ABSTRACT Background: Chronic patients suffer a greater number of health problems and have greater needs for assistance and care. The objective was to describe the use of health services in Primary Care in patients with chronic conditions according to risk level by adjusted morbidity groups (AMG) and analyze the associated factors. Methods: Cross-sectional study. We included patients ≥18 years-old identified as chronic by the stratification tool according to AMG in a basic health area in the Community of Madrid with an assigned population of 18,107 inhabitants. Sociodemographic, clinical-care and use of services variables were collected and were classified according to the “behavioral” model in predisposing, need or facilitators factors. Univariate, bivariate and multiple linear regression adjusted with robust estimators was performed. Results: 9,443 chronic patients (52.1% of the population in the selected zone) were identified, mean age of 57.8 (SD=18.7); 62.1% women. According to their risk level 4.7% were high risk, 18.7% medium risk and 76.6% low risk. The mean number of contacts per year was 14.1 (SD=15.2); 34.4 (SD=27.9) in high risk; 21.8 (SD=17.2) in medium risk and 10.1 (SD=10.2) in low risk. 7.5 (SD=7.1) contacts were with the doctor and 12.9 (SD=12.9) were face-to-face. The factors associated with higher use of services were high risk (Coefficient B(CB)=12.6; IC95%=11-14.2), immobilization (CB=8.8; IC95%=7.3-10.4), polypharmacy (CB=6; IC95%=5-8.6), female sex (CB=1; IC95%=0.4-1.5), number of chronic diseases (CB=1; IC95%=0.8-1.2) and age (CB=0.03; IC95%=0.01-0.05). Conclusions: The health services utilization in Primary Care in chronic patients is high and increased according with the risk level by AMG. The contact with the doctor is superior to nurse and the most frequent type is face-to-face. The greater utilization of services responds to predisposing factors (female sex and age) and above all to need factors (high risk, immobility, multimorbidity and polypharmacy).

RESUMEN Fundamentos: Los pacientes crónicos sufren mayor número de problemas de salud y tienen mayores necesidades de asistencia y cuidados. El objetivo de este estudio fue describir la utilización de servicios de salud de Atención Primaria en los pacientes crónicos según el nivel de riesgo asignado por los grupos de morbilidad ajustados (GMA), así como analizar los factores asociados. Sujetos y métodos: Se realizó un estudio transversal. Se incluyeron pacientes ≥ 18 años identificados como crónicos por el estratificador GMA en una zona básica de salud de la Comunidad de Madrid, con una población adscrita de 18.107 habitantes. Se recogieron variables sociodemográficas, clínico-asistenciales y de utilización de servicios, y se clasificaron según el modelo “conductual” en “factores predisponentes”, “factores de necesidad” o “factores facilitadores”. Se empleó un análisis univariado, bivariado y multivariante, ajustando un modelo de regresión lineal múltiple con estimadores robustos. Resultados: Se incluyeron 9.443 pacientes crónicos (el 52,1% de la población de la zona seleccionada), con una edad media de 57,8 años (Desviación estándar (DE)=18,7), siendo mujeres el 62,1%. El 4,7% eran pacientes de alto riesgo, el 18,7% de medio riesgo y el 76,6% presentaba bajo riesgo. La media de contactos/año fue de 14,1 (DE=15,2). 34,4 (DE=27,9) en alto riesgo, 21,8 (DE=17,2) en riesgo medio y 10,1 (DE=10,2) en bajo riesgo. De estos contactos, 7,5 (DE=7,1) fueron con médico y 12,9 (DE=12,9) presenciales. Los factores asociados a mayor utilización fueron el riesgo alto (Coeficiente B (CB)=12,6; IC95%=11,1-14,2), el estar inmovilizado (CB=8,8; IC95%=7,3-10,4), la polimedicación (CB=6; IC95%=5,1-6,9), el ser mujer (CB=1; IC95%=0,4-1,5), el número de enfermedades crónicas (CB=1; IC95%=0,8-1,2) y la edad (CB=0,03; IC95%=0,01-0,05). Conclusiones: La utilización de servicios de Atención Primaria en los pacientes crónicos es elevada y aumenta según el nivel de riesgo asignado por los GMA. El contacto con el médico es superior frente al de la enfermería, y el tipo más frecuente es presencial. La mayor utilización responde a factores predisponentes (ser mujer y la edad) y, sobre todo, de necesidad clínica (alto riesgo, multimorbilidad, polimedicación e inmovilidad).

ABSTRACT Background: Chronic patients suffer a greater number of health problems and have greater needs for assistance and care. The objective was to describe the use of health services in Primary Care in patients with chronic conditions according to risk level by adjusted morbidity groups (AMG) and analyze the associated factors. Methods: Cross-sectional study. We included patients ≥18 years-old identified as chronic by the stratification tool according to AMG in a basic health area in the Community of Madrid with an assigned population of 18,107 inhabitants. Sociodemographic, clinical-care and use of services variables were collected and were classified according to the “behavioral” model in predisposing, need or facilitators factors. Univariate, bivariate and multiple linear regression adjusted with robust estimators was performed. Results: 9,443 chronic patients (52.1% of the population in the selected zone) were identified, mean age of 57.8 (SD=18.7); 62.1% women. According to their risk level 4.7% were high risk, 18.7% medium risk and 76.6% low risk. The mean number of contacts per year was 14.1 (SD=15.2); 34.4 (SD=27.9) in high risk; 21.8 (SD=17.2) in medium risk and 10.1 (SD=10.2) in low risk. 7.5 (SD=7.1) contacts were with the doctor and 12.9 (SD=12.9) were face-to-face. The factors associated with higher use of services were high risk (Coefficient B(CB)=12.6; IC95%=11-14.2), immobilization (CB=8.8; IC95%=7.3-10.4), polypharmacy (CB=6; IC95%=5-8.6), female sex (CB=1; IC95%=0.4-1.5), number of chronic diseases (CB=1; IC95%=0.8-1.2) and age (CB=0.03; IC95%=0.01-0.05). Conclusions: The health services utilization in Primary Care in chronic patients is high and increased according with the risk level by AMG. The contact with the doctor is superior to nurse and the most frequent type is face-to-face. The greater utilization of services responds to predisposing factors (female sex and age) and above all to need factors (high risk, immobility, multimorbidity and polypharmacy).

RESUMEN Fundamentos: Los pacientes crónicos sufren mayor número de problemas de salud y tienen mayores necesidades de asistencia y cuidados. El objetivo de este estudio fue describir la utilización de servicios de salud de Atención Primaria en los pacientes crónicos según el nivel de riesgo asignado por los grupos de morbilidad ajustados (GMA), así como analizar los factores asociados. Sujetos y métodos: Se realizó un estudio transversal. Se incluyeron pacientes ≥ 18 años identificados como crónicos por el estratificador GMA en una zona básica de salud de la Comunidad de Madrid, con una población adscrita de 18.107 habitantes. Se recogieron variables sociodemográficas, clínico-asistenciales y de utilización de servicios, y se clasificaron según el modelo “conductual” en “factores predisponentes”, “factores de necesidad” o “factores facilitadores”. Se empleó un análisis univariado, bivariado y multivariante, ajustando un modelo de regresión lineal múltiple con estimadores robustos. Resultados: Se incluyeron 9.443 pacientes crónicos (el 52,1% de la población de la zona seleccionada), con una edad media de 57,8 años (Desviación estándar (DE)=18,7), siendo mujeres el 62,1%. El 4,7% eran pacientes de alto riesgo, el 18,7% de medio riesgo y el 76,6% presentaba bajo riesgo. La media de contactos/año fue de 14,1 (DE=15,2). 34,4 (DE=27,9) en alto riesgo, 21,8 (DE=17,2) en riesgo medio y 10,1 (DE=10,2) en bajo riesgo. De estos contactos, 7,5 (DE=7,1) fueron con médico y 12,9 (DE=12,9) presenciales. Los factores asociados a mayor utilización fueron el riesgo alto (Coeficiente B (CB)=12,6; IC95%=11,1-14,2), el estar inmovilizado (CB=8,8; IC95%=7,3-10,4), la polimedicación (CB=6; IC95%=5,1-6,9), el ser mujer (CB=1; IC95%=0,4-1,5), el número de enfermedades crónicas (CB=1; IC95%=0,8-1,2) y la edad (CB=0,03; IC95%=0,01-0,05). Conclusiones: La utilización de servicios de Atención Primaria en los pacientes crónicos es elevada y aumenta según el nivel de riesgo asignado por los GMA. El contacto con el médico es superior frente al de la enfermería, y el tipo más frecuente es presencial. La mayor utilización responde a factores predisponentes (ser mujer y la edad) y, sobre todo, de necesidad clínica (alto riesgo, multimorbilidad, polimedicación e inmovilidad).

Este estudo avaliou o desempenho motor de crianças entre 7 e 10 anos, participantes e não participantes de um programa social esportivo, nas habilidades motoras fundamentais (HMF) de locomoção (LOC) e controle de objetos (CO), de acordo com o sexo. A amostra foi composta por 75 crianças, divididas em dois grupos: 43 crianças do grupo interventivo que participavam do programa Segundo Tempo e tinham aulas de educação física escolar, sendo 26 meninas e 17 meninos com média de idade de 7.6±1.3 e 8.7±1.3 anos, respectivamente e 32 crianças do grupo controle sendo 18 meninos e 14 meninas com média de idade 8.6±1.5 e 8.2±1.2 anos, respectivamente, que tinham apenas aulas de educação física. O TGMD-2 foi utilizado para avaliar as habilidades motoras de locomoção e controle de objeto antes e após o programa social esportivo. Os resultados indicaram: melhoras significativas após o término do programa para os meninos e meninas nas habilidades de locomoção e controle de objeto: ganhos semelhantes foram encontrados entre os sexos do grupo interventivo; os meninos e meninas do grupo interventivo obtiveram melhor desempenho quando comparados aos seus pares do grupo controle ao final do programa. O projeto social esportivo promoveu melhoras significativas no desempenho motor de crianças participantes.

This study evaluated the children's motor performance between 7 and 10 years, participants and non-participants in a social sports program in fundamental motor skills (HMF) mobility (LOC) and control objects (CO), according to sex. The sample consisted of 75 children, divided into two groups: 43 children in the intervention group participating in the program second time and had physical education classes, 26 girls and 17 boys with a mean age of 7.6 ± 1.3 and 8.7 ± 1.3 years respectively and 32 control children and 18 boys and 14 girls with a mean age 8.6 ± 1.5 and 8.2 ± 1.2 years, respectively, who had only physical education classes. The TGMD-2 was used to assess motor skills of movement and object control before and after social sports program. The results indicated: significant improvements after the program ends for boys and girls in locomotor skills and object control: Similar gains were found between the sexes in the intervention group; boys and girls in the intervention group performed better when compared to their peers in the control group at the end of the program. The social sports project promoted significant improvements in engine performance of participating children.

Objective to evaluate the prognostic factors of volume replacement in patients with trauma due to penetrating injuries. Methods retrospective cohort study whose data were obtained by analyzing medical records of 544 patients who were admitted to the emergency unit, victims of penetrating trauma. Results among the victims, 282 (51.9%) suffered stab wound, 262 (48.2%) injury by firearms, 486 (89.3%) were male, 382 (70.2%) were aged between 14 and 30 years. Most who received volume greater than 2000ml, systolic blood pressure ≤90mmHg and mean arterial pressure ≤65mmHg presented more mortality, with p <0.05, p <0.002 and p <0.003, respectively. Conclusion the limited volume replacement can help in the good prognosis of victims of penetrating trauma.

Objetivo avaliar os fatores prognósticos da reposição volêmica em pacientes com trauma por lesões penetrantes. Métodos estudo de coorte retrospectiva cujos dados foram obtidos através da análise de prontuários de 544 pacientes que deram entrada no serviço de emergência, vítimas de traumatismo penetrante. Resultados dentre as vítimas, 282 (51,9%) sofreram ferimento por arma branca, 262 (48,2%) ferimento por arma de fogo, 486 (89,3%) eram do sexo masculino, com idade entre 14 e 30 anos 382 (70,2%). A maioria que recebeu fluído maior que 2000ml, pressão arterial sistólica ≤90mmHg e pressão arterial média ≤65mmHg, apresentou mais mortalidade, com valor de p<0,05, p<0,002 e p<0,003, respectivamente. Conclusão a reposição volêmica limitada pode auxiliar no bom prognóstico do paciente vítima de trauma penetrante.

The germination and development of several plant species can be limited when those plants are grown in soils with high salinity, which reduces seedling viability and vigor, as well as activating the antioxidant defense system. The aim of this study was to evaluate germination, initial growth and activity of antioxidant enzymes (superoxide dismutase, catalase and ascorbate peroxidase) in seedlings of three onion cultivars (Madrugada, Fepagro 27 and Petroline) exposed to different concentrations of NaCl (0, 40, 80, 120 and 160 mM). Seedlings were evaluated for viability, vigor and antioxidant enzyme activity. The experimental procedures were completely randomized in 3 × 5 factorial design, with each treatment performed in triplicate, at a significance level of 5%. For all cultivars, viability and vigor decreased in parallel with increasing NaCl concentrations, whereas antioxidant enzyme activity increased, and one cultivar (Madrugada) showed less salt tolerance than did the others. We conclude that high NaCl concentrations have a negative effect in the physiological quality of onion seeds, resulting in lower seedling growth rates and increased antioxidant enzyme activity, where Fepagro 27 and Petroline cultivars were more tolerant to salt stress than 'Madrugada'.

O objetivo neste trabalho foi analisar o efeito de diferentes temperaturas na qualidade fisiológica e relacionar com a atividade antioxidante de três lotes de sementes de milho, as quais foram expostas por 24h às temperaturas de 15, 25, 35 e 40°C e, após, avaliadas quanto à porcentagem, índice de velocidade e primeira contagem de germinação, como também crescimento inicial e atividade de enzimas antioxidantes nas plântulas. O delineamento experimental foi inteiramente casualizado, com quatro repetições, com posterior análise de regressão polinomial. Os resultados evidenciaram que as sementes dos três lotes de milho, expostas às temperaturas de 15 e 40°C, foram de melhor qualidade fisiológica (vigor), o que explica a baixa atividade das enzimas do sistema de defesa antioxidante nessas mesmas temperaturas. O sistema de defesa antioxidante tem relação com a qualidade fisiológica de sementes de milho expostas ao estresse térmico.

The aim of this research was to analyze the effect of different temperatures on physiological quality and relate the responses with the antioxidant activity of three lots of corn seeds. The seeds from three lots were exposed for 24h at temperatures of 15, 25, 35 and 40°C and then evaluated for percentage, speed index and first germination count, as well as early growth and activity of antioxidant enzymes in the seedlings. The experimental design was completely randomized with four replications, with subsequent polynomial regression analysis. The results showed that the seeds from the three lots of corn exposed to temperatures of 15 and 40°C, were of better high physiological quality (vigor), which explains the low activity of enzymes of the antioxidant defense system in these same temperatures. The antioxidant defense system is related to the physiological quality of corn seeds exposed to thermal stress.

Certain mutations in BRCA1 and BRCA2 genes are frequent in the Ashkenazi Jewish population. Several factors contribute to this increased frequency, including consanguineous marriages and an event known as a "bottleneck', which occurred in the past and caused a drastic reduction in the genetic variability of this population. Several studies were performed over the years in an attempt to elucidate the role of BRCA1 and BRCA2 genes in susceptibility to breast cancer. The aim of this study was to estimate the carrier frequency of certain common mutations in the BRCA1 (185delAG and 5382insC) and BRCA2 (6174delT) genes in an Ashkenazi Jewish population from Porto Alegre, Brazil. Molecular analyses were done by PCR followed by RFLP (ACRS). The carrier frequencies for BRCA1 185delAG and 5382insC were 0.78 and 0 respectively, and 0.4 for the BRCA2 6174deT mutation. These findings are similar to those of some prior studies but differ from others, possibly due to excluding individuals with a personal or family history of cancer. Our sample was drawn from the community group and included individuals with or without a family or personal history of cancer. Furthermore, increased dispersion among Ashkenazi subpopulations may be the result of strong genetic drift and/or admixture. It is therefore necessary to consider the effects of local admixture on the mismatch distributions of various Jewish populations.