Abstract Objective To assess the effect of a long-term educational intervention by telephone on breastfeeding duration rates. Methods This is a controlled randomized clinical trial conducted at a maternity hospital in the city of Fortaleza. A.so-called 240 women were answers in the immediate puerperium. An educational intervention was used by telephone centered on the principles of self-efficacy and with motivational interview approach at 7, 30, 90 and 150 days postpartum for the intervention group. The control group received the standard guidelines from the health service. Breastfeeding duration rates were verified using a questionnaire elaborated by the researcher applied to the intervention group and control group at 60, 120 and 180 days. To verify the effect of the intervention on the variables studied, the chi-square test and the Mann-Whitney U test were used. Brazilian Clinical Trial Registry: RBR-7m7vc8. Results There was a difference between the groups regarding non-exclusive and exclusive breastfeeding duration and rates. The intervention group had higher breastfeeding rates at 60 (p<0.001), 120 (p=0.001) and 180 days (p=0.001), and exclusive breastfeeding, at 180 days (p=0.005), as well as non-exclusive (p<0.001) and exclusive (p<0.001) breastfeeding longer duration. Conclusion the educational intervention by telephone has the potential to increase breastfeeding rates, duration and exclusivity, and can be used as an alternative to improve breastfeeding rates in the country. Brazilian Clinical Trial Registry (ReBEC): RBR-7m7vc8

Resumen Objetivo Evaluar los efectos de una intervención educativa telefónica de larga duración en los índices de duración de la lactancia materna. Métodos Ensayo clínico aleatorizado controlado realizado en una maternidad en la ciudad de Fortaleza. Se asignaron 240 mujeres en puerperio inmediato. Se utilizó intervención educativa por teléfono centrada en los principios de la autoeficacia y entrevista con enfoque motivacional a los 7, 30, 90 y 150 días del posparto en el grupo experimental. El grupo de control recibió las instrucciones estándar del servicio de salud. La duración y los índices de lactancia materna fueron verificados mediante cuestionario elaborado por la investigadora, aplicado al grupo experimental y al grupo de control a los 60, 120 y 180 días. Para verificar el efecto de la intervención sobre las variables estudiadas, se utilizó la prueba χ2 de Pearson y la prueba U de Mann-Whitney. Registro Brasileño de Ensayo Clínico: RBR-7m7vc8. Resultados Hubo diferencia entre los grupos en lo que se refiere a la duración e índices de lactancia materna no exclusiva y exclusiva. El grupo experimental presentó índices más elevados de lactancia materna a los 60 (p<0,001), 120 (p=0,001) y 180 días (p=0,001), y de lactancia exclusiva a los 180 días (p=0,005), así como mayor duración de la lactancia materna no exclusiva (p<0,001) y exclusiva (p<0,001). Conclusión La intervención educativa telefónica tiene potencial para elevar los índices, duración y exclusividad de la lactancia materna y puede ser utilizada como alternativa para mejorar los índices de lactancia materna en el país.

Resumo Objetivo Avaliar o efeito de uma intervenção educativa de longa duração por telefone nas taxas e duração do aleitamento materno. Métodos Ensaio clínico randomizado controlado realizado em uma maternidade na cidade de Fortaleza. Foram alocadas 240 mulheres no puerpério imediato. Utilizou-se intervenção educativa por telefone centrada nos princípios da autoeficácia e com abordagem da entrevista motivacional aos 7, 30, 90 e 150 dias pós-parto para o grupo intervenção. O grupo controle recebeu as orientações padrão do serviço de saúde. A duração e as taxas do aleitamento materno foram verificadas com uso de questionário elaborado pela pesquisadora aplicados ao grupo intervenção e grupo controle aos 60, 120 e 180 dias. Para verificar o efeito da intervenção sobre as variáveis estudadas utilizou-se o teste Qui-quadrado e o Teste U de Mann-Whitney. Registro Brasileiro de Ensaio Clínico: RBR-7m7vc8. Resultados Houve diferença entre os grupos no que diz respeito à duração e taxas de aleitamento materno não exclusivo e exclusivo. O grupo intervenção apresentou taxas mais elevadas de aleitamento materno aos 60 (p<0,001), 120 (p=0,001) e 180 dias (p=0,001), e de aleitamento exclusivo aos 180 dias (p=0,005), bem como maior duração do aleitamento materno não exclusivo (p<0,001) e exclusivo (p<0,001). Conclusão a intervenção educativa por telefone possui potencial para elevar as taxas, duração e a exclusividade do aleitamento materno, podendo ser utilizada como alternativa para melhorar os índices do aleitamento materno no país. Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-7m7vc8

Abstract Purpose The aim of this study was to compare pharmacokinetic characteristics between intermittent infusion and continuous infusion of vancomycin for critically ill patients admitted to intensive care units. Methods Intermittent therapy was administered for 60 minutes and prescribed as a loading dose of 30 mg/kg and continued with 15 mg/kg q12 h. Continuous infusion was prescribed as a loading dose of 30 mg/kg followed by 30 mg/kg on constant infusion pump. Blood samples from vancomycin intermittent infusion group were collected 1 h before third dose, 1 h, 8 h and 24 h after third dose infusion. Blood samples from vancomycin continuous infusion group were collected 1 h after loading dose, 12 h, 24 h, 36 h, and 48 h after continuous infusion initiation. Results Median serum concentration of continuous infusion group at 24-hour was 23.59 µg/mL [14.52–28.97], while of intermittent infusion group at 23-hour was 12.30 µg/mL [7.27–18.12] and on 25-hour was 17.58 µg/mL [12.5–22.5]. Medians AUC24–48h were 357.2 mg.h/L and 530.2 mg.h/L for intermittent infusion and continuous infusion groups, respectively (p = 0.559). Conclusion Vancomycin CI reached steady state earlier, which guaranteed therapeutic levels from the first day and made it possible to manage therapeutic drug monitoring faster.

ABSTRACT Background: Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. Methods: An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. Results: Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p = 0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p < 0.001). Expenditure decreased by $2089.99 (p < 0.001) immediately after intervention and was maintained at this level over the intervention period ($−38.45; p = 0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. Conclusions: The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.

RESUMO A Prática Organizada de atividades físicas (PO) é um tipo de atividade física realizada por programa organizado com frequência e duração, sob a supervisão de um adulto (professor ou treinador), e envolve algum tipo de demonstração do seu desempenho, que pode ser por meio de competições e/ou festivais. Este estudo teve como objetivo investigar a relação entre a Competência Atlética Percebida (CAP) e o tempo gasto em Práticas Organizadas em esportes, lutas e danças, considerando o estado maturacional e o sexo de adolescentes. Neste estudo transversal e correlacional participaram 213 rapazes e moças com idade entre 13 e 16 anos. A CAP e as PO dos indivíduos foram avaliadas por meio de questionários. O estado maturacional foi determinado pelo cálculo do pico de volocidade de crescimento. Correlações bivariadas e parciais foram realizadas para análise dos dados. Os resultados mostraram que independentemente do estado maturacional dos indivíduos, houve uma relação positiva entre a Competência Atlética Percebida e o Total de Práticas Organizadas para rapazes e moças (rho = 0,40, p <0,01). Neste estudo, a relação entre a Competência Atlética Percebida e o tempo gasto nas Práticas Organizadas, durante a infância até a adolescência, pareceu ser um evento independente do estado maturacional.

ABSTRACT The Organized Practice of physical activities (OP) is a kind of physical activity carried out in an organized program of frequency and duration, under the supervision of an adult (teacher or coach), and involve some kind of demonstration of performance which may be competitions and/or festivals. This study aimed to investigate the relationship between the Perceived Athletic Competence (PAC) and the time spent in Organized Practices in sports and dance, considering the adolescent maturational status and sex. In this cross-sectional and correlational study participated 213 boys and girls aged between 13 and 16 years. The Perceived Athletic Competence and the Organized Practices of the individuals was assessed by questionnaires. The maturational status was determined by calculating the peak growth rate. Bivariate and partial correlations were performed. The results showed that regardless of maturational status of individuals, there was a positive relationship between Perceived Athletic Competence and total Organized Practices for boys and girls (rho = 0.40, p < 0.01). In this study, the relationship between Perceived Athletic Competence and time spent in Organized Practices during childhood until adolescence appeared to be an independent event from maturational status.

Resumen Introdução: A desnutrição é um fator de risco (La desnutrición es un factor de riesgo) importante de complicações pós-operatórias e o ângulo de fase (AF), por ser interpretado (y el ángulo de fase, al ser interpretado) como indicador de integridade de membrana e preditor de massa celular corporal, tem sido descrito como um (se describe como un) parâmetro útil para identificar a desnutrição. Objetivo: Verificar a associação entre o AFe indicadores de triagem de risco e de avaliação do (de clasificación del riesgo y de evaluación del) estado nutricional em pacientes pré-cirúrgicos. Métodos: Estudo observacional realizado no período de maio a dezembro/2014 em hospital universitário localizado no Nordeste brasileiro, envolvendo 83 pacientes no período (incluyendo 83 pacientes en el período) pré-operatório. Foram estudadas variáveis (Se estudiaron variables) demográficas, clínicas, antropométricas (índice de massa corporal (IMC), circunferência do braço (del brazo) (CB), triagem de risco nutricional através da Nutritional Risk Screening (NRS, 2002), e o AF através da impedância bioelétrica. Resultados: A média de idade foi (La media de edad fue de) 51.3 ± 14.9 anos, predominando o sexo feminino (73.5%). Verificou-se predomínio das cirurgias oncológicas (53%). Foi observada prevalência de 27.7% de baixo (de bajo) AF, 30.1% de risco nutricional 27.7% de desnutrição, segundo a (según la) CB. Foi observada uma correlação inversa do AF com a idade (Se observó una correlación inversa del AF en relación con la edad) (r =-0.421; p < 0.001), e triagem nutricional (r = -0.216; p = 0.049), e correlação positiva com os demais (con los otros) parâmetros (IMC e CB). Conclusão: O AF mostrou correlação moderada com os parâmetros antropométricos e de risco nutricional, sugerindo cautela na adoção isolada desse (y de riesgo nutricional, lo que sugiere cautela en la adopción aislada de este) parâmetro como método diagnóstico e indicador de risco nutricional em pacientes cirúrgicos.

Abstract Introduction: Malnutrition is an important risk factor for postoperative complications and the phase angle (PA) marker, since it is interpreted as an indicator of membrane integrity and as a predictor of body cell mass. It has been described as a useful parameter to identify malnutrition. Objective: To verify the association between PA and indicators of risk screening and assessment of nutritional status in pre-surgical patients. Methods: Observational study performed in the period from May to December 2014 in a university hospital in the Northeast of Brazil, including 83 patients in the preoperative period. We studied demographic, clinical, anthropometric variables (body mass index (BMI), arm circumference (AC)), Nutritional Risk Screening (NRS, 2002), and PA through bioelectrical impedance. Results: The mean age was 51.3 ± 14.9 years, predominantly female (73.5%). There was a predominance of oncological surgeries (53%). A prevalence of 27.7% of low PA, 30.1% of nutritional risk and 27.7% of malnutrition was observed, according to AC. A positive correlation with the other parameters (BMI and AC) was observed in relation to age (r = -0.421; p

SUMMARY Pheochromocytoma (PCC) is a tumor derived from adrenomedullary chromaffin cells. Prognosis of malignant PCC is generally poor due to local recurrence or metastasis. We aim to report a case of malignant PCC with 18-year survival and discuss which factors may be related to mortality and long-term survival in malignant pheochromocytoma. The patient, a 45-year-old man, reported sustained arterial hypertension with paroxysmal episodes of tachycardia, associated with head and neck burning sensation, and hand and foot tremors. Diagnosis of PCC was established biochemically and a tumor with infiltration of renal parenchyma was resected. No genetic mutation or copy number variations were identified in SDHB, SDHD, SDHC, MAX and VHL. Over 18 years, tumor progression was managed with 131I-MIBG (iodine-metaiodobenzylguanidine) and 177Lutetium-octreotate therapy. Currently, the patient is asymptomatic and presents sustained stable disease, despite the presence of lung, para-aortic lymph nodes and femoral metastases. Adequate response to treatment with control of tumor progression, absence of significant cardiovascular events and other neoplasms, and lack of mutations in the main predisposing genes reported so far may be factors possibly associated with the prolonged survival in this case. Early diagnosis and life-long follow-up in patients with malignant pheochromocytoma are known to be crucial in improving survival.

Introduction: Sarcopenia is defined as a geriatric syndrome, multifactorial, characterized by progressive loss of skeletal muscle mass and strength and associated with serious consequences, such as comorbidities, poor quality of life and mortality. Objective: To identify the prevalence and factors associated with sarcopenia in elderly assisted outpatients. Methods: Cross-sectional, observational study with elderly patients of both sexes assisted in geriatric outpatient clinic between June and December 2014. Sarcopenia was determined by muscle (calf circumference < 31 cm), muscle strength (measured by grip strength palmar < 30 kg for men and < 20 kg for women) and gait speed (< 0.8 meters/second). Among the association of variables, socioeconomic and demographic, clinical, lifestyle and anthropometry were considered. The tabulation and analysis were performed using the statistical package SPSS version 13.0. Results: The sample consisted of 50 patients with a mean age of 73.9 (± 7.4) years, in which 18% prevalence of sarcopenia was observed. Sarcopenia was more prevalent in patients aged ≥ 80 years (p = 0.012), in the elderly with low weight according to BMI (p < 0.001), with malnutrition according to CB (p = 0.004) and in patients without hypertension (p = 0.027), and there was no association with socioeconomic, clinical and lifestyle. Conclusions: The prevalence of sarcopenia was significant and similar to that described by other authors, being in association with advancing age, malnutrition and lack of hypertension.

Introducción: la sarcopenia se define como un síndrome geriátrico, multifactorial, caracterizado por la pérdida progresiva de masa muscular esquelética, asociada a consecuencias graves, tales como comorbideces, mala calidad de vida y mortandad. Objetivo: identificar la prevalencia y los factores asociados a la sarcopenia en ancianos atendidos ambulatoriamente. Métodos: estudio transversal y observacional realizado con pacientes ancianos de ambos sexos atendidos en ambulatorio geriátrico, entre junio y diciembre de 2014, en un hospital universitario ubicado en el nordeste brasileño. Se determinó la sarcopenia a través de la masa muscular (circunferencia de la pantorrilla < 31 cm), fuerza muscular (evaluada por la fuerza de prensión palmar < 30 kg para hombres y < 20 kg para mujeres) y velocidad de marcha (< 0,8 metros/segundo). Entre las variables de asociación, se consideraron aspectos socioeconómicos y demográficos, variables clínicas, estilo de vida y antropometría. La tabulación y análisis de los datos se realizaron por medio del paquete estadístico SPSS versión 13.0. Resultados: la muestra se compuso de 50 pacientes, con promedio de edad de 73,9 (± 7,4) años, en la que se verificó una prevalencia de sarcopenia del 18%. La sarcopenia fue más prevalente en individuos con edad ≥ 80 años (p = 0,012), en los ancianos con bajo peso según el IMC (p < 0,001), con desnutrición de acuerdo con la CB (p = 0,004) y en los pacientes sin hipertensión arterial (p = 0,027), no encontrándose asociación con variables socioeconómicas, clínicas y del estilo de vida. Conclusiones: la prevalencia de la sarcopenia fue significativa y semejante a la descrita por otros autores, encontrándose asociación con la edad avanzada, desnutrición y ausencia de hipertensión.

Pressure ulcer (PU) is a lesion in the skin and/or underlying tissue, usually over bony prominences caused by pressure and / or shear associated. Although preventable, is still very prevalent, and pointed out that multiple factors are involved in its etiology. Objective: to identify the incidence of pressure ulcers, clinical and nutritional factors associated in patients admitted to the Intensive Care Unity (ICU) of a university hospital. Methods: a prospective, observational study, with patients admitted to an ICU from June to November 2014. The UP was determined by inspection body three times a week during the morning bath, based on the characteristics established by the National Pressure Ulcer Advisory Panel, 2014. We collected demographic, clinical, biochemical and nutritional. The Braden Scale was used to verify individuals at risk of PU development. Results: the sample consisted of 51 patients with a mean age of 57.7 (�≤16.4) years. There was an incidence of UP 52.9%, and the factors associated with its development were: use of vasoactive drugs (p = 0.029), length of hospital stay > 10 days (p ≤0.001) and absence of anemia (p = 0.011). Conclusion: the high incidence of UP highlights the vulnerability of patients in intensive care. Although characterized by being a multifactorial condition only the use of vasoactive drugs, length of hospital stay and the absence of anemia were associated with the appearance of refs. Nutritional and clinical factors often related to trauma were not associated with their development.

La úlcera por presión (UP) es una lesión localizada en la piel y/o tejido subyacente, generalmente sobre prominencias óseas, provocada por la presión y/o asociada a cizallamiento. Aunque evitable, todavía es muy prevalente, siendo destacable que en su etiología están involucrados múltiples factores. Objetivo: identificar la incidencia de úlceras por presión y los factores demográficos, clínicos y nutricionales asociados en pacientes internados en la UCI de un hospital universitario. Métodos: estudio prospectivo, observacional, con pacientes internados en una UCI de un hospital universitario ubicado en el nordeste brasileño, durante el periodo de junio a noviembre de 2014. Se determiní la UP a través de la inspeccion corporal tres veces a la semana durante el baño matinal, con base en las características establecidas por la National Pressure Ulcer Advisory Panel, 2014. Se recolectaron datos demográficos, clínicos, bioquímicos y nutricionales. Se utilizó la escala de Braden para verificar a los individuos con riesgo de desarrollo de UP. Resultados: la muestra se compuso de 51 pacientes, con un promedio de edad de 57,7(�≤16,4) años. Se verificó una incidencia de UP del 52,9%, y los factores asociados a su desarrollo fueron: uso de droga vasoactiva (p = 0,029), tiempo de hospitalización > 10 dias (p ≤0,001) y ausencia de anemia (p = 0,011). Conclusion: la elevada incidencia de UP resalta la vulnerabilidad de los pacientes en cuidados intensivos. A pesar de caracterizarse por ser una condición multifactorial, solo el uso de drogas vasoactivas, el tiempo de hospitalización y la ausencia de anemia se asociaron a la aparicion de UP. Factores nutricionales y clínicos frecuentemente relacionados a las lesiones se asociaron con su desarrollo.

Na primeira infância é esperada uma melhora no desempenho de habilidades locomotoras com o avanço da idade. Pode também haver diferenças entre meninos e meninas devido à especificidade da tarefa motora. Este estudo teve como objetivo analisar o desempenho de crianças em habilidades locomotoras de acordo com idade e gênero. O desempenho locomotor de 389 pré-escolares de três a cinco anos da cidade do Recife - PE foi avaliado mediante o TGMD-2. Os resultados mostraram que: crianças mais velhas apresentaram melhor desempenho motor; no geral, meninos obtiveram melhor desempenho no correr, salto horizontal, deslize lateral e escore total locomotor, e meninas no saltitar com um pé aos cinco anos de idade; na análise da progressão do desenvolvimento motor, comportamentos motores mais complexos ocorreram após aqueles considerados menos complexos. Conclui-se que o desenvolvimento locomotor dos pré-escolares recifenses obedeceu aos princípios da progressividade e do aumento da complexidade, entretanto, meninos e meninas mostraram diferenças no seu desempenho dependendo da tarefa.

In early childhood the performance of locomotor skills is expected to be improved in with advancing age. Differences between boys and girls due to the specificity of motor task may exist. This study aimed to analyze the locomotor skills performance of children regarding age and gender. The locomotor performance of 389 preschool children from three to five years from the city of Recife - PE was evaluated by TGMD-2. The results showed that: older children outperformed the younger ones; in general, the boys outperformed the girls in the skills to run, horizontal jump, slide and in the locomotor total score, and the girls had a better performance in the skill to hop at five years; at the analysis of the progression of motor development, more complex motor behaviors occurred after those considered less complex. It is concluded that the locomotor development of preschoolers from Recife followed the principles of progressivity and complexity, however, boys and girls showed differences on the performance depending on the task.

Este estudo investigou a aprendizagem de uma tarefa motora seriada em diferentes estágios de desenvolvimento. Quinze crianças, 14 adultos e 13 idosos praticaram a tarefa de rastrear uma sequência de seis estímulos luminosos durante 10 blocos de tentativas ou até descobrir a sequência, constituindo a fase de estabilização e mais dois blocos de tentativas, referentes as fases de adaptação I e II. O desempenho foi mensurado por meio das respostas funcionais e não-funcionais e das sequências funcionais. Os resultados indicaram que os adultos foram superiores aos demais participantes, e idosos apresentaram melhor desempenho que crianças apenas no início da prática, sugerindo que o estágio de desenvolvimento interage com o processo de aprendizagem motora.

This study investigated the learning of a serial tracking task in different developmental stages. Fifteen children, fourteen adults and thirteen elderly practiced the task of tracking a sequence of six light stimuli for ten blocks of trial or until discover the sequence, during the stabilization phase, and two blocks of trial at the adaptation tests I and II. Performance was measured by the functional and non-functional responses and functional sequences. The results showed that adults were superior to the other participants, and elderly participants performed better than children only in the early practice, suggesting that the development stage interacts with the process of motor learning.