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Resumo O uso abusivo de substâncias psicoativas é um problema para a saúde em todo o mundo, pois possui ampla magnitude, na infância e na vida adulta. O objetivo deste artigo é compreender os sentimentos e as percepções dos familiares sobre a rede de apoio, cuidado e tratamento dos filhos usuários de crack e outras drogas acompanhados em um centro de referência. Como trajetória metodológica, foi utilizada a pesquisa qualitativa, com dados coletados e analisados à luz do referencial da Fenomenologia. A pesquisa foi realizada no CERSAMi de Belo Horizonte, Minas Gerais. Foram entrevistados 11 participantes, sendo a saturação o critério de finalização. A análise foi fundamentada em três etapas: a descrição, a redução e a compreensão fenomenológica. Os resultados evidenciaram categorias, cada qual, com seus temas de análise ou subcategorias. Como proposta para o trabalho, a fundamentação, a apresentação e a discussão estão fundamentadas na categoria: Sentimentos e percepções dos familiares em relação à rede de apoio, ao cuidado e ao tratamento. No encontro com os sujeitos e na imersão das falas, evidenciam-se momentos que fragilizam a estrutura da família. Na realidade diária se estabelece um futuro de incertezas em relação ao cuidado, ao apoio e à reabilitação dos filhos. Abstract The abuse of psychoactive drugs is a health problem throughout the entire world, as its magnitude pervades childhood and adult life. The objective of this article is to understand the feelings and perceptions of family members regarding the support network, care and treatment of their offspring who use crack and associated drugs, in the context of a reference center for treatment. In line with methodological approach, qualitative research was used, with data collected and analyzed under the light of Phenomenology. The research was conducted at Belo Horizonte’s CERSAMi in the State of Minas Gerais, Brazil. Eleven participants were interviewed, their participation being finalized at saturation point. The analysis was founded on three steps: description, reduction and phenomenological comprehension. Proposal for the work: the foundation, the presentation and the discussion are founded in the category Feelings and perceptions of family members in relation to the network for support, care and treatment. In the encounter with the subjects and during their immersion in discourse, moments which make family structure fragile are noticeable. In the day-to-day reality there becomes established a future of uncertainties in relation to the care, support and rehabilitation of the children.

Objective: To verify the knowledge, beliefs, sources of information, practices and attitudes of the parents/caregivers in the management of childhood fever. Material and Methods: This was a descriptive, cross-sectional study, with a quantitative approach. The sample was composed of 286 parents/caregivers who sought the emergency service of a Children's Hospital in Minas Gerais with complaints of fever in their children. Results: 45.6% of parents had high school education level; 54% earned up to one minimum wage; and 42% had one child. A total of 70% of respondents had a thermometer, 48.4% did not observe the adequate time to remove the mercury thermometer; and 29.4% of them verified fever by palpation. 34.3% reported fever at 37.5 °C; 96.3% administered antipyretics; 50.5% administered dipyrone and 39.3% paracetamol; 83.3% were unaware of the adverse effects; 14% administered antibiotics; 70% considered that the fever was harmful and that the worst damage is the seizure. To detect fever, the interviewees used the thermometer and palpation. They consider the fever dangerous because they believe it may cause convulsion, drowsiness, prostration, dehydration and brain damage. For fever control, they used pharmacological and non-pharmacological methods. As sources of information, they access the internet, books, television, newspapers, health professionals, friends and relatives. Conclusion: The participants had similar socioeconomic profiles, fears, beliefs and practices of fever management. They showed limited knowledge and perceptions leading to erroneous attitudes towards fever management. Conceptions guide conduct and practices in the management of fever. The phobia of fever persists, and parents/caregivers show insecurity to care for the febrile child. DESCRIPTORS Fever.Knowledge.Child.Perception.Attitude.

Visceral leishmaniasis (VL) is a potentially fatal disease, in which the treatment based on chemotherapy is considered toxic. The cure of disease is associated with the life-long Th1-type immunity against the infection. The Th1-related cytokines production by peripheral blood mononuclear cells (PBMCs) seems to be crucial for host control of parasite load and clinical cure. In the current study, we used five proteins (IgE-dependent histamine-releasing factor [HRF], LiHyD, LiHyV, LiHyT and LiHyp6) recently shown to be antigenic and/or immunogenic in the canine VL, aiming to evaluate the antigen-specific antibody levels and cytokine production in PBMCs culture supernatants collected from VL patients before and after anti-VL treatment. In the results, when PBMCs were exposed to rHRF, rLiHyD and rLiHyT, higher IFN-γ and lower IL-10 levels were observed in all patients that were treated and clinically cured. Analysis of specific antibody subclasses was in line with in vitro cellular response, since a higher IgG2 production was found in the treated and cured patients, when compared to the IgG1 subclass levels. In addition, evaluating the diagnostic efficacy of the recombinant molecules, the rHRF, rLiHyD and rLiHyT proteins showed the best results in the serology assays to identify all VL patients, as well as these antigens were not recognized by antibodies in sera from non-infected subjects or those with leishmaniasis-related diseases. Our results corroborate the view that clinical cure of VL is associated with a sustained Th1-related response, and indicate the potential use of rHRF, rLiHyD and rLiHyT as immune biomarkers of VL treatment.

Serological methods used to diagnose visceral leishmaniasis (VL) are considered minimally invasive, but they present problems related with their sensitivity and/or specificity. In this study, a subtractive selection using the phage display technology against antibodies from healthy subjects living in endemic and non-endemic areas of disease, as well as from Chagas disease patients and those developing active VL, was developed. The aim of this study was to select bacteriophage-fused epitopes to be used in the serodiagnosis of human VL. Eight phage clones were selected after the bio-panning rounds, and their reactivity was evaluated in a phage-ELISA assay against a human serological panel. A wild-type clone and the recombinant K39-based immunochromatographic test were used as controls. In the results, it was shown that all clones showed an excellent performance to serologically identify VL patients, demonstrating the feasibility of the isolated phages for developing a specific and sensitive serodiagnosis of human VL.

ObjectiveTo study the influence of adolescence characteristics on asthma management.MethodsThis was a qualitative study conducted in the city of Divinópolis, Minas Gerais, Southeast Brazil. Data were collected through semistructured interviews guided by a questionnaire with seven asthmatic adolescents followed-up in the primary public health care service of the city.ResultsUsing content analysis, three thematic categories were observed in the adolescents' responses: 1) family relationships in the treatment of asthma in adolescence; 2) the asthmatic adolescents and their peers; and 3) the role of the school for the asthmatic adolescents.ConclusionsThe results demonstrated that peers, family, and school should be more valued by health professionals and by health care services when treating asthmatic adolescents, as these social relationships are closely associated with the adolescent and have an important role in asthma management. Attempts to meet the demands of adolescents contribute to improve asthma management.

Toxocariasis is caused by the helminth Toxocara spp. Its prevalence is underestimated in many settings and affects primarily children due to their vulnerability. Toxocariasis may be an asymptomatic infection or it may progress to cause severe clinical forms. The aim of this paper is to describe the epidemiology, risk factors, clinical and laboratory diagnosis of visceral larva migrans that manifest in the liver, lung, or central nervous system. It is recommended that antiparasitic treatment should be instituted even in asymptomatic patients to prevent migration of the larva to vital organs. There is a lack of awareness of the population of this parasitic infection and also among clinicians regarding the clinical manifestations of toxocariasis. The lack of public health preventive measures leads to its high prevalence in many settings, usually impoverished areas in tropical settings. Thus, it is imperative to prevent transmission and to provide early treatment of asymptomatic or symptomatic cases to prevent complications and late sequelae of this parasitic infection.

RESUMO Objetivo: Compreender as repercussões do uso de drogas por um filho no ambiente familiar. Métodos: Trata-se de pesquisa qualitativa com abordagem fenomenológica, com 11 pais e responsáveis de crianças e adolescentes usuários de crack e outras drogas acompanhados em um centro de referência. As entrevistas foram gravadas; e os dados, transcritos e analisados na perspectiva fenomenológica. Resultados: Após a descrição, redução e compreensão fenomenológica, os resultados e a discussão se fundamentaram na categoria. Compreendendo as repercussões do uso de drogas por crianças e adolescentes dentro das famílias. Discussão: A pesquisa possibilitou a compreensão de situações de fragilidades emocionais, comportamentais, socioeconômicas e relacionais do fenômeno uso de drogas por crianças e adolescentes e seus familiares, desvelando conflitos e fragilidades. Conclusão e implicações para a prática: O desenvolvimento de ações que atendam às necessidades individuais e coletivas contribui para o planejamento de ações intersetoriais que minimizem o sofrimento das famílias e dos filhos. RESUMEN Objetivo: Comprender las repercusiones en el ambiente familiar de la utilización de drogas por un hijo. Métodos: Se trata de una investigación cualitativa con abordaje fenomenológico, con 11 padres y responsables de niños y adolescentes usuarios de crack y otras drogas, acompañados en un centro de referencia. Las entrevistas fueron grabadas; y los datos, transcritos y analizados en la perspectiva fenomenológica. Resultados: Tras la descripción, reducción y comprensión fenomenológica, los resultados y la discusión se fundamentaron en la categoría: Comprendiendo las repercusiones de la utilización de drogas por niños y adolescentes dentro de las familias. Discusión: La investigación posibilitó comprender las situaciones de fragilidades emocionales, comportamentales, socioeconómicas y relacionales del fenómeno utilización de drogas por niños y adolescentes y sus familiares, desvelando conflictos y fragilidades. Conclusión e implicaciones para la práctica: El desarrollo de acciones que atiendan las necesidades individuales y colectivas contribuye para el planeamiento de acciones intersectoriales que minimicen el sufrimiento de las familias y de los hijos. ABSTRACT Objective: Understanding the impact of drug abuse by a child in the family environment. Methods: This is a qualitative research with a phenomenological approach, with 11 parents and guardians of children and adolescents whom use crack and other drugs followed at a referral center. The interviews were recorded; and data, transcribed and analyzed on the phenomenological perspective. Results: After the phenomenological description, reduction and understanding, the results and discussion were based on the category "Understanding the impact of drug abuse by children and adolescents within families". Discussion: The research allowed us to understand situations of emotional frailties, behavioral, socioeconomic and relational phenomenon of drug abuse by children and adolescents and their families, revealing conflicts and weaknesses. Conclusion and implications for practice: The development of actions that meet individual and collective needs contributes to the planning of intersectoral actions to minimize the suffering of families and children.

The abuse of psychoactive drugs is a health problem throughout the entire world, as its magnitude pervades childhood and adult life. The objective of this article is to understand the feelings and perceptions of family members regarding the support network, care and treatment of their offspring who use crack and associated drugs, in the context of a reference center for treatment. In line with methodological approach, qualitative research was used, with data collected and analyzed under the light of Phenomenology. The research was conducted at Belo Horizonte's CERSAMi in the State of Minas Gerais, Brazil. Eleven participants were interviewed, their participation being finalized at saturation point. The analysis was founded on three steps: description, reduction and phenomenological comprehension. Proposal for the work: the foundation, the presentation and the discussion are founded in the category Feelings and perceptions of family members in relation to the network for support, care and treatment. In the encounter with the subjects and during their immersion in discourse, moments which make family structure fragile are noticeable. In the day-to-day reality there becomes established a future of uncertainties in relation to the care, support and rehabilitation of the children.O uso abusivo de substâncias psicoativas é um problema para a saúde em todo o mundo, pois possui ampla magnitude, na infância e na vida adulta. O objetivo deste artigo é compreender os sentimentos e as percepções dos familiares sobre a rede de apoio, cuidado e tratamento dos filhos usuários de crack e outras drogas acompanhados em um centro de referência. Como trajetória metodológica, foi utilizada a pesquisa qualitativa, com dados coletados e analisados à luz do referencial da Fenomenologia. A pesquisa foi realizada no CERSAMi de Belo Horizonte, Minas Gerais. Foram entrevistados 11 participantes, sendo a saturação o critério de finalização. A análise foi fundamentada em três etapas: a descrição, a redução e a compreensão fenomenológica. Os resultados evidenciaram categorias, cada qual, com seus temas de análise ou subcategorias. Como proposta para o trabalho, a fundamentação, a apresentação e a discussão estão fundamentadas na categoria: Sentimentos e percepções dos familiares em relação à rede de apoio, ao cuidado e ao tratamento. No encontro com os sujeitos e na imersão das falas, evidenciam-se momentos que fragilizam a estrutura da família. Na realidade diária se estabelece um futuro de incertezas em relação ao cuidado, ao apoio e à reabilitação dos filhos.

Drugs abuse is a complex phenomenon with many causes, and it affects children and adolescents. The objective of this research was to seek scientific evidence that contributes to the understanding of the existing relation between the use of crack and other drugs by children and adolescents and the family. The method used was the integrative review. The bases analyzed were: MEDLINE, LILACS, Cochrane, BDENF and IBECS. Descriptors: cocaine, crack, family and family relationships. Three categories were evidenced: Family environment as a protector and/or facilitator for the use of crack and other drugs by children and adolescents; Lack of knowledge and the repercussions of the use of crack and other drugs by children and adolescents in the family environment; Networks to support the family and coping with the use of crack and other drugs. The family environment has a protective function against the use of drugs, but the issue of drugs has to be faced and addressed. It is also necessary to strengthen the social networks and discuss prevention themes.

Objectives To present a detailed investigation of risk factors, symptoms, and laboratory and imaging tests that may be useful to establish the clinical laboratory diagnosis of visceral larva migrans (VLM) in children, demonstrating the importance of diagnosis and treatment to prevent complications in the eyes, liver, and other organs. Sources Literature review using the MEDLINE and LILACS (1952-2009) databases, selecting the most recent and representative articles on the topic. Summary of the findings VLM is an infectious disease with non-specific clinical presentation, whose transmission is related to contact with dogs, especially puppies, and which may progress to late systemic complications in vital organs such as the eyes and the central nervous system. IgG (ELISA) anti-T. canis can be used to establish the laboratory diagnosis. Higher cutoff points suggest recent illness and lower cutoff points demonstrate mild infection or infection in remission. Therapeutic response may be assessed by means of eosinophil blood cell count. The present article provides the pediatrician with updated information regarding VLM, a disease of high prevalence worldwide and in Brazil. Conclusions The diagnosis of VLM depends mainly on the presence of dogs in the child's household, associated with ELISA (IgG anti-T. canis), using excretory-secretory antigens of Toxocara canis. Prospective studies are warranted to assess the best drug therapy. Prevention is the most important strategy because of the high prevalence of T. canis in urban areas.

OBJETIVOS: Apresentar investigação detalhada de fatores de risco, sintomatologia, exames laboratoriais e de imagem que possam contribuir para o diagnóstico clínico-laboratorial da larva migrans visceral (LMV) em crianças e mostrar a importância do diagnóstico e do tratamento para evitar complicações oculares, hepáticas e em outros órgãos. FONTES DOS DADOS: Revisão de literatura utilizando os bancos de dados MEDLINE e LILACS (1952-2009), selecionando os artigos mais atuais e representativos do tema. SÍNTESE DOS DADOS: LMV é uma doença infecciosa de apresentação clínica inespecífica cuja transmissão está relacionada ao contato com cães, principalmente filhotes, podendo evoluir com complicações sistêmicas tardias em órgãos vitais como o olho e sistema nervoso central. Para diagnóstico laboratorial, pode ser utilizado IgG (ELISA) anti-Toxocara canis, cujos pontos de corte mais elevados sugerem doença recente e, os mais baixos, infecção leve ou em resolução. A resposta terapêutica pode ser avaliada por meio da contagem de eosinófilos no sangue. Esse artigo atualiza o pediatra em relação à LMV, doença de alta prevalência no mundo e no Brasil. CONCLUSÕES: O diagnóstico de LMV depende principalmente da epidemiologia da presença de cães no domicílio da criança, associada ao ELISA (IgG para T. canis), utilizando antígenos Toxocara de excreção e secreção. São necessários estudos prospectivos para avaliar a melhor droga na terapêutica. A prevenção é a estratégia mais importante devido à alta prevalência de T. canis na região urbana. OBJECTIVES: To present a detailed investigation of risk factors, symptoms, and laboratory and imaging tests that may be useful to establish the clinical laboratory diagnosis of visceral larva migrans (VLM) in children, demonstrating the importance of diagnosis and treatment to prevent complications in the eyes, liver, and other organs. SOURCES: Literature review using the MEDLINE and LILACS (1952-2009) databases, selecting the most recent and representative articles on the topic. SUMMARY OF THE FINDINGS: VLM is an infectious disease with non-specific clinical presentation, whose transmission is related to contact with dogs, especially puppies, and which may progress to late systemic complications in vital organs such as the eyes and the central nervous system. IgG (ELISA) anti-T. canis can be used to establish the laboratory diagnosis. Higher cutoff points suggest recent illness and lower cutoff points demonstrate mild infection or infection in remission. Therapeutic response may be assessed by means of eosinophil blood cell count. The present article provides the pediatrician with updated information regarding VLM, a disease of high prevalence worldwide and in Brazil. CONCLUSIONS: The diagnosis of VLM depends mainly on the presence of dogs in the child's household, associated with ELISA (IgG anti-T. canis), using excretory-secretory antigens of Toxocara canis. Prospective studies are warranted to assess the best drug therapy. Prevention is the most important strategy because of the high prevalence of T. canis in urban areas.

A clinical study of 34 previously healthy young patients simultaneously infected in an endemic area of schistosomiasis mansoni is presented, emphasizing the initial phase of the infection. Its intensity was established according to the occurrence, intensity, and duration of the signs and symptoms in order to investigate the possible correlations between the worm burden (estimated by the number of eggs in faeces), the blood eosinophilia and specific levels of IgE (estimated by the area of immediate intradermal reaction), with the clinical manifestations. A significant but low-level association was found between the worm burden and morbidity, suggesting that multiple factors, besides worm burden itself, may contribute to the pathogenesis of the disease.

Objective: To study the influence of adolescence characteristics on asthma management. Methods: This was a qualitative study conducted in the city of Divinópolis, Minas Gerais, Southeast Brazil. Data were collected through semistructured interviews guided by a questionnaire with seven asthmatic adolescents followed-up in the primary public health care service of the city. Results: Using content analysis, three thematic categories were observed in the adolescents' responses: 1) family relationships in the treatment of asthma in adolescence; 2) the asthmatic adolescents and their peers; and 3) the role of the school for the asthmatic adolescents. Conclusions: The results demonstrated that peers, family, and school should be more valued by health professionals and by health care services when treating asthmatic adolescents, as these social relationships are closely associated with the adolescent and have an important role in asthma management. Attempts to meet the demands of adolescents contribute to improve asthma management.

Recent clinical data suggest that severe kala-azar (or visceral leishmaniasis) is an exaggerated innate immune response mediated by inflammatory cytokines, leading to a systemic inflammatory syndrome similar to what is observed in malaria, sepsis and other diseases. We tested this hypothesis by measuring serum cytokines in individuals with kala-azar.We compared patients with severe kala-azar (i.e. hemorrhagic manifestations, n = 38) with patients without evidence of hemorrhage (n = 96). We conducted a detailed clinical and laboratory evaluation, measuring serum IL-1beta, IL-6, IL-8, IL-10, IL-12, interferon-gamma, and TNF-alpha, and markers of disseminated intravascular coagulation (DIC).Infants had higher levels of inflammatory cytokines, while HIV-infected patients had lower concentrations of IL-10 and interferon-gamma. Higher levels of IL-6, interferon-gamma, and IL-8 were found among deceased patients. IL-8 and interferon-gamma were independently associated with bleeding. Several cytokines were associated with different signs of severe clinical and laboratory manifestations, including DIC. IL-6 was highly positively and independently associated with IL-1beta, IL-8, IL-10, and negatively associated with TNF-alpha. IL-1beta and TNF-alpha were also highly independently associated with disease severity.In its severe form, kala-azar, a neglected tropical disease, initiates a systemic inflammatory response that leads to DIC and other manifestations. Children may have higher risk of death due to the more intense cytokine release. The data supports the notion that IL-6 is the central cytokine that is associated with lethal disease, but interferon-gamma, IL1beta, IL-8, and TNF-alpha are also involved with disease severity. Inhibition of IL-6 is a potential target of adjuvant therapy for severe or pediatric forms of this disease.

An integrative review was conducted in order to evaluate available evidence in the literature on the acceptance of Family Health Teams (FHT). The bibliography covered national and international publications available on the Virtual Health Library, from which 42 references were identified. The results revealed differences between the concepts of acceptance and healthcare practices in family health units. More effort must be put in developing research to maximize how professionals in the FHTs offer assistance so as to enable theory/practice integration.

Clinical gastro-intestinal manifestations were studied in 34 patients in the initial phase of schistosomiasis mansoni. The patients, all men, were of similar age and in similar nutritional condition and had been infected simultaneously at the same transmission site. Most (85%) showed some gastro-intestinal sign or symptom, generally of light or moderate intensity; 56% had liquid or pasty diarrhoea, 41% abdominal pain, 29% hepatomegaly, 21% dysentery, 15% anorexia, 12% pain on colon palpation and 9% nausea and/or vomiting. High worm burden was associated with blood in faeces but apparently not with any other clinical manifestation. There was no apparent association between any clinical manifestation and peripheral-blood eosinophil counts or titres of IgE specific for Schistosoma mansoni (evaluated by the area of immediate intradermal reaction to injected adult worm antigen). The absence of association between worm burden and nearly all the clinical gastro-intestinal manifestations strengthens the concept that factors other than worm burden, such as host reactivity, constitute important pathogenetic elements in the initial phase of schistosomiasis mansoni.

In this paper the history of 115 recruits that had bathed simultaneously in streams contaminated with Schistosoma mansoni, during military maneuvers, is reported. Thirty four of the infected patients presented the initial phase of the infection diagnosed through epidemiologic, clinical and laboratorial parameters. Three out of the 34 patients did not reveal the clinical picture of the infection, thus being considered representatives of the non-apparent form of the disease. Differences between the intensity of blood eosinophilia, the area of immediate cutaneous reaction and the number of Schistosoma eggs eliminated in the stools proved not to be statistically significant (p>0.05) when the non-apparent and acute cases of schistosomiasis were compared. These cases actually may be considered evidences of the non-apparent form hitherto merely taken for granted in the literature. Foram estudados 115 recrutas que tiveram contato simultaneamente com águas infectadas pelo Schistosoma mansoni. Trinta e quatro pacientes apresentaram a fase inicial da infecção, diagnosticada através de parâmetros laboratoriais, clínicos e epidemiológicos, sendo que três deles não evidenciaram quadro clínico, sendo considerados como portadores da forma inaparente da doença. Não se verificou, entretanto, diferença estatística entre a intensidade da eosinofilia sanguínea, as áreas da reação intradérmica de leitura imediata e as médias das contagens do número de ovos de 5. mansoni eliminados nas fezes, quando se compararam os resultados obtidos em pacientes com as formas aguda e inaparente. Os casos ora descritos constituem evidenciação objetiva da forma inaparente, antes apenas presumida na literatura.

Trata-se de estudo descritivo transversal, realizado com 384 responsáveis por crianças cadastradas em seis equipes de saúde da família. Foi utilizado o Instrumento de Avaliação da Atenção Primária (PCATool). Em relação às crianças, 52,9% eram do sexo feminino, 55,5% menores de 3 anos, 71,6% viviam com o pai e a mãe. O serviço de referência para o atendimento foi a unidade de saúde da família 77,6%. Em relação ao acolhimento/postura, 74,2% consideram que o profissional entende o que ele diz e pergunta, e 79,2% respondem da forma que o cuidador da criança entende. Para 77,2% dos responsáveis sempre que precisam conversar com o profissional eles conseguem, e 73,8% se sentem à vontade para falar com o profissional. A partir destes resultados pode-se inferir que o acolhimento/postura nestes serviços tem permitido uma interação usuário- profissional satisfatória, imprescindível para um atendimento à saúde com qualidade. This was a descriptive cross-sectional study with parents and guardians (n = 384) of children enrolled under six family health teams, using the Primary Care Assessment Tool (PCATool). Characteristics of the children were: 52.9% girls; 55.5% < 3 years of age; and 71.6% living with both parents. For 77.6%, the reference service for health care was the family health facility. In relation to reception and attitudes, 74.2% of parents reported that the health professional understood their complaints and questions, and 79.2% reported that the health professional responded in such a way that parents could understand. A total of 77.2% of the parents/guardians stated that they were always able to talk to the health professional when needed, and 73.8% felt comfortable about this dialogue. These results indicate that the family health team's reception of children and their attitudes in these services have allowed satisfactory user-provider interaction, an indispensable factor for quality health care.

This was a descriptive cross-sectional study with parents and guardians (n = 384) of children enrolled under six family health teams, using the Primary Care Assessment Tool (PCATool). Characteristics of the children were: 52.9% girls; 55.5%3 years of age; and 71.6% living with both parents. For 77.6%, the reference service for health care was the family health facility. In relation to reception and attitudes, 74.2% of parents reported that the health professional understood their complaints and questions, and 79.2% reported that the health professional responded in such a way that parents could understand. A total of 77.2% of the parents/guardians stated that they were always able to talk to the health professional when needed, and 73.8% felt comfortable about this dialogue. These results indicate that the family health team's reception of children and their attitudes in these services have allowed satisfactory user-provider interaction, an indispensable factor for quality health care.

Objective: To investigate the etiology, main clinical manifestations and other concurrent findings in mouth-breathing children aged 3 to 9 years and resident in the urban area of Abaete (MG), Brazil. Methods: This study was based on a representative random sample of the town population, of 23,596 inhabitants. Clinical diagnosis of mouth-breathing was defined as a combination of snoring, sleeping with mouth open, drooling on the pillow and frequent or intermittent nasal obstruction. Children with a clinical diagnosis of mouth-breathing underwent nasal endoscopy, allergy skin tests and X ray of the rhinopharynx, full blood tests, eosinophil counts, total IgE assay and fecal parasitology. Data were analyzed using SPSS® version 10.5. Results: The main causes of mouth-breathing were: allergic rhinitis (81.4%), enlarged adenoids (79.2%), enlarged tonsils (12.6%), and obstructive deviation of the nasal septum (1.0%). The main clinical manifestations of mouth breathers were: sleeping with mouth open (86%), snoring (79%), itchy nose (77%), drooling on the pillow (62%), nocturnal sleep problems or agitated sleep (62%), nasal obstruction (49%), and irritability during the day (43%). Conclusion: Certain clinical manifestations are very common among mouth-breathing children. These manifestations must be recognized and considered in the clinical diagnosis of mouth-breathing.

OBJETIVO: Investigar a etiologia, as principais manifestações clínicas e as alterações presentes em crianças de 3 a 9 anos, respiradoras orais, residentes na região urbana de Abaeté (MG). MÉTODOS: Estudo com amostra aleatória representativa da população do município de 23.596 habitantes. Clinicamente, foram consideradas respiradoras orais as crianças que roncavam, dormiam com a boca aberta, babavam no travesseiro e apresentavam queixas de obstrução nasal freqüente ou intermitente. As crianças com diagnóstico clínico de respirador oral foram submetidas a endoscopia nasal, teste alérgico cutâneo e raio X do cavum, hemograma, contagem de eosinófilos, dosagem de IgE total e parasitológico de fezes. Os dados foram analisados utilizando o programa SPSS® versão 10.5. RESULTADOS: As principais causas da respiração oral foram: rinite alérgica (81,4%), hipertrofia de adenóides (79,2%), hipertrofia de amígdalas (12,6%) e desvio obstrutivo do septo nasal (1,0%). As principais manifestações clínicas do respirador oral foram: dormir com a boca aberta (86%), roncar (79%), coçar o nariz (77%), babar no travesseiro (62%), dificuldade respiratória noturna ou sono agitado (62%), obstrução nasal (49%) e irritabilidade durante o dia (43%). CONCLUSÃO: Algumas manifestações clínicas são muito freqüentes na criança respiradora oral. Essas manifestações devem ser reconhecidas e consideradas no diagnóstico clínico da respiração oral. OBJECTIVE: To investigate the etiology, main clinical manifestations and other concurrent findings in mouth-breathing children aged 3 to 9 years and resident in the urban area of Abaeté (MG), Brazil. METHODS: This study was based on a representative random sample of the town population, of 23,596 inhabitants. Clinical diagnosis of mouth-breathing was defined as a combination of snoring, sleeping with mouth open, drooling on the pillow and frequent or intermittent nasal obstruction. Children with a clinical diagnosis of mouth breathing underwent nasal endoscopy, allergy skin tests and X ray of the rhinopharynx, full blood tests, eosinophil counts, total IgE assay and fecal parasitology. Data were analyzed using SPSS® version 10.5. RESULTS: The main causes of mouth breathing were: allergic rhinitis (81.4%), enlarged adenoids (79.2%), enlarged tonsils (12.6%), and obstructive deviation of the nasal septum (1.0%). The main clinical manifestations of mouth breathers were: sleeping with mouth open (86%), snoring (79%), itchy nose (77%), drooling on the pillow (62%), nocturnal sleep problems or agitated sleep (62%), nasal obstruction (49%), and irritability during the day (43%). CONCLUSION: Certain clinical manifestations are very common among mouth-breathing children. These manifestations must be recognized and considered in the clinical diagnosis of mouth breathing.

Objective: To determine the prevalence of mouth breathing among children aged 3 to 9 years living in the urban districts of the town of Abaete, MG, Brazil. Methods: This study assesses a representative, randomized sample of the town’s population (23,596 inhabitants). Children were selected by lots according to a random number table until 370 had been enrolled; this number had been determined by statistical calculation. A protocol for anamnesis and clinical assessment of the patients was specially developed for this project since no preexisting instruments could be found in the literature that had been validated and were appropriate for the purpose. Data were analyzed using SPSS version 10.5. Results: The prevalence of mouth breathing was found to be 55%, or 204 children. Conclusion: Further studies are needed to validate a questionnaire for the clinical diagnosis of mouth breathers at the primary care level.

OBJETIVO: Determinar a prevalência de crianças respiradoras orais com idade entre 3 a 9 anos residentes na região urbana de Abaeté (MG). MÉTODOS: Estudo com amostra aleatória representativa da população do município, que é de 23.596 habitantes. Foram realizados sorteios através de tabela de números aleatórios até completar 370 crianças, número determinado por cálculo estatístico. Elaborou-se roteiro para anamnese e avaliação clínica dos pacientes, especificamente para esta pesquisa, pois não foi encontrado na literatura instrumento adequado e validado para esta finalidade. Os dados foram analisados utilizando o programa SPSS versão 10.5. RESULTADOS: A prevalência da respiração oral foi determinada em 204 crianças (55%). CONCLUSÃO: São necessários estudos adicionais para validar questionário para o diagnóstico clínico de respiradores orais no nível primário de atendimento médico. OBJECTIVE: To determine the prevalence of mouth breathing among children aged 3 to 9 years living in the urban districts of the town of Abaeté, MG, Brazil. METHODS: This study assesses a representative, randomized sample of the town's population (23,596 inhabitants). Children were selected by lots according to a random number table until 370 had been enrolled; this number had been determined by statistical calculation. A protocol for anamnesis and clinical assessment of the patients was specially developed for this project since no preexisting instruments could be found in the literature that had been validated and were appropriate for the purpose. Data were analyzed using SPSS version 10.5. RESULTS: The prevalence of mouth breathing was found to be 55%, or 204 children. CONCLUSION: Further studies are needed to validate a questionnaire for the clinical diagnosis of mouth breathers at the primary care level.

Foram estudados 115 pacientes esquistossomóticos, 31 com radiologia torácica normal sem sinais de hipertensão pulmonar (HP); 73 com alterações radiológicas cardiopulmonares sem sinais de HP e 11 com alterações clínicas de HP. A forma pulmonar crônica (FPC) sem HP é de alta incidência e benigna. Nao se associa à forma hepatosplênica (FHE) da esquistossomose mansoni, à faixa etária, sexo ou naturalidade. As alterações radiológicas torácicas predominantes são hilares, seguidas das parenquimatosas (micronodulação, especialmente base direita). Associa-se às cargas parasitárias baixa ou média. A FPC com HP é de baixa incidência, mas determina repercussão cardíaca significativa. Associa-se à faixa etária superior a 12 anos e a FHE; não se relaciona ao sexo, cor e naturalidade. As alterações radiológicas torácicas são observadas no hilo e parênquima em igual proporção (arco médio abaulado e micronodulação em ambas as bases).One hundred and fifteen patients with Schistosomiasis mansoni were studied: 31 with a normal chest x-rays and no signs of pulmonary hypertension (PH) and 84 with x-rays compatible with cardiopulmonary abnormalities (73 without symptoms and 10 with symptoms of PH). The chronic pulmonary form (CPF) without pulmonary hypertension is frequent and benign. There was no association between the CPF and the hepatosplenic form (HEF),nor with age, sex or patient origin. Pulmonary hilum alterations were the most common x-ray findings, followed by parenchymatous abnormalities (micronodules). The CPF was associated with a low to medium worm burden. The incidence of CPF with pulmonary hypertension is low but usually related to significant heart abnormalities. It is more common in patients over 12 years, with the HEF of the disease and has no correlation with sex, race or place of birth. Chest x-ray alterations are seen with similar frequency both in parenchymatous and hilar regions.

Objetivos: Identificar fatores associados a níveis elevados de pressão arterial em crianças. Métodos: Estudo transversal da pressão arterial de 672 crianças entre 2 e 11 anos de idade em duas instituições de ensino de Belo Horizonte, entre setembro e dezembro de 2001. A pressão arterial foi mensurada seguindo os parámetros estabelecidos pelo relatório do Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. As seguintes variáveis foram estudadas: idade, sexo, cor da pele, índice de qualidade de vida urbana, estatura e índice de massa corporal. Para a comparação das médias, foi utilizada a análise de variãncia, e para a comparação de proporções, o teste quiquadrado. As variãveis associadas a níveis mais elevados de pressão arterial foram incluídas em análise de regressão linear múltipla. Resultados: Na análise univariada, níveis mais elevados de pressão arterial sistólica e diastólica estiveram associados com crianças de cor branca, crianças da região com alto índice de qualidade de vida urbana e com elevado índice de massa corporal. Na análise multivariada, apenas o índice de massa corporal, o índice de qualidade de vida urbana e a estatura mantiveram-se associados com níveis elevados de pressão sistólica. Em relação aos níveis mais elevados de pressão arterial diastólica, apenas as variáveis índice de qualidade de vida urbana e idade foram mantidas no modelo após o ajustamento. Conclusão: O sobrepeso e a obesidade estiveram associados com níveis mais elevados de pressão arterial sistólica. Outros fatores, não identificados, foram parcialmente associados a níveis mais elevados de pressão arterial de crianças do estabelecimento privado do ensino To identify factors associated with increased arterial blood pressure in children. Methods: In this cross-sectional study, arterial blood pressure was measured in 672 children between 2 and 11 years of age from two schools in the city of Belo Horizonte, Brazil. After providing informed consent, all children had their blood pressure and anthropometric parameters measured. Blood pressure was measured based on the recommendations of the Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. The following variables were assessed: age, sex, race, urban life quality index, weight, height, and body mass index. Analysis of variance was used for comparison of means and the chi-square was used for comparison of proportions. Variables associated with increased blood pressure were included in a multiple regression model. Results: According to univariate analysis, increased systolic and diastolic blood pressure were associated with high urban life quality index, white race and high body mass index. On multivariate analysis, body mass index, urban life quality index and height remained associated with increased systolic blood pressure; urban life quality index and age were associated with increased diastolic blood pressure. Conclusion: In this study, excess weight and obesity were associated with increased systolic blood pressure. Other unidentified factors were partially associated with increased blood pressure in children from the school with elevated urban life quality index

OBJETIVOS: Identificar fatores associados a níveis elevados de pressão arterial em crianças. MÉTODOS: Estudo transversal da pressão arterial de 672 crianças entre 2 e 11 anos de idade em duas instituições de ensino de Belo Horizonte, entre setembro e dezembro de 2001. A pressão arterial foi mensurada seguindo os parâmetros estabelecidos pelo relatório do Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. As seguintes variáveis foram estudadas: idade, sexo, cor da pele, índice de qualidade de vida urbana, estatura e índice de massa corporal. Para a comparação das médias, foi utilizada a análise de variância, e para a comparação de proporções, o teste qui-quadrado. As variáveis associadas a níveis mais elevados de pressão arterial foram incluídas em análise de regressão linear múltipla. RESULTADOS: Na análise univariada, níveis mais elevados de pressão arterial sistólica e diastólica estiveram associados com crianças de cor branca, crianças da região com alto índice de qualidade de vida urbana e com elevado índice de massa corporal. Na análise multivariada, apenas o índice de massa corporal, o índice de qualidade de vida urbana e a estatura mantiveram-se associados com níveis elevados de pressão sistólica. Em relação aos níveis mais elevados de pressão arterial diastólica, apenas as variáveis índice de qualidade de vida urbana e idade foram mantidas no modelo após o ajustamento. CONCLUSÃO: O sobrepeso e a obesidade estiveram associados com níveis mais elevados de pressão arterial sistólica. Outros fatores, não identificados, foram parcialmente associados a níveis mais elevados de pressão arterial de crianças do estabelecimento privado do ensino. OBJECTIVE: To identify factors associated with increased arterial blood pressure in children. METHODS: In this cross-sectional study, arterial blood pressure was measured in 672 children between 2 and 11 years of age from two schools in the city of Belo Horizonte, Brazil. After providing informed consent, all children had their blood pressure and anthropometric parameters measured. Blood pressure was measured based on the recommendations of the Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. The following variables were assessed: age, sex, race, urban life quality index, weight, height, and body mass index. Analysis of variance was used for comparison of means and the chi-square was used for comparison of proportions. Variables associated with increased blood pressure were included in a multiple regression model. RESULTS: According to univariate analysis, increased systolic and diastolic blood pressure were associated with high urban life quality index, white race and high body mass index. On multivariate analysis, body mass index, urban life quality index and height remained associated with increased systolic blood pressure; urban life quality index and age were associated with increased diastolic blood pressure. CONCLUSION: In this study, excess weight and obesity were associated with increased systolic blood pressure. Other unidentified factors were partially associated with increased blood pressure in children from the school with elevated urban life quality index.

Stability of faecal egg excretion and correlation with results related to worm burden at the initial phase of schistosomiasis mansoni were observed in two groups of mice infected with different Schistosoma mansoni cercarial burdens, by means of analysis of quantitative parasitological studies and schistosome counts after perfusion. Thus, it may be stated that few quantitative parasitological stool examinations could be sufficient to express the infection intensity at the initial phase, on the same grounds that it was already demonstrated at the chronic phase. Furthermore, it is confirmed that the use of the number of eggs passed in the faeces as a tool to estimate the worm burden at the initial phase of schistosome infection is adequate. Através da análise de exames parasitológicos quantitativos seriados e da contagem de esquistossomos após perfusão em dois grupos de camundongos infectados com diferentes cargas de cercárias de Schistosoma mansoni, verificou-se a existência da estabilidade da eliminação de ovos e sua correlação com a carga parasitária na fase inicial da esquistossomose mansoni. Deste modo, pode-se afirmar que poucos exames parasitológicos de fezes quantitativos podem ser suficientes para traduzir a intensidade da infecção também na fase inicial , à semelhança do já demonstrado para a crônica. Além disto, comprova-se a adequação do uso do número de ovos eliminados nas fezes como expressão da carga parasitária na fase inicial da infecção esquistossomótica.

INTRODUCTION Early identification of patients at higher risk of progressing to severe disease and death is crucial for implementing therapeutic and preventive measures; this could reduce the morbidity and mortality from kala-azar. We describe a score set composed of four scales in addition to software for quick assessment of the probability of death from kala-azar at the point of care. METHODS: Data from 883 patients diagnosed between September 2005 and August 2008 were used to derive the score set, and data from 1,031 patients diagnosed between September 2008 and November 2013 were used to validate the models. Stepwise logistic regression analyses were used to derive the optimal multivariate prediction models. Model performance was assessed by its discriminatory accuracy. A computational specialist system (Kala-Cal(r)) was developed to speed up the calculation of the probability of death based on clinical scores. RESULTS: The clinical prediction score showed high discrimination (area under the curve [AUC] 0.90) for distinguishing death from survival for children ≤2 years old. Performance improved after adding laboratory variables (AUC 0.93). The clinical score showed equivalent discrimination (AUC 0.89) for older children and adults, which also improved after including laboratory data (AUC 0.92). The score set also showed a high, although lower, discrimination when applied to the validation cohort. CONCLUSIONS: This score set and Kala-Cal(r) software may help identify individuals with the greatest probability of death. The associated software may speed up the calculation of the probability of death based on clinical scores and assist physicians in decision-making.

A leishmaniose visceral (LV) é uma doença potencialmente fatal e o tratamento é tóxico e/ou apresenta custo elevado. A proteção contra a infecção pelo parasito Leishmania está associada a uma imunidade do tipo Th1, sendo baseada na produção de citocinas como IFN-gama e IL-12 por células mononucleares de sangue periférico (PBMC) do hospedeiro mamífero. No presente trabalho, cinco proteínas do parasito Leishmania infantum, denominadas de fator de liberação de histamina dependente de IgE (HRF) e quatro proteínas hipotéticas (LiHyD, LiHyV, LiHyT e LiHyp6), em suas formas recombinantes, foram utilizadas com o objetivo de se avaliar a resposta celular e humoral específica em amostras de soros e nos sobrenadantes de culturas de PBMCs estimulados coletados de pacientes com LV antes e após o tratamento da doença. Nos resultados obtidos avaliando a resposta celular, quando PBMCs foram estimulados com as proteínas rHRF, rLiHyD e rLiHyT, níveis elevados de IFN-gama e uma baixa produção de IL-10 foram observados nos pacientes tratados. Na análise das subclasses de anticorpos, uma maior produção de IgG2 foi encontrada nos pacientes tratados, quando comparados com os níveis obtidos da subclasse IgG1, usando tais proteínas nas placas de ELISA. Adicionalmente, avaliando a eficácia diagnóstica dos antígenos recombinantes, as proteínas rHRF, rLiHyD e rLiHyT apresentaram também os melhores valores de sensibilidade e especificidade nos testes sorológicos para identificar os pacientes com LV, assim como eles não foram reconhecidos por anticorpos presentes nos soros de indivíduos não infectados ou daqueles desenvolvendo doenças relacionadas à LV. As proteínas rLiHyV e rLiHyp6 mostraram uma produção mista de IFN-gama e IL-10 e menores valores de sensibilidade e especificidade nos testes sorológicos. Em conclusão, este trabalho apresenta a indicação de que o tratamento e a cura da LV podem estar associados com uma resposta celular do tipo Th1, baseado na produção de IFN-gama e de anticorpos do isotipo IgG2, e denota a possibilidade de utilização das proteínas rHRF, rLiHyD e rLiHyT como possíveis biomarcadores de avaliação diagnóstica e de evolução de tratamento da LV. Visceral leishmaniasis (VL) is a potentially fatal disease, in which treatment is toxic and/or presents high costly. The protection against Leishmania infection is associated with the development of Th1- type immunity, being based on the production of cytokines, such as IFN- gama and IL-12, by peripheral blood mononuclear cells (PBMCs) of the infected mammalian hosts. In the present study, five parasite proteins, namely IgE-dependent histamine releasing factors (HRF) and four hypothetical proteins (LiHyD, LiHyV, LiHyT and LiHyp6), when in their recombinant formats, were used to evaluate the cellular and humoral response developed, by using sera samples and stimulated PBMC culture supernatants from VL patients, before and after the treatment against the disease. In the results obtained evaluating the cellular response, when PBMCs were stimulated with the rHRF, rLiHyD and rLiHyT proteins, higher IFN- levels and lower IL-10 production were found in the treated patients. Evaluating the antibody production, a higher production of rHRF, rLiHyD and rLiHyT-specific IgG2 isotype was found in sera from treated patients, when compared to the levels of the IgG1 antibody. Additionally, evaluating the diagnostic efficacy of the recombinant molecules, rHRF, rLiHyD and rLiHyT proteins were those presenting better sensitivity and specificity values in the serological assays to diagnose VL. The rLiHyV and rLiHyp6 proteins showed a mixed production of IFN-gama and IL-10, besides worse results in the serological assays. In conclusion, this work indicates that the evolution of the treatment of VL can be associated with the development of Th1-type cell response, based on the production of IFN-gama, and denotes the potential use of the rHRF, rLiHyD and rLiHyT proteins as possible biomarkers for the diagnostic evaluation and treatment against VL.

A leishmaniose visceral (LV) é uma das mais graves doenças tropicais negligenciadas e fatal se não tratada. Os fatores de risco para o óbito e os mecanismos imunopatogênicos da doença ainda não estão totalmente estabelecidos. Assim, neste trabalho foram avaliadas citocinas plasmáticas durante a doença ativa e após o tratamento da LV e sua associação com a coinfecção com HIV e com a presença de parâmetros clínicos e laboratoriais de gravidade da doença ou a ocorrência de óbito. Os níveis plasmáticos das citocinas IL-2, IL-4, IL-6, IL-10, IL-17A, TNF, IFN-gama foram obtidos pela citometria de fluxo, antes e após o tratamento da LV. Os pacientes com LV ativa apresentaram maiores concentrações plasmáticas de IL-2, IL-4 e IL-10 quando comparados aos pacientes após tratamento específico. Pacientes coinfectados com HIV apresentaram menores níveis de IL-10 que pacientes com LV sem coinfecção com HIV, na análise univariada. Menores níveis de IFN-gama foram encontrados na análise univariada entre os pacientes que apresentaram sangramentos e entre os pacientes que morreram, mostrando sua possível associação com a gravidade da doença. A ocorrência de icterícia foi associada ao aumento de IL-10 na análise univariada. Observou-se correlação negativa entre os níveis de hemoglobina e o número de leucócitos e os níveis plasmáticos de IL-2 e IL-6. Também foi encontrada correlação positiva entre o número de leucócitos e os níveis de IL-10. Assim, esses achados destacam a importância da IL-2, IL-4 e IL-10 durante a LV ativa, a associação entre a coinfecção LV/HIV e baixos níveis de IL-10 e o possível papel das citocinas nos complexos mecanismos envolvidos nos achados clínicos e laboratoriais na LV. Visceral leishmaniasis is one of the most severe neglected tropical diseases and fatal if left untreated. Risk factors for death and immunopathogenesis of VL are still not fully elucidated. Thus, in this study plasma cytokines were evaluated during active disease and after VL treatment, as well as their association with HIV co-infection, and clinical and laboratorial parameters of disease severity or death. Plasma levels of IL-2, IL-4, IL-6, IL-10, IL-17A, TNF and IFN-gamma were measured by flow cytometry, in VL patients before and after treatment. Active VL patients showed higher IL-2, IL-4 and IL-10 plasma concentrations as compared to VL patients after specific therapy. HIV co-infected patients showed lower levels of IL-10 as compared to patients with VL without HIV, in univariate analysis. Lower levels of IFN-gamma were found in patients who had bleeding episodes and it was also slightly lower in those who died, in univariated analysis, showing its possible association with disease severity. Occurrence of jaundice was associated with high IL-10. There were negative correlation between hemoglobin levels and leukocyte numbers with plasma IL-2 and IL-6. Positive association between leukocyte numbers with IL-10 were also found. Therefore, these findings highlight the importance of IL-2, IL-4 and IL-10 during active VL, the association between HIV co-infection and low IL-10 levels and the possible role of cytokines in the complex mechanisms involved in clinical and laboratorial findings in VL patients.

O processo de reestruturação da política de saúde mental tem como meta fortalecer os modelos de base comunitária, orientado pelos princípios da reforma psiquiátrica. Esse movimento tem como objetivo melhorar a qualidade da assistência prestada, bem como favorecer o acesso da população que necessita de acompanhamento, incluindo a abordagem aos usuários de álcool, crack e outras drogas no que tange a prevenção, ao tratamento e a reabilitação. Trata-se de um problema de saúde pública com ampla magnitude e diversas questões envolvidas. O consumo de drogas ilícitas vem aumentando em todos os segmentos sociais, principalmente entre as crianças e os adolescentes, sendo o impacto, em nível individual e familiar, imensurável. Nesse contexto, o trabalho objetivou compreender as experiências e as vivências dos pais sobre o filho usuário de crack e outras drogas. Trata-se de uma pesquisa qualitativa, com a fenomenologia como corrente de análise. As entrevistas foram realizadas com os pais e responsáveis de crianças e adolescentes usuárias de crack e outras drogas acompanhadas no Centro de Referência em Saúde Mental Infantil (CERSAMi) do Município de Belo Horizonte, Minas Gerais. Após assinatura do TCLE, as entrevistas foram gravadas e guiadas pela seguinte questão norteadora: Como é para você ter um filho que faz uso de drogas?. Foi utilizado o critério de saturação para determinar o número de participantes e o fim da coleta. Esse momento foi caracterizado pela repetição das falas, fato ocorrido na 11a entrevista. Os depoimentos foram analisados com fundamento em três momentos propostos por Martins e Bicudo, 1989: a descrição, a redução e a compreensão fenomenológica. Inicialmente, após a leitura exaustiva das unidades de significados, foi possível a elaboração de dezenove temas de análise que confluíram para a construção de três categorias de análise, que vem desvelar o fenômeno relacionado ao significado dado pelos pais ao uso de drogas pelo filho. 1) Percepções e críticas às ações do poder público no enfrentamento do uso/abuso de drogas; 2) Sentimentos e percepções de familiares em relação à rede de apoio, cuidado e tratamento; 3) Compreendendo as repercussões do uso de drogas por crianças e adolescentes dentro das famílias. A realização da pesquisa possibilitou ampliar o conhecimento sobre os significados e as dificuldades enfrentadas pelas famílias que possuem um filho (criança ou adolescente) usuário de crack e outras drogas, além de fornecer subsídios para o planejamento, a implementação e a melhoria da qualidade da assistência dos serviços que realizam o atendimento individual e coletivo. The restructuringprocess of the mental healthpolicyaims tostrengthencommunity-basedmodels, guided by the principlesof psychiatric reform.This movementaims toimprove thequality of assistance, as well as facilitating accessof the populationthat needsfollow-up, includingthe approachtoalcohol users, crack and other drugsregarding theprevention, treatmentand rehabilitation. This isapublic health problemwith largemagnitudeandseveral issues involved. Consumption of illegaldrugshas increasedinall segments of society, especially amongchildren andadolescents,impactingonindividual and family, immeasurably. In this context, the study aimed to understandthe parents experienceson thechild userof crack andother drugs. This isa qualitative research, with phenomenologyas stream ofanalysis. Interviews were conducted with parents and guardians of children and adolescents users of crack and other drugs monitored in the Reference Center on Children's Mental Health ( CERSAMi ) in the city of Belo Horizonte, Minas Gerais . After signing the informed consent, the interviews were recorded and guided by the following question: "How is for you having a son who is a drug user?". The saturation criterion was used to determine the number of participants and the end of the collection. This moment was characterized by the repetition of speeches, fact occurred in the 11th interview. The testimonials were analyzed based on three moments proposed by Martins and Bicudo, 1989: description, reduction and phenomenological understanding. Initially, after an exhausting reading of the meaning units,it was possible the development of nineteen subjects of analysis which converged to the construction of three categories of analysis that expose the phenomenon related to the meaning given by parents to drug use by their son.1) perceptions and criticisms to the actions of public power in confronting the use/abuse of drugs. 2) feelings and perceptions of family regarding the support, care and treatment network. 3) understanding the repercussion of drug use by children and adolescents inside of the families. The research allowed to increase the knowledge about the meanings and the difficulties faced by families who have a son (child or adolescent) user of crack and other drugs, besides providing funding for planning, implementing and improving the quality of services assistance that perform individual and collective attendance.

Introdução: O teste de contato é utilizado para identificar o alérgeno responsável pela dermatite de contato alérgica (DCA). Tem o objetivo de induzir o processo da segunda fase da DCA, ou seja, a via eferente da reação imunológica do tipo IV. O conhecimento sobre a freqüência de alérgenos em crianças e adolescentes pode ajudar nas medidas preventivas para evitar o desenvolvimento de DCA. Há poucos dados sobre os resultados de testes de contato de crianças e adolescentes no Brasil. No Brasil há duas baterias de alérgenos padronizadas disponíveis: bateria padrão e bateria de cosméticos. Geralmente, todos os pacientes que se submetem à realização do teste de contato são testados com a bateria padrão. Se necessário, a bateria de cosméticos também é testada. O uso dessa segunda bateria de alérgenos aumenta o custo e dificulta a técnica em crianças. Esse estudo tem por objetivo descrever o perfil dos testes de contato de crianças e adolescentes atendidos na clínica dermatológica da Santa Casa de Belo Horizonte, identificando os alérgenos mais frequentes, comparando-os nessas faixas etárias e avaliando a necessidade do uso da bateria de cosméticos brasileira complementar nesses pacientes. Metodologia: É um estudo transversal, de avaliação de resultados de testes de contato de 125 crianças e adolescentes de 1 ano a 19 anos de idade, apresentando suspeita de DCA. Foi realizada a leitura de prontuários referentes aos testes de contato de crianças e adolescentes realizados no período de 01/07/2003 a 30/06/2010, em uma clínica dermatológica em Belo Horizonte, Minas Gerais, Brasil. Os dados foram coletados e armazenados no programa estatístico EpiInfo 3.5.1. Para a análise de variáveis categóricas foi empregado o teste Qui quadrado e, quando necessário, o teste exato de Fisher. Considerou-se um nível de significância de 0,05 para todas as análises. Os materiais utilizados para a realização dos testes de contato foram duas baterias: Bateria Padrão Brasileira e Bateria Brasileira de Cosméticos e fitas adesivas com câmaras de alumínio. As leituras dos testes foram realizadas às 48 e 96 horas. Somente a leitura de 96 horas foi considerada para fins de análise estatística. Resultados: Os resultados de testes de contato foram avaliados em um total de 125 pacientes, 96 meninas (76,8%) e 29 meninos (23,2%), sendo 18 crianças, de um a 9 anos e 107 adolescentes de 10 a 19 anos. De todos os 125 pacientes testados, 74 apresentaram pelo menos uma reação positiva, sendo a taxa de sensibilização de contato de 59,2% (74/125). Dos 74 pacientes que apresentaram pelo menos uma reação positiva, 57 pacientes apresentaram relevância clínica atual (57/74; 77,0%) aos seus testes positivos. O diagnóstico de DCA ocorreu em 45,6% dos pacientes testados. Houve maior frequência de testes positivos em adolescentes (p=0,0014) do que em crianças e no sexo feminino (p=0,0002) do que no masculino. Não houve diferença estatística significativa em relação à sensibilização de contato entre pacientes com história de atopia e sem história de atopia. As substâncias que apresentaram maior frequência de sensibilização da Bateria Padrão Brasileira em crianças e adolescentes (n=125) foram: níquel (36,8%), thimerosal (18,4%), neomicina (6,4%), cobalto e perfume mix (4,0% cada), formaldeído (3,2%), bicromato de potássio e etilenodiamina (2,4% cada). As crianças (n=18) só apresentaram reações positivas ao níquel e ao perfume mix. Das substâncias testadas da Bateria de Cosméticos Brasileira (n= 73), não houve nenhuma reação positiva em crianças e somente duas substâncias apresentaram reação positiva em adolescentes: resina tonsilamida/formaldeído (6,8%) e cloracetamida (1,4%). Houve diferença estatística significativa em relação à sensibilização ao níquel (p=0,029) e em relação ao thimerosal (p=0,042) entre as duas faixas etárias. Cabeça e tronco foram os locais do corpo mais frequentemente acometidos pela dermatite em pacientes com testes positivos. Quando o acometimento inicial da dermatite ocorreu no pescoço e tronco, a frequência de testes positivos relevantes foi alta. Conclusão: Níquel e fragrâncias foram os únicos alérgenos positivos (e relevantes) em crianças. Níquel e resina tonsilamida/formaldeído foram os alérgenos mais frequentes e relevantes em adolescentes. Considerando que ocorreram somente seis reações positivas ao teste com a Bateria de Cosméticos Brasileira nessas duas faixas etárias estudadas e que desses testes positivos, 6,8% foram da resina tonsilamida/formaldeído, pode-se pensar na maior importância dessa substância, em relação às outras substâncias dessa bateria, a fim de avaliar as baterias necessárias para esses pacientes. Introduction: The patch-test is used for the identification of the allergen responsible for allergic contact dermatitis (ACD). It intends to reproduce a delayed type of hypersensitivity reaction by inducing the second phase of ACD (the efferent way). The knowledge about the frequency of allergens in children and adolescents may enable doctors to take preventive measures to avoid the development of ACD. There are few data about patch-test results in children and adolescents in Brazil. In Brazil there are two standardized patch-test series available: standard and cosmetics. Usually, all patients are patch tested with the standard series. When necessary, the cosmetic series is also tested. The use of this complementary cosmetic series increases cost and makes the technique more difficult in children. The objective of this study is to evaluate patch-test results in children and adolescents in a dermatology clinic in Brazil, identifying the most frequent allergens, comparing them in these two age groups and evaluating the need for the complementary cosmetic series use in those patients. Methods: This is a cross-sectional study to assess patch-test results of 125 children and adolescents with suspected allergic contact dermatitis from 1 to 19 years of age. Data from patch test results in children and adolescents in a dermatology clinic in Belo Horizonte, Minas Gerais Brazil, from 07/01/2003 to 06/30/2010 were collected and stored in the EpiInfo 3.5.1. Statistic program. Chi- square test was used for the analysis of the categorical variables and, when necessary, Fisher´s Exact Test was also employed. The significance level considered for all the analysis was 0.05. The materials used for the patch-tests were two series: Brazilian Standard Patch-Test Series and Brazilian Cosmetic Standard Patch-Test Series and aluminum chambers on adhesive tapes. Test readings were carried out at 48 and 96 hours. Only the 96 hour reading was considered for the statistical analysis. Results: Patch-test results were evaluated in 125 patients, 96 girls (76.8%) and 29 boys (23.2%). Age varied from 1 to 19 years, including 18 children, from 1 to 9 years and 107 adolescents from 10 to 19 years. Among the 125 tested patients, 74 had at least one positive reaction, the contact sensitization rate being 59.2% (74/125). Among 74 patients who had at least one positive reaction, 57 patients had present clinical relevance (57/74; 77.0%) to their positive tests. ACD diagnosis occurred in 45.6% of the tested patients. Tests were more frequently positive in adolescents (p=0.0014) than children and in females (p=0.0002) than in males. There was no significant statistical difference related to contact sensitization in patients with and without history of atopy. The substances from the Brazilian Standard Series that showed a higher sensitization frequency in children and adolescents (n=125) were as follows: nickel sulfate (n=46; 36.8%), thimerosal (n=23, 18.4%), neomycin (n=8; 6.4%), cobalt chloride and fragrance mix (n=5; 4.0% each), formaldehyde (n=4; 3.2%), potassium dichromate and ethylenediamine (n=3; 2.4% each). Children (n=18) had positive reactions only to nickel and fragrance mix. Among the substances tested with the Brazilian Cosmetic Series, for children and adolescents (n= 73), there was no positive reaction in children and only two substances had a positive reaction in adolescents: tosylamide formaldehyde resin (n=5; 6.8%) and chloroacetamide (n=1; 1.4%). There was a significant statistical difference (p=0.029) related to the sensitization to nickel (p=0.029) and thimerosal (p=0.042) between the two age groups. The head and the trunk were the body areas most affected by dermatitis most frequent in patients with positive tests. When the dermatitis initial affection occurred on the neck and trunk, the frequency of relevant positive tests was high. Conclusion: Nickel and fragrances were the only positive allergens (and relevant) in children. Nickel and tosylamide formaldehyde resin were the most frequent and relevant allergens among adolescents. Considering that there were only six positive reactions to the test with the Brazilian Cosmetics Series in the two age groups under study, and that, among these positive tests, 6.8% were to tosylamide formaldehyde resin, one can think of the utmost relevance of this substance, in relation to the other substances in this series, so as to evaluate the necessary screening for such patients.