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Background: Manfredini et al. demonstrate that the new rating protocol, EMOnco, can triage of cancer patients in acute care settings safely, considering their cancer type, stage and treatment histories and oncological emergencies, enabling the appropriate classification from high-risk patients to non-urgent patients., Background: ■ EMOnco considers variables related to the cancer history and treatment., Background: ■ Triages patients in the emergency care in less than three minutes., Background: ■ Cancer patients need priority care regarding infection, and this protocol consider it., Background: ■ EMOnco has shown to be a valid and reliable scale for the triage of oncological patients in the emergency room or acute care clinics., Objective: To validate a risk rating scale for triaging of cancer patients in emergency rooms that can identify individuals needing urgent care or in imminent worsening of the clinical condition., Methods: This is a health instrument validation study developed in the emergency care ward of a Brazilian hospital, a referral center for cancer and hematological diseases. We built the Emergency Oncology Scale (EMOnco) based on literature review and a Delphi survey with 20 experienced oncologists (physicians and nurses). We validated the scale by assessing its construct validity, interobserver agreement and reliability after applying them in a convenience sample of all consecutive patients with cancer who visited the ward between August 2017 and January 2018. We compared the EMOnco Scores with those from other scales, used by six trained nurses: the Emergency Severity Index, the Manchester Triage System, and the Karnofsky Performance Status. We also recorded socio-demographic and clinical features and the Sequential Organ Failure Assessment (SOFA) results in the intensive care unit., Results: We included 250 patients with locally advanced or recurrent disease and undergoing chemotherapy. EMOnco screening took 2.24 (± 2.9) minutes in average. The interobserver correlation coefficient was 0.9. EMOnco was highly correlated with Emergency Severity Index (r=0.617) and also correlated with Karnofsky Performance Status (0.420) Manchester Triage System (0.491; p<0.001 for all)., Conclusion: EMOnco in Portuguese considers variables related to the cancer history and treatment and has proven to be a valid and reliable for the risk classification of oncological patients in emergency care services.

Objective: To design and validate a Brazilian version of the Animal Empathy Scale, based on the existing Portuguese version., Methods: Content validity assessment was performed by expert judges, and the adapted scale was administered to a sample of 386 participants. Exploratory and confirmatory factor analyses were performed., Results: The bifactorial profile of the scale remained consistent, comprising Empathic Concern for Animals (Cronbach's alpha and McDonald's omega coefficients: 0.75) and Emotional Attachment with Animals (Cronbach's alpha and McDonald's omega coefficients: 0.79). Considering the One Health framework, collaborative, multidisciplinary, and intersectoral approaches are essential for achieving optimal health conditions for people, animals, and the environment given their intricate interconnections. Empathy plays a crucial role in promoting proximity between humans and animals, fostering positive connections that encourage biodiversity conservation., Conclusion: The 13 statements were retained, confirming the validity of the animal empathy scale for use in Brazil, and a Brazilian version of the Animal Empathy Scale was established.

Background: Healthy aging encompasses more than the absence of disease, emphasizing the preservation of functional abilities for enhanced well-being and quality of life. Nature-based interventions are scientifically proven contributors to healthy aging., Objective: To develop an evidence map showcasing nature-based interventions targeting older individuals' health and well-being., Methods: The evidence map was developed through critical analysis of systematic reviews and clinical trials utilizing the tools AMSTAR2 and CONSORT. A systematic search spanning the past decade was conducted across databases: Cochrane, SCOPUS, PubMed, Web of Science, Embase, and LILACS., Results: Twelve articles met the eligibility criteria. Nature-based interventions such as forest bathing, hiking, therapeutic gardens, virtual reality, and forest sounds were identified. Outcomes were categorized into physical aspects (cardiovascular and pulmonary; neuro-immuno-endocrinological) and mental/behavioral aspects. The final map integrated interventions, outcomes, and quality assessments., Conclusions: The survey highlights the positive impact of nature-based interventions on the health of the elderly. This study provides insights across various domains, fostering the development of programs and policies in management to promote healthy aging. Regarding healthcare, it encourages discourse among professionals regarding the integration of nature-based practices for equitable care in both individual and group settings. Furthermore, it underscores the need for research in the Southern Hemisphere, particularly in Brazil, where the study was conducted.

The Scientists of Tomorrow/ Cientistas do Amanhã project is an immersive science training program developed by the Program of Post-Graduation in Health Sciences at Hospital Israelita Albert Einstein. This program was conducted in partnership with Volunteering and Escola Municipal de Ensino Fundamental Professor Paulo Freire in Paraisópolis, São Paulo, Brazil. The Scientists of Tomorrow Program comprised a short training period conducted in May 2022 involving 37 students, and a long training period from August to December 2022, which included 15 students. It aimed to popularize science through practical activities; transfer knowledge to young students; sensitize and guide them to pursue academic-scientific careers; reduce stereotypes about scientific work and scientists; and help students understand the social, political, and ethical roles of science within society. All activities were led by postgraduate students and professors from our postgraduate program, physicians, nurses, physiotherapists, biomedicals, and veterinarians from Hospital Israelita Albert Einstein, as well as medical students from Faculdade Israelita de Ciências da Saúde Albert Einstein . Activities in the short training included lectures on cinema and science, strategies to combat fake news, non-violent communication, innovation, design-thinking framework, and developing a scientific project. During the long training period, discussions were focused on nanotechnology, animal research, big data, bioinformatics, meditation, blood and bone marrow donation, telemedicine, sex and sexually-transmitted infections, rehabilitation, career opportunities, and scientific integrity. In addition, practical activities were further expanded using optical and confocal microscopy, cytometry, and basic concepts regarding the structure and function of living cells. The program also included the launching of the open-air outreach Education E-natureza activity, which turned students into ambassadors of nature. In conclusion, the Scientists of Tomorrow Program was innovative and enabled young students to learn that science is a collective activity that can enhance public health. In Brief Rangel et al. enumerated the Scientists of Tomorrow/Cientistas do Amanhã program, an immersive science initiative conducted in collaboration with a public school. The program, which involved 15 students, aimed to promote science, share knowledge, inspire academic paths, and underscore societal impacts. Led by postgraduates, professors, and healthcare experts, the program included diverse lectures and practical laboratory activities. Highlights Every research endeavor commences with a fundamental question. Sharing of findings by researchers and students contributes toward the expansion of knowledge. Teaching scientific methodology is a pivotal step in nurturing critical thinking skills. Science permeates our daily lives and plays a crucial role in addressing societal issues.

The incidence of cancer cases is increasing worldwide, and chemotherapy is often necessary as part of the treatment for many of these cases. Nature-based interventions have been shown to offer potential benefits for human well-being., Objective: This study aims to investigate the outcome of nature images on clinical symptom management related to chemotherapy., Methods: A randomized clinical trial was conducted in an outpatient cancer unit of a private hospital in Brazil, with 173 participants over the age of 18 who were undergoing chemotherapy and had signed an informed consent form. The intervention consisted of the presentation of a 12-min video featuring nature images categorized under the themes of Tranquility, Beauty, Emotions Up, or Miscellany. Images were sourced from the e-Nature Positive Emotions Photography Database (e-NatPOEM), a publicly available collection of affectively rated images. Sociodemographic and clinical data, as well as the participants' connection to nature, were investigated. The Positive Affect/Negative Affect Scale (PANAS) and the Edmonton Symptom Assessment System (ESAS) were applied pre- and post-intervention., Results: Data showed very strong evidence of a reduction in negative affect for the intervention group ( p < 0.001) and moderate evidence for the control group ( p = 0.034). There was also a significant reduction in the intervention group for pain ( p < 0.001), tiredness ( p = 0.002), sadness ( p < 0.001), anxiety ( p < 0.001), and appetite ( p = 0.001). The Beauty video had the best performance, while the Tranquility video showed no significant improvement in any of the symptoms evaluated. These findings suggest that images of nature may be a valuable tool to help control clinical and psychological symptoms in cancer patients undergoing chemotherapy.

Persons with severe mental disorders have higher chances of presenting oral health problems than persons in the general population. Mental disorders are considered public-health problems worldwide. Interpreting statements on oral health made by medical students receiving instruction in psychiatry is essential to provide elements for reflection on their difficulties, barriers or limited knowledge in managing their patients' oral health. Based on the presupposition that doctors provide their patients with no instruction or support concerning oral complaints, because these do not symbolize the same challenges as those emerging from severe mental disorders. The aim of this study was to interpret symbolic meanings of statements expressed by medical residents in psychiatry at a specialized university outpatient clinic, about their patients' oral health. Qualitative research using the Qualitative-Clinical method was conducted, adopting the theoretical reference of medical psychology. Data were analyzed by the Clinical-Qualitative Content method and the Seven-Step technique. Based on 06 interviews analyzed, the following categories emerged: "What do I do? Psychiatrists' dilemmas about not understanding their role in patients' oral health; and "Dentists do not participate in Balint' so-called "collusion in anonymity". It was concluded that among others, the paradigm consisted of a sociological composition, therefore it was stronger than personal decisions that might eventually oppose the barriers to interdisciplinary work posed by the institutional model, which were intertwined with paradigmatic barriers. Thus, specialist training should include a dental perspective, so that oral examinations would always be included in the physical examinations, from an interdisciplinary perspective of the integrity of health-care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Guerra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation of visitors, affecting the quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults' daily life, were also interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these institutions. In this context, this study aims to evaluate the impact of the return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers., Methods: This study used a pre-test and post-test design within the same group. The first round of data collection was conducted before volunteer-led activities returned and the second round after 1 month of return. The instrument used to assess QoL was the EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in Brazil. Volunteer-led activities were part of residents' daily life before the COVID-19 pandemic, when these activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29 residents, 27 volunteers, and 23 employees of the long-term care institution., Results: Using a Wilcoxon signed-rank test, the analyses indicated improvements after the 1 month return in different QoL aspects for the three groups. Volunteers improved their personal relationships (Z - 2.332, p < .05), residents their overall health (Z - 2.409, p < .05) and employees in their overall QoL perception (Z - 2.714, p < .05). Influencing factors for residents were the number of activities (3 or more), gender (male), and education (undergraduate/graduate). For employees, those who assumed additional activities due to the volunteer-led activities interruption had a significant impact on their overall QoL., Conclusions: Evidence from this study suggests that volunteers' return positively impacted different QoL aspects for volunteers, residents, and employees., (© 2023. The Author(s).)

Introduction and Objective: Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents., Methods: A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence"., Results and Conclusions: Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Purpose: To determine the effect of upper blepharoplasty on corneal topography and intraocular lens power calculation using Galilei and IOLMaster., Methods: Thirty patients submitted to upper blepharoplasty from May 2014 to March 2017 at the Hospital Oftalmológico de Sorocaba (São Paulo, Brazil) were included in this observational case series. All patients underwent imaging sessions with Galilei and IOLMaster preoperatively (baseline) and at 1 and 6 months postoperatively. Primary outcome measures using both devices included flattest, average, and steepest corneal curvature, corneal astigmatism, and blepharoplasty-induced corneal astigmatism. Determination of axial length and lens power calculation were performed using only IOLMaster (Holladay formula). Paired t-test and vectorial analysis were used for statistical analysis., Results: Sixty eyes from 30 patients were prospectively included. Vectorial analysis showed that 6 months after surgery, blepharoplasty induced on average 0.39 D and 0.31 D of corneal astigmatism, as measured with Galilei and IOLMaster, respectively. IOLMaster measurements showed that average corneal curvature (44.56 vs 44.64 D, p=0.01), steepest corneal curvature (45.17 vs 45.31, p=0.01) and corneal astigmatism (1.22 vs 1.34, p=0.03) were higher 6 months after surgery. IOLMaster measurements also showed that intraocular lens power was significantly smaller 6 months after surgery (22.07 vs 21.93, p=0.004). All other parameters showed no change for comparisons between baseline and 6 months (p>0.05 for all comparisons)., Conclusion: Upper eyelid blepharoplasty influenced intraocular lens calculation using the IOLMaster. However, the influence was not clinically significant. No topographic changes were found using Galilei.

Introduction: Papanicolaou test (Pap smear) is the standard screening test of pre-neoplastic lesions and cervical cancer. This study aimed to investigate cervical cancer screening results and risk factors such as age, reason for the examination, the epithelia detected in the sample, microbiota and signs of sexually transmitted infection (STIs) of women in a maternity school in Fortaleza, Ceará, Brazil., Methods: In this cross-sectional study, data were retrieved of 353 women who underwent Pap smear between April 2016 and January 2017 at the Federal University of Ceará., Results: Of all Pap smear samples retrieved, 54.1% (191/353) had glandular epithelium and 40.2% (142/353) had metaplastic epithelium. After statistical analyses adjusted for the final model, age ≥51 years (odds ratio = 3.47) and signs of STIs (odds ratio = 4.95) remained as risk factors., Conclusions: The diagnosis of high-grade lesions and carcinomas in patients older than 50 years indicates a deficiency in cervical screening. Women with signs and symptoms of STIs and candidiasis sought medical services more frequently than asymptomatic women, and presence of these signs and symptoms contributes to the diagnosis of cervical cancer. We highlight the importance of obtaining a correct smear sampling to allow prompt detection of all preneoplastic lesions; moreover, the implementation of human papillomavirus vaccination and an efficient routine Pap screening are necessary in low-resource settings., (© 2020 John Wiley & Sons Ltd.)

Objective: The aim of this study was to verify determinant factors for depression and analyze the relationship between possible changes in HPA axis and depression, in this case NR3C1 DNA methylation and serum cortisol levels., Methods: 349 adult volunteers were recruited to evaluate depression, socio-demographic, economic and lifestyle factors, serum cortisol levels and NR3C1 DNA methylation by pyrosequencing. Depression determinant factors were investigated using a Poisson regression model with robust variance (p < 0.05)., Results: Poisson regression with robust variance adjusted by gender, tobacco use, self-perceived stress, leisure activity, suicidal ideation, low cortisol levels and NR3C1 DNA methylation was performed and predicted risk factors for depression. Furthermore, depressive volunteers showed a significant increase in NR3C1 DNA methylation when compared to healthy volunteers., Conclusions: This findings provide a basis for understanding the role of HPA axis in depression, especially its regulation by NR3C1 DNA methylation. Furthermore, it emphasizes the stressful lifestyle risk factors (female, tobacco uso, self perceived stress, leisure activities absence and suicidal ideation) that can contribute to future research and the search for public health policies to improve quality of live, mental and general health., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective:  To explore the experiences of women with obesity regarding self-care and the care provided by their families and health team after childbirth., Methods:  A clinical qualitative study performed at the Postnatal Outpatient Clinic of Hospital da Mulher, Universidade Estadual de Campinas, Brazil. The sample was selected using the saturation criteria, with 16 women with obesity up to 6 months after childbirth., Results:  The analysis comprised three categories: 1) postnatal self-care; 2) family support for woman after childbirth; and 3) postnatal health care service for women with obesity., Conclusion:  Women with obesity need support from the health team and from their families after childbirth, when they are overwhelmed by the exhausting care for the newborn. The present study reveals how important it is for health care professionals to broaden their perception and care provided after childbirth for women with obesity so they may experience an improvement in their quality of health and of life., Competing Interests: The authors have no conflict of interests to declare., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)

Human activities have long been altering the natural conditions of streams, including the quality of their water, throughout most of Brazil. This problem is even worse in regions with low rainfall levels, such as the Brazilian Northeast, where water quality needs to be monitored more carefully. In this context, the present study investigated the effects of environmental integrity on the physicochemical characteristics of the streams of the basin of the Itapecuru River in northeastern Brazil. We tested the hypothesis that streams with lower habitat integrity would have higher conductivity, pH, and temperature, due to the reduced input of allochthonous organic matter and the greater washout of sediments to the stream bed. A total of 15 streams, of a sedimentary basin, were evaluated in the municipality of Caxias, in the Brazilian state of Maranhão, between June 2015, and July 2016; each stream was sampled once a month during the drought period in the region, where physicochemical measurements were taken to determine the environmental integrity of the stream through the application of a habitat integrity index. Streams with greater habitat integrity had lower conductivity, pH, and temperature and had higher discharge rates. The index proved to be not an effective tool for the evaluation of water quality, but was found to be important for the management of hydrographic basins by indicating important changes in environmental variables. In this case, the index can be used primarily for the management of hydrographic basins, given that it can be applied straightforwardly, it can be interpreted easily by decision-makers, and it can quantify alterations to the structure of the system with precision.

Objective: to adapt the Consultation and Relational Empathy Measure (Brazilian version) for nurses; to evaluate the concurrence between empathy self-reported by nurses and that perceived by patients; To correlate self-compassion to the empathy self-reported by nurses and perceived by patients., Method: seven specialists validated the Consultation and Relational Empathy Measure Nurses (Brazilian version)' adaptation by original author's authorization. A sample with 15 triage nurses and 93 patients they admitted to the Emergency Department of a philanthropic private hospital were interviewed according to the following instruments: Consultation and Relational Empathy Measure - Nurses (Brazilian version) and the Self-Compassion Scale (Brazilian version)., Results: the psychometrics properties of Consultation and Relational Empathy Measure - Nurses (Brazilian version) showed appropriate internal consistency (Cronbach's alpha=0,799). The evaluation of empathy provided by the patients was better than that self-reported by the nurses (p<0,001). The nurses with higher level of self-compassion also showed higher empathy scores (p=0,002)., Conclusion: our results confirmed the psychometrics properties' adequacy of Consultation and Relational Empathy Measure - Nurses (Brazilian version), allowing to compare empathy scores embased at same parameters. Self-compassion showed to influence self-reported empathy.

Purpose: Enteropathogens are frequently associated with diarrheal disease. Knowledge of their etiology and epidemiology is essential for the prevention and control of the sickness. This study describes the microbiological and epidemiological features of diarrheal disease in 197 symptomatic and 223 asymptomatic under-five-year-old children from southeastern Brazil, between January 2015 and September 2016., Methods: Isolation of Escherichia coli, Salmonella, Shigella and Campylobacter was realized by culture. E. coli strains were screened by multiplex PCR, PFGE and O:H serotyping. Antimicrobial susceptibility testing was also performed., Results: Most of the 127 enteropathogens isolated were diarrheagenic E. coli (96.1 %), with predominance of several serotypes of enteropathogenic E. coli (EPEC) and enteroaggregative E. coli (EAEC). Age, sex, rotavirus vaccination, recent use of antibiotics and previous contact with pets, were factors that revealed no significant effects on the probability of infection by the predominant pathogens. Even so, higher incomes could be related to a lesser chance of testing positive for EPEC. Evidence of possible EAEC clonal spread was detected, as well as genetic similarity among strains from both symptomatic and asymptomatic children. Resistance to antimicrobial agents was more pronounced among EAEC than EPEC., Conclusion: The occurrence of genetically similar diarrheagenic E. coli in both groups of children, likewise resistant to these agents, underscores the importance of establishing strategies for the prevention of outbreaks, especially among low-income households.

The aim of this study was to analyze the value and meanings that dental surgeons attribute to the Primary Health Care setting, where health promotion is encouraged over a mechanistic performance of procedures. A qualitative study, involving ten Brazilian dental surgeons working in Primary Care in 2016, was designed. In-depth semi-structured interviews were performed, with all interviews recorded, transcribed and subsequently submitted to Qualitative Content Analysis. Despite the Healthcare Promotion model proposed by the Brazilian oral health policy, dental surgeons demonstrated preferences for private and traditional dental practices. These characteristics are counterproductive in public oral health services, which aim to achieve collective health benefits. Traditional practice is based upon a specific and restricted focus, as opposed to overall patient care, hence maintaining the original professional identity, ruled by manual procedures, while demonstrating scientifically fragile understanding of disease processes. Despite the implementation of public service models that aim at change, counterproductive characteristics associated with the deeply rooted traditional management strategies were evidenced., Competing Interests: The authors have declared that no competing interests exist.

Roads play an important role in the economic development of cities and regions, but the transport of cargo along highways may represent a serious environmental problem because a large portion of transported goods is composed of dangerous products. In this context, the development and validation of risk management tools becomes extremely important to support the decision-making of people and agencies responsible for the management of road enterprises. In the present study, a method for determination of environmental vulnerability to road spills of hazardous substances is coupled with accident occurrence data in a highway, with the purpose to achieve a diagnosis on soil and water contamination risk and propose prevention measures and emergency alerts. The data on accident occurrences involving hazardous and potentially harmful products refer to the highway BR 050, namely the segment between the Brazilian municipalities of Uberaba and Uberlândia. The results show that many accidents occurred where vulnerability is high, especially in the southern sector of the segment, justifying the implementation of prevention and alert systems. The coupling of vulnerability and road accident data in a geographic information system proved efficient in the preparation of quick risk management maps, which are essential for alert systems and immediate environmental protection. Overall, the present study contributes with an example on how the management of risk can be conducted in practice when the transport of dangerous substances along roads is the focus problem.

Purpose: We describe the results of a risk-adapted, response-based therapeutic approach from the Brazilian GCT-99 study on germ cell tumors., Patients and Methods: From May 1999 to October 2009, 579 participants were enrolled in the Brazilian GCT-99 study. Treatment, defined as specific chemotherapy regimen and number of cycles, was allocated by means of risk-group assignment at diagnosis with consideration for stage and primary tumor site. Patients at low risk received no chemotherapy. Patients at intermediate risk (IR) with a good response (GR) received four cycles of platinum and etoposide (PE), for total doses of platinum 420 mg/m(2) and etoposide 2,040 mg/m(2). Patients at IR with a partial response (PR) received three cycles of PE plus three cycles of ifosfamide, vinblastine, and bleomycin. Patients at high risk (HR) with a GR received four cycles of PE and ifosfamide (PEI) at total doses of platinum 420 mg/m(2), etoposide 1,200 mg/m(2), and ifosfamide 30 g/m(2). Patients at HR with a PR received six cycles of PEI., Results: The risk-group distribution was 213 LR, 138 IR, and 129 HR for 480 evaluable patients. Overall survival (OS) and event-free survival (EFS) rates at 10 years were, respectively, 90% and 88.6% in the IR-GR group (n = 126) and 74.1% and 74.1% in the IR-PR group (n = 12). Ten-year rates for the HR-GR group (n = 86) were an OS of 66.8% and an EFS of 62.5%. The HR-PR group (n = 43) had an OS of 74.8% and an EFS of 73.4%. In univariable and multivariable analysis, increased serum lactate dehydrogenase level and histology for a metastatic immature teratoma were prognostic of a worsened outcome., Conclusion: Reduction of therapy to two drugs did not compromise survival outcomes for patients in the IR-GR group, and escalation of therapy with PEI did not significantly improve OS and EFS in patients at HR., (© 2016 by American Society of Clinical Oncology.)

Objective: To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population., Methods: The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011., Results: There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth., Conclusion: Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age.

Aim: To show additional prognostic information about the mutational profile and new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification of adenocarcinoma (ADC) in patients without epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor treatments., Methods: In human lung ADC patients (n = 125), including 24 lepidic, 67 acinar, 23 papillary, and 11 solid predominant subtypes, EGFR and KRAS were sequenced, and anaplastic lymphoma kinase (ALK) rearrangements were screened using fluorescence in situ hybridization (FISH)., Results: EGFR was mutated in 21.6% of patients with 19.57% showing a mean expression. The most frequent EGFR mutation was a deletion in exon 19, followed by an L858R amino acid substitution in exon 21. KRAS was mutated in 26.4% of patients with 50% displaying mean expression. ALK rearrangement was detected in 6 patients (4.8%). Predominant acinar ADC was strongly associated with EGFR and KRAS mutation. Clinical stage, lymph node metastases, and EGFR mutation in exon 18 showed a significant difference in disease-free and overall survival, but only a trend significance for EGFR and KRAS mutations. Multivariate analysis revealed that men aged >71 years, with a history of smoking (<72 packs/year), clinical stage I/II, and acinar histologic subtype presented better survival than women aged ≤ 71 years, with a history of smoking (>72 packs/year), and having a predominant solid ADC and EGFR mutation in exon 18., Conclusions: These results indicate that the mutational profile and new IASLC/ATS/ERS classification provide additional prognostic information about lung ADC., (© 2015 S. Karger AG, Basel.)

Objective: To describe the academic profile, research experience, beliefs, and self-efficacy in research of clinical nurses in a Magnet Journey™ hospital., Methods: Quantitative descriptive designed to assess research experience of clinical nurses. The survey was divided into demographics characteristics; scientific/academic profile (Nursing degree; membership in academic research groups, involvement in papers, teaching activities, scientific conferences, and posters presented); beliefs related to nursing research (about skills, benefits to career, reputation of institution, patient care; job satisfaction level); and Research Self-Efficacy (conducting literature review; evaluating quality of studies; using theory; understanding evidence; and scientific writing: putting ideas on paper easily; recognize and adapt the text to the reader; write to the standards required by science; write with objectivity, logical sequence, coherence, simplicity, clarity, and precision; insert the references in the text correctly; write the references appropriately; use correct spelling and grammar; write texts in English)., Results: Most clinical nurses had low research experience, yet had positive beliefs in and perception of well-developed research skills., Conclusion: Our findings should contribute to the preparation of research programs aimed at facilitating the engagement of clinical nurses in the development of scientific projects.

Background: Despite being curable, tuberculosis is still a stigmatized disease. Not only is TB patients' suffering due to its clinical manifestations, but also because of society's prejudice, embarrassing situations, and even self-discrimination. This study aims to investigate psychosocial experiences of patients who have completed tuberculosis treatment in São Carlos a municipality in the interior of São Paulo State, Brazil., Methods: This study, of a clinical-qualitative nature, sought to understand the meanings provided by the participants themselves. Fifteen individuals, who had successfully completed tuberculosis treatment, participated in this research. The sample size was established using the information saturation criterion. Data were collected by means of interviews with in-depth open-ended questions. Data were treated by categorizing and analyzing content according to themes., Results: Regardless of all progress, this study found that TB still causes patients to suffer from fear of transmission, social prejudice, and death. Despite the fact that the emotional support provided by families and healthcare professionals is considered essential to treatment adherence and completion, participants in this study reveal that friends and colleagues have distanced themselves from them for fear of contagion and/or prejudice. Ignorance about the disease and its transmission modes can be found in the interviewees' statements, which seems to indicate that they have become vectors of transmission of stigma themselves. Patients' medical leave from work during treatment may be due to both their health conditions and their attempt to avoid social/emotional embarrassment. There are accounts that TB has caused psychosocial damage to patients' lives and that they feel more fatigue and lassitude and have begun to pay more attention to their own health., Conclusions: Healthcare workers should be aware of the ways TB treatment affect patients' psychosocial life and develop strategies to mitigate these effects and provide opportunities for them to share their anxiety, suffering, and bio-psychosocial changes. In addition, healthcare professionals should seek to educate and, as a result, empower TB patients and their families with regard to this disease so as to break the existing vicious cycle of misinformation and prejudice.

Objective: The objective of this study was to evaluate whether adolescent pregnancy is a risk factor for low birth weight (LBW) babies., Methods: This was a cross-sectional study of mothers and their newborns from a birth cohort in Aracaju, Northeastern Brazil. Data were collected consecutively from March to July 2005. Information collected included socioeconomic, biological and reproductive aspects of the mothers, using a standardized questionnaire. The impact of early pregnancy on birth weight was evaluated by multiple logistic regression., Results: We studied 4,746 pairs of mothers and their babies. Of these, 20.6% were adolescents (< 20 years of age). Adolescent mothers had worse socioeconomic and reproductive conditions and perinatal outcomes when compared to other age groups. Having no prenatal care and smoking during pregnancy were the risk factors associated with low birth weight. Adolescent pregnancy, when linked to marital status "without partner", was associated with an increased proportion of low birth weight babies., Conclusions: Adolescence was a risk factor for LBW only for mothers without partners. Smoking during pregnancy and lack of prenatal care were considered to be independent risk factors for LBW.

Background: The transcription factor FOXP3 is increased in acute renal rejection, but its influence on graft outcomes is unclear. This study correlated FOXP3 with dendritic cells and graft outcomes., Methods: We assessed 96 kidney transplants undergoing allograft biopsy for cause. FOXP3 mRNA was analyzed by real-time polymerase chain reaction (PCR) and FOXP3 protein and DCsCD83(+) by immunohistochemistry. Graft function and survival were assessed at 5 years post-transplantation, as well as by independent predictors of graft loss., Results: Intragraft FOXP3 gene and protein expression were significantly correlated (r = 0.541, p < 0.001). Both FOXP3 mRNA and protein were increased in patients with acute rejection (AR). High expression of FOXP3 mRNA or protein in biopsies did not correlate with clinical variables, but there was a trend to higher positive variation in the glomerular filtration rate (GFR) from biopsy to last follow-up. Patients with FOXP3-mRNA(high) had more DCsCD83(+) in biopsy, but these cells did not associate with AR. Five-year graft survival was not influenced by either FOXP3 mRNA or protein expressions., Conclusions: FOXP3 mRNA and protein had a good correlation in archival renal graft tissue. Increased FOXP3 expression was found in AR and FOXP3 associated with high numbers of DCs. However, both FOXP3 mRNA and protein was not associated with better allograft outcomes.

Balera fiuzai sp. nov. is described based on male specimens obtained from light trap collections at Mata do Paraíso, Municipality of Viçosa, Minas Gerais State, Brazil. An identification key to the species of Balera is given. Additionally, Habralebra gillettei Young is redescribed from the same locality. These specimens of H. gillettei differ somewhat from previously described specimens, but are considered intra-specific variations. Both genera, Balera Young and Habralebra Young, are recorded from Minas Gerais State for the first time.

A new species of Thraulodes Ulmer, 1920 is described from Rio de Janeiro. The species resembles the recently published Thraulodespelicanus Mariano and Froehlich, 2011 (in Mariano et al. 2011) due to the length and width of the penes. However, Thraulodes bonito sp. nov. differs from this and all other species of the genus by the wide penes, the triangular shape of the styliger plate with median projection short and apex rounded, the abdominal color pattern and the presence of 1-3 weakly marked cross veins basal to bullae. The new species is described based on male imagos, female subimagos and nymphs.

Purpose: The objective of this study was to explore the psychosocial meaning and repercussions on lifestyle associated with erectile dysfunction and urinary incontinence (UI) in men following radical prostatectomy., Subjects and Setting: Ten men from Southeastern Brazil who underwent radical prostatectomy for prostate cancer were interviewed. All participants underwent treatment at a urology clinic during the period of September 2007 to February 2009., Methods: A clinical-qualitative study was conducted, using semi-structured interviews with open-ended questions. All interviews were recorded and transcribed verbatim. Each man was interviewed once. The average length of the interviews was 37 minutes (range: 16 to 81 minutes). Data from the interviews were subjected to content thematic analysis and development of categories based on psychodynamic references., Results: Three themes were identified: (1) sexuality called into question; (2) a body without governance; and (3) experiencing loss. These men reported difficulties in dealing both with the physical and emotional impotence resulting from the treatment. Urinary incontinence and erectile dysfunction affected their body by accentuating conflicts related to masculinity, triggering subjective feelings of powerlessness, and psychological distress., Conclusion: Study respondents assigned multiple psychological meanings to issues related to feelings of powerlessness in general, leading to a narcissistic wound. The men experienced UI as a bodily deficiency, and erectile dysfunction was experienced as a feeling of being devitalized. These results suggest that UI from prostate cancer treatment affects sexuality and self-esteem.

Purpose: We explored the meanings of silence for Brazilian women with urinary incontinence (UI)., Subjects and Setting: The sample consisted of 8 women, aged 30 to 45 years. Respondents worked as housekeepers or cleaning staff and were from lower social, economic, and educational strata. Their years of formal education varied from 0 to 8 years and they earned up to 4.5 times the Brazilian minimum wage, which is equivalent to US$900., Methods: A qualitative method using semistructured interviews was employed to gather data. Individual semistructured interviews were recorded and subsequently transcribed, including researchers' observations of subjects' nonverbal behaviors. The interviews began with the question: "Can you tell me about your experience with urinary incontinence?" Data were analyzed using a content analysis technique., Results: Respondents avoided discussing UI and initially resisted labeling themselves as incontinent, but their nonverbal behaviors provided clues to the psychosocial distress caused by urinary leakage. Results suggest that respondents' underprivileged social, economic, and cultural situation may aggravate their limitations when expressing their feelings. We found that the women employed silence as a means to contain the psychosocial distress created by their UI, and that the silence itself should be interpreted as an expression of distress associated with UI., Conclusion: The silence of Brazilian women with UI is an essential element of communication about incontinence. We believe that the silence used by these women expresses the pain and anxiety they experienced, and it acts as an adaptive psychosocial mechanism.

Objective: To determine the prevalence of smoking and the frequency of smoking cessation counseling among patients at a university hospital, as well as to compare smokers and former smokers in terms of smoking history., Methods: A cross-sectional study involving 629 patients at the Federal University of Paraná Hospital de Clínicas, located in the city of Curitiba, Brazil., Results: Of the 629 patients, 206 (32.7%) were male, 76 (12.1%) were smokers, 179 (28.5%) were former smokers, and 374 (59.5%) were nonsmokers. The mean age of the patients was 49.9 ± 15.0 years (range, 18-84 years). Of the 76 smokers and 179 former smokers, 72 (94.7%) and 166 (92.7%), respectively, were questioned about tobacco use. Smoking history and degree of nicotine dependence were higher among the former smokers (p = 0.0292 and p = 0.0125, respectively). Gender, age at smoking initiation, physician inquiry about tobacco use, and smoking cessation counseling were comparable between the two groups. The smoking cessation rate was 0.70. The prevalence of heavy smoking varied by gender and by age bracket, being higher in males and in the 41-70 year age bracket., Conclusions: The smoking prevalence in this group of patients was lower than that reported for patients at another university hospital, for adults in Curitiba, and for adults in Brazil. The smoking cessation rate was higher in these patients than in the general population of Curitiba. Smokers and former smokers differed regarding age, smoking history, and degree of nicotine dependence. Heavy smoking and a moderate or high degree of nicotine dependence were not obstacles to smoking cessation.

Objective: To estimate the prevalence of pediatric end-stage renal disease and evaluate demographics and renal disease characteristics in state of São Paulo over the year 2008., Methods: Observational, descriptive, and cross-sectional study based on a population sample with subjects < 18 years. The data collecting assumed three forms: 1. A questionnaire for dialysis units; 2. Search in the Transplant Center to determine the number and characteristics of patients who had been in a transplant waiting list over the study period; 3. Search in the database of patients registered at the Latin American Collaborative Registry of Pediatric Kidney Transplantation., Results: Data from 301 patients aged 9.0 ± 5.8, including 140 girls (46.5%), resulting in an estimate prevalence of 23.4 cases per million age-related population (pmarp). The age group most frequently found was 10 to 15 years (32.2%), and urinary tract malformation was the most usual known etiology (24.9%). Most children underwent kidney transplantation (62.1%) and among subjects on dialysis, hemodialysis was predominant (71.2%). The Sistema Único de Saúde - Unified National Health System - (SUS) provided the financial support for treatments., Conclusion: The prevalence of 23.4 cases pmarp found by the authors is lower than that reported in Western world. We believe data were underestimated in the present study, as few dialysis units returned the completed questionnaire. This potential bias does not invalidate the exploratory character of results. Further mechanisms for retrospective and earlier data collecting on pediatric chronic renal disease (CRD) are needed so that the burden of this serious health condition can be appropriately sized up.

Background: Obesity has serious implications on a woman's quality of life and body image. We propose a qualitative investigation aimed at understanding the postoperative significance of bariatric surgery for women suffering from morbid obesity and how these factors influence the outcomes, with an emphasis on body image and on the possible psychological complications that may jeopardize the operation's success., Subjects and Methods: This study uses a clinical qualitative method, through a semidirected interview with open-ended questions in an intentional sample, closed by saturation, with seven women operated in a period of 1.5-3 years, following the definition of emergent categories and qualitative content analysis., Results: Bariatric surgery is a procedure that brings about rapid physical, social, and emotional changes, and it is seen by patients as a possibility of being reinstated and accepted socially. The reencounter with the feminine body after surgery is experienced as a means of reinstatement but also with a feeling of defenselessness, which may lead to the development of phobic symptoms. Imbalance in family and conjugal relationships may be factors that discourage the continuation of the treatment. The patient sees the skin folds, flaccidity, and the scars as therapeutic failures, which can lead to a constant quest for plastic surgery., Conclusion: We observe the necessity of studies that allow the health team to identify those aspects of a patient's psychological makeup which would be expected to improve or worsen their prognosis and to provide the necessary preoperative and postoperative psychosocial interventions.

Objective: Juvenile Neuronal Ceroid-Lipofuscinosis (JNCL, CLN 3, Batten Disease) (OMIM #204200) belongs to the most common group of neurodegenerative disorders of childhood. We report the clinical data and molecular analysis of a large Brazilian family., Method: Family composed of two consanguineous couples and thirty-two children. Clinical data of ten JNCL patients and molecular analyses on 13 participants were obtained., Results: The large 1.02 kb deletion was detected. The most severe phenotype, with autistic behavior, tics and parkinsonism was seen in a 12-year-old female and a milder phenotype in a 14-year-old male. Nyctalopia was the first symptom in one deceased child. The visual loss of six patients has been first observed in the school and not at home., Conclusion: The report highlights the phenotypical intrafamily variation in 10 affected children of this family. The molecular investigation of this large family in our metabolic center turned possible the diagnosis, right approach and genetic counseling.

The aim of this article is to describe the public service of Manaus to elderly, either victims of accidents or violence, on three levels of service (32 pre-hospital, 5 hospital and 5 rehabilitation). It is a descriptive study with a quantitative and qualitative approach, where 42 health units were investigated. The results reveal that the emergency services department presents a better physical structure. The organization concerning these matters is still incipient in Manaus. It was detected scarcity in the number of hospital beds and vacancies in the intensive care unit to offer the continuity of the treatment. There's a need for professional qualifications and medical specialties to attend elderly admitted due to injury. Very little has been done in the prevention area. Data entry and notification appear as one of the weakest points on the three levels of attention. The most critical point is related to hospitalization, being this level of attention largely mentioned by managers and health professionals as in great need for re-structuring.

Background: The increase in bariatric surgeries has called into question the aspects that contribute to or impair the results. Psychosocial factors directly influence the results of the surgery, but a lot of controversy exists in relation to the degree of influence of these factors. We propose a qualitative investigation to understand the significance of the surgery for women and how these factors influence the outcomes., Methods: This study is a clinical-qualitative method, through the semi-directed interview with open-ended questions in an intentional sample, closed by saturation, with seven women operated in a period of 1.5-3 years, following the definition of emergent categories and qualitative content analysis., Results: The experience of acceptance and social reinsertion is a motivating factor to keep up the challenge of weight loss; social discrimination is a risk factor leading to losing the stimulus to continue the process; the recuperation of self-esteem and personal identity is a factor that improves the quality of life and psychopathological symptoms; disillusionment is an important risk factor, linked principally to the experiences of failure., Conclusion: We observe the necessity of qualitative studies that serve the health team in the handling of these patients, aiming for a greater understanding of their psychological dynamics and of the meanings that weight loss has for them.

This study investigated the ethics of qualitative research by using bibliographic research. Data were collected in scientific articles from a Brazilian journal of collective health and the access to the sources was electronic. It were analyzed 117 articles of qualitative research which corresponded to 23.49% of the total production of the journal from 01/1998 to 03/2007. The information collected was organized considering the identification, themes/object, theoretical referential, methodology and ethical aspects involved. The analysis proposed a discussion based on what the researchers express about ethics on their qualitative studies when it comes to two different kinds of relation: between the researchers and their research-subject and with their co-workers. The conclusions brought up many issues to be discussed on the daily routine of the research activity and that demands exposition and openness to criticism. There is also an urge to think what the "said" and the "unsaid" can reveal underneath the obedience to the rules, launching to the process of maturing and to the theoretical consistence of the researchers, especially in the ethical dimension of the researching activity. A huge part of those challenges are of direct responsibility of the institutions which are in charge of the researcher's formation.

This study sought to compare the perception of domestic violence of women, victims of this kind of violence, with the perception of pregnant women, victims or not of domestic violence, as well as to search for elements allowing for the planning and execution of a cohort study on domestic violence among pregnant women. A qualitative exploratory research was conducted using the technique of convenience sampling for selecting a focal group. The subjects were twenty four women divided into two groups: (1) thirteen women from a follow-up group from a Referral Center for victims of domestic violence, and (2) eleven pregnant women that were participating in the pre-natal care program in a primary care unit, selected independently of suffering domestic violence or not. The data collected were transcribed, conceptually decoded and qualified for qualitative analysis. The contents of the women's discourse were analyzed on the basis of thematic categories. It was observed that domestic violence was perceived in a similar way by both studied groups, independently from the fact of having or not experienced a situation of this kind. The understanding and discussion of the topics proposed for the groups allowed developing a more appropriate approach to the studied women. The way the questions were formulated in the questionnaire was considered of easy understanding by both groups of women.

Echovirus (Echo) 30 or human enterovirus B is the most frequent enterovirus associated with meningitis cases. Epidemics and outbreaks of this disease caused by Echo 30 have occurred in several countries. In Brazil, Echo 30 has been isolated from sporadic cases and outbreaks that occurred mainly in the south and southeast regions. We used RT-PCR to examine Echo 30 isolates from meningitis cases detected from March 2002 to December 2003 in Belém, state of Pará, in northern Brazil. The patients were attended in a Basic Health Unit (State Health Secretary of Pará), where cerebrospinal fluid (CSF) was collected and stored in liquid nitrogen. Weekly visits were made by technicians from Evandro Chagas Institute to the health unit and samples were stored at -70 degrees C in the laboratory until use. HEp-2 and RD cell lines were used for viral isolation and neutralization with specific antisera for viral identification. RNA extraction was made using Trizol reagent. The RT-PCR was made in one step, and the total mixture (50 microL) was composed of: RNA, reaction buffer, dNTP, primers, Rnase inhibitor, reverse transcriptase, Taq polymerase and water. The products were visualized in agarose gel stained with ethidium bromide, visualized under UV light. Among the 279 CSF samples examined, 30 (10.7%) were EV positive, 29 being Echo 30 and one was Cox B. Nineteen Echo 30 were examined with RT-PCR; 18 tested positive (762 and 494 base pairs). The use of this technique permitted viral identification in less time than usual, which benefits the patient and is of importance for public-health interventions.

An exploratory, descriptive and qualitative survey was conducted at the Dentistry School, Santa Catarina State Federal University, Brazil, in order to identify and analyze the ethical problems involved in patient care at this teaching clinic. Data were collected through semi-structured interviews with professors of clinical disciplines and assessed through the Analysis of Content technique, using the bioethical principles of the autonomy of the patient and the confidentiality of the information as references. Some analysis categories were identified, pointing to the existence of several ethical problems in the daily patient care routines at this teaching clinic. They include scheduling stand-by patients, favored care for the friends of lecturers and employees, a lack of information offered to patients on treatment and imaging procedures, distortions in the use of deed of informed consent, etc. The constantly vulnerable situation of the patients became quite clear, together with the importance and responsibility of the professors in building up the ethical competence of future dentists.

This article discusses hemodialysis experiences in terms of meanings women attribute to several associated phenomena. Renal insufficiency may present a progressive reduction in renal function, in which the kidneys are affected and become unable to remove metabolic material from the blood. Living with hemodialysis is associated to important psychosocial adaptation mechanisms. This clinical-qualitative study was performed in two general hospitals' nephrology service. The method included purposive sample of nine women in hemodialysis and a semi-directed interview with open-ended questions was applied. After categorizing interviewees' discourse, psychodynamic approaches were used for interpretation. It was concluded that the subjects experienced different degrees of desire to get pregnant and become mothers, now challenged by a limiting illness. Considering the adoption matter, besides symbolizing a generosity act, it would represent a solution to a deep individual demand. Fantasize about adoption, even if it does not become reality, may enhance these women's self-esteem.

Context and Objective: Medical literature should consist of knowledge applicable to professional education; nevertheless, the profusion of articles in databases provokes disquiet among students. The authors considered the premise that scientific production in the field of health follows a mechanical description of phenomena without the clarity of motivating questions. The aim was to interpret material from expert reports, applied by medical students to analyze articles from renowned journals., Design and Setting: This research project was exploratory, searching for latent meanings regarding methodological problems in a sample of papers. It was performed in a Brazilian medical school., Methods: The sample was intentionally built, consisting of articles related to original research in the field of health, published over the previous five years. The results came from text content analysis, performed by a professor and his medical students., Results: (1) Failure to state a hypothesis is an equivocal practice: articles did not show clarity of hypothesis to demonstrate that their authors had epistemological knowledge of the methods chosen. (2) There is a certain belief that in normal scientific practice, hypotheses are unnecessary: studies without explicit hypotheses led to suppositions that they merely repeat dominant models. (3) Presentation of common sense as scientific conclusions: research brings together what would have mobilized the researchers initially., Conclusions: Absence of formal hypotheses leaves scientific production vulnerable when put under epistemological discussion. Conclusions from scientific articles are often confounded with common-sense statements. Quantitative research is suggested, for studying the frequency of occurrence of these dubious methodological points.

This study aimed to know lupus outpatients' life experiences, in terms of the meanings they attributed to several phenomena associated to the process of becoming ill. Systemic Lupus Erythematosus is a chronic inflammatory disease, probably caused by a combination of inborn/hereditary predispositions and environmental factors, which leads to an abnormal stimulation of the immune system. Lupus life experience is associated to important psychosocial adaptation mechanisms of affected people. This work had a clinical-qualitative design and was performed in the dermatology service of a Brazilian General Hospital. The method included purposive sample, and a semistructured interview with open-ended questions was applied. After categorizing the interviewees' discourse, the discussion employed psychodynamic theories. The patients' reactions included the attempt to rebuild their relationships with their own strengths. Lupus patients' familiar and interpersonal conflicts seem to be associated with the idea that family and friends do not understand the nature of the disease.

Celiac disease (CD) is a permanent condition of gluten intolerance and a number of autoimmune diseases have been associated with it. In the past few years, a relation between CD and dilated cardiomyopathy (CM) was described in Europe and United States. The aim of this study was to evaluate the prevalence of CD among south Brazilian precardiac transplant patients with advanced CM. A total of 74 patients on a list for heart transplantation were evaluated for the presence CD. The presence of anti-endomisial antibody (IgA-EmA) was determined by indirect immunofluorescence and for the anti-transglutaminase antibody (IgA anti-h-tTG) by ELISA. Serologically positive patients were submitted to upper endoscopy with intestinal biopsy. Two individuals (2.63%) were positive for IgA-EmA and 5 (6.75%) for IgA anti-h-tTG; 1 (1.35%) had both tests positive. Histologic confirmation of CD occurred only in the IgA-EmA positive patients. In conclusion, data from the present study allows recommend the screening for CD in patients with CM using IgA-EmA test as the method of choice.

Objective: To describe and discuss Year 5 medical students' perceptions of their own learning about the doctor-patient relationship., Methods: We carried out a qualitative study of semi-structured interviews with 16 Year 5 medical students using 3-way analysis at the School of Medicine, Federal University of São Paulo, São Paulo, Brazil., Results: For experiences at the pre-clinical stage, the subcategories were: positive aspects of the medical psychology course; great distance between theory and reality, and strong desire for clinical practice. For experiences at the clinical stage, the subcategories were: demand for opportunities to discuss the doctor-patient relationship; teachers as either role models or anti-models; clinical situations favourable for developing empathic relationships, and clinical situations unfavourable for developing empathic relationships. For views about future experiences, the subcategories were: apprehension about ethical behaviour; anxiety about handling patients' psychosocial characteristics, and fear of professional ethics cases or legal action., Discussion: To compensate for the lack of practical activities during the pre-clinical stage, students search for extracurricular activities that often overload them. Because teachers function as professional role models, their attitudes towards patients have great importance. Students fear not being able to maintain their empathic capacity in the future because of work-related issues. Knowledge of the psychological aspects of the doctor-patient relationship helps students to comprehend their experiences. Gradual contact between student and medical practice from the beginning of the course is advised. It should be followed by interdisciplinary discussions that deal with the technical aspects of cases and the doctor-patient relationship.

Objectives: To evaluate the knowledge level on the screening and diagnosis of breast cancer among the gynecologists of the State of Goiãs, Brazil., Methods: Questionnaires containing professional information and questions on breast cancer screening were posted for all the 427 gynecologists associated to the Goiãs Society of Gynecology and Obstetrics, between May and July of 1999., Results: Of the 427 questionnaires, 26 (6%) were returned because incorrect mailing address. Of the 401 doctors who received the questionnaire, 85 (21%) answered and returned them back. Of these, 28% were female; the average of the profession time was of 17 years. The medical residence was the highest title level for 70%. The average age of the doctors was 44 years. The rates of correct answers were: 94% for the knowledge of the most frequent sign of breast cancer, 75% for the best method for screening, 88% for the period of when the mammography begins, 93% for the periodicity of the mammography after the 50 years and 83% about the indication of the complementary ultrasound. The doctors who have studied in a program of medical residence was the only factor that influenced the rate of correct answers, if compared to those that did not cursed it. The professional's gender, the Title in Gynecology and Obstetrics Specialty (TEGO) holders and the city of work did not influence the rates of correct answers., Conclusion: The gynecologists of the State of Goiãs who answered the questionnaire have a good knowledge on the screening and diagnosis of breast cancer. Medical residence was the single factor that influenced the rate of correct answers.

This study aimed to analyze undergraduate Nursing students' knowledge in two education institutions, one public and one private, about alternative/complementary therapies, since both institutions offer a specific subject in this area under the optional and obligatory form, respectively. Data suggest that, apart from academic education, knowledge about this theme originates from common sense. The students recommend the use of alternative/complementary therapies although they do not use them much. Flower therapy, acupuncture, homeopathy, cromotherapy, fitotherapy, music therapy and massage are more utilized. The most neglected aspect in the teaching-learning process refers to the legal aspects of specialization in this area for the nurse.

A new leafhopper species, Scaris angrensis sp.nov., is described and illustrated based on an adult male from Angra dos Reis, State of Rio de Janeiro, southeastern Brazil. The holotype is deposited in the entomological collection of Museu Nacional, Universidade Federal do Rio de Janeiro, Brazil. The new species seems to be more closely related to S. bahiensis because of its single ventral process on the aedeagal base, being distinguished from that by the apical shape of the stylus. A problem related to the illustrations in the original description of S. nessimiani and S. bahiensis is herein corrected.

The aim of this study was to assess the prevalence and severity of dental caries and need for treatment among 18 years-old males in Florianópolis, Southern Brazil. In addition, the associations between dental caries and socioeconomic conditions were tested. A cross sectional study was carried out. A random sample of 300, was selected from a list of Brazilian Army conscripts. Clinical data were collected according to World Health Organization criteria. Socioeconomic data (years of education of the subjects, their fathers and mothers and family income) were collected through interviews. The statistical significance of associations between socioeconomic indicators and dental caries prevalence were tested using the chi-square test whilst for severity of dental caries Mann-Whitney test was used. The prevalence of dental caries was 81% and the mean DMF-T was 4.5. The mean number of teeth that needed treatment was 1.2. Both dental status and treatment need were statistically significantly associated with socioeconomic indicators. Those with low levels of education and income experienced more disease and needed more treatment than those from high levels of education and income.

Objective: To compare the prevalence of pregnancy among adolescents and analyze trends in some social and biological variables among two cohorts of adolescent mothers in Ribeirão Preto, Brazil, during 1978/79 and 1994., Methods: Two cohorts of adolescent mothers were interviewed shortly after delivery, comprising 943 women in the first survey (1978/79) and 499 in the second (1994). Both surveys covered more than 98% of births in all childbirth clinics. Only singleton livebirths from adolescent mothers living in the municipality were included in the analysis. The Chi-square test was used for statistical analysis, with a 0.05 significance level., Results: The percentage of adolescent mothers increased from 14.1% in 1978/79 to 17.5% in 1994 (p<0.05), mainly due to an increase in deliveries in the 13-17 years age group. There was a reduction in the number of smokers and mothers with lower schooling. The number of prenatal care visits increased. There was also an increase in the proportion of single mothers, of those who were employed and got private delivery care. Low birth weight and preterm birth rates remained unchanged for all of them. Cesarean section and forceps delivery rates increased substantially. Mothers in the 13-17 years age group however showed twice as much premature and low birth weight children, a higher proportion of single mothers with lower schooling, and higher rate of forceps delivery., Conclusions: Some characteristics of the adolescent mothers in the 13-17 years age group were more unfavorable when compared to the 18-19 years age group. The characteristics of adolescent age groups need to be better understood and taken into account in the prenatal and delivery care planning.