ABSTRACT Objective: To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Subjects and methods: Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results: The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with obesity than in normal-weight (55.8% vs 53.7%, p = 0.008). BMI positively and significantly correlated with fasting plasma glucose (FPG) levels in the 1stT (rs = 0.213, p = 0.001) and 2ndT (rs = 0.210, p = 0.001). Excessive GWG occurred in 44.9% women with overweight and in 40.2% with obesity (p < 0.001). From women with obesity, 65.1% required pharmacological treatment (p < 0.001). Gestational hypertension (GH) was more frequent in women with obesity (p = 0.016). During follow-up, 132 cesareans were performed, the majority in mothers with obesity (p = 0.008). Of the 17 large-for-gestational-age (LGA) birthweight delivered, respectively 6 and 9 were offsprings of women with overweight and obesity (p = 0.019). Maternal BMI had a predictive value only for macrosomia [aOR 1.177 (1.006-1.376), p = 0.041]. BMI and GWG positively correlated with birthweight (rs = 0.132, p = 0.005; rs = 0.188, p = 0.005). Conclusion: Maternal obesity is related with a major probability of diagnosis of GDM in 1stT, fasting hyperglycemia in 2ndT and a more frequent need for pharmacological therapy. Pre-gestational obesity is associated with GH, cesarean delivery and fetal macrosomia.

Little is known about the evolution of head circumference (HC) in children with congenital Zika syndrome (CZS). This study aims to evaluate HC growth in children with CZS in the first three years of life and identify associated factors. HC data obtained at birth and in neuropediatric consultations from 74 children with CZS were collected from the Child’s Health Handbook, parents’ reports, and medical records. Predictors of HC z-score were investigated using different mixed-effects models; Akaike’s information criterion was used for model selection. The HC z-score decreased from -2.7 ± 1.6 at birth to -5.5 ± 2.2 at 3 months of age, remaining relatively stable thereafter. In the selected adjusted model, the presence of severe brain parenchymal atrophy and maternal symptoms of infection in the first trimester of pregnancy were associated with a more pronounced reduction in the HC z-score in the first three years of life. The decrease of HC z-score in CZS children over the first three months demonstrated a reduced potential for growth and development of the central nervous system of these children. The prognosis of head growth in the first 3 years of life is worse when maternal infection occurs in the first gestational trimester and in children who have severe brain parenchymal atrophy.

Pouco se sabe sobre a evolução do perímetro cefálico (PC) em crianças com síndrome congênita associada à infecção pelo vírus Zika (SCZ) em acompanhamentos contínuos. Este estudo buscou avaliar o crescimento do PC em crianças com SCZ nos primeiros três anos de suas vidas e identificar os fatores associados a ele. Os dados do PC ao nascimento e obtidos em consultas neuropediátricas de 74 crianças com SCZ foram coletados no Cartão da Criança, nos laudos paternos e em seus prontuários. Os preditores de escore-z para PC foram investigados utilizando-se diferentes modelos de efeitos mistos. O critério de informação de Akaike foi utilizado para selecionar os modelos usados. O escore-z de PC diminuiu de -2,7 ± 1,6 ao nascimento para -5,5 ± 2,2 aos 3 meses de idade, mas permaneceu relativamente estável desde então. No modelo ajustado selecionado, a presença de atrofia parênquimal cerebral grave e sintomas maternos de infecção no primeiro trimestre de sua gravidez estiveram associados a uma redução mais acentuada no escore-z de PC nos primeiros três anos de vida dos participantes. A diminuição do escore-z de PC em crianças com SCZ nos primeiros 3 meses de sua vida monstra o potencial reduzido de crescimento e desenvolvimento do sistema nervoso central dessas crianças. O prognóstico de crescimento do perímetro cefálico nos primeiros 3 anos de vida é pior quando a infecção materna ocorreu no primeiro trimestre gestacional e em crianças que tiveram atrofia parênquimal grave.

Se conoce poco sobre la evolución del perímetro cefálico (PC) en niños con síndrome de Zika congénito (SZC) en los seguimientos continuos. El objetivo del estudio fue evaluar el crecimiento del PC en niños con SZC en los primeros 3 años de vida e identificar los factores asociados. Se recogieron datos del PC al nacimiento y obtenidos en las consultas de neuropediatría de 74 niños con SZC a partir de la Tarjeta del Niño, los informes de los padres y los registros médicos. Se investigaron los predictores de la puntuación Z del PC mediante diferentes modelos de efectos mixtos; se utilizó el criterio de información de Akaike para la selección del modelo. La puntuación Z del PC disminuyó de -2,7 ± 1,6 al nacer a -5,5 ± 2,2 a los 3 meses de edad, pero a partir de entonces se mantuvo relativamente estable. En el modelo ajustado seleccionado, la presencia de atrofia grave del parénquima cerebral y los síntomas maternos de infección en el primer trimestre del embarazo se asociaron con una reducción más pronunciada de la puntuación Z del PC en los primeros 3 años de vida. La disminución de la puntuación Z del PC en los niños con SZC durante los primeros 3 meses demuestra el menor potencial de crecimiento y desarrollo del sistema nervioso central de estos niños. El pronóstico del crecimiento de la cabeza en los primeros 3 años de vida es peor cuando la infección materna se produjo en el primer trimestre gestacional y en los niños que tenían una atrofia grave del parénquima cerebral.

Pouco se sabe sobre a evolução do perímetro cefálico (PC) em crianças com síndrome congênita associada à infecção pelo vírus Zika (SCZ) em acompanhamentos contínuos. Este estudo buscou avaliar o crescimento do PC em crianças com SCZ nos primeiros três anos de suas vidas e identificar os fatores associados a ele. Os dados do PC ao nascimento e obtidos em consultas neuropediátricas de 74 crianças com SCZ foram coletados no Cartão da Criança, nos laudos paternos e em seus prontuários. Os preditores de escore-z para PC foram investigados utilizando-se diferentes modelos de efeitos mistos. O critério de informação de Akaike foi utilizado para selecionar os modelos usados. O escore-z de PC diminuiu de -2,7 ± 1,6 ao nascimento para -5,5 ± 2,2 aos 3 meses de idade, mas permaneceu relativamente estável desde então. No modelo ajustado selecionado, a presença de atrofia parênquimal cerebral grave e sintomas maternos de infecção no primeiro trimestre de sua gravidez estiveram associados a uma redução mais acentuada no escore-z de PC nos primeiros três anos de vida dos participantes. A diminuição do escore-z de PC em crianças com SCZ nos primeiros 3 meses de sua vida monstra o potencial reduzido de crescimento e desenvolvimento do sistema nervoso central dessas crianças. O prognóstico de crescimento do perímetro cefálico nos primeiros 3 anos de vida é pior quando a infecção materna ocorreu no primeiro trimestre gestacional e em crianças que tiveram atrofia parênquimal grave.

Little is known about the evolution of head circumference (HC) in children with congenital Zika syndrome (CZS). This study aims to evaluate HC growth in children with CZS in the first three years of life and identify associated factors. HC data obtained at birth and in neuropediatric consultations from 74 children with CZS were collected from the Child’s Health Handbook, parents’ reports, and medical records. Predictors of HC z-score were investigated using different mixed-effects models; Akaike’s information criterion was used for model selection. The HC z-score decreased from -2.7 ± 1.6 at birth to -5.5 ± 2.2 at 3 months of age, remaining relatively stable thereafter. In the selected adjusted model, the presence of severe brain parenchymal atrophy and maternal symptoms of infection in the first trimester of pregnancy were associated with a more pronounced reduction in the HC z-score in the first three years of life. The decrease of HC z-score in CZS children over the first three months demonstrated a reduced potential for growth and development of the central nervous system of these children. The prognosis of head growth in the first 3 years of life is worse when maternal infection occurs in the first gestational trimester and in children who have severe brain parenchymal atrophy.

Se conoce poco sobre la evolución del perímetro cefálico (PC) en niños con síndrome de Zika congénito (SZC) en los seguimientos continuos. El objetivo del estudio fue evaluar el crecimiento del PC en niños con SZC en los primeros 3 años de vida e identificar los factores asociados. Se recogieron datos del PC al nacimiento y obtenidos en las consultas de neuropediatría de 74 niños con SZC a partir de la Tarjeta del Niño, los informes de los padres y los registros médicos. Se investigaron los predictores de la puntuación Z del PC mediante diferentes modelos de efectos mixtos; se utilizó el criterio de información de Akaike para la selección del modelo. La puntuación Z del PC disminuyó de -2,7 ± 1,6 al nacer a -5,5 ± 2,2 a los 3 meses de edad, pero a partir de entonces se mantuvo relativamente estable. En el modelo ajustado seleccionado, la presencia de atrofia grave del parénquima cerebral y los síntomas maternos de infección en el primer trimestre del embarazo se asociaron con una reducción más pronunciada de la puntuación Z del PC en los primeros 3 años de vida. La disminución de la puntuación Z del PC en los niños con SZC durante los primeros 3 meses demuestra el menor potencial de crecimiento y desarrollo del sistema nervioso central de estos niños. El pronóstico del crecimiento de la cabeza en los primeros 3 años de vida es peor cuando la infección materna se produjo en el primer trimestre gestacional y en los niños que tenían una atrofia grave del parénquima cerebral.

ABSTRACT Objective: To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Subjects and methods: Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results: The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with obesity than in normal-weight (55.8% vs 53.7%, p = 0.008). BMI positively and significantly correlated with fasting plasma glucose (FPG) levels in the 1stT (rs = 0.213, p = 0.001) and 2ndT (rs = 0.210, p = 0.001). Excessive GWG occurred in 44.9% women with overweight and in 40.2% with obesity (p < 0.001). From women with obesity, 65.1% required pharmacological treatment (p < 0.001). Gestational hypertension (GH) was more frequent in women with obesity (p = 0.016). During follow-up, 132 cesareans were performed, the majority in mothers with obesity (p = 0.008). Of the 17 large-for-gestational-age (LGA) birthweight delivered, respectively 6 and 9 were offsprings of women with overweight and obesity (p = 0.019). Maternal BMI had a predictive value only for macrosomia [aOR 1.177 (1.006-1.376), p = 0.041]. BMI and GWG positively correlated with birthweight (rs = 0.132, p = 0.005; rs = 0.188, p = 0.005). Conclusion: Maternal obesity is related with a major probability of diagnosis of GDM in 1stT, fasting hyperglycemia in 2ndT and a more frequent need for pharmacological therapy. Pre-gestational obesity is associated with GH, cesarean delivery and fetal macrosomia.

Resumo O objetivo deste artigo é avaliar práticas de atenção ao parto e nascimento em maternidades do Norte e Nordeste brasileiros. Avaliação qualitativa realizada em 91 maternidades no Norte e 181 no Nordeste do Brasil. A técnica de pesquisa foi a observação sistematizada, realizada por 44 avaliadores previamente treinados e registrada em diário de campo. Foi realizada análise de conteúdo na modalidade temática. Os núcleos temáticos encontrados foram: Desafios da Gestão Colegiada; Desafios para o enfrentamento da Violência Obstétrica; e Potencial do processo avaliativo na indução de mudanças. Foram identificados avanços na implantação de boas práticas na gestão do cuidado e atenção à saúde, embora algumas maternidades ainda reproduzam um modelo hierárquico, sem espaços colegiados de gestão e com práticas de violência obstétrica. Situações de risco em gestantes justificaram menor adesão dos profissionais de saúde às boas práticas, ainda que ações em direção à humanização também tenham sido visibilizadas. Identificou-se a potência do processo avaliativo na indução de mudanças. Foram evidenciadas mudanças em direção às boas práticas preconizadas pela Rede Cegonha, tanto na gestão quanto na atenção, mas são muitos os desafios frente ao predomínio de um modelo de gestão hierárquico associado a um modelo de atenção com práticas intervencionistas.

Abstract This article eevaluates delivery and birth care practices in maternity facilities in Brazil’s North and Northeast regions. We conducted a qualitative evaluation of 91 facilities in the North and 181 facilities in the Northeast. The data was collected using systematic observation by a team of 44 previously trained evaluators and recorded in a field diary. A thematic analysis of the collected data was performed, resulting in three core themes: challenges of collegial management; challenges for coping with obstetric violence; and the potential of the evaluation process for driving change. Advances were made in the implementation of good labor and childbirth care practices; however, some maternity facilities still reproduce hierarchical models without spaces for collegial management and accounts of obstetric violence were common. Health professionals used the presence of risk to justify the low level of adoption of good practices. However, the findings reveal progress towards the humanization of care. The results also show the potential of the evaluation process for driving change. Although progress has been made towards the adoption of the good practices recommended by the Stork Network Program both in the area of management and care delivery, many challenges remain in view of the dominance of a hierarchical management model associated with an interventionist approach to health care.

Resumo O objetivo deste artigo é avaliar práticas de atenção ao parto e nascimento em maternidades do Norte e Nordeste brasileiros. Avaliação qualitativa realizada em 91 maternidades no Norte e 181 no Nordeste do Brasil. A técnica de pesquisa foi a observação sistematizada, realizada por 44 avaliadores previamente treinados e registrada em diário de campo. Foi realizada análise de conteúdo na modalidade temática. Os núcleos temáticos encontrados foram: Desafios da Gestão Colegiada; Desafios para o enfrentamento da Violência Obstétrica; e Potencial do processo avaliativo na indução de mudanças. Foram identificados avanços na implantação de boas práticas na gestão do cuidado e atenção à saúde, embora algumas maternidades ainda reproduzam um modelo hierárquico, sem espaços colegiados de gestão e com práticas de violência obstétrica. Situações de risco em gestantes justificaram menor adesão dos profissionais de saúde às boas práticas, ainda que ações em direção à humanização também tenham sido visibilizadas. Identificou-se a potência do processo avaliativo na indução de mudanças. Foram evidenciadas mudanças em direção às boas práticas preconizadas pela Rede Cegonha, tanto na gestão quanto na atenção, mas são muitos os desafios frente ao predomínio de um modelo de gestão hierárquico associado a um modelo de atenção com práticas intervencionistas.

Abstract This article eevaluates delivery and birth care practices in maternity facilities in Brazil’s North and Northeast regions. We conducted a qualitative evaluation of 91 facilities in the North and 181 facilities in the Northeast. The data was collected using systematic observation by a team of 44 previously trained evaluators and recorded in a field diary. A thematic analysis of the collected data was performed, resulting in three core themes: challenges of collegial management; challenges for coping with obstetric violence; and the potential of the evaluation process for driving change. Advances were made in the implementation of good labor and childbirth care practices; however, some maternity facilities still reproduce hierarchical models without spaces for collegial management and accounts of obstetric violence were common. Health professionals used the presence of risk to justify the low level of adoption of good practices. However, the findings reveal progress towards the humanization of care. The results also show the potential of the evaluation process for driving change. Although progress has been made towards the adoption of the good practices recommended by the Stork Network Program both in the area of management and care delivery, many challenges remain in view of the dominance of a hierarchical management model associated with an interventionist approach to health care.

Resumo Objetivo: Avaliar a ação antimicrobiano do gás ozônio (O3) em superfícies e ar ambiente climatizado artificialmente. Métodos: Estudo experimental/laboratorial e transversal realizado em dez salas de um laboratório de pesquisa em microbiologia médica, com risco de segurança biológica classe 2. As superfícies demarcadas do chão, parede e bancada foram avaliadas, quanto à presença ou ausência de micro-organismos, a partir de coletas feitas com swab umedecido em água destilada estéril, antes e após a exposição do gás O3 gerado por dois equipamentos distintos. Após este procedimento, o swab foi inoculado na superfície do meio de cultura Brain Heart Infusion Agar DIFCO® (BHI), seguindo-se a incubação a 35ºC por 24 horas. Para a análise microbiológica do ar, uma placa com BHI foi exposta aberta por uma hora, antes e após o tratamento do gás O3, sendo incubadas segundo os mesmos critérios. Resultados: A atividade antimicrobiana do gás O3 gerado por ambos os equipamentos foi constatada para todas as áreas investigadas, com registros de redução do número de Unidades Formadoras de Colônias. O potencial de inibição antimicrobiana dos aparelhos se manteve próximo para os critérios de análise adotados, com destaque para as áreas de chão e bancada. Considerando-se todas as salas e percentuais de inibição microbiana, frente aos dois equipamentos, os resultados foram: chão (100%), bancada (90%), parede (50%) e ar, 70%. Conclusão: Os equipamentos geradores de gás O3 apresentaram potencial antimicrobiano para medida de controle de microrganismos presentes em superfícies e ar ambiente climatizado artificialmente, sendo um sanitizante factível para utilização.

Abstract Objective: Assess the antimicrobial action of ozone gas (O3) on surfaces and artificially cooled ambient air. Methods: Cross-sectional experimental/laboratory study carried out in ten rooms of a medical microbiology research lab, with class 2 biosafety risk. The demarcated surfaces on the floor, wall and counter were assessed in relation to the presence or absence of microorganisms, based on collections done with swabs dampened in sterile distilled water, before and after exposure to ozone gas produced by two different generators. After this procedure, each swab was inoculated on the surface of a Brain Heart Infusion Agar DIFCO® (BHI) culture, followed by incubation at 35ºC for 24 hours. For the microbiological analysis of the air, a petri dish with BHI was openly exposed for one hour, before and after treatment with O3 gas, and were incubated according to the same criteria. Results: The antimicrobial activity of the O3 gas produced by both generators was checked in all the areas investigated, with records indicating a decrease in the number of colony-forming units. The antimicrobial inhibition potential of the generators was close to the analysis criteria adopted, particularly for the floor and counter areas. Based on all the rooms and microbial inhibition percentages, in relation to the two generators, the results were: floor (100%), counter (90%), wall (50%) and air (70%). Conclusion: The O3 generators had antimicrobial potential as a procedure for controlling microorganisms present on surfaces and in artificially cooled ambient air, constituting a feasible sanitizer.

Resumen Objetivo: Evaluar la acción antimicrobiana del gas ozono (O3) en superficies y en el aire interior climatizado artificialmente. Métodos: Estudio experimental/de laboratorio y transversal realizado en diez salas de un laboratorio de investigación en microbiología médica, con riesgo de seguridad biológica clase 2. Se evaluaron las superficies delimitadas en el piso, pared y mesa en cuanto a la presencia o ausencia de microorganismos, a partir de muestras recolectadas con hisopo humedecido en agua destilada estéril, antes y después de la exposición del gas O3 generado por dos máquinas distintas. Luego de este procedimiento, el hisopo fue inoculado en la superficie del medio de cultivo Brain Heart Infusion Agar DIFCO® (BHI), y después incubado a 35 °C por 24 horas. Para el análisis microbiológico del aire, se expuso una placa con BHI abierta durante una hora, antes y después del tratamiento del gas O3, y luego se incubó con los mismos criterios. Resultados: Se constató la actividad antimicrobiana del gas O3 generado por ambas máquinas en todas las áreas investigadas, y se registró una reducción del número de unidades formadoras de colonias. El potencial de inhibición antimicrobiana de los dispositivos se mantuvo próximo a los criterios de análisis adoptados, con énfasis en el área del piso y mesa. Considerando todas las salas y porcentajes de inhibición microbiana, con las dos máquinas, los resultados fueron: piso (100 %), mesa (90 %), pared (50 %) y aire (70 %). Conclusión: Las máquinas generadoras de gas O3 presentaron potencial antimicrobiano como medida de control de microorganismos presentes en superficies y aire interior climatizado artificialmente, lo que lo convierte en un desinfectante factible para ser usado.

ABSTRACT OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon.

ABSTRACT OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon.

ABSTRACT BACKGROUND: Fungi are ubiquitous in the environment. They are able to grow in water and many of them may be opportunistic pathogens. OBJECTIVE: The aims were to identify fungi in registered wells (RWs) and nonregistered wells (NRWs) that tap into groundwater; and to correlate the results from physicochemical assays on this water (free residual chlorine and pH) with the presence of fungi. DATA AND SETTING: Analytical cross-sectional quantitative study on groundwater wells in São José do Rio Preto, São Paulo, Brazil. METHODS: 52 samples of 500 ml of water were collected from RWs and 107 from NRWs. These were sent to a microbiology laboratory to identify any fungi that were present. In addition, free residual chlorine and pH were measured immediately after sample collection. Several statistical analysis tests were used. RESULTS: Fungal contamination was present in 78.8% of the samples from RWs and 81.3% from NRWs. Filamentous fungi were more prevalent than yeast in both types of wells. There was no significant difference in presence of fungi according to whether chloride and pH were within recommended levels in RWs; or according to whether pH was within recommended levels in NRWs. Furthermore, there was no statistical difference in the levels of fungal contamination between RWs and NRWs. CONCLUSION: Both RWs and NRWs are potential reservoirs for many types of fungi. Many of these may become opportunistic pathogens if they infect immunosuppressed individuals. Furthermore, this study confirms that fungi are able to grow even when chlorine and pH parameters are within the standards recommended.

Marco contextual: La utilización de los servicios de urgencias (SU) en situaciones no urgentes constituye una preocupación a nivel nacional y mundial. Objetivos: Evaluar las características sociodemográficas y el acceso al SU de usuarios no urgentes e identificar los factores que motivan su demanda. Metodología: En este estudio transversal se utilizó una entrevista y se consultaron los registros médicos electrónicos de 357 pacientes seleccionados como no urgentes en un SU en un hospital portugués, para lo cual se siguió un muestreo accidental. Resultados: Los usuarios de la muestra son mayoritariamente del sexo femenino, de mediana edad, con reducidas cualificaciones literarias, que recurren al SU sobre todo en el período diurno y por iniciativa propia. Los motivos que más se indicaron fueron: Mi enfermedad justifica ir a urgencias (91,7%) y Puedo realizar todos los exámenes el mismo día (65,6%). La mayoría de los usuarios (87,9%) tuvo alta clínica, y el 84,9% de los usuarios tiene acceso al médico de familia. Conclusión: Se identificaron varios determinantes del acceso al servicio de urgencias que apuntan a una utilización racional de la atención de la salud.

Enquadramento: A utilização dos serviços de urgência (SU) por situações não urgentes constitui uma preocupação a nível nacional e mundial. Objetivos: Avaliar as características sociodemográficas e o acesso ao SU por utentes não urgentes e identificar os fatores que motivam a sua procura. Metodologia: Neste estudo transversal recorreu-se a uma entrevista e à consulta dos processos clínicos eletrónicos de 357 doentes triados como não urgentes num SU de um hospital português seguindo-se uma amostragem acidental. Resultados: Os utentes da amostra são maioritariamente do sexo feminino, de meia-idade, com reduzidas habilitações literárias, que recorrem ao SU, sobretudo no período diurno e por iniciativa própria. Os motivos mais referenciados foram: A minha doença justifica a ida à urgência (91,7%) e Posso realizar os exames todos no mesmo dia (65,6%). A maioria dos utentes (87,9%) teve alta clínica, sendo que 84,9% dos utentes tem acesso ao médico de família. Conclusão: Foram identificados múltiplos determinantes do acesso ao SU, permitindo apontar sugestões que visam uma utilização racional dos cuidados de saúde.

Background: The use of the emergency department (ED) for non-urgent situations is a source of concern, both at the national and international levels. Objectives: To assess the sociodemographic characteristics and ED use of non-urgent patients and to identify the reasons for non-urgent ED use. Methodology: This cross-sectional study used patient interviews and the electronic medical records of 357 patients triaged as non-urgent at a Portuguese hospital ED, using an accidental sampling technique. Results: The majority of patients were women, middle-aged, and had a low education level; most of them used the ED during the day and on their own initiative. The most common reasons were: My disease justifies ED use (91.7%) and I can undergo all medical examinations on the same day (65.6%). The majority of patients (87.9%) were discharged, and 84.9% had access to a family doctor. Conclusion: Multiple determinants of non-urgent ED use were identified. Some recommendations were put forward to improve the rational use of healthcare services.

RESUMO: Corynespora cassiicola é um ascomiceto cosmopolita amplamente conhecido como fitopatógeno em diversas culturas e, mais recentemente, como patógeno emergente em humanos. Na região Norte do Brasil é responsável por perdas significativas em cultivos tanto em casa de vegetação como em campo aberto. Neste estudo foi avaliada a variabilidade genética de 60 isolados de Corynespora cassiicola procedentes de diferentes hospedeiras e municípios do Amazonas, usando marcadores moleculares AFLP. Foram identificados sete grupos genéticos de acordo com dendrograma obtido pelo método de agrupamento UPGMA, indicando significativa variabilidade entre os isolados. Três isolados de diferentes hospedeiras (isolado 28, obtido de mamoeiro; isolado 55, obtido de pepineiro; e isolado 58, proveniente de tomateiro) permaneceram como indivíduos únicos em grupos distintos, sugerindo variação genética marcante em comparação com os demais e possível especificidade pela hospedeira de origem.

ABSTRACT: Corynespora cassiicola is a cosmopolitan ascomycete widely known as phytopathogen in several crops, and more recently as an emerging pathogen in humans. In this study the genetic variability of 60 isolates of Corynespora cassiicola from different hosts and cities of Amazonas was evaluated, using AFLP molecular markers. Seven genetic groups were identified according to a dendrogram obtained by the Unweighted Pair Group Method using Arithmetical Averages, indicating significant variability among the isolates. Three isolates of different hosts (28, obtained from papaya; 55, obtained from cucumber; and 58, from tomato) remained as single individuals in distinct groups, suggesting marked genetic variation in comparison to the other isolates and possible specificity by the host.

RESUMO Sacha inchi (Plukenetia volubilis L.) é uma espécie com benefícios nutracêuticos tradicionalmente consumida por populações indígenas e urbanas amazônicas. Estudos de diversidade genética e do sistema reprodutivo são necessários para a conservação e uso dos recursos genéticos da espécie. Objetivou-se estimar parâmetros de diversidade genética e do sistema reprodutivo de sacha inchi, utilizando-se marcadores Amplified Fragment Length Polymorphism (AFLP). Um total de 360 progênies de 30 subamostras da espécie foram analisadas, com três combinações de primers AFL. Foram estimadas, dentre outros parâmetros, a porcentagem de variação entre e dentro de famílias e a taxa de cruzamento. Os marcadores AFLP foram eficientes na diferenciação genética das progênies, revelando 251 (98,82 %) fragmentos polimórficos. A análise de variância molecular mostrou que a maior parte da variação ocorre entre famílias (57,16 %). No entanto, a diferenciação genética dentro destas foi considerável (42,84 %), podendo ser explorada em programas de melhoramento. A estimativa da taxa de cruzamento multiloco foi alta (0,957), indicando se tratar de uma espécie predominantemente alógama. Por outro lado, 33,7 % dos cruzamentos ocorreram entre indivíduos aparentados. A estimativa para cruzamentos biparentais revelou que as progênies são constituídas principalmente por meios-irmãos (66,9 %) e irmãos-completos (28,8 %). Para fins de melhoramento e conservação genética ex situ, sementes de sacha inchi devem ser coletadas de um grande número de plantas matrizes.

ABSTRACT Sacha inchi (Plukenetia volubilis L.) is a species with nutraceutical benefits traditionally consumed by Amazonic indigenous and urban communities. Studies on the genetic diversity and mating system are required to preserve and make the best use of the genetic resources for this species. This study aimed to estimate the genetic diversity and mating system parameters of sacha inchi progenies using Amplified Fragment Length Polymorphism (AFLP) markers. A total of 360 progenies from 30 accessions of sacha inchi were analyzed using three AFLP primers combinations. The percentage variation between and within families and the crossing rate, among other parameters, were estimated. The AFLP markers were efficient in genetically differentiating progenies, revealing 251 (98.82 %) polymorphic fragments. The analysis of molecular variance showed that the strongest variation occurs between progenies (57.16 %). However, the genetic differentiation within progenies was considerable (42.84 %), and could be exploited in breeding programs. The estimated population outcrossing rate was high (0.957), indicating it is a predominantly allogamous species. On the other hand, 33.7 % of the crosses occurred between related individuals. The estimate for biparental crosses revealed that the progenies consisted mainly of half-siblings (66.9 %) and full-siblings (28.8 %). For purposes of breeding and ex situ genetic conservation, sacha inchi seeds should be collected from a large number of parent plants.

Introduction: The use of iodinated contrast angiography in the diagnostic and therapeutic approach to arteriovenous access (AVA) problems is limited by nephrotoxicity and allergic reactions. The use of alternatives such as CO2 or ultrasound guidance has increased over the last few decades. Purpose: To evaluate the results and complications of the diagnostic and therapeutic procedures of AVA performed at our centre without the use of iodinated contrast. Methods: We evaluated retrospectively all patients submitted to endovascular diagnostic and/or therapeutic procedures using CO2 or ultrasound at our hospital between January 2013 and December 2016. Results: 30 procedures were performed in 22 patients: 15 ultrasound-guided angioplasties and 15 CO2 procedures (14 angioplasties and 1 diagnostic angiography). The mean age of patients was 74±10 years (41--94). Most procedures (90%) were performed on proximal arteriovenous fistulas (AVFs) and 3 were performed on distal AVFs. Iodinated contrast was not used because of its potential nephrotoxicity. Ultrasound-guided angioplasty was performed to treat outflow stenoses in the majority (73%) of the cases. The result was favourable in all procedures. One was complicated by venous rupture. Regarding angioplasties with CO2, outflow stenoses were the most treated (38%). The result was favourable in all procedures. Diagnostic angiography with CO2 was performed in a patient with signs of limb venous hypertension and was inconclusive. There were two complications in CO2 procedures: formation of pseudoaneurysm at the place of insertion of the introducer (n=1) and transient headache and nausea (n=1). Three of the patients who underwent angioplasty with CO2 and one patient who underwent ultrasound-guided procedure were submitted to balloon-assisted maturation. Conclusion: In our experience, the use of alternative methods with no iodinated contrast (CO2/ultrasound) in the evaluation and treatment of vascular access problems in patients with renal dysfunction is effective and safe

Marco contextual: Los cuidados de enfermería durante el embarazo deben basarse en un proceso de actuación dinámico, de escucha, confianza, respeto y negociación con la pareja. Objetivos: Este estudio metodológico tiene como objetivo la adaptación cultural a la realidad portuguesa de la Empowerment Scale for Pregnant Women de Kameda y Shimada (2008), así como su evaluación psicométrica. Metodología: El instrumento se aplicó a una muestra accidental no probabilística de 166 embarazadas con una edad de gestación de 12 a 41 semanas y con una edad igual o superior a 18 años. Para evaluar las propiedades métricas de la escala se recurrió a la validación de constructo y de criterio y al análisis de la consistencia interna. Resultados: El análisis de los componentes principales sujeto a 5 factores confirma las dimensiones propuestas por las autoras (Autoeficacia, Previsión de Futuro, Autoestima, Apoyo y Seguridad de Otros y Alegría por la Inclusión de un Nuevo Miembro en la Familia), lo que explica el 50,76 % de la varianza total. La escala reveló una consistencia interna global de 0,88. Conclusión: La Empowerment Scale for Pregnant Women se mostró como un instrumento fiable, válido y útil para medir el empoderamiento de las embarazadas portuguesas.

Enquadramento: Os cuidados de enfermagem no contexto da gravidez deverão basear-se num processo de atuação dinâmico, de escuta, confiança, respeito e negociação com os casais. Objetivos: O presente estudo metodológico teve como objetivo a adaptação cultural para o contexto português da Empowerment Scale for Pregnant Women e respetiva avaliação psicométrica. Metodologia: O instrumento foi aplicado a uma amostra não probabilística acidental de 166 grávidas, com idade gestacional entre 12 e 41 semanas e com idade igual ou superior a 18 anos. Para avaliar as propriedades métricas da escala recorreu-se à validação de construto e de critério e à análise de consistência interna. Resultados: A análise dos componentes principais fixada a 5 fatores confirma as dimensões propostas pelas autoras (Autoeficácia, Previsão do Futuro, Autoestima, Apoio e Segurança de Outros e Alegria pela Inclusão de um Novo Membro na Família), explicando 50,76% da variância total. A escala revelou uma consistência interna global de 0,88. Conclusão: A escala de empowerment da Grávida mostrou ser um instrumento fiável, válido e útil para medir o empowerment das grávidas portuguesas.

Background: Nursing prenatal care should be based on a dynamic process of listening, trust, respect and negotiation with couples. Objectives: The purpose of this methodological study was the cultural adaptation of the Empowerment Scale for Pregnant Women (ESPW) to the Portuguese population and its psychometric evaluation. Methodology: The instrument was applied to a non-probability accidental sample of 166 pregnant women, between 12 to 41 weeks of gestation and aged 18 or more years. In order to assess the psychometric properties of the scale, we used construct and criterion validity and analyzed its internal consistency. Results: The principal components analysis with 5 factors (Self-efficacy, Future Image, Self-Esteem, Support and Assurance from Others, and Joy of an Addition to the Family), which explain 50.76% of the total variance. The scale revealed a overall internal consistency of .88. Conclusion: The Portuguese version of the ESPW (EEG, Escala de Empowerment da Grávida) proved to be a reliable and useful instrument to measure the empowerment of Portuguese pregnant women.