Abstract Background: Malignant skin melanoma is a serious public health problem, especially among the elderly population. Knowing the dynamics of the mortality rates of this disease in Brazil is essential to support the creation of public health policies. Objective: To analyze the temporal trend of mortality from malignant skin melanoma in elderly people in Brazil, from 2001 to 2016. Methods: This was a descriptive analytical study of mortality rates from malignant skin melanoma in the elderly. The data were obtained from the Mortality Information System, and information related to the population was obtained from the 2010 population census and population estimates from the Brazilian Institute of Geography and Statistics. Mortality coefficients were calculated and simple linear regression analysis of the coefficients was performed by sex and macro-region. Results: A total 12,712 deaths due to malignant skin melanoma in the elderly were registered. The majority (56.8%) occurred in the male population. In females, a tendency of increase in mortality rates due to malignant skin melanoma was observed in the Northeast (p ≤ 0.001), Midwest (p = 0.002), and Brazil as a whole (p = 0.003). In males, an upward trend was observed in all regions, except for the Southeast region. For both sexes, there was also an upward trend in all regions, with the exception of the Southeast region. Study limitations: Secondary databases are directly influenced by the quality of death certificate completion and their heterogeneous scope in Brazilian regions. Conclusion: The increase in mortality indicates a potential public health challenge for the coming decades. The prevention of skin cancer among the elderly should become a priority, mainly through the implementation of preventive measures.

ABSTRACT: BACKGROUND: Most persons with type 2 diabetes are overweight and obesity worsens the metabolic and physiologic abnormalities associated with diabetes. OBJECTIVE: The objective of this review is to assess the effectiveness of lifestyle and behavioral weight loss and weight control interventions for adults with type 2 diabetes. METHODS: Search methods: Studies were obtained from computerized searches of multiple electronic bibliographic databases, supplemented with hand searches of selected journals and consultation with experts in obesity research. Selection criteria: Studies were included if they were published or unpublished randomized controlled trials in any language, and examined weight loss or weight control strategies using one or more dietary, physical activity, or behavioral interventions, with a follow-up interval of at least 12 months. Data collection and analysis: Effects were combined using a random effects model. MAIN RESULTS: The 22 studies of weight loss interventions identified had a 4,659 participants and follow-up of 1 to 5 years. The pooled weight loss for any intervention in comparison to usual care among 585 subjects was 1.7 kg (95 % confidence interval [CI] 0.3 to 3.2), or 3.1% of baseline body weight among 517 subjects. Other main comparisons demonstrated non significant results: among 126 persons receiving a physical activity and behavioral intervention, those who also received a very low calorie diet lost 3.0 kg (95% CI -0.5 to 6.4), or 1.6% of baseline body weight, more than persons receiving a low-calorie diet. Among 53 persons receiving identical dietary and behavioral interventions, those receiving more intense physical activity interventions lost 3.9 kg (95% CI -1.9 to 9.7), or 3.6% of baseline body weight, more than those receiving a less intense or no physical activity intervention. Comparison groups often achieved significant weight loss (up to 10.0 kg), minimizing between-group differences. Changes in glycated hemoglobin generally corresponded to changes in weight and were not significant when between-group differences were examined. No data were identified on quality of life and mortality. AUTHORS CONCLUSIONS: Weight loss strategies using dietary, physical activity, or behavioral interventions produced small between-group improvements in weight. These results were minimized by weight loss in the comparison group, however, and examination of individual study arms revealed that multicomponent interventions including very low calorie diets or low calorie diets may hold promise for achieving weight loss in adults with type 2 diabetes.

The clinical case of a 3 months first-born infant is described who had been evaluated by a specialist of Clinical Genetics in "Dr. Juan de la Cruz Martínez Maceira" Northern Pediatric Hospital in Santiago de Cuba, for presenting a fissure in the inferior third of the sternum. Later on hemangiomas emerged in the inferior lip, the lobe of the right ear and the lateral right part of the neck, as well as a mid abdominal raphe from the sternal fissure to the navel. The required complementary tests were carried out and she was scheduled for several specialties, with which it was concluded that the patient presented an association of sternal malformation and vascular dysplasia. It is the first case notified in Cuba

Se describe el caso clínico de un lactante primogénito de 3 meses de edad, que había sido evaluado por un especialista de Genética Clínica en el Hospital Infantil Norte "Dr. Juan de la Cruz Martínez Maceira" de Santiago de Cuba, por presentar hendidura del tercio inferior del esternón. Posteriormente aparecieron hemangiomas en el labio inferior, el lóbulo de la oreja derecha y la parte lateral derecha del cuello, así como un rafe abdominal medio desde la hendidura esternal hasta el ombligo. Se practicaron los exámenes complementarios requeridos y se interconsultó con varias especialidades, con lo cual se concluyó que el paciente presentaba una asociación de malformación esternal y displasia vascular. Se trata del primer caso notificado en Cuba

BACKGROUND: Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. OBJECTIVE: This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" METHODS: Search methods: The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. Selection criteria: The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomized at a cluster level, six clusters were required. Data collection and analysis: Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardized BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). MAIN RESULTS: This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged v 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2 = 82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI -0.53 to 0.00) (0- 5 years), - 0.15 kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09 kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. AUTHORS' CONCLUSIONS: We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies: school curriculum that includes healthy eating, physical activity and body image; increased sessions for physical activity and the development of fundamental movement skills throughout the school week; improvements in nutritional quality of the food supply in schools; environments and cultural practices that support children eating healthier foods and being active throughout each day; support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities); parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities. However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs. Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Existem vários padrões e recomendações para a qualidade do ar respirável relacionado aos equipamentos de proteção respiratória, mas pouco tem sido feito em relação a uma possível contaminação microbiana do ar medicinal. O presente trabalho demonstra quantitativa e qualitativamente que as linhas de ar estão relacionadas à contaminação microbiológica do ar comprimido e ar sintético para uso medicinal. Amostras de ar foram coletadas por um equipamento especialmente resistente a pressão, e o conteúdo bacteriano e fúngico foi identificado após crescimento em placa. A flora bacteriana isolada tanto dos sistema periféricos de ar foi virtualmente a mesma encontrada nas instalações centralizadas, sendo uma mistura de patógenos e bactérias normais da pele. Vários fatores contribuintes para a contaminação microbiana do ar medicinal e medidas preventivas são discutidas.

There are many standards and recommendations for breathing air quality associated with respiratory protection equipment, but little has been done regarding the possible microbial contamination of medical air. The present study demonstrates quantitatively and qualitatively that pipelines might be incriminated as source of microbial contamination of compressed and synthetic air for medical use. Air samples were drawn into an especially pressure-resistant device and the bacterial and fungi contents were identified after growth on agar plates. The bacterial flora isolated from peripheral air outlets was virtually the same as that found in the central air-generating installations, consisting of a mixture of pathogens and normal skin bacteria. Several factors contributing to microbial contamination of medical air are mentioned and preventive measures are discussed.