Os valores da cultura masculina envolvem comportamentos de risco à saúde, sendo que a forma como os homens constroem e vivenciam a sua masculinidade torna-se uma das matrizes dos modos de adoecer e morrer. O objetivo deste estudo foi identificar os fatores associados à procura por serviços de saúde e diferenças entre os sexos, selecionando usuários de serviços de saúde, investigando como variável dependente o sexo do usuário (indicador cultural) e a não procura pelo serviço de saúde e variáveis independentes: características sóciodemográficas e clínico-epidemiológicas. Para a análise de associação entre variáveis empregou-se a Razão de Prevalência através de análises univariadas e multivariada. Os fatores associados à não procura por serviços de saúde foram: sexo masculino, horário de funcionamento das unidades de saúde, horário de trabalho do usuário e não possuir nenhuma doença. Pela análise multivariada, os fatores facilitadores da procura por serviços de saúde (proteção) foram: sexo feminino entre 26 e 49 anos de idade. É relevante a efetiva consolidação de um modelo de atenção à saúde que questiona a contradição existente entre os dados epidemiológicos quanto à saúde masculina e a posição dos serviços de saúde de permanecerem no senso comum da invulnerabilidade dos homens ao adoecimento.

Background: Obesity in children/adolescents is a major public health problem worldwide. In Brazil there is great variability in published data on the prevalence of obesity among children/adolescents. Aims: To show a systematic review with meta-analysis of cross-sectional studies, conducted in Brazil between 2008 and 2014. Methods: A systematic review and meta-analysis was conducted the outcome of which was obesity (Body Mass Index ≥ 95th percentile for sex/age). A graphical presentation was done separately (Forest plot) for the results. Global and dichotomous outcomes were presented by employing, respectively the gross rates of prevalence and prevalence ratio (PR) and its confidence intervals at 95% (95% CI). The degree of heterogeneity was calculated employing the Q Cochran, while the I² test was used to describe the variation between studies. Results: Twenty-one studies with a sample of 18,463 children/adolescents were included; the overall prevalence of obesity was 14.1%. Among boys it was 16.1% and in girls it was 14.95%. There was no difference in obesity prevalence between sexes (PR 1.06; 95%CI: 0.81 to 1.40; p>0.05). Conclusions: The prevalence of obesity among children and adolescents in Brazil is high and urgently needs measures to prevent consequences associated with the disease, as well as measures to reduce the impact, in the short term, the overweight and childhood obesity.

INTRODUÇÃO: A hanseníase é considerada um grande problema de saúde pública nos países em desenvolvimento. Estima-se que somente 1/3 dos doentes sejam notificados e que, dentre esses, muitos fazem tratamento irregular ou o abandonam, aumentando o impacto da doença. Assim o objetivo desse artigo foi descrever o perfil epidemiológico da população com diagnóstico de hanseníase, no município de Uberaba, Estado de Minas Gerais, Brasil, no período de 2000 a 2006. MÉTODOS: Trata-se de um estudo retrospectivo, que utilizou os dados secundários de notificação de casos hanseníase do Sistema de Informação de Agravos de Notificação do Ministério da Saúde do Brasil. RESULTADOS: Foram registrados 455 casos da doença, sendo 55,4% do sexo masculino, a faixa etária dos 34 a 49 anos (31,4 %) foi a mais afetada, houve registro de nove (2%) casos de hanseníase em menores de 15 anos. A forma clínica prevalente foi a dimorfa (69,1%) e a classe operacional foi a multibacilar (87%). Tais achados são preocupantes, considerando-se que são de faixa etária economicamente ativa e potencialmente, os principais disseminadores da doença. CONCLUSÕES: O relato de que a maioria dos casos eram multibacilares, indica diagnósticos tardios, assim, torna-se necessário descentralizar o serviço de hanseníase e capacitar mais profissionais para possibilitar diagnóstico e tratamentos mais precoces.

Background In routine practice, assessment of the nutritional status of critically ill patients still relies on traditional methods such as anthropometric measurements, biochemical markers, and predictive equations. Objective To compare resting energy expenditure measured by indirect calorimetry (REE_IC) with REE calculated by using the Harris-Benedict equation with 3 different sources of body weight (from bed scale, REE_HB1; ideal body weight, REE_HB2; and predicted body weight, REE_HB3). Methods This study included 205 critically ill patients (115 men, 90 women) evaluated within the first 48 hours of admission and undergoing mechanical ventilation. REE was measured by indirect calorimetry for 30 minutes and calculated by using the Harris-Benedict equation with the 3 sources of body weight. Data were compared by the Bland-Altman method. Results The values based on ideal and predicted body weight (REE_HB2 and REE_HB3) did not agree with REE_IC. Bland-Altman analysis showed that the limits of agreement varied from +796.1 kcal/d to −559.6 kcal/d for REE_HB2 and from +809.2 kcal/d to −564.7 kcal/d for REE_HB3. REE_IC and REE_HB1 (body weight determined by bed scale) agreed the best; the bias was −18.8 kcal/d. However, REE_HB1 still overestimated REE_IC by +555.3 kcal/d and underestimated it by −593.0 kcal/d. Conclusion For measuring REE in critically ill patients undergoing mechanical ventilation, calculation via the Harris-Benedict equation, regardless of the source of body weight, cannot be substituted for indirect calorimetry. (American Journal of Critical Care. 2016;25:e21–e29)

Thoracolumbar fractures are most frequent along the spine, and surgical treatment is indicated for unstable fractures. Percutaneous minimally invasive surgery was introduced to reduce the pain associated with the open posterior approach and reduce the morbidity of the procedure by avoiding damage and dissection of the paravertebral muscles. The goal of this study is to compare the surgical treatment of fractures of the thoracolumbar spine treated by the conventional open approach and the percutaneous minimally invasive approach using similar types of pedicle spine fixation systems. This study is designed as a multi-center, randomized controlled trial of patients aged 18–65 years who are scheduled to undergo surgical posterior fixation. Treatment by the conventional open approach or percutaneous minimally invasive approach will be randomly assigned. The primary outcome measure is postoperative pain, which will be measured using the visual analogue scale (VAS). The secondary outcome parameters are intraoperative bleeding, postoperative drainage, surgery time, length of hospital stay, SF-36, EQ-5D-5 l, HADS, pain medication, deambulation after surgery, intraoperative fluoroscopy time, vertebral segment kyphosis, fracture vertebral body height, compression of the vertebral canal, accuracy of the pedicle screws, and breakage or release of the implants. Patient will be followed up for 1, 2, 3, 6, 12 and 24 months postoperatively and evaluated according to the outcomes using clinical and radiological examinations, plain radiographs and computed tomografy (CT). Surgical treatment of thoracolumbar fractures by the open or percutaneous minimally invasive approach will be compared in a multicenter randomized study using similar types of fixation systems, and the results will be evaluated according to clinical and radiological parameters at 1, 2, 3, 6, 12 and 24 months of follow-up. ClinicalTrial.gov approval number: 1.933.631, code: NCT03316703 in may 2017.