Abstract Beekeeping generates currencies for Mexico, however, Tabasco ranks 25th in national production. The municipality of Comalcalco has agroecological resources with beekeeping potential. In order to analyze the socioeconomic and technical aspects of beekeeping, 11 beekeepers were interviewed, classifying them into four strata. The apiaries were georeferenced for geoprocessing. Africanization was determined by mtDNA in drones. The average age of the beekeepers was 48 years, with 8 years of experience, detecting that beekeeping is not their main economic activity. Honey yield was 46.2 kg Colony−1 higher than the state average (37 kg Colony−1). The mtDNA analysis identified 100% Africanization, possibly due to the fact that the annual replacement of queen bees of European origin does not take place. Four contrasting agroecosystems were identified. The results found indicate that it is necessary to implement strategies for the sustainable use of beekeeping and generational germplasm in the entity.

Resumen La apicultura genera divisas para México, sin embargo, Tabasco ocupa el 25vo lugar en producción a nivel nacional. El municipio de Comalcalco, posee recursos agroecológicos con potencial apícola. Con el objetivo de analizar los aspectos socioeconómicos y técnicos de la apicultura, se entrevistaron 11 apicultores, clasificándolos en cuatro estratos. Los apiarios fueron georreferenciados para geoprocesamiento. Se determinó la africanización mediante ADNmt en zánganos. La edad promedio de los apicultores fue 48 años, con 8 años de experiencia, detectando que la apicultura no es su principal actividad económica. El rendimiento de miel fue de 46.2 kg Colonia−1 mayor al promedio estatal (37 kg Colonia−1). El análisis del ADNmt identificó 100% de africanización, posiblemente debido a que el cambio anual de abejas reinas de origen europeo no se realiza. Se identificaron cuatro agroecosistemas contrastantes. Los resultados encontrados indican que se requiere implementar estrategias para el aprovechamiento sustentable del germoplasma apícola y generacional en la entidad.

Abstract: Objective: To describe the outcome and associated complications with the use of peripherally inser ted central venous catheters in neonates, and to identify risk factors associated with the presence of major complications. Subjects and Method: Analytical study of the follow-up of catheters placed in 541 neonates hospitalized in a neonatal intensive care unit. Outcome and complications were descri bed. To assess risk factors associated with major complications, multivariate logistic regression analy sis was used. Results: 655 catheters were placed in 541 infants with birth-weight ranging from 420g to 4.575g. The mean duration was 11.6 ± 8.5 days. 29 patients (4.4%) presented major complications, and associated bloodstream infection was the most frequent (n = 17), determining an infection rate of 2.25 %o catheter days. Infections were more frequent among catheters lasting > 14 days: 9/179 (5%) vs 8/476 (1.7%) of those lasting ≤ 14 days (p < 0.05). Other complications included: pleural effusion due to extravasation (n = 6) and atrial thrombosis (n = 3). Multivariate analysis showed that the presence of major complications was associated with a gestational age < 28 weeks: OR 5.9 (95% CI 1.2 to 40), and upper extremities use: OR 3.2 (95% CI 1.1-7.0). Infections were associated with a greater number of punctures during placement: OR 2.1 (95% CI 1.2-4.8) for each puncture and ges tational age < 28 weeks: OR 7.9 (95% CI: 1.4-73). Conclusion: The use of catheters was long-lasting and with a low rate of major complications, which were more common in extremely preterm infants. Infections were associated with an increased number of punctures and duration > 14 days. Other complications were more frequent when upper extremities insertion was used.

Resumen: Objetivo: Describir la evolución y complicaciones asociadas al uso del catéter venoso central de inserción periférica en recién nacidos e identificar los factores de riesgo asociados a ellas. Sujetos y Método: Estudio analítico del seguimiento de catéteres instalados en 541 recién nacidos hospita lizados en una Unidad Neonatal. Se caracterizan su evolución y complicaciones. Para evaluar los factores de riesgo asociados a complicaciones se realizó análisis de regresión logística multivariado. Resultados: Se instalaron 655 catéteres en 541 recién nacidos con peso de nacimiento entre 420 y 4.575 g. La duración promedio fue de 11,6 ± 8,5 días. En 29 pacientes (4,4%) se observaron compli caciones mayores, siendo la más frecuente la infección del torrente sanguíneo (n = 17), determinando una tasa de 2,25 %o días-catéter. Ellas fueron más frecuentes en aquellos catéteres que permanecie ron > 14 días: 9/179 (5%) vs 8/476 (1,7%) de los ≤ 14 días (p < 0,05). Entre las complicaciones no infecciosas destacaron: derrame pleural por extravasación (n = 6) y trombosis auricular (n = 3). El análisis multivariado mostró que ellas se asociaron a una edad gestacional < 28 semanas: OR 5,9 (IC95%: 1,2-40) y a su instalación en extremidades superiores OR 3,2 (IC95% 1,1-7,0). Las infeccio nes se asociaron a > número de punciones en su instalación: OR 2,1 (IC95% 1,2-4,8) por punción y edad gestacional < 28 semanas: OR 7,9 (IC 95%: 1,4-73). Conclusión: Los catéteres resultaron de larga duración y baja tasa de complicaciones mayores. Éstas se presentan mayormente en prematuros extremos. Las infecciones se asociaron a > número de punciones y duración > 14 días, las otras com plicaciones se asociaron con la instalación en extremidades superiores.

Abstract Access to genetic resources (GR) and/or traditional knowledge associated with genetic resources (ATK) has been regulated in Brazil since 2001. The law 13,123 / 2015 determined a significant change in the theme, mainly on the rules of distribution of benefits obtained for conservation and sustainable use of biodiversity, the access to technology and technology transfer, the exploitation of products or reproductive material from the GR or ATK and consignment to the outside of part or all the living or dead organism shipped for GR. The implementation of international treaties on GR and ATK for research, biotechnological development and bioprospecting have been causing difficulties for Brazilian researchers, mainly due to the lack of information and dissemination available for compliance with the legislation. In this work, the members of the Committee for Access to Genetic Resources and Associated Traditional Knowledge of the Federal Fluminense University (UFFGEN) - Brazil, and collaborators performed a critical reflection on the new law, helping Brazilian researchers with information necessary to understand the changes made by the new legislation, especially in the field of Biotechnology associated with Brazilian Biodiversity.

ABSTRACT Objectives: To determine the factors associated with Mycobacterium tuberculosis complex-positive blood culture. Methods: Case-control study. Sociodemographic, clinical and laboratory data were collected from 2000 to 2015. Results: We reviewed medical records of 533 patients with culture-proven tuberculosis, of whom 27.2% (145/533) had blood culture available. Patients with mycobacteremia presented more frequently with abdominal tuberculosis, body mass index <18 kg/m2, and had lower hemoglobin and albumin levels. No differences were observed regarding HIV status. Conclusions: Few studies have reported on the characteristics associated with Mycobacterium tuberculosis complex bacteremia, especially among Human Immunodeficiency Virus-negative patients. Out of 145 tuberculosis-infected patients with blood culture results available, 21 turned out positive. Anemia, hypoalbuminemia, and a body mass index < 18 kg/m2 were associated with mycobacteremia.

Purpose - This paper aims to investigate the relatiónship between legitimate and expert social power types of preadolescent childrenon the influence perceptión in their mothers’ purchasing behavior in Peruvian toy stores. The literature review takes into consideratión the concepts of social power and the influenceon family behavior to then focuson social power within family behavior with the purpose of mainly developing four hypotheses regarding purchasing behavior. Design/methodology/approach - The methodology followed a non-experimental transversal correlatiónal-causal design. A pilot sample size of 67 cases was used. The sample was basedon an objective populatión of Peruvian mothers of families that live in northern Lima and that go to purchase toys to major shopping centers with their children aged 8-11 years. Findings - The results show that the expert social power, as well as the legitimate social power, has a strong relatiónship. In additión, both social powers have an impacton the influence perceptión in purchasing child-mother, but noton the influence perceptión in purchasing mother-child. Moreover, the test of moderatión of the expenditure levelon toy purchases did not have an effecton the context that was studied. Originality/value - The contributión shows that important changes are happening in the consumptión behavioron the aspect of children influencing mothers, and that for Latin American contexts, the level of expenditure still does not crucially affect the causality demonstrated.

Abstract Objective: Ventricular fibrillation (VF)-related sudden cardiac death (SCD) is a leading cause of mortality and morbidity. Current biological and imaging parameters show significant limitations on predicting cerebral performance at hospital admission. The AWAKE study (NCT03248557) is a multicentre observational study to validate a model based on spectral ECG analysis to early predict cerebral performance and survival in resuscitated comatose survivors. Methods: Data from VF ECG tracings of patients resuscitated from SCD will be collected using an electronic Case Report Form. Patients can be either comatose (Glasgow Coma Scale GCS --- ≤8) survivors undergoing temperature control after return of spontaneous circulation (RoSC), or those who regain consciousness (GCS = 15) after RoSC; all admitted to Intensive Cardiac Care Units in 4 major university hospitals. VF tracings prior to the first direct current shock will be digitized and analyzed to derive spectral data and feed a predictive model to estimate favorable neurological performance (FNP). The results of the model will be compared to the actual prognosis. Results: The primary clinical outcome is FNP during hospitalization. Patients will be categorized into 4 subsets of neurological prognosis according to the risk score obtained from the predictive model. The secondary clinical outcomes are survival to hospital discharge, and FNP and survival after 6 months of follow-up. The model-derived categorisation will be also compared with clinical variables to assess model sensitivity, specificity, and accuracy. Conclusions: A model based on spectral analysis of VF tracings is a promising tool to obtain early prognostic data after SCD.

Resumen Objetivo: La muerte súbita (MS) por fibrilación ventricular (FV) es una importante causa de morbilidad y mortalidad. Los métodos biológicos y de imagen actuales muestran limitaciones para predecir el pronóstico cerebral al ingreso hospitalario. AWAKE es un estudio observacional, multicéntrico, con el objetivo de validar un modelo basado en el análisis espectral del elec- trocardiograma (ECG), que predice precozmente el pronóstico cerebral y la supervivencia en pacientes resucitados y en estado de coma. Métodos: Se recogerán datos de los ECG con FV de pacientes reanimados de MS. Los pacientes pueden ser tanto supervivientes en estado de coma (Glasgow Coma Scale GCS ≤ 8) sometidos a control de temperatura tras la recuperación de circulación espontánea (RCE), como aquellos que recuperan la consciencia (GCS = 15) tras RCE; todos ellos ingresados en unidades de terapia intensiva cardiológica de 4 hospitales de referencia. Los registros de FV previos al primer choque se digitalizarán y analizarán para obtener datos espectrales que se incluirán en un modelo predictivo que estime el pronóstico neurológico favorable (PNF). El resultado del modelo se comparará con el pronóstico real. Resultados: El objetivo principal es el PNF durante la hospitalización. Los pacientes se categorizarán en 4 subgrupos de pronóstico neurológico según la estimación de riesgo obtenida en el modelo predictivo. Los objetivos secundarios son supervivencia al alta hospitalaria, y PNF y supervivencia a los 6 meses. El resultado de este modelo también se comparará con el pronóstico según variables clínicas. Conclusiones: Un modelo basado en el análisis espectral de registros de FV es una herramienta prometedora para obtener datos pronósticos precoces tras MS por FV.

ABSTRACT In recent years composite materials have been developed for different applications in engineering areas. This paper first presents the tensile properties of a polymer, in this case an epoxy resin, to be used as the matrix of a fiber reinforced composite material. A study of the mechanical properties is presented, which was carried out by performing tensile tests under the regime of ASTM D638; five resin specimens were manufactured in which a suitable molding process was performed to optimize specimens type I. The objective was to determine the properties of the thermoset matrix to be reinforced with carbon fiber to improve the composite properties. Subsequently, mechanical properties of the composite reinforced with carbon 3k fibers, are analyzed. For proper analysis ten specimens with an orientation [0/+45/-45]s were made; five tensile tests were conducted in composite specimens based on ASTM standard D3039. The specimens manufacturing process followed the VACCUM BAG WET LAY-U method, under normal air. It is found that epoxy resin specimens generate bubbles by mixing and curing in air. These bubbles, working as stress concentrators, weaken the material tensile strength as compared to the mechanical response of the composite material, which certainly shows better performance due to reinforcing carbon fibers and the manufacturing process in vacuum.

RESUMEN En los últimos años los materiales compuestos se han desarrollado para diferentes aplicaciones del área ingenieril. En este trabajo se expone primeramente un análisis de una matriz polimérica, en este caso resina epóxica para su aplicación en un material compuesto reforzado con fibras. Se presenta un estudio de las propiedades mecánicas, el cual se llevó a cabo mediante pruebas de tensión realizadas bajo el régimen de la norma ASTM D638; se manufacturaron cinco especímenes de resina los cuales llevaron un proceso de preparación de moldeo adecuado para la optimización de probetas tipo I. El objetivo fue conocer las propiedades de la matriz termoestable para así reforzarla con fibras de carbono y mejorar las propiedades del material compuesto. Posteriormente se analizaron las propiedades mecánicas del material compuesto en el cual se utilizó el refuerzo de fibra de carbono 3k. Para el análisis se fabricaron especímenes con una orientación [0/+45/-45]s; las pruebas realizadas en los especímenes de material compuesto fueron cinco ensayos de tracción basados en la norma ASTM D3039. El proceso de manufactura empleado para la realización de los especímenes de material compuesto fue el método VACCUM BAG WET LAY-UP. Se comprobó que las probetas de matriz polimérica de resina epóxica generan burbujas por el mezclado y por el curado al ambiente; así mismo estas burbujas trabajan como concentradores de tensiones que debilitan el material en pruebas de tracción. En comparación con las propiedades mecánicas del material compuesto, estos muestran un mejor comportamiento por el refuerzo de fibra de carbono y por el proceso de manufactura al vacío.

El niño con desnutrición grave tiene una disfunción de la respuesta inmune que puede aumentar de manera significativa la morbilidad y la mortalidad por infecciones. El objetivo de la presente investigación fue evaluar el efecto de la recuperación nutricional en las concentraciones séricas de citocinas inflamatorias; tales como: interleucina 12 (IL-12), interleucina 17 (IL-17), interferón gamma (IFN-γ) y factor de necrosis tumoral alfa (TNF-α). En un estudio de tipo prospectivo y longitudinal, se seleccionó la población con base a criterios clínicos y antropométricos, constituida por 24 niños desnutridos graves en edades comprendidas entre 1 y 2 años, quienes formaban parte de un programa de recuperación nutricional. La concentración sérica de las citocinas investigadas se determinó antes y después del tratamiento nutricional, empleando la técnica de Inmunoanálisis Enzimático (ELISA) de doble anticuerpo. Para establecer comparaciones se utilizó la t de Student, y se consideró una p<0,05 como estadísticamente significante. Se observó una diferencia en las concentraciones de IL-12, IL-17, IFN-γ y TNF-α antes y después del tratamiento (p<0,05), lo cual parece indicar que la desnutrición per se provoca un estado inflamatorio y que 2 meses de apoyo nutricional intensivo, favorecen no solo la recuperación clínica del niño desnutrido grave, sino también la recuperación de su respuesta inmunitaria en cuanto a la producción de mediadores solubles como son las citocinas.

Children with severe malnutrition have a dysfunction of the immune response that can significantly increase morbidity and mortality from infections. The aim of this investigation was to evaluate the effect of nutritional recovery in serum measurements of inflammatory cytokines; such as interleukin 12 (IL-12), interleukin 17 (IL-17), interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). In a prospective and longitudinal study, 24 severe malnourished children aged between 1 and 2 years-old, who were part of a program of nutritional recovery, were selected based on clinical and anthropometric criteria. Serum measurements of cytokines were determined before and after dietary treatment, using the technique of sandwich Enzyme-Linked ImmunoSorbent Assay (ELISA). For comparisons, Student’s t test was used, considered p <0.05 as statistically significant. A difference was observed in the concentrations of IL-12, IL-17, IFN-γ and TNF-α before and after treatment (p <0.05), which suggests that malnutrition provokes an inflammatory state and two months of intensive nutritional support, not only promotes the clinical recovery of severe malnourished children, but also the recovery of the immune response with regard to the production of soluble mediators, such as cytokines.

Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.


Objetivo Analizar la fuerza de los músculos del suelo pélvico (FMSP), la continencia urinaria y la calidad de vida en mujeres en el primer trimestre del embarazo. Método Estudio transversal cuyo muestra incluyó 500 mujeres que comenzaron la atención prenatal en un servicio del sector de salud complementaria en Guarulhos, SP, en 2012-2013. La FMSP fue evaluada por la perineometría y las mujeres embarazadas con incontinencia urinaria (IU) respondieron al International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados Muestran que edad materna (OR=1,06 IC95% 1,02-1,11) y IU previa (OR=15,12; IC95% 8,19-27,92) son las variables que, en conjunto, mejor explican la ocurrencia de IU al inicio del embarazo. La media del escore ICIQ-SF fue 8,2 (d.p.=3,9), considerado como de impacto moderado en la calidad de vida. Conclusión Las embarazadas con más edad y con IU previa tienen chance mayor de presentar IU en el primer trimestre del embarazo.

Objetivo Analisar a força dos músculos do assoalho pélvico (FMAP), a continência urinária e a qualidade de vida associada à incontinência urinária (IU) em mulheres no primeiro trimestre da gestação. Método Estudo transversal cuja amostra incluiu 500 gestantes que iniciaram o pré-natal em um serviço do setor de saúde suplementar, em Guarulhos, SP, em 2012-2013. A FMAP foi avaliada por meio da perineometria e as gestantes com IU responderam o International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados A idade materna (OR=1,06 IC95% 1,02-1,11) e IU prévia (OR=15,12; IC95% 8,19-27,92) são as variáveis que, em conjunto, melhor explicam a ocorrência de IU no início da gestação. A média do escore do ICQ-SF foi 8,2 (d.p.=3,9), considerado como de impacto moderado na qualidade de vida. Conclusão As gestantes com mais idade e com IU prévia têm maior chance de apresentar IU no primeiro trimestre da gravidez.


Objetivo Analisar a força dos músculos do assoalho pélvico (FMAP), a continência urinária e a qualidade de vida associada à incontinência urinária (IU) em mulheres no primeiro trimestre da gestação. Método Estudo transversal cuja amostra incluiu 500 gestantes que iniciaram o pré-natal em um serviço do setor de saúde suplementar, em Guarulhos, SP, em 2012-2013. A FMAP foi avaliada por meio da perineometria e as gestantes com IU responderam o International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados A idade materna (OR=1,06 IC95% 1,02-1,11) e IU prévia (OR=15,12; IC95% 8,19-27,92) são as variáveis que, em conjunto, melhor explicam a ocorrência de IU no início da gestação. A média do escore do ICQ-SF foi 8,2 (d.p.=3,9), considerado como de impacto moderado na qualidade de vida. Conclusão As gestantes com mais idade e com IU prévia têm maior chance de apresentar IU no primeiro trimestre da gravidez.


Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.


Objetivo Analizar la fuerza de los músculos del suelo pélvico (FMSP), la continencia urinaria y la calidad de vida en mujeres en el primer trimestre del embarazo. Método Estudio transversal cuyo muestra incluyó 500 mujeres que comenzaron la atención prenatal en un servicio del sector de salud complementaria en Guarulhos, SP, en 2012-2013. La FMSP fue evaluada por la perineometría y las mujeres embarazadas con incontinencia urinaria (IU) respondieron al International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados Muestran que edad materna (OR=1,06 IC95% 1,02-1,11) y IU previa (OR=15,12; IC95% 8,19-27,92) son las variables que, en conjunto, mejor explican la ocurrencia de IU al inicio del embarazo. La media del escore ICIQ-SF fue 8,2 (d.p.=3,9), considerado como de impacto moderado en la calidad de vida. Conclusión Las embarazadas con más edad y con IU previa tienen chance mayor de presentar IU en el primer trimestre del embarazo.

Objetivo: Foi descrito um incremento da depuração renal em alguns grupos de pacientes gravemente enfermos, o qual pode induzir à eliminação de concentrações de fármacos por filtração glomerular aquém do ideal, principalmente no caso de antibióticos. Sua ocorrência e os fatores determinantes têm sido pouco estudados. Nossos objetivos foram determinar a incidência e os fatores associados ao incremento da depuração renal, bem como seus efeitos nas concentrações e na posologia de vancomicina em uma série de pacientes em unidade de terapia intensiva. Métodos: Estudamos, de forma prospectiva, 363 pacientes admitidos durante 1 ano em uma unidade de terapia intensiva clínico-cirúrgica. Foram excluídos pacientes que tivessem nível de creatinina sérica >1,3mg/dL. A depuração de creatinina foi calculada a partir da coleta de urina de 24 horas. Os pacientes foram agrupados segundo a presença de incremento da depuração renal (depuração de creatinina >120mL/min/1,73m2), e os possíveis fatores de risco foram analisados por meio de análise bivariada e logística. Em pacientes tratados com vancomicina, foram registradas a posologia e as concentrações plasmáticas. Resultados: O incremento da depuração renal esteve presente em 103 pacientes (28%), os quais eram mais jovens (48±15 versus 65±17 anos; p<0,0001), tinham mais frequentemente admissões obstétricas (16 versus 7%; p=0,0006) e por trauma (10 versus 3%; p=0,016), e menos comorbidades. Os únicos determinantes independentes para o desenvolvimento de incremento da depuração renal foram idade (OR=0,95; IC95%=0,93-0,96; p<0,0001;) e ausência de diabetes (OR 0,34; IC95% 0,12-0,92; p=0,03). Doze dos 46 pacientes que receberam vancomicina tinham incremento da depuração renal e, apesar das doses elevadas, tinham concentrações plasmáticas de vancomicina mais baixas. Conclusões: Nessa coorte de pacientes gravemente enfermos, foi frequente o achado de incremento da depuração renal. Idade e ausência de diabetes foram os únicos determinantes independentes. Assim, pacientes jovens e previamente saudáveis podem necessitar de doses mais elevadas de vancomicina.

Objective: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients. Methods: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. Results: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p<0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. Conclusions: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.

A medicalização do parto, como resultado da medicalização social, tem sido descrita como um processo sociocultural complexo que transforma em necessidades médicas, vivências, sofrimentos e dores antes administradas no próprio ambiente familiar ou comunitário. O objetivo é refletir sobre o excesso de cesarianas no Brasil, em uma perspectiva crítica e propositiva. Dados sobre taxas de cesariana e estudos sobre a preferência das mulheres sobre a via de parto são discutidos com a finalidade de contribuir para o debate sobre autonomia das usuárias do sistema de saúde. A medicalização é uma transformação cultural que influenciou a capacidade de enfrentamento autônomo da experiência de parir, visto que implica em dependência excessiva, heteronomia e consumo abusivo de cesarianas. Além disso, discutem-se as redes e os movimentos sociais como possíveis facilitadores da autonomia das mulheres, na medida em que possibilitam apoio mútuo e compartilhamento de experiências, contribuindo para a construção de relações mais igualitárias entre as mulheres e os profissionais de saúde. A participação nessas redes possibilita a mobilização coletiva das mulheres no sentido de reivindicarem seus direitos junto às diversas instâncias da sociedade.

The medicalization of childbirth as an outcome of social medicalization has been described as a complex sociocultural process that transforms the experiences, suffering and pain - which were formerly managed in the family or community settings - into medical needs. The scope of this paper is to reflect upon the excessive number of cesarean sections in Brazil from a critical and objective standpoint. Data on caesarean section statistics and studies on women's preference on the manner of delivery are discussed in order to contribute to the discussion on the empowerment of the health system consumers. Medicalization is a cultural change that influences the empowerment to cope with the experience of giving birth, as it involves excessive dependency on and abuse of cesarean sections. Furthermore, social networks and movements are discussed as possible facilitators of women's empowerment, as they enable mutual support, sharing of experiences and a contribution to the construction of more balanced relations between women and health professionals. Participation of these networks fosters the collective mobilization of women to insist on their rights from society as a whole.

A medicalização do parto, como resultado da medicalização social, tem sido descrita como um processo sociocultural complexo que transforma em necessidades médicas, vivências, sofrimentos e dores antes administradas no próprio ambiente familiar ou comunitário. O objetivo é refletir sobre o excesso de cesarianas no Brasil, em uma perspectiva crítica e propositiva. Dados sobre taxas de cesariana e estudos sobre a preferência das mulheres sobre a via de parto são discutidos com a finalidade de contribuir para o debate sobre autonomia das usuárias do sistema de saúde. A medicalização é uma transformação cultural que influenciou a capacidade de enfrentamento autônomo da experiência de parir, visto que implica em dependência excessiva, heteronomia e consumo abusivo de cesarianas. Além disso, discutem-se as redes e os movimentos sociais como possíveis facilitadores da autonomia das mulheres, na medida em que possibilitam apoio mútuo e compartilhamento de experiências, contribuindo para a construção de relações mais igualitárias entre as mulheres e os profissionais de saúde. A participação nessas redes possibilita a mobilização coletiva das mulheres no sentido de reivindicarem seus direitos junto às diversas instâncias da sociedade.

The medicalization of childbirth as an outcome of social medicalization has been described as a complex sociocultural process that transforms the experiences, suffering and pain - which were formerly managed in the family or community settings - into medical needs. The scope of this paper is to reflect upon the excessive number of cesarean sections in Brazil from a critical and objective standpoint. Data on caesarean section statistics and studies on women's preference on the manner of delivery are discussed in order to contribute to the discussion on the empowerment of the health system consumers. Medicalization is a cultural change that influences the empowerment to cope with the experience of giving birth, as it involves excessive dependency on and abuse of cesarean sections. Furthermore, social networks and movements are discussed as possible facilitators of women's empowerment, as they enable mutual support, sharing of experiences and a contribution to the construction of more balanced relations between women and health professionals. Participation of these networks fosters the collective mobilization of women to insist on their rights from society as a whole.