides that, the values undergone in a t-test, which returned a t-value = 2.879 with a p-value = 0.0129. The result is significant at p < 0.05. Conclusion: The Anastomosis Index can be useful in diagnosis of bronchial stenosis after lung transplantation, it is harmless and subsequently may help as a basis for new studies involving treatments. It is worth mentioning that is also a rational use of resources, since lower costs are generated by the CT analysis than performing a bronchoscopy, besides not requiring hospitalization and sedation, taking into account that these patients presents greater risks by the immunosuppression and other comorbidities.Supplemental Material Figure 1. Shown in red, the three points of measure used to calculate the Anastomosis index Figure 2: Boxplot showing distribuition of Anastomosis Index in control and stenosis group Figure 3: Boxplot showing the diferences in percentages between FEV1 in stenosis and control group References Margreiter R. History of lung and heart-lung transplantation, with special emphasis on German-speaking countries. Transplant Proc. 2016;48(8):2779-81. Hardy The first lung transplant in man (1963) and the first heart transplant in man (1964). Transplant Proc. 1999;31:25-9. Derom F, Barbier F, Ringoir S, Versieck J, Rolly G, Berzsenyi G, Vermeire P, Vrints L.Ten-month survival after lung homotransplantation in man. J Thorac Cardiovasc Surg. 1971;61(6):835-46. Awori Hayanga JW, Aboagye JK, Shigemura N, Hayanga HK, Murphy E, Khaghani A,D;Cunha J. Airway complications after lung transplantation: Contemporary survival and outcomes. J Heart Lung Transplant. 2016;35(10):1206-11. Fonseca HV, Iuamoto LR, Minamoto H, Abdalla LG, Fernandes LM, Camargo PC, Samano MN, Pêgo-Fernandes PM. Stents for bronchial stenosis after lung transplantation: should they be removed? Transplant Proc. 2015;47(4):1029-32. Kraft BD, Suliman HB, Colman EC, Mahmood K, Hartwig MG, Piantadosi CA, Shofer SL. Hypoxic gene expression of donor bronchi linked to airway complications after lung transplantation. Am J Respir Crit Care Med. 2016;193(5):552-60

A REVOLUÇÃO VERDE E SEUS IMPACTOS NA SAÚDE HUMANA COM A MODERNIZAÇÃO DA AGRICULTURA

O artigo registra os cursos do congresso internacional de inovação tecnológica nas ciências da saúde: a sustentabilidade das práticas integrativas a agroecologia, mais especificamente o minicurso A revolução verde e seus impactos na saúde humana com a modernização da agricultura. O minicurso tratou o papel do homem como componente incontestável do meio ambiente e suas ações na sociedade. O evento aconteceu de 15 a 18 de novembro de 2017 no IFBA SAJ sob a direção da Universidade Federal do Recôncavo da Bahia. Palavras-chave: Revolução verde. Saúde. Meio ambiente. Moviment

A comparison of two bronchial anastomotic techniques in lung transplantation by means of tridimensional tomographic analysis:: the bronchial anastomotic index

Background: The objective of this study was to compare two different techniques of bronchial anastomosis in lungtransplant, assessing differences in bronchial narrowing post-surgery.Methods: The surgical team at our center switched between simple stitches to continuous suture to anastomose the anterior bronchial wall in lung transplant procedures. CT scans of the patients obtained three months after the surgery were subject to analysis. The cross section area of the airway at the point of anastomosis was compared with an average of the cross sections of the bronchus 5mm proximal and distal to the point of anastomosis, determining the anastomotic index (AI). Data of 32 bronchi anastomosed with continuous suture from 19 patients were compared to data of 37 bronchi anastomosedwith interrupted suture from 20 patients.Results: Multivariate analysis showed significant difference in bronchial diameter reduction between patients subjected to the two techniques, with no difference between the two sides in any of the groups. The bronchi anastomosed with simple stitches had a significantly larger AI than those anastomosed with running suture (mean AI 0.98 vs 0.82, p < 0.001). A significantly larger number of bronchi subjected to this method had their AI greater than 1 comparing to bronchi anastomosed with a running suture (13 vs 1, p < 0.001).Discussion: The use of simple stitches to join the anterior bronchial wall surpasses a running suture in terms of bronchial narrowing. The interrupted suture technique seems to result in a mechanical widening at the point of anastomosis

Temporal analysis of leptospirosis incidence according to rainfall levels

The aim of this study was to analyze the temporal trend of leptospirosis incidence according to rainfall levels in Santa Catarina State between 2005 and 2015. This is an ecological time-series study involving data on leptospirosis incidence and rainfall indexes in Santa Catarina State Health Regions. The distribution of leptospirosis, rainfall indexes, and cases/rainfall ratios, according to seasonality and stratified by Health Regions, were evaluated. There were 5,274 cases, with an average rate of 7.03 cases/100,000 inhabitants per year, varying from 24 to 1,458 cases (Serra Catarinense and Northeast regions, respectively) in Santa Catarina, revealing an increase in the rates of 0.70 cases/100,000 inhabitants in Serra Catarinense and 13.99 cases/100,000 inhabitants in the Northeast. Four regions (Foz do Rio Itajaí, Médio Vale do Itajaí, Grande Florianópolis and Northeast) were responsible for 71.8% of the cases, particularly in the Northeast region (38.5%). The five regions with the highest rates presented greater risk of leptospirosis (RR > 1), ranging from 10.9 to 19.9 more new cases of the disease. The average rainfall volume for Santa Catarina State was 158.69 mm, ranging from 136.44 mm in Laguna to 186.81 mm in the Northeast. The five regions contributed with 32.8% of the rainfall index accumulated in the period. In conclusion, leptospirosis occurred all around Santa Catarina State, differing its temporal trend according to the Health Regions. The aim of this study was to analyze the temporal trend of leptospirosis incidence according to rainfall levels in Santa Catarina State between 2005 and 2015. This is an ecological time-series study involving data on leptospirosis incidence and rainfall indexes in Santa Catarina State Health Regions. The distribution of leptospirosis, rainfall indexes, and cases/rainfall ratios, according to seasonality and stratified by Health Regions, were evaluated. There were 5,274 cases, with an average rate of 7.03 cases/100,000 inhabitants per year, varying from 24 to 1,458 cases (Serra Catarinense and Northeast regions, respectively) in Santa Catarina, revealing an increase in the rates of 0.70 cases/100,000 inhabitants in Serra Catarinense and 13.99 cases/100,000 inhabitants in the Northeast. Four regions (Foz do Rio Itajaí, Médio Vale do Itajaí, Grande Florianópolis and Northeast) were responsible for 71.8% of the cases, particularly in the Northeast region (38.5%). The five regions with the highest rates presented greater risk of leptospirosis (RR > 1), ranging from 10.9 to 19.9 more new cases of the disease. The average rainfall volume for Santa Catarina State was 158.69 mm, ranging from 136.44 mm in Laguna to 186.81 mm in the Northeast. The five regions contributed with 32.8% of the rainfall index accumulated in the period. In conclusion, leptospirosis occurred all around Santa Catarina State, differing its temporal trend according to the Health Regions