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This study aimed to evaluate the frequency of cryptic Candida species from candidemia cases in 22 public hospitals in São Paulo State, Brazil, and their antifungal susceptibility profiles. During 2017 and 2018, 144 isolates were molecularly identified as 14 species; C. parapsilosis (32.6%), C. albicans (27.7%), C. tropicalis (14.6%), C. glabrata (9.7%), C. krusei (2.8%), C. orthopsilosis (2.8%), C. haemulonii var. vulnera (2.1%), C. haemulonii (1.4%), C. metapsilosis (1.4%), C. dubliniensis (1.4%), C. guilliermondii (1.4%), C. duobushaemulonii (0.7%), C. kefyr (0.7%), and C. pelliculosa (0.7%). Poor susceptibility to fluconazole was identified in 6.4% of C. parapsilosis isolates (0.12 to >64 µg/mL), 50% of C. guilliermondii (64 µg/mL), 66.6% of C. haemulonii var. vulnera (16-32 µg/mL), and C. duobushaemulonii strain (MIC 64 µg/mL). Our results corroborated the emergence of C. glabrata in Brazilian cases of candidemia as previously reported. Importantly, we observed a large proportion of non-wild type C. glabrata isolates to voriconazole (28.6%; <0.015 to 4 µg/mL) all of which were also resistant to fluconazole (28.6%). Of note, C. haemulonii, a multidrug resistant species, has emerged in the Southeast region of Brazil. Our findings suggested a possible epidemiologic change in the region with an increase in fluconazole-resistant species causing candidemia. We stress the relevance of routine accurate identification to properly manage therapy and monitor epidemiologic trends.

Among the main factors that affect patients' quality of life, fatigue is a significant symptom experienced by children during treatment. Despite the high incidence, there has been no validated scale to evaluate fatigue in children with cancer in Brazil. The purpose of this study was to examine the psychometric properties of the PedsQL™ Multidimensional Fatigue Scale, using self-reports of Brazilian children, 8 to 18 years of age, and proxy reports. A cross-sectional method was used to collect data from 216 subjects over an 18-month period. Reliability ranged from .70 to .90 except for sleep/rest fatigue, self-report (α = .55). No floor or ceiling effects were found in any dimension. Convergent validity was higher than .40 and divergent validity had 100% adjustment. The root mean square error of approximation was acceptable. The comparative fit index was lower than expected. The agreement between self and proxy responses was weak and moderate. The results demonstrate the reliability and validity of the Brazilian version in children with cancer. This is the first validated scale that assesses fatigue in Brazilian children and adolescents with cancer., (© 2014 by Association of Pediatric Hematology/Oncology Nurses.)

Coagulase-negative staphylococci (CoNS), which are generally neglected as foodborne bacteria, are emerging as significant opportunistic pathogens that may be highly resistant to available antimicrobial drugs. In this study, antimicrobial susceptibility patterns, mecA gene occurrence, and virulence-associated characteristics were evaluated in CoNS isolated from soft cheese in Brazil. A total of 227 bacterial isolates were recovered from 35 cheese samples belonging to 5 batches with 7 different trademarks. The CoNS counts ranged from 10(6) to 10(7) CFU/g. High antimicrobial resistance percentages were observed for oxacillin (76.2%), penicillin (78.5%), erythromycin (67.8%), gentamicin (47.2%), clindamycin (35.7%), rifampicin (26.8%), azithromycin (14.7%), tetracycline (14.7%), levofloxacin (14.2%), and sulfamethoxazole-trimethoprim (11.9%). A low antimicrobial resistance percentage was observed for chloramphenicol (2.3%), and all of the tested bacteria were susceptible to vancomycin and linezolid. In total, a multiple antibiotic resistance (MAR) index of >0.2 was observed for 80.6% of the isolated CoNS. However, the MAR index ranged from 50% to 92.6% when only bacterial cheese isolates belonging to the same trademark were considered. Regarding to the prevalence of CoNS carrying mecA gene, 81.5% of the isolated strains were mecA(+) , and 76.2% of these were phenotypically resistant to oxacillin. Three isolates carried the enterotoxin A gene (sea), 29.5% produced biofilm in a laboratory test, and α- or ß-hemolysis were observed for 3% and 5.2%, respectively. This study highlights the extent of the antimicrobial resistance phenomenon in neglected foodborne microorganisms and the potential public health risks that are related to the consumption of CoNS-contaminated soft cheese., (© 2013 Institute of Food Technologists®)

One aimed to know the causes of hospitalization among children under five years in a public hospital in Paraná to subsidize nursing actions. A descriptive, quantitative, exploratory study was carried out, with inferential statistical analysis. One assessed 722 medical records from 2005-2009. It was observed that children under one year had more hospitalizations (42%) than those with one to five years; a higher percentage of male admissions (65%); respiratory diseases predominated (56%) compared to all other; mean length of stay of 9.4 days for those under one year and 8.3 days for children under five years; 95% were discharged as the outcome. This profile helps to direct nursing care, incorporating the data in planning, both in primary care and in hospital.

This study's purpose was to identify the therapeutic journey of families seeking health care for their children with respiratory diseases. This qualitative study had the participation of parents of children younger than five years old who were hospitalized with respiratory diseases. Path mapping was used as an instrument to collect data, which was analyzed through thematic analysis. The findings indicate that families sought the health services as soon as they perceived symptoms and had access to medical care, however such care was not decisive in resolving their health issues. Even though the families returned to the service at least another three times, the children had to be hospitalized. The attributes of primary health care were not observed in the public health services, while therapeutic encounters had no practical success.

This study aims to describe the trajectory children and adolescents experience from the beginning of cancer signs and symptoms until the confirmation of the diagnosis, based on their parents' report. A total of eight mothers and two fathers participated in the study. Data were collected through semi structured interviews, and data were subject to qualitative analysis. We found that this period is significant for parents, who are capable of recognizing that something wrong started to happen to their children, expressed through signs and symptoms. They precisely reported the chronological time of this trajectory. The challenges they mentioned refer to the different diagnostic hypotheses, the difficulty to performing specific diagnostic exams and to be referred to specialized care services. This search for health service care revealed to be a difficult journey, which permits to identify that the Brazilian Basic Health System's principles of accessibility and problem-solving capacity are jeopardized.

The aim of this paper is to identify the routine (school, work, free time activities and relationships with friends and family) of children and adolescents with Cystic Fibrosis (CF) through their experiences and identify situations that can affect these routines. The objects of analysis of this research are children and adolescents with CF who attend a teaching hospital in a city of the State of São Paulo--Brazil. It is a qualitative research, with data collection based on open interviews and patient charts. The data brought the following themes: misleading knowledge about the disease, concern with self-image, search for self-care and hope of improvement in the future. The results evidence the repercussion of CF in those patients' socialization process, evidencing the importance of health professionals knowing about these demands and incorporating them into the care plan, with a view to effective interventions to promote infant-juvenile growth and development.

Expansion of the cattle and soy industries in the Amazon basin has increased deforestation rates and will soon push all-weather highways into the region's core. In the face of this growing pressure, a comprehensive conservation strategy for the Amazon basin should protect its watersheds, the full range of species and ecosystem diversity, and the stability of regional climates. Here we report that protected areas in the Amazon basin--the central feature of prevailing conservation approaches--are an important but insufficient component of this strategy, based on policy-sensitive simulations of future deforestation. By 2050, current trends in agricultural expansion will eliminate a total of 40% of Amazon forests, including at least two-thirds of the forest cover of six major watersheds and 12 ecoregions, releasing 32 +/- 8 Pg of carbon to the atmosphere. One-quarter of the 382 mammalian species examined will lose more than 40% of the forest within their Amazon ranges. Although an expanded and enforced network of protected areas could avoid as much as one-third of this projected forest loss, conservation on private lands is also essential. Expanding market pressures for sound land management and prevention of forest clearing on lands unsuitable for agriculture are critical ingredients of a strategy for comprehensive conservation.

The Integrated Management of Childhood Illnesses (IMCI) strategy aims at improving the quality of care delivered and children's health conditions. This article presents a description and reflection on the introduction of the Integrated Management of Childhood Illnesses in the Nursing undergraduate curriculum, based on the literature and on the experience of the authors teaching at the Nursing program on Children's Health from University of São Paulo (Nursing School and Nursing School from Ribeirão Preto). The authors mention historical aspects regarding the IMCI in Brazil and the principles that guide it. In the end, they indicate the potentials regarding the application of this strategy at the health care units for children, focusing on nurses' performance.

Contrary to common sense, the population aging process is due to the decline in fertility rather than mortality. The aging process began around the end of the 19th century in a number of Western European countries, expanded to the rest of the so-called First World over the past century, and reached several Third World countries afterwards, including Brazil over the last decades. In the Brazilian case, a sharp and widespread fertility decline began by the end of the 1960s, and an accelerated population aging process can thus be expected. This process will necessarily be faster and with deeper structural changes, demographically speaking, than in First World countries, for two reasons: the fertility decline in Brazil was faster, and it took place in a population with a younger age structure.

We have interviewed 23 women from December 2000 to April 2001 at a Public Health Unit on a Family Health Program, aiming to analyze their beliefs regarding the use or not of contraceptive methods, and to identify their central or peripheral axis. 123 beliefs were emitted and categorized in five types, each one of them classified in 11 structural units, representing rationales for supporting the beliefs. There was a tendency to centralize the beliefs, with a worrisome 47.15% of the women pertaining to type B: unwilling to accept changes. There is a need to discuss beliefs and partners as part of educational programs.

Purpose: To describe Brazilian mothers' experiences of home care for their low birth weight (LBW) infants., Design: Descriptive., Sample: Eleven Brazilian mothers whose LBW infants were hospitalized at birth and followed up for a period of four weeks., Main Outcome Variable: Brazilian mothers' recollections about the home care of their infants., Results: The study identified the infants' and mothers' profiles and the mothers' concerns about disruption in attachment due to hospitalization and their infants' growth. After hospital discharge, these mothers mainly worried about their infants' weight gain, breathing, and overall development, as well as breastfeeding, feeding, and medication preparation.