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Background Early reconstruction after mastectomy for breast cancer with definitive implants has been widely used, especially with the evolution of conservative surgical breast cancer treatments. We aimed to identify different characteristics associated with plastic surgery, based on immediate or delayed reconstruction time and evaluate quality of life in patients undergoing mastectomy for cancer. Methods This is a cross-sectional analytical study that evaluated adult patients undergoing mastectomy for breast cancer and breast reconstruction in Plastic Surgery Service at a tertiary hospital. Results Between March 2011 and November 2015, 58 patients who underwent mastectomy were included, with a mean age of 51.6±10.6 years and 98.3% of them being women. Eighty percent of the patients underwent a radical mastectomy and 20% underwent segmentectomies. Immediate and delayed surgical reconstructions occurred in 22.4% and 77.6% of the cases, respectively, including immediate reconstruction with the local flap trade (15.5%), immediate reconstruction with prosthesis (6.9%), transverse rectus abdominis myocutaneous (TRAM) flap (6.9%), delayed reconstruction with local flap (8.6%), expander and prosthesis (35.7%), and reconstruction with latissimus dorsi flap and prosthesis (22.4%). When comparing subjects undergoing reconstructive surgery based on timing of reconstruction, it was observed that patients undergoing delayed breast reconstruction surgery presented a higher proportion of radical mastectomy (90.7% vs. 41.7%; P=0.001) and the need for two or more surgical interventions (64.1% vs. 20.0%; P=0.029). There was no difference in the quality of life according to reconstruction time. Conclusions The characteristics associated with postmastectomy reconstruction timing are related to preoperative factors such as the procedure employed and the number of interventions performed and have no influence on complications or the quality of life.

Object A previous study published by the authors showed that a single intervention could not change the baseline attitudes toward neurotrauma prevention. The present study was designed to evaluate the effectiveness of multiple interventions in modifying knowledge and attitudes for the prevention of neurotrauma in Brazilian preteens and adolescents. Methods In a randomized controlled trial, fifth-year primary school (PS) and second-year high school (HS) students were divided into a control and 2 intervention (single/multiple) groups. The study was conducted in the following 8 stages: T1, questionnaire to measure baseline characteristics; T2, lecture on trauma prevention; T3, reapplying the questionnaire used in T1; T4, Traffic Department intervention; T5, a play about trauma and its consequences; T6, Fire Department intervention; T7, Emergency Medical Service intervention; and T8, reapplying the questionnaire used in T1 and T3. Positive answers were considered those affirming the use of safety devices “always or sometimes” and negative as “never” using safety devices. Results The sample consisted of 535 students. Regarding attitudes, students in all groups at any stage of measurement showed protective behavior more than 95% of the time about seat belt use. There were only differences between attitudes in PS and HS students on T8 assessment concerning the use of safety equipment on bikes in the multiple-intervention group and concerning the use of safety equipment on skateboards and rollerblades in single- and multiple-intervention groups. These differences were caused mainly by the reduction in positive answers by the HS group, rather than by the increase in positive or protective answers by the PS group. However, there was no difference when the control and intervention groups were compared, independent of the attitudes or the student groups studied. The most important reason for not using protective devices was the belief that they would not get hurt. Conclusions Multiple and different types of educational interventions, such as lectures, scenes from plays about trauma and its consequences, traffic and fire department intervention, and medical emergency intervention directed to preteens and adolescents from public and private schools did not modify most students' attitudes toward injury prevention. Clinical trial registration no: U1111–1121–0192 (National System of Ethics and Research in Brazil).

OBJETIVO: Avaliar os fatores perinatais associados a recem-nascidos de termo com pH

Object Trauma is the leading cause of mortality and morbidity in children, young people, and working-age adults. Because of the high incidence of intentional and unintentional injuries in young people, it is necessary to implement injury-prevention programs and measure the efficacy of these initiatives. The authors evaluated the effectiveness of an injury-prevention program in high school students in a city in southern Brazil. Methods In a randomized controlled study, 1049 high school students were divided into a control group and intervention group. The study was conducted in the following 3 stages: a questionnaire was applied 1 week before the educational intervention (P0), shortly after the intervention (P1), and 5 months later (P3). In the control group, a questionnaire based on the Pense Bem Project was applied at the 3 time stages, without any intervention between the stages. Results The postintervention analysis evidenced a slight change in knowledge about unintentional spinal cord and brain injuries. Regarding attitudes, the only significant improvement after the intervention lecture was in the use of helmets, which remained high 5 months later. A substantial number of students only partially agreed with using safety behaviors. The only significant postintervention change was the major agreement to check swimming pool depth before entering the water (P0 89% and P1 97.8%, p < 0.001; P2 92.8%, p = 0.005). Conclusions An educational intervention based on a single lecture improved students' knowledge of traumatic brain and spinal cord injuries, but this type of intervention did not modify most attitudes toward injury prevention. Clinical trial registration no.: U1111-1121-0192.

Aims: To assess the perinatal results of newborns with a zero Apgar score at the first minute of life. Methods: Case-control study conducted over a period of 10 years. We assessed maternal, fetal, and neonatal variables. Data were analyzed using SPSS 19.0. Results: Of the 15,616 births occurring during the study period, 29 (0.2%) had a zero Apgar score at the first minute of life (Group I). A control group comprised three newborns with Apgar scores greater than zero for each case (Group II). Comparing cases (Group I) and controls (Group II) showed a higher rate of cesarean deliveries (69% vs. 46.7%; p < 0.05), younger gestational age (34.8 ± 5.5 years vs. 38.5 ± 2.5 years; p < 0.0001), higher incidence of hemorrhagic amniotic fluid (27.6% vs. 17.2%; p < 0.0001), lower fetal weight (2,307 ± 958 g vs. 3,069 ± 609 g; p < 0.0001), lower fifth-minute Apgar score (2.5 ± 2.0 vs. 8.9 ± 0.7; p < 0.0001), lower pH of the umbilical artery (7.01 ± 0.21 vs. 7.21 ± 0.08; p < 0.0001), need for neonatal intensive care unit (100% vs. 20.7%; p < 0.0001), and early neonatal mortality rate (n = 12, 41.4% vs. n = 0). Conclusion: The perinatal assessment of newborns with zero Apgar score in the first minute of life showed a higher rate of operative deliveries and preterm fetuses with low birth weight than in control infants. The higher need for neonatal intensive care therapy is associated with more significant fetal acidosis and apparent death.

Some studies have demonstrated that physiotherapists have a high prevalence of low back pain (LBP). The association between physiotherapy students, who are potentially exposed to the same LBP occupational risks as graduates, and LBP has never been demonstrated. The objective of the study is to evaluate the association between undergraduate physiotherapy study and LBP. The study design includes a cross-sectional study. A questionnaire-based study was carried out with physiotherapy and medical students. LBP was measured as lifetime, 1-year and point prevalence. Bivariate and multivariate analyses were performed to find the factors associated with LBP. Bivariate analyses were also performed to assess differences between LBP characteristics in the two courses. 77.9% of the students had LBP at some point in their lives, 66.8% in the last year and 14.4% of them reported they were suffering from LBP at the moment of answering the questionnaire. Physiotherapy students reported a higher prevalence of LBP when compared with the medical students in all measures. In the logistic regression model, physiotherapy students (A-OR 2.51; 95% CI 1.35–4.67; p = 0.003), and being exposed to the undergraduate study for more than four semesters (A-OR 2.55; 95% CI 1.43–4.55; p = 0.001) were independently associated with LBP. There were no differences between the courses concerning pain intensity and disability. As it was a cross-sectional study, we were not able to observe accurately if there is an increasing incidence of LBP during the course. Also, we did not intend to identify which activities in the course were associated with the development of LBP. This study clearly demonstrated an association between undergraduate physiotherapy study and LBP. The length of course exposure is also associated with LBP.

Sleep disorders are very common in the young, being a result of the typical lifestyle lived by young people or a sleep disease that requires assistance and treatment. Furthermore, according to previous findings, sleep alterations can favor the development of depressive mood disorder. This survey aimed to assess the prevalence and characteristics of sleep disorders in a young population sample and their association with depressive symptoms. With a cross-sectional study design, self-administered questionnaires were applied to 1,180 undergraduate students. The Mini-Sleep Questionnaire (MSQ) and the Beck Depression Inventory were used to evaluate sleep disturbances and depressive symptoms, respectively. Bivariate and multivariate analyses were conducted, with the main findings being the presence of disrupted sleep (MSQ > 24), with an alpha error of 5%. The median point of the MSQ was 26 (P25–P75, 21–32 points). Sleep alterations were found in 59.6%. The prevalence of depression was 9.3% (n = 110), mild depression being identified in 5.9% (n = 62), moderate in 3.4% (n = 40), and severe in 0.7% (n = 8) of the students. In logistic regression, female gender (OR, 1.48; CI 95%, 1.09–2.01; P = 0.012) and being depressed (OR, 4.42; CI 95%, 2.30–8.50; P

OBJECT.: A previous study published by the authors showed that a single intervention could not change the baseline attitudes toward neurotrauma prevention. The present study was designed to evaluate the effectiveness of multiple interventions in modifying knowledge and attitudes for the prevention of neurotrauma in Brazilian preteens and adolescents.In a randomized controlled trial, fifth-year primary school (PS) and second-year high school (HS) students were divided into a control and 2 intervention (single/multiple) groups. The study was conducted in the following 8 stages: T1, questionnaire to measure baseline characteristics; T2, lecture on trauma prevention; T3, reapplying the questionnaire used in T1; T4, Traffic Department intervention; T5, a play about trauma and its consequences; T6, Fire Department intervention; T7, Emergency Medical Service intervention; and T8, reapplying the questionnaire used in T1 and T3. Positive answers were considered those affirming the use of safety devices "always or sometimes" and negative as "never" using safety devices.The sample consisted of 535 students. Regarding attitudes, students in all groups at any stage of measurement showed protective behavior more than 95% of the time about seat belt use. There were only differences between attitudes in PS and HS students on T8 assessment concerning the use of safety equipment on bikes in the multiple-intervention group and concerning the use of safety equipment on skateboards and rollerblades in single- and multiple-intervention groups. These differences were caused mainly by the reduction in positive answers by the HS group, rather than by the increase in positive or protective answers by the PS group. However, there was no difference when the control and intervention groups were compared, independent of the attitudes or the student groups studied. The most important reason for not using protective devices was the belief that they would not get hurt.Multiple and different types of educational interventions, such as lectures, scenes from plays about trauma and its consequences, traffic and fire department intervention, and medical emergency intervention directed to preteens and adolescents from public and private schools did not modify most students' attitudes toward injury prevention. Clinical trial registration no: U1111-1121-0192 (National System of Ethics and Research in Brazil).

To assess perinatal factors associated with term newborns with pH7.1 in the umbilical artery and 5th min Apgar score7.0.Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score7.0 and umbilical artery pH7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p0.05.Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH7.1 in the umbilical artery and a 5th min Apgar score7.0. Breech presentation (OR=12.9, p0.005), cesarean section (OR=3.5, p0.01) and modified intrapartum cardiotocography (OR=7.8, p0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p0.0001), need for resuscitation (OR=12.2, p0.0001) and base deficit were associated with the event (15.0 versus -4.5, p0.0001).Low Apgar score at the 5th min of life associated with pH7.1 in the umbilical artery can predict adverse neonatal outcomes.

Trauma is the leading cause of mortality and morbidity in children, young people, and working-age adults. Because of the high incidence of intentional and unintentional injuries in young people, it is necessary to implement injury-prevention programs and measure the efficacy of these initiatives. The authors evaluated the effectiveness of an injury-prevention program in high school students in a city in southern Brazil.In a randomized controlled study, 1049 high school students were divided into a control group and intervention group. The study was conducted in the following 3 stages: a questionnaire was applied 1 week before the educational intervention (P0), shortly after the intervention (P1), and 5 months later (P3). In the control group, a questionnaire based on the Pense Bem Project was applied at the 3 time stages, without any intervention between the stages.The postintervention analysis evidenced a slight change in knowledge about unintentional spinal cord and brain injuries. Regarding attitudes, the only significant improvement after the intervention lecture was in the use of helmets, which remained high 5 months later. A substantial number of students only partially agreed with using safety behaviors. The only significant postintervention change was the major agreement to check swimming pool depth before entering the water (P0 89% and P1 97.8%, p0.001; P2 92.8%, p = 0.005).An educational intervention based on a single lecture improved students' knowledge of traumatic brain and spinal cord injuries, but this type of intervention did not modify most attitudes toward injury prevention. Clinical trial registration no.: U1111-1121-0192.

Antecedentes: Se define trauma al nacimiento las lesiones sufridas por el feto durante el trabajo de parto o expulsión. Objetivo: Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. Método: Estudio casos y controles, realizado en el período de julio/2004 a diciembre/2005, en la División de Ginecología y Obstetricia del Hospital General de Caxias do Sul/ Facultad de Medicina, Universidad de Caxias do Sul, RS, Brasil. Fueron analizadas variables maternas, del parto y fetales, utilizando el programa estadístico SPSS versión 19.0. Los factores que obtuvieron nivel significativo 33 cm (OR-A: 3,36; IC95%: 1,35-9,73; p=0,010). Conclusión: Los factores de riesgo asociados a lesiones durante el nacimiento involucran el parto vaginal y el perímetro torácico igual o superior a 33cm. Background: Obstetrics injuries can be defined as fetal lesions suffered by the fetus during labor or expulsion. Objective: Identify risk factors for fetal birth trauma. Method: Case-control study conducted from July 2004 to December 2005. We analyzed maternal and fetal variables using software SPSS 19.0. The variables showing a significance level 33 cm (OR-A: 3.36; 95%CI: 1.35-9.73; p=0.010). Conclusion: The risk factors for fetal birth injury were vaginal delivery and chest circumference equal to or larger than 33 cm. Other variables were not associated with the outcome in discussion.

Alguns dos indivíduos submetidos à cirurgia de coluna vertebral terão desfechos pós-operatório desfavoráveis, independente do êxito técnico. Esse insucesso gera aumento da morbidade e dos custos socioeconômicos. Sabe-se que fatores psicossociais interferem na impressão do sujeito. Com o propósito de identificá-los, tem-se estimulado a busca de preditores prognósticos por meio de instrumentos de triagem. Porém, a eleição do mais adequado pode ser difícil, já que existe um grande número de questionários. Entre os aspectos abordados por eles, podemos citar: incapacidade funcional, qualidade de vida, satisfação, dor, depressão, distúrbios do humor e atividade funcional. O trabalho objetiva revisar as particularidades, indicações e limitações dos instrumentos de avaliação do paciente com doença na coluna vertebral.