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This study aimed to analyze whether there is an association between intimate partner violence during pregnancy and time to return to sexual activity after childbirth in the BRISA cohort in São Luís, Maranhão State, Brazil, between 2010 and 2013. This is a longitudinal study conducted with 665 women. Intimate partner violence during pregnancy was measured using an instrument created and validated by the World Health Organization to measure violence against women. Time to return to sexual activity after childbirth was investigated using a structured questionnaire. Logistic regression models were used to analyze whether there is an association between intimate partner violence during pregnancy and time to return to sexual activity after childbirth. The prevalence of violence by an intimate partner during pregnancy was 24.06%. The prevalence of women who returned to sexual activity within 3 months after childbirth was 67.96%. When analyzing the association between exposure and outcome, no association was found in the crude model (OR = 0.88; 95%CI: 0.60-1.30), nor in the adjusted model (OR = 1.00; 95%CI: 0.61-1.63). The study results highlight the importance of providing comprehensive care to women, considering both physical and psychological aspects, since violence has a significant impact on several aspects of women's lives.

Backgrounds: COVID-19 pandemic led to a sharp decline in surgical volume worldwide due to the postponement of elective procedures. This study evaluated the impact of COVID-19 pandemic in surgical volumes and outcomes of abdominal surgery in high-risk patients requiring intensive care unit admission., Methods: patients admitted for postoperative care were retrospectively evaluated. Data concerning perioperative variables and outcomes were compared in two different periods: January 2017-December 2019 and January 2020-December 2022, respectively, before (period I) and after (period II) the onset of COVID-19 pandemic., Results: 1.402 patients (897 women, mean age 62+17 years) were investigated. Most of the patients underwent colorectal (n=393) and pancreato-biliary (n=240) surgery, 52% of elective procedures. Surgical volume was significantly lower in period II (n=514) when compared to period I (n= 888). No recovery was observed in the number of surgical procedures in 2022 (n=135) when compared to 2021(n=211) and 2020 (n=168). Subjects who underwent abdominal surgery in period II had higher Charlson comorbidity index (4,85+3,0 vs. 4,35+2,8, p=0,002), more emergent/urgent procedures (51% vs. 45%, p=0,03) and more clean-contaminated wounds (73,5% vs. 66,8%, p=0,02). A significant decrease in the volume of colorectal surgery was also observed (24% vs, 31%, p<0,0001) after the onset of COVID-19 pandemic, 125 (8,9%) died, no deaths due to COVID-19 infection. Mortality was higher in period II when compared to period I (11% vs. 8%, p=0,08)., Conclusions: COVID-19 pandemic was associated with a decrease in surgical volume of high-risk patients without apparent recovery in recent years. No influence of COVID-19 was noted in postoperative mortality.

The COVID-19 pandemic had a significant impact on the living and working conditions of the entire population of Brazil, having a different and more intense effect on groups considered to be vulnerable. The objective of this article is to present an overview of the evolution of the pandemic in the country according to the bulletins of the Covid-19 Fiocruz Observatory in the period between the declarations of the beginning and end of the Public Health Emergency of National Concern (ESPIN, in Portuguese), February 2020 to April 2022. Several of the indicators adopted in the 69 bulletins published for the analysis of the pandemic were used, such as cases and deaths due to SARIs and COVID-19, age groups, % of occupancy of ICU beds, and vaccination, among others. The evolution analysis was organized between years and phases of the pandemic, seeking to highlight what characterized each moment. The closing statement of ESPIN in Brazil coincides with the discussions on the transition from a pandemic to an endemic scenario, without this representing the elimination of the virus, infections, and disease, posing the challenges of advances in vaccination processes in Brazil and around the world, as well as living with scenarios that may require the adoption of temporary protection measures in epidemic periods and periods of greater risk for vulnerable groups.

In investigations determining the duration of exclusive breastfeeding (EBF), the variable paid maternal work is mostly dichotomized into no and yes. This study analyzes possible associations between the characteristics of maternal occupation and shorter EBF duration. A cohort study was conducted in a systematic sample of births in the city of São Luís (State of Maranhão, Brazil), in 2010. The variables type of maternal occupation, numbers of days worked/week and hours worked/day, if they work while standing for most of the time, and if they lift heavy objects at work were collected with 5,166 mothers of live births. The final sample of this study had 3,268 observations. Survival analysis was used to evaluate associations between variables and EBF outcomes up to 4 months (EBF4) and EBF up to 6 months (EBF6). Not having paid work was the reference category. Adjusted Cox regressions showed that mothers with semi-specialized manual work (95% confidence interval, 95%CI: 1.02-1.58 for EBF4 and 95%CI: 1.11-1.56 for EBF6) and mothers who worked 8 or more hours daily (95%CI: 1.01-1.36 for AME4 and 95%CI: 1.11-1.41 for ESA6) more frequently discontinued EBF. Mothers with in-office occupations (95%CI: 1.07-1.46), who worked 4-5 days (95%CI: 1.01-1.36) or 6-7 days/week (95%CI: 1.09-1.40) and for 5-7 hours (95%CI: 1.03-1.43) also practiced less EBF6. Working (95%CI: 1.08-1.40) or not (95%CI: 1.03-1.34) while standing for most of the workday and lifting (95%CI: 1.07-1.56) or not (95%CI: 1.06-1.33) heavy objects at work decreased the duration of EBF6. Types of occupation and working time interfered more frequently in the duration of EBF6.

The literature has few studies on the seasonality of tuberculosis (TB) in the southern hemisphere, entailing the fill of this knowledge gap. This study aims to analyze whether TB incidence in Brazilian capitals and the Federal District is seasonal. This is an ecological study of a time series (2001-2019) of TB cases, conducted with 26 capitals and the Federal District. The Ministry of Health database, with 516,524 TB cases, was used. Capitals and the Federal District were divided into five groups based on social indicators, disease burden, and the Koppen climate classification. The seasonal variation of TB notifications and group amplitude were evaluated. We found TB seasonality in Brazil with a 1% significance in all capital groups (Stability assumption and Krusall-Wallis tests, p < 0.01). In the combined seasonality test, capital groups A, D, and E showed seasonality, whereas groups B and C, its probability. Our findings showed that health service supply and/or demand - rather than climate - may be the most relevant underlying factor in TB seasonality. It is challenging to raise the other seasonal factors underlying TB seasonality in tropical regions in the Southern Hemisphere.

Objectives: To analyze the prevalence at birth and the spatial and temporal distribution of congenital anomalies (CAs) among live births in the state of Maranhão in 2001 to 2016. To describe demographic, gestational and neonatal variables of interest., Methods: Ecological, population-based study, using secondary data from the Live Birth Information System (SINASC). Annual prevalence of total and per-group CAs was calculated. Spatial analyzes were based on the Local Indicators of Spatial Association (LISA) and the Moran I Index, and interactive maps were generated. Demographic, gestational and neonatal variables of interest available from SINASC were described in the group of newborns with CAs., Results: 1,831,830 live births, 6,110 with CAs (33.4/10,000) were included. Higher frequencies occurred in more recent years. Spatial clusters have been observed in specific years. The prevalence of newborns with CAs was different between categories of variables considered as risk factors for this outcome., Conclusion: The prevalence at birth of total CAs was lower than expected for major human defects (3%). The temporal peak of records in 2015/2016 is probably related to the increase in CAs caused by gestational infection by the Zika virus. The spatial clusters were probably due to variations at random due to the small number of births as they are not repeated in other years. Studies like this are the basis for the establishment of CA surveillance programs.

Objective: to identify adherence to the safe surgery checklist from its filling out in a general referral hospital in the interior of Minas Gerais state, as well as to verify factors associated with its use., Methods: this is a retrospective, documentary, cross-sectional study with a quantitative approach. Data collection was performed through a retrospective review of medical records of patients undergoing surgery within one year. Patients of all specialties, aged 18 years or older, and with hospitalization period equal to or greater than 24 hours were included. The probabilistic sample was composed of 423 cases., Results: the checklist was present in 95% of the medical records. However, only 67.4% of them were completely filled out. The presence of the checklist in the medical record was significantly associated with the anesthetic risk of the patient. There was no difference in the filling out percentage among the three checklist moments: before anesthetic induction (sign in), before surgical incision (time out or surgical pause), and before the patient leaves the operating room (sign out). There were also no significant differences regarding the filling out percentage of the surgeon's responsibility items. Considering the surgical procedure performed, inconsistencies were found in the laterality item., Conclusion: despite the high percentage of medical records with checklist, the presence of incompleteness and inconsistency may compromise the expected results in the safety of the surgical patient.

Objective: To analyze the temporal trend of leprosy indicators in a hyperendemic state of Brazil, from 2001-2015., Methods: This is a time-series study of leprosy indicators in the state of Maranhão, Northeastern region of Brazil. The study used data from the Brazilian National System of Reportable Diseases, for the period between 2001 and 2015. The following indicators were evaluated: (i) detection coefficient in the general population; (ii) detection coefficient in people under 15 years old; (iii) rate of cases with grade 2 physical disability in the diagnosis; (iv) rate of examined contacts, and (v) proportion of healing . The Prais-Winsten regression model was used for trend analysis. Analyses were performed for the state and by each health region., Results: 77,697 leprosy cases were analyzed in the general population and 7,599 in individuals under 15 years old. The detection coefficient in the general population ranged from 80.7/100 thousand inhabitants in 2001 to 51.2/100 thousand inhabitants in 2015. The coefficient in the general population presented a downward trend (annual percentage variation [APV] = -2.98; 95%CI -4.15- -1.79). For the population under 15 years old, the rate was 24.9/100 thousand inhabitants in 2001, and 19.9/100 thousand inhabitants in 2015, with downward trend (APV = -3.07; 95%CI -4.95- -1.15). It was observed upward trend in rate of contacts examined (APV = 2.35; 95%CI 0.58-4.15) and rate of cases with grade 2 disability (APV = 2.19; 95%CI 0.23-4.19). Stationary trend was observed in the proportion of healing (APV = -0.10; 95%CI -0.50-0.30). Regional differences were found in the performance of the indicators., Conclusions: A downward trend for the detection coefficients in the general population and in individuals under 15 years old was found in Maranhão. Despite this result, the rates are still very high, demanding efforts from all spheres of public administration and health professionals to reduce the burden of the disease in the state.

Objective: Unveil the perception of students from basic education about drugs., Methods: Phenomenological study based on Maurice Merleau-Ponyt, conducted with 14 students of a school in Bahia, Brazil, through the Focus Group, in the months of April to June of 2013. The reports have been analyzed based on the Ambiguity Analytics technique., Results: They have been presented in the form of three categories: common sense and scientific knowledge occupy opposite locus; drug addicts; the good and evil of legal and illegal drugs., Conclusions: The students' perception of drugs intertwined with scientific knowledge and at the same time placing it at the center of the phenomenon, separating the lawful as good and illicit as bad, which points to the need for socio-educational measures among educators, students and family members, aimed at the decentralization of the drug place in the context in which the phenomenon happens so that we understand the complexity involved in the theme.

Objective To assess the information needs of family caregivers of candidates on the waiting list for a liver transplant. Methods It is a cross-sectional study conducted in a transplant center in São Paulo State in the period between April and October of 2012. For the assessment of information needed, an instrument submitted to face and content value was used. The caregivers put 10 subjects in order according to their importance and the amount of interest they had in learning about each, prior to the transplant their family member would be subjected to. Sociodemographic characteristics were also recorded. For data analysis, descriptive statistics were used. Results 42 families participated in the study. The information need about liver disease complications, complications after transplantation and care needed after surgery had higher averages. Conclusions Knowing the information needs of caregivers is important to plan teaching-learning strategies aimed at improving assistance to patients and families in transplant programs.

OBJECTIVE To estimate the prevalences of tobacco use, tobacco experimentation, and frequent smoking among Brazilian adolescents. METHODS We evaluated participants of the cross-sectional, nation-wide, school-based Study of Cardiovascular Risks in Adolescents (ERICA), which included 12- to 17-year-old adolescents from municipalities of over 100 thousand inhabitants. The study sample had a clustered, stratified design and was representative of the whole country, its geographical regions, and all 27 state capitals. The information was obtained with self-administered questionnaires. Tobacco experimentation was defined as having tried cigarettes at least once in life. Adolescents who had smoked on at least one day over the previous 30 days were considered current cigarette smokers. Having smoked cigarettes for at least seven consecutive days was an indicator for regular consumption of tobacco. Considering the complex sampling design, prevalences and 95% confidence intervals were estimated according to sociodemographic and socio-environmental characteristics. RESULTS We evaluated 74,589 adolescents. Among these, 18.5% (95%CI 17.7-19.4) had smoked at least once in life, 5.7% (95%CI 5.3-6.2) smoked at the time of the research, and 2.5% (95%CI 2.2-2.8) smoked often. Adolescents aged 15 to 17 years had higher prevalences for all indicators than those aged 12 to 14 years. The prevalences did not differ significantly between sexes. The highest prevalences were found in the South region and the lowest ones, in the Northeast region. Regardless of sex, the prevalences were found to be higher for adolescents who had had paid jobs, who lived with only one parent, and who reported having been in contact with smokers either inside or outside their homes. Female public school adolescents were found to smoke more than the ones from private schools. CONCLUSIONS Tobacco use among adolescents is still a challenge. Intending to reduce the prevalence of tobacco use among young people, especially the ones under socioeconomic vulnerability conditions, Brazil must consolidate and increase effective public health care measures.

A pioneering study conducted at the Center for Chemical Dependency (CEDEQ) of the Brazilian Navy (MB), by means of an ethnographic study with participant observation, investigated the influence of MB in the identification of alcoholism among patients. This article presents one of the research results, namely the dual commitment of this Outpatient Clinic to the patients and to the institution. The results encompass topics such as the organization and functioning of CEDEQ, therapeutic contract, anonymity and confidentiality, discharge, relapses, readmission and abandonments, secondary gains, "scams" and sanctions in addition to the ambiguous perceptions about treatment. In essence, these findings clarify a little more about the institutional intricacies that contribute to lead many patients to alcoholism.

Objective: To assess the impact of intracranial pressure monitoring on the short-term outcomes of traumatic brain injury patients., Methods: Retrospective observational study including 299 consecutive patients admitted due to traumatic brain injury from January 2011 through July 2012 at a Level 1 trauma center in São Paulo, Brazil. Patients were categorized in two groups according to the measurement of intracranial pressure (measured intracranial pressure and non-measured intracranial pressure groups). We applied a propensity-matched analysis to adjust for possible confounders (variables contained in the Crash Score prognostic algorithm)., Results: Global mortality at 14 days (16%) was equal to that observed in high-income countries in the CRASH Study and was better than expected based on the CRASH calculator score (20.6%), with a standardized mortality ratio of 0.77. A total of 28 patients received intracranial pressure monitoring (measured intracranial pressure group), of whom 26 were paired in a 1:1 fashion with patients from the non-measured intracranial pressure group. There was no improvement in the measured intracranial pressure group compared to the non-measured intracranial pressure group regarding hospital mortality, 14-day mortality, or combined hospital and chronic care facility mortality. Survival up to 14 days was also similar between groups., Conclusion: Patients receiving intracranial pressure monitoring tend to have more severe traumatic brain injuries. However, after adjusting for multiple confounders using propensity scoring, no benefits in terms of survival were observed among intracranial pressure-monitored patients and those managed with a systematic clinical protocol.

Objective: To analyze the epidemiological clinical profile of women with maternal near miss according to the new World Health Organization criteria., Methods: A descriptive cross-sectional study was conducted, in which the records of patients admitted to the obstetric intensive care unit of a tertiary hospital in Recife (Brazil) over a period of four years were analyzed. Women who presented at least one near miss criterion were included. The variables studied were age, race/color, civil status, education, place of origin, number of pregnancies and prenatal consultations, complications and procedures performed, mode of delivery, gestational age at delivery, and maternal near miss criteria. The descriptive analysis was performed using the program Epi-Info 3.5.1., Results: Two hundred fifty-five cases of maternal near miss were identified, with an overall ratio of maternal near miss of 12.8/1,000 live births. Among these cases, 43.2% of the women had incomplete primary education, 44.7% were primiparous, and 20.5% had undergone a previous cesarean section. Regarding specific diagnoses, there was a predominance of hypertensive disorders (62.7%), many of which were complicated by HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (41.2%). The laboratory near miss criteria were the most often observed (59.6%), due mainly to the high frequency of acute thrombocytopenia (32.5%)., Conclusions: A high frequency of women who had a low level of education and who were primiparous was observed. According to the new criteria proposed by the World Health Organization, hypertensive pregnancy disorders are still the most common among maternal near miss cases. The high frequency of HELLP syndrome was also striking, which contributed to acute thrombocytopenia being the most frequent near miss criterion.

Purpose: To investigate the relationship between sexual function and quality of life in pregnant women living in two cities of Northeastern Brazil., Methods: The sample consisted of 207 pregnant women. The data were collected through a questionnaire containing questions about socio-demographic, gynecological and obstetrical data, body and sexual knowledge. Quality of life was assessed by applying the Ferrans & Powers Quality of Life Index (QLI Ferrans and Power). Sexual function was assessed using the Female Sexual Function Index (IFSF). Data were statistically analyzed using the Shapiro-Wilk, Mann-Whitney and Wilcoxon tests., Results: The pregnant women studied had a median age of 30 years (quartile 26-33 years) and were approximately at the 26th gestational week. A significant decrease in the monthly frequency of sexual relations of the couple was observed, with a median of 12 to 4 times per month (Z=-10.56; p<0.001). Sexual dysfunction was detected in 35.7% of the pregnant women studied, whose quality of life was lower when compared to women with unchanged sexual function (Z=-2.9; p=0.004)., Conclusion: The results of this study show that sexual dysfunction negatively affected the quality of life of pregnant women, and this should be an important aspect for review during prenatal consultations.

This article contains part of the results of the "Youth, Disaffiliation and Violence" extension project developed at the Institute of Psychiatry of the Federal University of Rio de Janeiro in 2008. It seeks to present experiences of violence experienced in three different contexts, namely in the family home, on the streets and in shelter units (SU), from the standpoint of adolescents. Thirty adolescents in five SUs in the municipality of Rio de Janeiro were interviewed. A qualitative approach was used in order to examine a relatively unknown reality, seeking a contextual understanding from the perspective of the social actors. To achieve this goal, this study sought the contribution of oral reports as the methodology for data collection. The theory of communication was the method of analysis, through the objective/subjective narratives of experiences of adolescents, establishing categories and points of analysis that permeate these experiences. The results revealed that youths housed in shelters are exposed to various psychosocial risks related to violence experienced in the environments visited. Lastly, the need for setting up an intersectorial network aiming at providing effective and comprehensive care for adolescents was highlighted.

Objective: To evaluate self-esteem and self-image of respiratory diseases patients in a Pulmonary Rehabilitation Program, who participated in socialization and physical fitness activities, and of patients who participated only in physical fitness sessions., Methods: A descriptive cross-sectional exploratory study. Out of a total of 60 patients analyzed, all enrolled in the Pulmonary Rehabilitation Program, 42 participated in at least one of the proposed activities, 10 did not participate in any activity and 8 were excluded (7 were discharged and 1 died)., Results: When the two groups were compared, despite the fact that both demonstrated low self-esteem and self-image, the difference between them was relevant (p<0.05) regarding self-esteem, indicating that those who participated in the proposed socialization activities had better self-esteem than the individuals who only did the physical fitness sessions. Regarding self-image, the difference between the groups was not relevant (p>0.05)., Conclusion: The Pulmonary Rehabilitation Program patients evaluated presented low self-esteem and self-image; however, those carrying out some socialization activity proposed had better self-esteem as compared to the individuals who did only the physical fitness sessions.

Systematic reviews aim to summarize all evidence using very rigorous methods in order to address a specific research question with less bias as possible. Systematic reviews are widely used in the field of physical therapy, however not all reviews have good quality. This tutorial aims to guide authors of the Brazilian Journal of Physical Therapy on how systematic reviews should be conducted and reported in order to be accepted for publication. It is expected that this tutorial will help authors of systematic reviews as well as journal editors and reviewers on how to conduct, report, critically appraise and interpret this type of study design.

On January 2013, a disaster at Santa Maria (RS) due to a fire in a confined space caused 242 deaths, most of them by inhalation injury. On November 2013, four individuals required intensive care following smoke inhalation from a fire at the Memorial da América Latina in São Paulo (SP). The present article reports the clinical progression and management of disaster victims presenting with inhalation injury. Patients ERL and OC exhibited early respiratory failure, bronchial aspiration of carbonaceous material, and carbon monoxide poisoning. Ventilation support was performed with 100% oxygen, the aspirated material was removed by bronchoscopy, and cyanide poisoning was empirically treated with sodium nitrite and sodium thiosulfate. Patient RP initially exhibited cough and retrosternal burning and subsequently progressed to respiratory failure due to upper airway swelling and early-onset pulmonary infection, which were treated with protective ventilation and antimicrobial agents. This patient was extubated following improvement of edema on bronchoscopy. Patient MA, an asthmatic, exhibited carbon monoxide poisoning and bronchospasm and was treated with normobaric hyperoxia,bronchodilators, and corticosteroids. The length of stay in the intensive care unit varied from four to 10 days, and all four patients exhibited satisfactory functional recovery. To conclude, inhalation injury has a preponderant role in fires in confined spaces. Invasive ventilation should not be delayed in cases with significant airway swelling. Hyperoxia should be induced early asa therapeutic means against carbon monoxide poisoning, in addition to empiric pharmacological treatment in suspected cases of cyanide poisoning.

Background: Observational instruments, such as the Rapid Entire Body Assessment, quickly assess biomechanical risks present in the workplace. However, in order to use these instruments, it is necessary to conduct the translational/cross-cultural adaptation of the instrument and test its measurement properties., Objectives: To perform the translation and the cross-cultural adaptation to Brazilian-Portuguese and test the reliability of the REBA instrument., Method: The procedures of translation and cross-cultural adaptation to Brazilian-Portuguese were conducted following proposed guidelines that involved translation, synthesis of translations, back translation, committee review and testing of the pre-final version. In addition, reliability and the intra- and inter-rater percent agreement were obtained with the Linear Weighted Kappa Coefficient that was associated with the 95% Confidence Interval and the cross tabulation 2×2. Results : The procedures for translation and adaptation were adequate and the necessary adjustments were conducted on the instrument. The intra- and inter-rater reliability showed values of 0.104 to 0.504, respectively, ranging from very poor to moderate. The percentage agreement values ranged from 5.66% to 69.81%. The percentage agreement was closer to 100% at the item 'upper arm' (69.81%) for the Intra-rater 1 and at the items 'legs' and 'upper arm' for the Intra-rater 2 (62.26%)., Conclusions: The processes of translation and cross-cultural adaptation were conducted on the REBA instrument and the Brazilian version of the instrument was obtained. However, despite the reliability of the tests used to correct the translated and adapted version, the reliability values are unacceptable according to the guidelines standard, indicating that the reliability must be re-evaluated. Therefore, caution in the interpretation of the biomechanical risks measured by this instrument should be taken.

Objective: To establish the abnormal title and the appropriate screening dilution for ANA (antinuclear antibodies) test by indirect immunofluorescence on HEp-2 cells (ANA HEp-2)., Methods: An analysis of ANA Hep-2 in serum samples from 126 healthy individuals was performed. The samples were screened at a dilution of 1:80, and those positive were diluted to the title of 1:5120. The abnormal title of ANA was defined as that corresponding to the 95th percentile of the test in this population. The sensitivity of the different titles of antinuclear antibodies was determined in a group of 136 patients with a diagnosis of autoimmune rheumatic disease, and the specificity was determined in a group of 118 patients with other rheumatic diseases. The optimal cutoff value of the test was determined by ROC curve analysis., Results: The frequency of ANA positivity in healthy subjects was 13.2%. There was no difference in the frequency of positive results according to gender or age. The abnormal title of ANA was defined as the dilution of 1:160. The 1:80 dilution had sensitivity of 87.7% and specificity of 67.8%, while the 1:160 dilution had sensitivity of 82% and specificity of 73.7%. By ROC curve analysis, a dilution of 1:160 corresponded to the optimal cutoff value., Conclusion: The abnormal title and the optimal cutoff value of ANA HEp-2 in the population was 1:160. Therefore, the dilution of 1:160 is the optimal screening dilution, with better specificity but without significantly compromising the sensitivity of the diagnostic test.

Objective: To determine the prevalence of fetal and neonatal deaths among patients with maternal near miss and the factors associated with this fatal outcome., Methods: The authors conducted a descriptive, cross-sectional, analyzing medical records of patients admitted to the ICU of a tertiary obstetric Recife (Brazil), between January 2007 and December 2010, who had at least one criterion of near miss defined by WHO. Statistical analysis was performed with Epi-Info 3.3.2, using chi-square and Fisher's exact test, considering a significance level of 5%. For multivariate analysis was constructed as a hierarchical model with the response variable fetal and neonatal deaths., Results: We included 246 cases of maternal near miss. Among women in the study, hypertensive disorders occurred in 62.7% to 41.2% in HELLP syndrome and the laboratory criteria for near miss in 59.6%. There were 48 (19.5%) stillbirths and 19 (7.7%) neonatal deaths. After analyzing the variables that remained statistically associated with fetal and neonatal deaths were: severe preeclampsia, placental abruption, endometritis, cesarean delivery, prematurity and the laboratory criteria for maternal near miss., Conclusion: The high incidence of fetal and neonatal deaths among patients with maternal near miss. Among these women there is an overlap of factors contributing to this fatal outcome, in our study, those who had severe preeclampsia, placental abruption, endometritis, premature birth or laboratory criteria positively associated with deaths., (Copyright © 2013 Elsevier Editora Ltda. All rights reserved.)

Introduction: The progressive increase in number of HIV/AIDS cases in old age brings the necessity of studies about the specificities of this phenomenon by region., Objective: To identify the epidemiology in AIDS cases diagnosed in Distrito Federal - Brasil, in individuals aged > 60 years old., Methods: We conducted a time serie study with secondary data from SINAN/AIDS for the period January 1999 to December 2009., Results: In this period, 4,258 new cases of AIDS were of whom 89 (2.0%) are elderly. Although a small percentage, the annual growth was continuous. The most frequent exposure category was heterosexual, the age group most affected was 60 and 69 years, with 71 (79.8%) cases; the proportion of cases man/woman has changed over the years, in 1999 was 1:1 and in 2006, 0,7:1., Conclusion: The HIV/AIDS epidemic among the elderly can be seen stable on the Distrito Federal.

Background: There was a clear grow, in the last 2 decades, of up to 6 fold in scientific articles that are directly relevant to physical therapy practice. However, along with this fast grow; little attention has been given to transparency when reporting research methods and results. More recently, groups of researchers around the world have made successful attempts to address this issue by creating guidelines that will help researchers not only on the preparation of manuscripts but also on making sure that important details related to design and methodology are controlled and reported., Objective: To present four specific reporting guidelines, which are best known as "statements"., Discussion: A network named EQUATOR (Enhancing the Quality and Transparency of Health Research) was created with the main mission of providing basic principles for responsible and transparent reporting. The EQUATOR network encompasses, among others, the CONSORT statement which is related to randomized controlled trials; the PRISMA statement, which is related to systematic reviews and meta-analysis; the STROBE Statement, which is related to observational studies; and the STARD statement, which is related to reporting of accuracy of diagnostic tests. Some journals have recommended the use of these statements, while in others their use is mandatory. The goal of the use of these statements by journals is to guarantee fast decisions regarding publication and the best possible quality of reporting. Ultimately, it will help readers, including physical therapists, to make better decisions in clinical practice.

Objectives: To evaluate the effects of the manual hyperinflation with thoracic compression (MHTC) maneuver on the clearance of secretions, pulmonary mechanics, hemodynamics and oxygenation in mechanically ventilated patients., Methods: This was a controlled, crossover study that included twenty patients who were under invasive ventilation for more than 48 hours. Four hours after the last airway suctioning procedure, the patients underwent the study interventions, Suction alone or MHTC plus Suction, in sequence at four hour intervals. The sequence order for the procedures was established by randomization. Data were collected before, during and 5, 15, 30 and 60 minutes after each intervention. The suctioned secretions were collected and weighed., Results: No significant differences between the procedures were found regarding tidal volume, plateau pressure and pulmonary compliance (p>0.05). The hemodynamic variables showed increased pressures and heart rate during the procedures and returned to baseline values five minutes after the end of the procedure (p≤0.001). No significant hemodynamic differences were seen between the interventions (p>0.05). For the duration of the study, oxygen saturation was 99% with only two exceptions during the MHTC + Suction procedure, where saturation was 98% (p<0.05). No significant differences were observed between the techniques regarding the weight of the suctioned secretion., Conclusion: The results suggest that MHTC, as performed in this study, adds no benefit with respect to oxygenation optimization, pulmonary mechanics and clearance of secretions. However, the MHTC maneuver did not result in hemodynamic changes when compared to the suctioning procedure alone.

Objective: To investigate the prevalence and distribution of renal arteries and their branches in vivo, correlating the particularities found in them with sex and laterality., Methods: Two hundred renal pedicles were studied by CT angiography and its arteries analyzed according to number, position of origin, size, length and trajectory in relation to renal segments. Its frequency and laterality were surveyed regarding gender and age., Results: There were multiple arteries in 61.5% of the pedicles (56% in the right and 67% in the left), occurring in 65% of men and 58% of women. The aortic origin to the multiple arteries was more frequent on the right and, more often, the renal arteries originated between vertebrae L1 and L2 as pre-hilar division of the main artery. The average length of the main artery was higher in right kidneys with a single artery. There was no difference between the diameters of the main renal arteries., Conclusion: There is a higher prevalence of multiple renal arteries than the one described in the literature, with no difference for gender or laterality. The renal arteries originated more frequently between vertebrae L1 and L2, with divisions of the pre-hilar route and main artery to the hilum of the kidney. The average length of the main artery is greater on the right and in kidneys with single artery. There was no difference in diameter between the main renal artery between kidneys with single and multiple arteries.

Background and Objectives: The development of subcutaneous emphysema involving face, neck, and thorax has been well-documented in cases of odontologic procedures, head and/or neck surgery, and craniofacial trauma. Its development without known damage to the mucosa is rare. This report describes the case of a patient who developed emphysema without an obvious lesion., Case Report: This is a male patient, healthy, undergoing epidural blockade and local anesthesia associated with sedation for lipoaspiration of the abdomen and submentonian region. Intercurrences were not observed during the procedure until a nasopharyngeal cannula was placed for oxygen administration. We also describe an alternative approach for its resolution., Conclusions: Although rare, subcutaneous emphysema can have serious repercussions. Manual lymphatic drainage can be an option for the treatment of this aesthetical complication., (Copyright © 2010 Elsevier Editora Ltda. All rights reserved.)

Background: The presence of anemia and renal dysfunction grants a bad prognosis for patients with heart failure and reduced ejection fraction (HFREF). The impact on patients with heart failure and normal ejection fraction (HFNEF) is not widely studied., Objectives: To study the prevalence and the prognosis of anemia and renal dysfunction (RD) in patients with heart failure according to the type of ventricular dysfunction., Methods: A total of 209 patients with chronic and stable heart failure were prospectively studied. Individuals with ejection fraction <50% were considered as HFREF patients. Anemia was defined, based on WHO criteria, as hemoglobin <13 g/dl for men and <12 g/dl for women. Renal function was calculated by means of the Simplified Modified Diet Renal Disease (sMDRD) formula. Hospitalizations, emergency admittances and obit by cardiac causes were considered as cardiac events., Results: Ninety patients had HFREF and 119 had HFNEF. The glomerular filtration rate (GFR) was smaller in HFREF group (57.6 +/- 66.2 versus 94.8 +/- 36.6 ml/min/1.73m(2); p=0.01). There was no difference in the prevalence of anemia between groups (23.3% versus 18.5%; p=0.34). Moderate to severe RD prevalence was higher in HFREF group (32.2% versus 16.8%; p=0.01). RD was the only factor associated with anemia that was independently associated with cardiac events (HR 2.52; 95%CI=1.27-5.2; p=0.01)., Conclusion: RD was less prevalent in HFNEF, while the prevalence of anemia did not differ between groups. RD was predictor of cardiac events independently on ejection fraction.

Background: the postoperative period of congenital cardiomyopathies correction is frequently accompanied by systemic inflammatory response., Objective: To assess the frequency of occurrence and clinical manifestations of the systemic inflammatory response syndrome after cardiopulmonary bypass (SIRS-CPB) in children submitted to cardiac surgery., Methods: Historical cohort study including patients up to 3 years old that were submitted to elective corrective surgeries for congenital cardiopathies with cardiopulmonary bypass (CPB). A total of 101 patients were assessed by means of clinical criteria of organ dysfunction through score tests, as comparing predisponent factors and aggregated morbidity to the presence of SIRS-CPB., Results: Twenty-two patients (21.9%) fulfilled the criteria for SIRS-CPB. The sex or type of cardiopathy did not differ between groups (p = NS). Patients diagnosed with SIRS-CPB (compared to patients without SIRS-CPB) presented lower mean age (6.8 +/- 5.5 versus 10.8 +/- 5.1 months, p < 0.05), lower weight (5.3 +/- 1.9 versus 6.9 +/- 2.0 kg, p < 0.05), and longer CPB duration (125.1 +/- 49.5 versus 93.9 +/- 33.1 minutes, p < 0.05). Longer median duration of mechanical ventilation (120.0 versus 13.0 hours, p < 0.05), longer stay in Intensive Care Unit (ICU) (265.0 versus 107.0 hours, p < 0.05) and in hospital (22.0 versus 10.0 days, p < 0.05) were observed. In the multivariate analysis, higher weight (OR = 0.68, p = 0.01) was identified as a protection factor., Conclusion: The adopted clinical criteria identified a risk group for SIRS-CPB, which presented lower weight and longer CPB duration as predisponent factors. Patients with SIRS-CPB remain in mechanical ventilation, in ICU and in hospitalization for a longer period of time.

Background: Anemia is common in patients with heart failure (HF). Its prevalence in patients with HF from a community-based cohort is unknown in our country., Objective: evaluate the prevalence and characteristics of patients with anemia in a non-selected population with HF from a community-based cohort, comparing it with that of a HF population treated at a specialized outpatient clinic., Methods: This was a transversal, prospective, observational study, carried out from January 2006 to March 2007. The patients with HF met the Boston criteria, with a score > 8. Anemia was defined through the criteria of the World Health Organization as hemoglobin levels < 13 g/dL for men and <12 g/dl for women. Patients treated at a primary care program in the community were randomly selected, as well as patients treated at a Heart Failure Outpatient Clinic in a university hospital., Results: A total of 206 patients were assessed, with a mean age of 61.3+/-13.1 years, of which 53.4% were females. The prevalence of anemia in the community-based cohort (n=114) was 21% and at the outpatient clinic (n=92), of 25% (p=0.50). The patients from the community-based cohort presented a lower rate of kidney dysfunction (GFR<60 ml/min/1,73-5), predominance of HF with normal ejection fraction and female sex. Kidney function parameters (urea or creatinine) independently correlated with anemia in both populations., Conclusion: The prevalence of anemia was similar in the studied populations. Kidney function was the only factor that independently correlated with anemia in both populations.

Purpose: to investigate factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil., Methods: a prospective study, with 195 pairs of mothers and progeny, in which the dependent variable was macrosomia (weight at delivery > or =4,000 g -- independent of the gestational age or of other demographic variables), and socioeconomic, previous pregnancies/gestation course, biochemical, behavioral and anthropometric, the independent variables. Statistical analysis has been done by multiple logistic regression. Relative risk (RR) values have been estimated, based on the simple form: RR=OR/ (1 - I0) + (I0 versus OR), in which I0 is the macrosomia incidence in non-exposed people., Results: Macrosomia incidence was 6.7%, the highest value being found in the progeny of women > or =30 years old (12.8%), white (10.4%), with two or more children (16.7%), with male newborns (9.6%), with height > or =1.6 m (12.5%), with overweight or obesity as a nutritional pre-gestational state (13.6%), and with excessive gestational gain of weight (12.7%). The final model has shown that having two or more children (RR=3.7; CI95%=1.1-9.9), and having a male newborn (RR=7.5; CI95%=1.0-37.6) were the variables linked to the macrosomia occurrence., Conclusions: macrosomia incidence was higher than the one observed in Brazil as a whole, but inferior to the one reported in studies from developed countries. Having two or more children and a newborn male were the factors accountable for the occurrence of macrosomia.

Air pollution is a major public health problem in the Amazon forest and in large Brazilian cities. During September of 2005, high concentrations of smoke from biomass burning were observed in the city of Rio Branco. An ecological study was conducted to evaluate the relationship between daily concentrations of particulate matter < 2.5 microm (PM2.5) and the number of respiratory disease (RD)-related emergency room visits. Daily PM2.5 concentrations exceeded recommended air quality limits on 23 days. The incidence of RDs was higher among children < 10 years of age. There was a significant positive correlation between PM2.5 concentrations and asthma emergency room visits.

This study of occupational accidents presents estimates for mortality, years of potential life lost, and cumulative incidence of severe cases (over 15 workdays lost) in Bahia State, Brazil, 2000. A correction factor was produced by comparing different data sources. Data were taken from compensation claims in the National Social Security Unified Benefits System (SUB), death certificates from the Ministry of Health Mortality Information System, and national census. Occupational accident-related mortality was estimated as 0.79 per 100,000 workers using the Mortality Information System, but increased to 13.17 per 100,000 using the SUB database. Assuming the latter result for the entire workforce produced a correction factor of 16.67 for the Mortality Information System database. Years of potential life lost were 23,249, and the cumulative incidence of severe occupational accidents was 2.3%. Occupational accidents are preventable, but still common in Brazil. Underreporting is widespread, and corrected statistics need to be published, thereby turning this neglected public health problem into a policy priority.

Qualitative study whose objective was to argue and to describe the feelings and the expectations lived deeply for 28 women about oncotic citology in a unit of the Family Health Program in Parnaíba-PI, through an interview with script of opened questions. The results were presented in categories and evidenced that the majority of the women do not carry through the examination, even so they all affirm the importance of this, mainly for detention of illnesses. It was observed despite during the procedure, the feelings most recurrent between the women were: shyness, unreliability, fear, shame and pain. Related to the expectations, they wish a better attendance of the professionals, and a result that does not present alterations, in special the cancer.

Objective: To observe in practice how noninvasive bilevel positive pressure, applied at different levels, may interfere with systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2), in patients with congestive heart failure (CHF)., Methods: Fourteen CHF patients (mean age 62.85 years) were treated with noninvasive bilevel mechanical ventilation. Patients were consecutively treated with an expiratory positive airway pressure (EPAP) of 5 cmH2O, 10 cmH2O, 15 cmH2O, 10 cmH2O, and 5 cmH2O, maintaining a variation in pressure (deltaP) of 5 cmH2O between the inspiratory pressure (IPAP) and the expiratory pressure (EPAP). Ventilation and hemodynamic data were collected at these time points, as well as 5 minutes before the beginning of the protocol and 5 minutes after its completion., Results: A statistically significant difference was observed in the respiratory rate between the moment just before the beginning of the protocol and 5 minutes after positive pressure mask placement (p=0.022), and in oxygen saturation, between the final minute of EPAP at 5 cmH2O and after the removal of the mask (p=0.05)., Conclusion: Noninvasive bilevel mechanical ventilation improves oxygenation and reduces respiratory work, thus being beneficial for patients with congestive heart failure. It was not possible to observe statistically significant changes in the hemodynamic data due to the small number of patients and to other associated heart diseases.

This paper analyzes the association between perinatal mortality and factors related to hospital care during labor, considering that healthcare assessment is needed in order to reduce perinatal mortality. A population-based case-control study was conducted with 118 perinatal deaths (cases) and 492 births (controls) that took place in maternity hospitals of the Brazilian Unified Health System (SUS) in Belo Horizonte, Minas Gerais, Brazil. Male sex, prematurity, diseases during pregnancy, low birth weight, newborn diseases, lack of prenatal care, lack of partograph use during labor, and less than one fetus assessment per hour during labor were significantly associated with perinatal deaths. In the multiple regression analysis, lack of partograph use during labor and type of hospital were associated with perinatal deaths. These results indicate inadequate quality of care in maternity hospitals and show that health services structure and health care process are related to perinatal mortality due to preventable causes.