-Context -The incidence and populational prevalence of inflammatory bowel diseases, hitherto unknown in Brazil, were estimated for a region in the Midwest of São Paulo State, Brazil. Methods -Using a sequential registry of 115 adult patients (>15 years old) with inflammatory bowel diseases -exclusively residing in the studied region with 533,508 inhabitants (2005) and attended at the reference hospital during a 20 year interval (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) -were estimated, in four consecutives periods of 5 years each, the incidences according to gender, type of the disease and the prevalence of these diseases, and its inner-relations evaluated by the Poisson regression model. Results -The inflammatory bowel diseases in the studied region predominated among young, white race and people living in urban area, and the incidence on the female population rose during this period. The incidence of ulcerative colitis were higher than Crohn's disease and non-classified colitis, and showed a progressive increase in the first three periods with a decrease in the last one (2001)(2002)(2003)(2004)(2005), where the observed rates of ulcerative colitis, Crohn's disease and non-classified colitis were 4.48, 3.50 and 1.75 cases/100,000 inhabitants, with prevalence of 22.61, 14.81, 5.65, 2.14 cases/100,000 inhabitants for total inflammatory bowel diseases. Conclusion -The inflammatory bowel diseases incidence in the studied area was as low as in other countries of Latin America and smaller than that found in countries of South Europe. The crescent prevalence justifies the policies to adequate medical cares for inflammatory bowel diseases patients in this area. HEADINGS -Inflammatory bowel disease, epidemiology. Colitis, ulcerative, epidemiology. Crohn disease, epidemiology. São Paulo (Brasil).

Studies estimate that gender-diverse persons represent 0.1 to 2% of populations investigated, but no such assessment was performed in Latin America. In a representative sample of Brazil’s adult population (n = 6000), we investigated participants' sociodemographic characteristics and possible associations between these and current gender identity, categorized as cisgender, transgender or non-binary gender. We also investigated transgender individuals' distress associated with gender-related body characteristics. As main results, we found that transgender individuals represented 0.69% (CI95% = 0.48–0.90) of the sample, whereas non-binary persons were 1.19% (CI95% = 0.92–1.47). These percentages were not different among Brazil’s 5 geographic regions. Preliminary analyses showed that transgender individuals were on average younger (32.8 ± 14.2 years, CI95% = 28.5–37.1), compared to cisgender (42.2 ± 15.9, CI95% = 42.5–42.8) and non-binary (42.1 ± 16.5 years, CI95% = 38.3–46.5) groups. Non-binary persons are less likely to be in a relationship compared to cisgender individuals (OR = 0.57, CI95% = 0.35–0.93). In the transgender group, 85% of transgender men and 50% of transgender women reported distress due to gender-related body characteristics. Our main findings draw attention that gender-diverse Brazilian individuals represent around 2% of the country's adult population (almost 3 million people), and are homogeneously located throughout the country, reiterating the urgency of public health policies for these individuals in the five Brazilian sub-regions.

Objective: To analyze whether an increase in patient severity and nursing workload are correlated to a greater incidence of adverse events (AEs) in critical patients. Method: A prospective single cohort study was performed on a sample of 138 patients hospitalized in an intensive care unit (ICU). Results: A total of 166 AEs, occurred, affecting 50.7% of the patients. Increased patient severity presented a direct relationship to the probability of AEs occurring. However, nursing workload did not present a statistically signifi cant relationship with the occurrence of AEs. Conclusion: The results cast light on the importance of using evaluation tools by the nursing personnel in order to optimize their daily activities and focus on patient safety. Descriptors: Nursing Care; Patient Severity; Workload; Safety Management; Patient Safety. RESUMO Objetivo: Analisar se o aumento da gravidade do paciente e a carga de trabalho de enfermagem está relacionado à maior incidência de Eventos Adversos (EAs) em pacientes críticos. Método: Estudo de coorte única, prospectivo, com amostra de 138 pacientes internados em uma Unidade de Terapia Intensiva (UTI). Resultados: Ao todo, foram evidenciados 166 EAs, que acometeram 50,7% dos pacientes. O aumento da gravidade do paciente apresentou relação direta com a chance de ocorrência de EAs. Entretanto, a carga de trabalho de enfermagem não apresentou relação estatisticamente signifi cativa, na ocorrência de EAs. Conclusão: Os resultados permitem refl etir acerca da importância da equipe de enfermagem, em utilizar instrumentos de avaliação, com o objetivo de melhorar e planejar suas ações diárias, com foco na segurança do paciente. Descritores: Cuidados de Enfermagem; Gravidade do Paciente; Carga de Trabalho; Gestão da Segurança; Segurança do Paciente. RESUMENObjetivo: Analizar si el aumento de la gravedad del paciente y la carga de trabajo de enfermería está relacionada con mayor incidencia de Eventos Adversos (EAs) en pacientes críticos. Método: Estudio de cohorte única, prospectivo, con muestra de 138 pacientes internados en una Unidad de Terapia Intensiva (UTI). Resultados: En total, fueron evidenciados 166 EAs, incidiendo sobre 50,7% de los pacientes. El aumento de la gravedad del paciente mostró relación directa con la posibilidad de ocurrencia de EAs. Sin embargo, la carga de trabajo de enfermería no demostró relación estadísticamente signifi cativa en la ocurrencia de EAs. Conclusión: Los resultados permiten refl exionar sobre la importancia del equipo de enfermería, en utilizar instrumentos de evaluación, con el objeto de mejorar y planifi car sus acciones diarias, enfocándose en la seguridad del paciente. Descriptores: Atención de Enfermería; Gravedad del Paciente; Carga de Trabajo; Gestión de la Seguridad; Seguridad del Paciente. Severity and workload related to adverse events in the ICU Serafim CTR, et al. Severity and workload related to adverse events in the ICU

BackgroundLow-dose combined oral contraceptives (COCs) can interfere with bone mass acquisition during adolescence. This study aimed to evaluate bone mineral density (BMD) and bone mineral content (BMC) in female adolescents taking a standard low-dose COC (ethinylestradiol 20 μg/desogestrel 150 μg) over a 1-year period and to compare their data with those of healthy adolescents from the same age group not taking COCs.MethodsThis was a non-randomized parallel-control study with a 1-year follow-up. Sixty-seven adolescents aged from 12 to 19 years, divided into COC users (n = 41) taking 20 μg ethinylestradiol/150 μg desogestrel and COC non-user controls (n = 26), were evaluated by bone densitometry examinations at baseline and after 12 months. Comparisons between the groups at the study onset were performed using the Mann–Whitney test with the significance level fixed at 5% or p < 0.05. Comparisons between the groups at the study onset and after 12 months were based on variations in the median percentages for bone mass variables.ResultsThe COC users presented with low bone mass acquisition in the lumbar spine, and had BMD and BMC median variations of 2.07% and +1.57%, respectively, between the measurements at baseline and 12 months. The control group had median variations of +12.16% and +16.84% for BMD and BMC, respectively, over the same period. The total body BMD and BMC showed similar evolutions during the study in both groups. Statistical significance (p < 0.05) was seen for the BMC percentage variation between COC users and non-users.ConclusionsUse of a low-dose COC (ethinylestradiol 20 μg/desogestrel 150 μg) was associated with lower bone mass acquisition in adolescents during the study period.Trial registrationRegistry Number, RBR-5h9b3c.

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The meta-analysis showed evidence favoring the use of CHOC in the management of DM1. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group.

The periodontal disease during pregnancy triggers an exacerbated immune response with high local and systemic concentrations of inflammatory markers. Objective To investigate the repercussion of periodontal disease (PD) in the pregnant woman health and the complications during pregnancy and delivery, as well as negative outcomes for the newborn (as infections, prematurity, low birth weight and fetal growth restriction). Method Retrospective cohort study, based on medical records of 142 pregnant women assisted at a prenatal service of usual risk between 2012-2014, with a dental evaluation for PD. Maternal variables, along with labor and newborn variables, were analyzed. The newborns were stratified into two groups: offspring of mothers with PD (subdivided into Severe Periodontal Disease-SPD) and offspring of mothers without PD. Each outcome was adjusted by a multiple logistic regression model, with significance for p-value <0.05, considering all potential confounding factors. Results Among women diagnosed with SPD, the odds ratio for vulvovaginitis was 3.45 times greater (OR = 3.45, p-value = 0.050) and 5.59 times higher for premature rupture of membranes (OR = 5.59; p-value = 0.017). For neonates, the chance of fetal growth restriction was 11.53 times higher for pregnant women with SPD (OR = 11.53, p = 0.041).

Extraparenchymal neurocysticercosis has an aggressive course because cysts in the cerebrospinal fluid compartments induce acute inflammatory reactions. The relationships between symptoms, imaging findings, lesion type and location remain poorly understood. In this retrospective clinical records-based study, we describe the clinical symptoms, magnetic resonance imaging features, and cyst distribution in the CSF compartments of 36 patients with extraparenchymal neurocysticercosis. Patients were recruited between 1995 and 2010 and median follow up was 38 months. During all the follow up time we found that 75% (27/36) of the patients had symptoms related to raised intracranial pressure sometime, 72.2% (26/36) cysticercotic meningitis, 61.1% (22/36) seizures, and 50.0% (18/36) headaches unrelated to intracranial pressure. Regarding lesion types, 77.8% (28/36) of patients presented with grape-like cysts, 22.2% (8/36) giant cysts, and 61.1% (22/36) contrast-enhancing lesions. Hydrocephalus occurred in 72.2% (26/36) of patients during the follow-up period. All patients had cysts in the subarachnoid space and 41.7% (15/36) had at least one cyst in some ventricle. Cysts were predominantly located in the posterior fossa (31 patients) and supratentorial basal cisterns (19 patients). The fourth ventricle was the main compromised ventricle (10 patients). Spinal cysts were more frequent than previously reported (11.1%, 4/36). Our findings are useful for both diagnosis and treatment selection in patients with neurocysticercosis.