A desafiante intervenção na obesidade pediátrica motivou um estudo quantitativo e qualitativo sobre os aspetos psicossociais num programa comportamental baseado no exercício físico com adolescentes e envolvendo os seus pais. Os 24 adolescentes (17 raparigas) com excesso de peso (31 ± 4,9 kg/m2), com 13,2 anos em média, seguidos na consulta dum hospital, participaram num programa de 4 meses que incluiu exercício físico estruturado, oito sessões educativas sobre mudança comportamental e envolvimento parental. Mediu-se a percepção do suporte da equipa técnica, a autoregulação para o tratamento, as necessidades psicológicas básicas e a percepção do suporte parental,aos 0 e 4 meses. Aos 2,5 meses 20 adolescentes e 16 pais participaram voluntariamente em grupos focais analisando o impacto do programa. Verificaram-se melhorias na satisfação da necessidade de relacionamento, mas não no peso. Na opinião dos filhos o exercício é a principal força do programa, mas para os pais é o formato personalizado e em grupo; sendo a desilusão com a escassa perda de peso uma fraqueza para ambos.A discussão compara os dados quantitativos com e as opiniões convergentes e divergentes de pais e filhos, reforçando a pertinência do exercício e da teoria da auto-determinação para a intervenção na obesidade, por trazer benefícios psicológicos mesmo sem perda de peso.

This study aimed to analyze the changes in self-regulation, basic psychological needs, staff and parents support after the first 4-months of a weight management program with adolescents. To improve our understanding about the clinical implications, we also analyze the participants' views (adolescents and their parents) about the program. The 24 overweight adolescents (31 ± 4.9 kg/m²; 17 girls; 13,2 years), followed in a tertiary health unit, participated in a 4-month program with structured exercise, eight educational sessions on behavioral change and parental involvement. We measured the perception of staff and parental support, self-regulation for treatment, basic psychological needs at 0 and 4 months. At 2,5 months 20 adolescents and 16 parents participated in focus groups to analyze the impact of the program. There were improvements in relatedness satisfaction, but not in weight. The adolescent’s opinion found the exercise as the main strength of the program, but for parents was the personalized and group format; for both parents and sons the main weakness of the program was the disillusionment with weight loss. The discussion suggests that the weight loss treatmentbased on exercise and self-determination theory principles could bring psychological benefits even without weight loss.

Resumo: Com este estudo objetivou-se descrever a topografia do cone medular do macaco-prego (Sapajus libidinosus) a fim de fornecer suporte para que a realização de procedimentos anestésicos, bem como exames de mielografia e coleta de líquor, dentre outros procedimentos que utilizam a via epidural. Para tanto foram dissecados oito animais, sendo seis machos e duas fêmeas, de diferentes faixas etárias. Rebateu-se a pele para retirada da musculatura da região dorsal, exposição de toda a coluna vertebral e identificação das vértebras lombares e sacrais. Para estabelecer o final da medula espinhal e medir o comprimento do cone medular, foi aberto todo o canal vertebral lombossacro, seccionando-se lateralmente os arcos vertebrais. Em seguida a duramáter foi seccionada para visualização do cone medular e observação da relação topográfica deste com as vértebras. Todos os animais apresentaram cinco vértebras lombares e três vértebras sacrais. As vértebras se apresentaram, de forma geral, muito próximas e com os processos espinhosos bem desenvolvidos e direcionados em sentido cranial. O cone medular dos macacos-prego situou-se entre as vértebras L2 e L5, com a base localizando-se com maior frequência na altura da vértebra L3, enquanto o ápice em L4. O comprimento corporal (espaço interarcual occiptoatlântico até o espaço interarcual sacrocaudal) variou de 22,9 a 31,8cm, com média de 27,44 ±3,1cm enquanto que comprimento do cone medular variou de 1,70 a 3,51cm, com média de 2,47 ±0,57cm. Não houve correlação entre o tamanho do corpo e o comprimento do cone medular (r = 0,212). Conclui-se que apesar das variações do comprimento e posicionamento do cone medular, o seu ápice não ultrapassa a articulação lombossacral, tornando seguro o acesso ao espaço epidural por esta via.

Abstract: This study aimed to describe the topography of the conus of capuchin monkey (Sapajus libidinosus) to provide support for anesthetic procedures, as well as examinations of myelography and CSF collection, among other procedures using the epidural route. Eight animals were dissected, six males and two females, of different ages. The skin was countered for removal of the dorsal musculature for exposure of the entire spine and identification of the lumbar and sacral vertebrae. To establish the end of the spinal cord and to measure the length of the conus medullaris, we opened the lumbosacral spinal canal through side section of the vertebral arches. The dura mater was sectioned to visualize the conus and to observe the topographical relation with the vertebrae. All animals showed five lumbar vertebrae and three sacral vertebrae. The vertebrae were in general very closed with the spinous processes well developed and directed cranially. The conus of capuchin monkeys was located between the L2 and L5 vertebrae, with the base mostly in the L3 vertebra, and the peak in L4. The body length (interarcual space occiptoatlântico until sacrocaudal interarcual space) ranged from 22.9 to 31.8cm, with a mean of 27.44±3.1cm while the medullary cone length ranged from 1.70 to 3.51cm, with a mean of 2.47±0.57cm. There was no correlation between body size and length of the medullary cone (r=0.212). It is concluded that despite the variations in length and positioning of the medullary cone, its height does not exceed the lumbosacral joint, making safe access to the epidural space in this way.

Processes involving heavy metals and other contaminants continue to present unsolved environmental questions. To advance the understanding of geochemical processes that involve the bioavailability of contaminants, cores where collected in the Rodrigo de Freitas lagoon, and analyzed for bacterial activity and metal concentrations. Results would suggest an extremely reducing environment where organic substances seem to be the predominant agents responsible for this geochemical process. Analytical data showed sulphate reduction to be the main agent driving this process, since this kind of bacteria was found to be active in all of the samples analyzed. Esterase enzyme production did not signal the influence of heavy metals and hydrocarbon concentrations and heavy metals were found to be unavailable for biota. However, correlation between results for bacterial biomass and the potentially mobile percentage of the total Ni concentrations would suggest a negative impact.

The purpose of the present study was to explore the usefulness of the Mexican sequential organ failure assessment (MEXSOFA) score for assessing the risk of mortality for critically ill patients in the ICU. A total of 232 consecutive patients admitted to an ICU were included in the study. The MEXSOFA was calculated using the original SOFA scoring system with two modifications: the PaO2/FiO2 ratio was replaced with the SpO2/FiO2 ratio, and the evaluation of neurologic dysfunction was excluded. The ICU mortality rate was 20.2%. Patients with an initial MEXSOFA score of 9 points or less calculated during the first 24 h after admission to the ICU had a mortality rate of 14.8%, while those with an initial MEXSOFA score of 10 points or more had a mortality rate of 40%. The MEXSOFA score at 48 h was also associated with mortality: patients with a score of 9 points or less had a mortality rate of 14.1%, while those with a score of 10 points or more had a mortality rate of 50%. In a multivariate analysis, only the MEXSOFA score at 48 h was an independent predictor for in-ICU death with an OR = 1.35 (95%CI = 1.14-1.59, P < 0.001). The SOFA and MEXSOFA scores calculated 24 h after admission to the ICU demonstrated a good level of discrimination for predicting the in-ICU mortality risk in critically ill patients. The MEXSOFA score at 48 h was an independent predictor of death; with each 1-point increase, the odds of death increased by 35%.

No final da década de 90, a comunidade de Rio Natal, no município de São Bento do Sul, SC, passou a fazer parte de uma Área de Preservação Ambiental e desde então, muitas áreas de cultivo, paulatinamente, estão retomando o processo de formação florestal. Neste cenário, foi sugerido pela comunidade, a possibilidade de cultivo de plantas medicinais adaptadas às condições de sombreamento. Em atendimento a essa demanda foi realizada uma pesquisa participativa na comunidade, de 2005 a 2008, onde foram avaliadas 14 espécies de plantas medicinais com potencial de mercado, cultivadas em áreas sombreadas, em três propriedades familiares. Foram avaliados: taxa de sobrevivência das espécies, incidência de doenças e pragas, teor de massa seca e altura das plantas. Apresentaram persistência ao cultivo em áreas sombreadas as espécies: Curcuma longa L. (açafrão-da-índia); Arctium lappa L. (bardana); Pfaffia glomerata (Spreng) Pedersen (fáfia ou ginseng-brasileiro); Mikania glomerata Sprengel (guaco); Alternanthera brasiliana L. Kuntze (penicilina); Pogostemon cablin (Blanco) Benth (patchuli) e Maytenus ilicifolia Mart. Ex Reissek (espinheira-santa).

In the end of the 1990s, the Rio Natal community, located in the city of São Bento do Sul, in the Brazilian State of Santa Catarina, started to be part of an Environmental Protection Area. Since then, many cultivation areas have been increasingly having their forest restored. In this scenario, the community proposed to cultivate medicinal plants that were adapted to shaded conditions. To attend this demand, we carried out a participatory research in the community between 2005 and 2008. Fourteen species of medicinal plants having market potential were evaluated, and were cultivated in shaded areas, in three family properties. The survival of the species, the incidence of illnesses and pests, the dry matter value and the height of the plants were evaluated. The species that presented persistence to be cultivated in shaded areas were: Curcuma longa L.; Arctium lappa L.; Pfaffia glomerata (Spreng) Pedersen.; Mikania glomerata Sprengel.; Alternanthera sp.; Pogostemon cablin (Blanco) Benth. e Maytenus ilicifolia Mart. Ex Reissek.

RESUMO Avaliou-se a intensidade de pragas e inimigos naturais em um consórcio de milho (Zea maiz) e feijão (Vigna unguiculata), assim como a incidência de pragas em grãos armazenados dos respectivos cultivos. Os tratamentos consistiram em: Solo sem adubação, Calagem e adubação química, Lodo não higienizado, Lodo higienizado com extrato de neem (Azadirachta indica), Lodo tratado com cal virgen, Composto orgânico de lodo e Ipomoea carnea, Composto orgânico de lodo e I. carnea + fosfato natural no início da compostagem, Lodo não higienizado + fosfato natural no campo, Lodo higienizado com neem + fosfato natural no campo, Lodo tratado com cal virgen + fosfato natural no campo, Composto orgânico de lodo e I. carnea + fosfato natural no campo. As avaliações de pragas e inimigos naturais foram semanais e os dados obtidos foram submetidos à análise de variância e ao teste Scott-Knott a 5% de probabilidade. O tratamento onde se avaliou o lodo higienizado com neem foi o que apresentou o menor ataque de pragas. Outro tratamento pouco atacado por pragas foi o que se avaliou o lodo higienizado com neem e fosfato no solo. Portanto, esses tratamentos são recomendados para os produtores.

RESUMEN Se evaluó la intensidad del ataque de plagas y enemigos naturales en una asociación de maíz (Zea maiz) y fríjol caupí (Vigna unguiculata), así como la incidencia de plagas en granos almacenados de los respectivos cultivos. Los tratamientos consistieron en: Suelo sin fertilización, Encalado y fertilización química, Lodo no higienizado, Lodo higienizado con extracto de neem (Azadirachta indica), Lodo tratado con cal virgen, Compuesto orgánico de lodo y Ipomoea carnea, Compuesto orgánico de lodo y I. carnea + fosfato natural al inicio del compostaje, Lodo no higienizado + fosfato natural en el campo, Lodo higienizado con neem + fosfato natural en el campo, Lodo tratado con cal virgen + fosfato natural en el campo, Compuesto orgánico de lodo y I. carnea + fosfato natural en el campo. Se realizaron observaciones semanales de plagas y enemigos naturales y los datos obtenidos se sometieron a análisis de varianza y la prueba de Scott-Knott a 5% de probabilidad. El suelo que recibió lodo de alcantarillado tratado con neem fue el que presentó el menor ataque de plagas. Otro tratamiento poco atacado por plagas fue el que recibió lodo de alcantarillado seco higienizado con extracto de neem + aplicación en el campo de fosfato natural reactivo. Por lo tanto, esos dos tratamientos son los recomendados para los productores.

O experimento foi realizado em dois anos para avaliar o potencial de produção de bovinos em pastagens de Brachiaria decumbens adubadas com nitrogênio (N). Foram determinadas as massas de forragem total (MFT) e de forragem verde (MFV), a composição morfológica e o valor nutritivo da forragem potencialmente consumível, bem como o desempenho animal e a taxa de lotação (TL) das pastagens. Os tratamentos consistiram de quatro doses de N - 75, 150, 225 e 300kg/ha.ano -, em delineamento de blocos ao acaso, com duas repetições. Nos dois anos, as MFT e MFV aumentaram linearmente em função da aplicação de N. A composição química da forragem potencialmente consumível foi pouco alterada pela aplicação de N. A adubação nitrogenada não influenciou o ganho de peso individual dos novilhos, mas aumentou a TL - de 3,6 para 5,3 e de 3,7 para 5,2UA/ha no primeiro e segundo ano, respectivamente - e a produção animal por área da pastagem - de 404,2 para 737,9 e de 619,7 para 1008,4kg/ha no primeiro e segundo anos, respectivamente.

The experiment which aimed to evaluate the potential of cattle production on nitrogen-fertilized Brachiaria decumbens pastures was carried out in two years. The total forage mass (TFM), green forage mass (GFM), morphological composition and nutritive value of the potentially consumed forage were determined, as well as the animal performance and the stocking rate (SR). The treatments encompassed four doses of N, being 75, 150, 225 and 300kg/ha.year. A randomized block design with two repetitions was used. The chemical composition of the potentially consumable forage was little altered by the N application. N-fertilization did not influence the weight gain of steers, but increased the SR from 3.6 to 5.3 in the first year and from 3.7 to 5.2 animal units per hectare in the second year, and the production by area of pasture from 404.2 to 737.9kg/ha in the first year and from 619.7 to 1008.4kg/ha in the second year. N-fertilization increases forage mass, stocking rate and animal production by area of pasture on B. decumbens cv. Basilisk pastures managed under continuous stocking with varying stocking rate.

Carbon nanotubes are highly versatile materials; new applications using them are continuously being developed. Special attention is being dedicated to the possible use of multiwalled carbon nanotubes in biomaterials contacting with bone. However, carbon nanotubes are also controversial in regards to effects exerted on living organisms. Carbon nanotubes can be used to improve the tribological properties of polymer/composite materials. Ultrahigh molecular weight polyethylene (UHMWPE) is a polymer widely used in orthopedic applications that imply wear and particle generation. We describe here the response of human osteoblast-like MG63 cells after 6 days of culture in contact with artificially generated particles from both UHMWPE polymer and multiwalled carbon nanotubes (MWCNT)/UHMWPE nanocomposites. This novel composite has superior wear behavior, having thus the potential to reduce the number of revision hip arthroplasty surgeries required by wear failure of acetabular cups and diminish particle-induced osteolysis. The results of an in vitro study of viability and proliferation and interleukin-6 (IL-6) production suggest good cytocompatibility, similar to that of conventional UHMWPE (WST-1 assay results are reported as percentage of control ± SD: UHMWPE = 96.19 ± 7.92, MWCNT/UHMWPE = 97.92 ± 8.29%; total protein: control = 139.73 ± 10.78, UHMWPE = 137.07 ± 6.17, MWCNT/UHMWPE = 163.29 ± 11.81 µg/mL; IL-6: control = 90.93 ± 10.30, UHMWPE = 92.52 ± 11.02, MWCNT/UHMWPE = 108.99 ± 9.90 pg/mL). Standard cell culture conditions were considered as control. These results, especially the absence of significant elevation in the osteolysis inductor IL-6 values, reinforce the potential of this superior wear-resistant composite for future orthopedic applications, when compared to traditional UHMWPE.

Since the advent of cardiopulmonary resuscitation more than 40 years ago, we have achieved a return to spontaneous circulation in a growing proportion of patients with cardiac arrest. Nevertheless, most of these patients die in the first few days after admission to the intensive care unit (ICU), and this situation has not improved over the years. Mortality in these patients is mainly associated to brain damage. Perhaps recognizing that cardiopulmonary resuscitation does not end with the return of spontaneous circulation but rather with the return of normal brain function and total stabilization of the patient would help improve the therapeutic management of these patients in the ICU. In this sense, the term cardiocerebral resuscitation proposed by some authors might be more appropriate. The International Liaison Committee on Resuscitation recently published a consensus document on the "Post-Cardiac Arrest Syndrome" and diverse authors have proposed that post-arrest care be integrated as the fifth link in the survival chain, after early warning, early cardiopulmonary resuscitation by witnesses, early defibrillation, and early advanced life support. The therapeutic management of patients that recover spontaneous circulation after cardiopulmonary resuscitation maneuvers based on life support measures and a series of improvised actions based on "clinical judgment" might not be the best way to treat patients with post-cardiac arrest syndrome. Recent studies indicate that using goal-guided protocols to manage these patients including therapeutic measures of proven efficacy, such as inducing mild therapeutic hypothermia and early revascularization, when indicated, can improve the prognosis considerably in these patients. Given that there is no current protocol based on universally accepted evidence, the Steering Committee of the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive Medicine and Cardiac Units has elaborated this document after a thorough review of the literature and an online discussion involving all the members of the committee and a consensus meeting with the aim of providing a platform for the development of local protocols in different ICSs in our country to fit their own means and characteristics.

Desde el advenimiento de la resucitación cardiopulmonar (RCP), hace más de 40 años, se ha conseguido que cada vez una mayor proporción de pacientes con parada cardiorrespiratoria logren la recuperación de la circulación espontánea (RCE). Sin embargo, la mayoría de estos pacientes fallecen en los primeros días tras su ingreso en las unidades de cuidados intensivos (UCI), y esta situación no ha mejorado en estos años. La mortalidad de estos pacientes se asocia en gran medida a daño cerebral. Posiblemente, el reconocimiento de que la RCP no se acaba con la RCE, sino con el retorno de la función cerebral normal y la estabilización total del paciente, nos ayudará a mejorar el tratamiento terapéutico de estos pacientes en las UCI. En este sentido, parece más apropiado el término "resucitación cardiocerebral", como proponen algunos autores. Recientemente, el Internacional Liaison Committee on Resuscitation (ILCOR) ha publicado un documento de consenso sobre el "síndrome posparada cardíaca" y diversos autores han propuesto que los cuidados posparada se integren como un quinto eslabón de la cadena de supervivencia, tras la alerta precoz, la RCP precoz por testigos, la desfibrilación precoz y el soporte vital avanzado precoz. El manejo terapéutico de los pacientes que recuperan la circulación espontánea tras las maniobras de RCP basada en medidas de soporte vital y una serie de actuaciones improvisadas basadas en el "juicio clínico" puede que no sea la mejor forma de tratar a los pacientes con "síndrome posparada cardíaca". Estudios recientes indican que el tratamiento de estos pacientes mediante protocolos guiados por objetivos -incluyendo las medidas terapéuticas que han demostrado su eficacia, como la hipotermia terapéutica inducida leve y la revascularización precoz, cuando esté indicada- puede mejorar notablemente el pronóstico de éstos. Dado que en el momento actual no existe un protocolo basado en la evidencia universalmente aceptado, el Comité Directivo del Plan Nacional de RCP de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), tras una revisión exhaustiva de la literatura científica sobre el tema, seguida de una discusión en línea entre todos los miembros del comité y una reunión de consenso, ha elaborado el presente documento con la intención de que pueda servir como base para el desarrollo de protocolos locales en las diferentes UCI de nuestro país, teniendo en cuenta sus medios y sus características propias.

Endothelial function (EF) plays an important role in the onset and clinical course of atherosclerosis, although its relationship with the presence and extent of coronary artery disease (CAD) has not been well defined. We evaluated EF and the ST segment response to an exercise test in patients with a broad spectrum of CAD defined by coronary angiography. Sixty-two patients submitted to diagnostic catheterization for the evaluation of chest pain or ischemia in a provocative test were divided into three groups according to the presence and severity of atherosclerotic lesions (AL): group 1: normal coronaries (N = 19); group 2: CAD with AL <70% (N = 17); group 3: CAD with AL ≥70% (N = 26). EF was evaluated by the percentage of flow-mediated dilatation (%FMD) in the brachial artery during reactive hyperemia induced by occlusion of the forearm with a pneumatic cuff for 5 min. Fifty-four patients were subjected to an exercise test. Gender and age were not significantly correlated with %FMD. EF was markedly reduced in both groups with CAD (76.5 and 73.1% vs 31.6% in group 1) and a higher frequency of ischemic alterations in the ST segment (70.8%) was observed in the group with obstructive CAD with AL ≥70% during the exercise test. Endothelial dysfunction was observed in patients with CAD, irrespective of the severity of injury. A significantly higher frequency of ischemic alterations in the ST segment was observed in the group with obstructive CAD. EF and exercise ECG differed among the three groups and may provide complementary information for the assessment of CAD.

We studied the ability of patients not experienced in the use of peak expiratory flow meters to assess the severity of their asthma exacerbations and compared it to the assessment of experienced clinicians. We also evaluated which data of physical examination and medical history are used by physicians to subjectively evaluate the severity of asthma attacks. Fifty-seven adult patients (15 men and 42 women, with a mean (± SD) age of 37.3 ± 14.5 years and 24.0 ± 17.9 years of asthma symptoms) with asthma exacerbations were evaluated in a University Hospital Emergency Department. Patients and physicians independently evaluated the severity of the asthma attack using a linear scale. Patient score, physician score and forced expiratory volume at the first second (FEV1) were correlated with history and physical examination variables, and were also considered as dependent variables in multiple linear regression models. FEV1 correlated significantly with the physician score (rho = 0.42, P = 0.001), but not with patient score (rho = 0.03; P = 0.77). Use of neck accessory muscles, expiratory time and wheezing intensity were the explanatory variables in the FEV1 regression model and were also present in the physician score model. We conclude that physicians evaluate asthma exacerbation severity better than patients and that physician's scoring of asthma severity correlated significantly with objective measures of airway obstruction (FEV1). Some variables (the use of neck accessory muscles, expiratory time and wheezing intensity) persisted as explanatory variables in physician score and FEV1 regression models, and should be emphasized in medical schools and emergency settings.

Preterm delivery is the main cause of neonatal death and ultrasonographic cervical assessment has been shown to be more accurate than digital examination in recognizing a short cervix. This is a cross-sectional study, involving 1131 women at 22-24 weeks of pregnancy, designed to determine the distribution of cervical length and to examine which variables of demographic characteristics and obstetric history increase the risk of a short cervix (15 mm or less). The distribution of maternal demographic and obstetric history characteristics among patients with cervical length £15 mm was analyzed and compared to the findings for the general population. Risk ratios (RR) between subgroups were generated from this comparison. Median cervical length was 37 mm and in 1.5% of cases it was 15 mm or less. The proportion of women with a short cervix (<=15 mm) was significantly higher among patients with a low body mass index (RR = 3.5) and in those with previous fetal losses between 16-23 weeks (RR = 33.1) or spontaneous preterm deliveries between 24-32 weeks (RR = 14.1). We suggest that transvaginal sonographic measurement of cervical length be performed as part of a routine midtrimester ultrasound evaluation. There are specific variables of demographic characteristics and obstetric history which increase the risk of detecting a short cervix at 22-24 weeks.

OBJETIVOS: Avaliar os resultados de colpocitologia oncótica de mulheres atendidas em ambulatório de ginecologia preventiva (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo). MÉTODOS: Foram estudadas 6821 mulheres submetidas a exame clínico e ginecológico com realização de colpocitologia oncótica pela técnica de Papanicolaou. Estas mulheres foram consideradas conforme a faixa etária em três grupos: abaixo de 40 anos, entre 41 e 60 anos e acima de 60 anos. RESULTADOS: Amaioria das mulheres reconhecem tanto a necessidade da colpocitologia como sua periodicidade, principalmente entre as mais jovens. As mulheres acima de 60 anos eram as que mais referiam (54,1%) não conhecer a necessidade da colpocitologia oncótica, nem sua periodicidade (58,8%); o grupo que melhor referia conhecimento da necessidade e periodicidade da colpocitologia oncótica foi o de mulheres entre 40 e 60 anos. O material foi considerado insuficiente para análise em 15,1% ou inadequado em 1,1%, sendo os resultados: classe I (21,7%), II (59,9%), III (2,0%), IV (0,1%) e V (0,1%). Não houve diferença significativa em relação à distribuição dos casos de neoplasia intraepitelial (NIC) entre as faixas etárias. O achado microbiológico mais freqüente foi Gardnerella sp. (8,6%). Presença de papilomavírus humano (HPV) foi significativamente menor nas mulheres acima de 60 anos. CONCLUSÕES: O diagnóstico de alterações colpocitológicas relacionadas a neoplasias foi de 2,2% com detecção de Gardnerella sp. como o agente microbiológico mais prevalente por este método. A distribuição de infecção pelo HPV mostrou declínio com o aumento da faixa etária. As mulheres mais velhas foram as que menos apresentavam conhecimento sobre a realização de colpocitologia.

BACKGROUND: evaluate the results of Pap smear in women attended at a gynecology preventive ambulatory (University of São Paulo Medical School Clinical Hospital). METHODS: 6821 women were submitted to a medical interview, clinical and gynecologic exam. Cervical and vaginal cytology (Pap smear) were analyzed according to the Papanicolaou method and classification. All women were grouped according to their age into three categories:under 40 years old, between 41 and 60 years and over 60 years. RESULTS: most of them, and mainly the younger ones, had been submitted to a previous Pap smear in a period shorter than 1 year (44.2%). The majority of women recognized the usefulness of the exam and knew its interval; the group that best knew its importance and interval was the one with ages between 41 and 60 years, while most women over 60 years did not know both its importance and interval. Cytological material was considered insufficient for analysis in 15,1% and inadequate in 1.1%, and for those with adequate material results were classes I (21.7%), II (59.9%), III (2.0%), IV (0.1%) and V (0.1%). Distribution of cervical intraepithelial neoplasia (CIN) were similar in the three groups. The main microbiologic findings was Gardnerella sp. (8,6%) and Human papillomavirus (HPV) incidence was significantly lower among women over 60 years. CONCLUSION: Cytological diagnoses of neoplastic modifications were performed in 2,2% and Gardnerella sp. was the most prevalent microbiologic agent. Distribution of HPV showed a decrease with age. Older women had lower knowledge on the importance of regular Pap smear examination.