rosiane MaTTar 4 RevisãoResumo Os adoçantes são freqüentemente utilizados por mulheres em idade reprodutiva. Esta é uma revisão narrativa da literatura a respeito dos adoçantes atualmente comercializados no mercado brasileiro. Existem poucas informações sobre o uso da sacarina e ciclamato na gestação, e seus efeitos sobre o feto. Devido às limitadas informações disponíveis e ao seu potencial carcinogênico em animais, a sacarina e o ciclamato devem ser evitados durante a gestação (risco C). O aspartame tem sido extensivamente estudado em animais, sendo considerado seguro para uso na gestação (risco B), exceto para mulheres homozigóticas para fenilcetonúria (risco C). A sucralose e o acessulfame-K não são tóxicos, carcinogênico ou mutagênicos em animais, mas não existem estudos controlados em humanos. Porém, como esses dois adoçantes não são metabolizados, parece improvável que seu uso durante a gestação possa ser prejudicial (risco B). A estévia, substância derivada de uma planta nativa brasileira, não produz efeitos adversos sobre a gestação em animais, porém não existem estudos em humanos (risco B). Os agentes de corpo usados na formulação dos adoçantes (manitol, sorbitol, xilitol, eritrol, lactilol, isomalte, maltilol, lactose, frutose, maltodextrina, dextrina e açúcar invertido) são substâncias consideradas seguras para o consumo humano. Concluindo, segundo as evidências atualmente disponíveis, o aspartame, a sucralose, o acessulfame e a estévia podem ser utilizados com segurança durante a gestação. AbstractSweeteners are frequently used by women of reproductive age. This is a narrative review about the sweeteners currently sold in the Brazilian commerce. There is a few information on the use of saccharin and cyclamates in pregnancy and their effects on the fetus. Due to the limited information available and their carcinogenic potential in animal species, saccharin and cyclamates should be avoided during pregnancy (risk C). Aspartame has been extensively studied in animals and it is considered safe for use during pregnancy (risk B), except by women homozygous for phenylketonuria (risk C). Sucralose and acessulfame-K are not toxic, carcinogenic or mutagenic in animals, but there are no controlled studies in humans. However, since these two sweeteners are not metabolized, it is unlikely that their use during pregnancy could be harmful (risk B). Stevia, a substance extracted from a native Brazilian plant, is innocuous in animal pregnancies, but there are no controlled studies in humans (risk B). Body agents found in the composition of artificial sweeteners (mannitol, sorbitol, xylitol, erithrol, lactilol, isomalt, maltilol, lactose, fructose, maltodextrin, dextrin, and inverted sugar) are substances generally regarded as safe for human consumption. In conclusion, according to the currently available evidence, aspartame, sucralose, acessulfame-K and stevia can be safely used during pregnancy.
2012Levels of selected persistent organic pollutants in blood from delivering women in seven selected areas of Sao Paulo State, Brazil ENVIRONMENT INTERNATIONAL, OXFORD, v. 40, Persistent organic pollutants (POPs) present in the living environment are thought to have detrimental health effects on the population, with pregnant women and the developing foetus being at highest risk. We report on the levels of selected POPs in maternal blood of 155 delivering women residing in seven regions within the São Paulo State, Brazil. The following selected POPs were measured in the maternal whole blood: 12 polychlorinated biphenyls (PCBs) congeners (IUPAC Nos. 99, 101, 118, 138, 153, 156, 163, 170, 180, 183, 187, 194); dichlordiphenyltrichloroethane p,p′-DDT, diphenyldichloroethylene p,p′-DDE and other pesticides such as hexachlorocyclohexanes (α-HCH, β-HCH, γ-HCH), hexachlorobenzene (HCB), chlordane derivatives cis-chlordane, transchlordane, oxy-chlordane, cis-nonachlor and trans-nonachlor. Statistical comparisons between regions were performed only on compounds having concentrations above LOD in 70% of the samples. PCB118 congener was found to be highest in the industrial site (mean 4.97 ng/g lipids); PCB138 congener concentration was highest in the Urban 3 site (mean 4.27 ng/g lipids) and congener PCB153 was highest in the industrial and Urban 3 sites with mean concentration of 7.2 ng/g lipids and 5.89 ng/g lipids respectively. Large differences in levels of p,p′-DDE between regions were observed with the Urban 3 and industrial sites having the highest concentrations of 645 ng/g lipids and 417 ng/g lipids, respectively; β-HCH was found to be highest in the Rural 1 site; the γ-HCH in Rural 1 and industrial; the HCB in the Rural 1 and industrial sites and oxy-chlordane and t-NC in the Rural 2 sites. An association between levels of some contaminants and maternal age and parity was also found.
Mary usChiyaMa nakaMura 2 rosiane MaTTar 2 Introdução A sexualidade é uma função biológica humana que não se atém à genitalidade e sim à corporalidade total. Segundo a Neuroendocrinologia, a função sexual é um fenômeno biopsicossocial complexo no qual estímulos internos e externos são modulados pelo sistema nervoso central e periférico, resultando em uma cascata de alterações bioquímicas, hormonais e circulatórias que culminam no resultado sexual físico e cognitivo 1,2 . É um fenômeno que envolve aspectos bioló-gicos, psicológicos e sociológicos 3 . Na atualidade, o comportamento sexual humano transcendeu o aspecto reprodutivo e passou a ser considerado parte integral da qualidade de vida 4,5 . Apesar de alguns avanços ao longo dos últimos séculos, o exercício da sexualidade ainda é cercado por tabus, preconceitos e crendices em muitas culturas modernas. O conceito de disfunções sexuais surgiu somente no século XX, após os primeiros estudos sobre a resposta sexual fisiológica humana. Em 1966, Masters e Johnson 6 propuseram o modelo que descrevia a resposta sexual masculina e feminina como um processo linear didaticamente subdividido em quatro fases denominadas excitação, platô, orgasmo e resolução. Embora cada fase tenha características específicas distintas, não são unidades separadas, mas partes inseparáveis de um processo unitário, sequencial, contínuo e ordenado. Em 2001, Basson propôs um novo modelo específico para a resposta sexual feminina segundo o qual a resposta sexual das mulheres seria circular e dividida em cinco fases (neutralidade, excitação, desejo responsivo, satisfação e intimidade) 7 . Segundo esse novo modelo, o desejo não necessariamente desencadearia toda a resposta sexual feminina, mas a intimidade física do casal poderia ser a base para a motivação sexual Sexualidade na gestaçãoSe a resposta sexual feminina foi esquecida durante muitos séculos, o estudo dessa função durante o ciclo gravídico-puerperal recebeu ainda menos atenção. A gravidez é caracterizada por modificações bioquímicas, funcionais e anatômicas que se iniciam logo após a implantação
Introduction Sexual difficulties and questions regarding sexual function are frequent in pregnancy, yet they are infrequently discussed in academic communities, medical schools, and residency programs. Embarrassment, lack of experience, inadequate communication skills and insufficient knowledge on how to deal with sexual complaints, and questions in pregnancy are common, especially among young health professionals. Aim The aim of this study was to assess and compare the attitude and behavior of Brazilian residents in three different medical programs (obstetrics gynecology, internal medicine, and psychiatry) toward sexual health issues of pregnant patients. Methods Survey conducted in a single Brazilian university using anonymous self responsive questionnaires on how residents deal with sexual health issues of obstetric patients. A total of 154 residents from the three different programs (47 obstetrics gynecology, 33 psychiatry, 74 internal medicine) participated. Main Outcome Measures Attitude and practice of medical residents regarding sexual health issues of pregnant patients. Results Less than 20% of the residents reported that they routinely asked obstetric patients about their sexual health, although almost 70% stated this should be part of every history. Psychiatry residents were significantly more likely to actively seek information about the sexual health of obstetric patients than others (57.6%, 17%, 4.1%, psychiatry, obstetrics gynecology, internal medicine, respectively, P < 0.001). Although over 80% answered that most obstetric patients react well or indifferently to questions about sexual function, less than 25% of the residents reported being completely confident answering these questions, and 71% of them admitted that they lacked specific knowledge in the area of sexual dysfunctions. The two main obstacles in evaluating patients’ sexuality were lack of specific knowledge and not enough time to explore these aspects in medical consultations, reported by 71% and 20% of all participants, respectively. Conclusions Most residents do not feel comfortable or confident and lack specific knowledge and skills to deal with questions related to sexual problems during pregnancy.
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