Health literacy, a more complex concept than knowledge, is a required capacity to obtain, understand, integrate and act on health information [1], in order to enhance individual and community health, which is defined by different levels, according to the autonomy and personal capacitation in decision making [2]. Medium levels of Health literacy in an adolescent population were found in a study conducted in 2013/2014, being higher in sexual and reproductive health and lower in substance use. It was also noticed that the higher levels of health literacy were in the area adolescents refer to have receipt more health information. The health literacy competence with higher scores was communication skills, and the lower scores were in the capacity to analyze factors that influence health. Higher levels were also found in younger teenagers, but in a higher school level, confirming the importance of health education in these age and development stage. Adolescents seek more information in health professionals and parents, being friends more valued as a source information in older adolescents, which enhance the importance of peer education mainly in older adolescents [3]. As a set of competences based on knowledge, health literacy should be developed through education interventions, encompassing the cultural and social context of individuals, since the society, culture and education system where the individual is inserted can define the way the development and enforcement of the health literacy competences [4]. The valued sources of information should be taken into account, as well as needs of information in some topics referred by adolescents in an efficient health education. Schizophrenia is a serious and chronic mental illness which has a profound effect on the health and well-being related with the well-known nature of psychotic symptoms. The exercise has the potential to improve the life of people with schizophrenia improving physical health and alleviating psychiatric symptoms. However, most people with schizophrenia remains sedentary and lack of access to exercise programs are barriers to achieve health benefits. The aim of this study is to evaluate the effect of exercise on I) the type of intervention in mental health, II) in salivary levels of alpha-amylase and cortisol and serum levels of S100B and BDNF, and on III) the quality of life and selfperception of the physical domain of people with schizophrenia. The sample consisted of 31 females in long-term institutions in the Casa de Saúde Rainha Santa Isabel, with age between 25 and 63, and with diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Physical fitness was assessed by the six-minute walk distance test (6MWD). Biological variables were determined by ELISA (Enzyme-Linked Immunosorbent Assay). Psychological variables were assessed using SF-36, PSPP-SCV, RSES and SWLS tests. Walking exercise has a positive impact on physical fitness (6MWD -p = 0.001) and physical components of the psychological test...

CONTEXT: Cigarette smoke, whether inhaled voluntarily or not, causes damage to the mother-infant pair. The antenatal period may present the best opportunity for performing effective anti-smoking campaigns. OBJECTIVE: To study the obstetric and perinatal effects of smoking on pregnancy and the infant. TYPE OF STUDY: Prospective study, interviewing pregnant women who were randomly selected at the maternity hospital as they were being discharged after giving birth. SETTING: Hospital Municipal Vereador José Storópolli, São Paulo, Brazil. METHODS: 758 patients were interviewed regarding smoke inhalation before being discharged from the maternity hospital. The groups were formed by 42 active smokers, 272 passive smokers, 108 who inhaled smoke both actively and passively, and 336 non-smokers. The groups were compared regarding age, parity, school education, incidence of spontaneous abortion, rate of caesarian births, average gestational age at birth, rate of low birth weight and adequacy of weight in relation to the gestational age of newborn infants. For all variables we considered p < 0.05 as statistically significant. RESULTS: There was a high rate (55.7%) of pregnant smokers, including 5.5% active, 35.9% passive and 14.3% active-passive smokers. Active and active-passive smokers were older and had higher parity. Active smokers had lower education levels and higher rates of previous spontaneous abortion. The weights of newborn babies were lower for smoking mothers. DISCUSSION: The study was performed among patients that were mostly of low economic, social and cultural levels, thus possibly explaining the high incidence of smokers. Worse still was that 35.9% of the non-smokers were actually passive smokers. These rates we report were similar to those from the literature. The typical receptiveness of teenage girls to unrestricted advertising in the media contributes towards an early start to acquiring the habit of smoking, including during pregnancy in our country. We emphasize the difficulties in quantifying exposure to cigarettes even among active smokers. CONCLUSIONS: Cigarette smoke, whether inhaled voluntarily or not, has an unfavorable effect on the mother-infant pair.

(RR: 4,42; IC 95%: 1,56. Apesar do melhor conhecimento dos fatores envolvidos na parturição e dos recursos terapêuticos à disposição do obstetra para bloquear o trabalho de parto, a incidência de parto pré-termo não tem declinado nos últimos 50 anos 3 . Deve ser enfatizado que não é conhecido o mecanismo pelo qual a parturição é iniciada, isto é, a preparação e o processo que leva à expulsão do produto conceptual, seja na gravidez a termo ou na pré-termo. Essa questão é fundamental para a seleção de estratégias ou tratamentos para a prevenção do parto prematuro.A prematuridade pode acontecer espontaneamente, decorrente do trabalho de parto prematuro (TPP) propriamente dito, ou da interrupção da gravidez, devido a complicações mater-

SummaryBackground: The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood.

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IntroduçãoAs contrações uterinas do trabalho de parto habitualmente comprimem os vasos maternos e alteram o fluxo sangüíneo através do espaço interviloso, reduzindo momentaneamente os intercâmbios metabólicos entre o feto e a mãe. Entretanto, a elevação patológica do tônus (hipertonia), intensidade (hipersistolia), freqüência (taquissistolia ou polissistolia) e duração das contrações uterinas, que podem ocorrem durante a fase ativa do trabalho de parto, determinam alterações do ritmo cardiofetal (principalmente desaceleração prolongada, variável e tardia) e sofrimento do concepto. Isto ocorre com maior freqüência em produtos que já apresentam menor reserva funcional durante a gestação, mas também pode acontecer em fetos hígidos.O exagero da cinética uterina é mais encontrado nos casos de uso intempestivo de ocitócicos, emprego inadequado de tocoanalgesia e anestesia e, também, de etiologia idiopática. A compressão de vasos umbilicais, especialmente em casos de oligoâmnio, também pode reduzir o fluxo de sangue, tanto no sentido para o feto, quanto para as vilosidades coriônicas, determinando hipoxemia (redução de oxigênio no sangue), hipercapnia (elevação do gás carbônico no sangue), acidose (redução do pH dos tecidos) e outros distúrbios homeostáticos do produto conceptual.A terapêutica normalmente realizada após o diagnóstico cardiotocográfico de sofrimento fetal (desaceleração prolongada e persistente da freqüência cardíaca) inclui posicionar a paciente em decúbito lateral esquerdo, ministrar oxigênio à mãe e ultimar o parto pela via mais rápida e segura, comumente por fórcipe ou vácuo-extração ou, então, operação cesariana 1 . Os resultados obtidos com tais métodos, contudo, deixam a desejar. Os recém-nascidos freqüentemente apresentam-se deprimidos, exigindo cuidados intensivos neonatais. Desta forma, diversos autores têm sugerido métodos alternativos e mais eficientes para tratar o concepto in utero, entre os quais destaca-se o emprego de fármacos tocolíticos, com o objetivo de inibir as contrações uterinas excessivas, visando aumentar o fluxo sangüíneo na placenta e a oxigenação fetal, realizando-se o parto somente após a estabilização hemodinâmica e metabólica do concepto.Relatos de Casos 20 (3): 161-163, 1998 RBGO

Childbirth is one of the most important moments in life. Delivery assistance is a major challenge today. Safety in childbirth care to avoid maternal-fetal morbidity and mortality is especially important. It is vital to avoid, on the one hand, the excess of medicalization with early and unnecessary interventions and, on the other hand, the lack of care that can lead to a delay in decision-making. In this delicate balance, it is also important to consider the expectation of the parturient with her desires related to how the birth she idealized will happen. Respecting her wishes without putting the maternal-fetal unity at risk is a great challenge for the obstetrician. It is important to avoid interventions as fundal pressure, routine episiotomy and the excess of unnecessary caesarean section. Cultural, socio-economical aspects and choosing the delivery mode are part of a big puzzle. This chapter aims to assess the best childbirth care among the scientific evidence and will cover the following topics: first stage of labor (differentiating latent from active phase), progression of the first and second stages of labor, pain relief during labor, prevention of postpartum hemorrhage, care of the newborn, and the puerperal woman.

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