ABSTRACT BACKGROUND: Managing cervical intraepithelial neoplasia grade 2 (CIN2) is challenging, considering the CIN2 regression rate, perinatal risks associated with excisional procedures, and insufficient well-established risk factors to predict progression. OBJECTIVES: To determine the ability of p16INK4a and Ki-67 staining in biopsies diagnosed with CIN2 to identify patients with higher-grade lesions (CIN3 or carcinoma). DESIGN AND SETTING: Cross-sectional study conducted at a referral center for treating uterine cervical lesions. METHODS: In 79 women, we analyzed the correlation of p16INK4a and Ki-67 expression in CIN2 biopsies with the presence of a higher-grade lesions, as determined via histopathology in surgical specimens from treated women or via two colposcopies and two cytological tests during follow-up for untreated women with at least a 6-month interval. The expression of these two biomarkers was verified by at least two independent pathologists and quantified using digital algorithms. RESULTS: Thirteen (16.8%) women with CIN2 biopsy exhibited higher-grade lesions on the surgical excision specimen or during follow-up. p16INK4a expression positively and negatively predicted the presence of higher-grade lesions in 17.19% and 86.67% patients, respectively. Ki-67 expression positively and negatively predicted the presence of higher-grade lesions in 40% and 88.24% patients, respectively. CONCLUSIONS: Negative p16INK4a and Ki67 immunohistochemical staining can assure absence of a higher-grade lesion in more than 85% of patients with CIN2 biopsies and can be used to prevent overtreatment of these patients. Positive IHC staining for p16INK4a and Ki-67 did not predict CIN3 in patients with CIN2 biopsies.

Phosphorus is a non-renewable element essential for the existence of life and also for food security. This resource has the property of limiting plant growth, becoming a fundamental part of agricultural production. On the other hand, when this element is present in high concentrations in aquatic environments, it can start a phenomenon called eutrophication, which causes a series of changes in biological succession processes and strongly negative impacts on species’ biodiversity and wealth. In this context, this work aimed, from an extensive bibliographical review, to gather strategic and essential information related to phosphorus sustainability, provoking a reflection regarding scenarios that involve this indispensable nutrient, focusing on the current situation of the State of São Paulo, Brazil, an important case study, both for the Brazilian and international scenario, by a gathering of data on the current situation of two of the main watersheds in the corresponding region. Relevant technologies used for phosphorus removal in eutrophicated environments are also addressed. Finally, the possibility of reusing the nutrients present in eutrophicated water bodies as an alternative source of phosphate fertilizer for agriculture is demonstrated. nonrenewable non renewable security growth production hand eutrophication species wealth context aimed review sustainability nutrient Paulo Brazil study scenario region addressed Finally demonstrated

ABSTRACT Introduction: Early integration between palliative care and other medical specialties in the care of patients with serious illnesses is consolidating itself as good medical practice, based on scientific and ethical evidence. Despite this, palliative care is still not part of the routine care of patients with hematological diseases, even in specialized centers. Objective and method: In this article, we review the benefits and the main barriers described in the literature for early integration of hematology and palliative care. We also point out the challenges encountered in clinical practice, such as end-of-life prognosis assessment in patients with hematological diseases and management of the most common symptoms in hematology. Finally, we review models of integration between palliative care and oncology centers in outpatient and inpatient settings. Results and conclusion: Patients with hematological diseases can greatly benefit from early integration with palliative care, with improvement in symptom control, quality of life, reduction of emotional distress and the development of advanced care directives. It is necessary to make hematologists aware of the benefits of palliative care, provide adequate training for multidisciplinary teams and encourage specific studies of palliative care in patients with hematological diseases.

ABSTRACT Despite substantial progress toward its control, Chagas disease continues to be a major public health problem in Latin America and has become a global health concern. The disease affects approximately 6 million people, of whom 20-40% will develop cardiomyopathy over the years after the initial Trypanosoma cruzi infection. Chagas cardiomyopathy is the most serious and frequent manifestation of Chagas disease. Clinical manifestations vary widely according to the severity of myocardial dysfunction, ranging from asymptomatic to severe forms, including dilated cardiomyopathy with heart failure, arrhythmias, thromboembolism events, and sudden death. Chagas disease is a risk factor for stroke regardless of the severity of cardiomyopathy, which is a leading cause of chronic disability. Classically, stroke etiology in patients with Chagas disease is thought to be cardioembolic and related to apical aneurysm, mural thrombus, and atrial arrhythmias. Although most strokes are thromboembolic, other etiologies have been observed. Small vessel disease, atherosclerosis, and cryptogenic diseases have been reported in patients with Chagas disease and stroke. The potential mechanisms involved in non-embolic strokes include the presence of associated risk factors, pro-inflammatory and prothrombotic disease states, and endothelial dysfunction. However, the contribution of each mechanism to stroke in Chagas disease remains unclear. The review aims to provide an overview of stroke in Chagas disease, highlighting the main pathophysiological mechanisms, clinical presentation, approaches for prevention, and unanswered questions regarding treatment strategies.

ABSTRACT Purpose: To compare four commercially available hydrogel formulations in the healing of partial thickness burns experimentally induced in rats. Methods: Wistar rats were used, and after the burn wound induction they were divided into the following treatment groups: G1) NaCl 0.9%; G2) 1% silver sulfadiazine; G3) Debrigel™; G4) Safgel™; G5) Dersani™; G6) Solosite™. The animals were followed during seven, 14 and 30 days after the injury induction. Morphometric, macroscopic and microscopic evaluations were performed. Results: The treatment with Dersani™ induced better results during the inflammatory and proliferative phases of the healing process (p<0.05). The animals treated with Safgel™ presented better scaring in the remodeling phase (p<0.05), and the treatment with Dersani™ and Solosite™ induced greater wound closure (p<0.05). Conclusions: The hydrogel-based dressings presented beneficial outcomes in the healing of burn wounds experimentally induced in rats due to their ability in maintain the humidity of the wound, in removing the exudate, in promoting cell migration and collagen production during the different phases of the healing process.

RESUMO A inoculação e coinoculação da soja por rizobactérias multifuncionais é uma alternativa sustentável que pode contribuir com o crescimento das plantas e com o aumento da produção agrícola, tornando o produto mais competitivo e, ainda, diminuir os custos para o produtor. Objetivou-se avaliar o efeito da inoculação e coinoculação com rizobactérias multifuncionais Serratia sp. e Bacillus sp. no desenvolvimento inicial da soja. O delineamento experimental foi o inteiramente casualizado, com 4 tratamentos e 10 repetições, totalizando 40 parcelas experimentais. Os tratamentos consistiram na microbiolização das sementes de soja e tratamento controle: isolado BRM 32114 (Serratia sp.); isolado BRM 63573 (Bacillus sp.) (antes nomeado 1301); coinoculação com BRM 32114 + BRM 63573; e controle (sem microbiolização). BRM 32114 e BRM 63753 isolados e combinados foram eficientes para melhorar o desenvolvimento inicial de plântulas da soja, proporcionando efeitos significativos para a maioria das variáveis analisadas (comprimento, superfície total, volume de raiz e biomassa de raiz, parte aérea e total), quando comparados ao tratamento controle.

ABSTRACT Soybean inoculation and co-inoculation with multifunctional rhizobacteria is a sustainable alternative that may contribute to plant growth and increased agricultural production, making the product more competitive, as well as reducing costs for the producer. This study aimed to evaluate the effect of inoculation and co-inoculation with multifunctional Serratia sp. and Bacillus sp. rhizobacteria on the early development of soybean. A completely randomized experimental design was used, with four treatments and ten replicates, totaling 40 experimental plots. The treatments consisted of the microbiolization of soybean seeds and a control treatment: BRM 32114 (Serratia sp.) isolate; BRM 63573 (Bacillus sp.) isolate (formerly named 1301); co-inoculation with BRM 32114 + BRM 63573; and control (without microbiolization). BRM 32114 and BRM 63753, both isolated and combined, were eficient to improve the initial development of soybean seedlings, providing significant effects for most of the analyzed variables (length, total surface, root volume and root, shoot and total biomass), when compared to the control treatment.

Resumo Fundamento A síndrome metabólica é caracterizada por um conjunto de comorbidades. Durante a síndrome, observam-se alterações estruturais no sistema cardiovascular, especialmente o remodelamento vascular. Uma das causas predisponentes para essas alterações é a inflamação crônica oriunda de mudanças na estrutura e composição do tecido adiposo perivascular. Atorvastatina é eficaz no tratamento das dislipidemias. No entanto, seus efeitos pleiotrópicos não são totalmente compreendidos. Supõe-se que, durante a síndrome metabólica, ocorre remodelamento vascular e que o tratamento com atorvastatina pode ser capaz de atenuar tal condição. Objetivos Avaliar os efeitos do tratamento com atorvastatina sobre o remodelamento vascular em modelo experimental de síndrome metabólica. Métodos Camundongos Swiss receberam dieta controle ou dieta hiperglicídica por 18 semanas. Após 14 semanas de dieta, os camundongos foram tratados com veículo ou atorvastatina (20mg/kg) durante 4 semanas. Foram avaliados o perfil nutricional e metabólico por testes bioquímicos; análise estrutural da artéria aorta por histologia e dosagem de citocinas por ensaio imunoenzimático. O nível de significância aceitável para os resultados foi p <0,05. Resultados A dieta hiperglicídica promoveu o desenvolvimento de síndrome metabólica. Tal fato culminou no remodelamento hipertrófico do músculo liso vascular e tecido adiposo perivascular. Além disso, houve aumentos das citocinas TNF-α e IL-6 circulantes e no tecido adiposo perivascular. O tratamento com atorvastatina reduziu significativamente os danos metabólicos, o remodelamento vascular e os níveis de citocinas. Conclusão Atorvastatina ameniza danos metabólicos associados à síndrome metabólica induzida por dieta hiperglicídica, além de atenuar o remodelamento vascular, sendo esses efeitos associados à redução de citocinas pró-inflamatórias.

Abstract Background Metabolic syndrome is characterized by an array of comorbidities. During this syndrome, structural changes are observed in the cardiovascular system, especially vascular remodeling. One of the predisposing causes for these changes is chronic inflammation resulting from changes in the structure and composition of perivascular adipose tissue. Atorvastatin is effective in the treatment of dyslipidemias. However, its pleiotropic effects have not been completely understood. We hypothesize that metabolic syndrome may lead to vascular remodeling and that atorvastatin therapy may be able to attenuate this condition. Objectives To assess the effects of atorvastatin therapy on vascular remodeling in an experimental model of metabolic syndrome. Methods Swiss mice received a control diet or a hyperglicemic diet for 18 weeks. After 14 weeks of diet, mice were treated with vehicle or atorvastatin (20mg/kg) during for 4 weeks. Nutritional and metabolic profiles were assessed by biochemical tests; moreover, a histological assessment of aorta structure was conducted, and cytokine levels were determined by the immunoenzyme assay. The acceptable level of significance for the results was set at p<0.05. Results Hyperglicemic diet promoted the development of metabolic syndrome. It indeed culminated in hypertrophic remodeling of vascular smooth muscle and perivascular adipose tissue. Furthermore, there were increases in the levels of circulating TNF-α and IL-6 and in the perivascular adipose tissue. Atorvastatin therapy significantly reduced metabolic damages, vascular remodeling, and cytokine levels. Conclusion Atorvastatin attenuate metabolic damages associated with metabolic syndrome induced by hyperglycemic diet, in addition to attenuating vascular remodeling; both effects are associated with reduced levels of pro-inflammatory cytokines.

RESUMO Objetivo: adaptar culturalmente e validar o Moral Sensitivity Questionnaire para avaliação da sensibilidade moral em enfermeiros brasileiros. Método: estudo metodológico, realizado com 106 enfermeiros de dois hospitais do Sul do Brasil. Foi realizada adaptação cultural do instrumento segundo recomendações internacionais, seguindo seis fases: primeira tradução; resumo das traduções; back translation; comitê de especialistas; pré-teste; revisão final pelos pesquisadores; e, por fim, a sua validação para utilização no contexto brasileiro por meio de análise fatorial e alfa de Cronbach. Resultados: após procedimentos de avaliação pelo comitê de especialistas, pré-teste, validade de face e conteúdo, o instrumento foi considerado satisfatório para aplicação em enfermeiros brasileiros. Foram identificados seis constructos: respeito à autonomia do paciente; autonomia modificada; experimentando conflito moral; confiança no conhecimento médico e de enfermagem; significado estrutural moral; e trabalho em equipe. O instrumento apresentou consistência interna satisfatória, com alfa de Cronbach 0,62 e os seis constructos variaram entre 0,60 a 0,67. Conclusão: o Moral Sensitivity Questionnaire, em sua versão brasileira, é um instrumento válido e confiável para sua aplicação em enfermeiros brasileiros e poderá contribuir para a compreensão de fatores que envolvem a tomada de decisão diante dos conflitos éticos.

ABSTRACT Objective: cultural adaptation and validation of the Moral Sensitivity Questionnaire to assess moral sensitivity among Brazilian nurses. Method: methodological study with 106 nurses from two hospitals located in the south of Brazil. The instrument was culturally adapted according to international guidelines, following six steps: translation, reconciliation of translated versions, back translation, expert panel, pretest, and final review. The Brazilian version was validated in the Brazilian context using factor analysis and Cronbach’s alpha. Results: after the expert panel’s assessment, pretest, and verification of face and content validity, the instrument was considered satisfactory to be applied among Brazilian nurses. Six constructs were identified: Respect for patients’ autonomy, modified autonomy, experiencing moral conflict, having confidence in medical and nursing knowledge, structuring moral meanings, and teamwork. The instrument presented satisfactory internal consistency, with a Cronbach’s alpha equal to 0.62; the Cronbach’s alpha of the six constructs ranged from 0.60 to 0.67. Conclusion: the Brazilian version of the Moral Sensitivity Questionnaire is valid and reliable to be applied among Brazilian nurses and can improve understanding of factors involving decision-making when facing ethical conflicts.

RESUMEN Objetivo: adaptar culturalmente y validar el Moral Sensitivity Questionnaire para evaluación de la sensibilidad moral en enfermeros brasileños. Método: estudio metodológico, realizado en 106 enfermeros de dos hospitales, en el sur de Brasil. Fue realizada la adaptación cultural del instrumento según recomendaciones internacionales, siguiendo seis etapas: traducción; resumen de las traducciones; back translation; comité de especialistas; pretest; y, revisión final por los investigadores. La validación para utilización en el contexto brasileño se realizó por medio del análisis factorial Alfa de Cronbach. Resultados: después de los procedimientos de evaluación por el comité de especialistas, pretest, validez aparente y de contenido, el instrumento fue considerado satisfactorio para aplicación en enfermeros brasileños. Fueron identificados seis constructos: respeto a la autonomía del paciente; autonomía modificada; experimentando conflicto moral; confianza en el conocimiento médico y de enfermería; significado estructural moral; y, trabajo en equipo. El instrumento presentó consistencia interna satisfactoria, con Alfa de Cronbach 0,62; los seis constructos variaron entre 0,60 y 0,67. Conclusión: el Moral Sensitivity Questionnaire, en su versión brasileña, es un instrumento válido y confiable para ser aplicado por enfermeros brasileños y podrá contribuir para la comprensión de factores que participan en la toma de decisiones delante de conflictos éticos.

RESUMO. A queixa de dificuldades para nomear pode ser comum em idosos. Na demência, a anomia é a manifestação mais frequente dos transtornos de linguagem. O treino de nomeação beneficia o acesso lexical e promove maior qualidade de comunicação para idosos com ou sem demência. Objetivo: Analisar as respostas de nomeação, o tempo de resposta e a generalização das respostas de nomeação de idosos neurotípicos e com demência de baixa escolaridade antes e após um treinamento de nomeação, com e sem estimulação da compreensão oral. Método: Participaram deste estudo 20 idosos, 10 com demência e 10 neurotípicos, incluídos após entrevista, rastreio de cognição e funcionalidade. O treinamento de nomeação foi baseado na prática de recuperação e realizado em cinco sessões. Metade do grupo foi submetido ao treino de nomeação exclusivo e metade ao treinamento associado à estimulação de compreensão oral. Resultado: Idosos com demência apresentaram melhor desempenho após o treinamento para pontuações na nomeação oral e compreensão de palavras orais, exceto para manipulação de objetos. O tempo de resposta para nomear estímulos treinados e não treinados também foi melhor para idosos com demência. Após a intervenção, os indivíduos neurotípicos tiveram desempenho estatisticamente melhor no tempo de compreensão e no escore na nomeação oral, compreensão de palavras orais e manipulação de objetos, para palavras treinadas e não treinadas. Conclusão: O treino de nomeação, exclusivo ou associado ao de compreensão oral, por meio da técnica de recuperação, beneficia o desempenho de linguagem de idosos neurotípicos e com demência e proporciona melhoras inclusive para estímulos não treinados.

ABSTRACT. Complaints about naming difficulties may be common in the elderly. In dementia, anomia is the most frequent symptom of language disorders. Naming training can improve lexical access and promote better quality of communication for elderly with or without dementia. Objective: To analyze naming scores, response time and the generalization of responses for naming of neurotypical and demented low-educated older adults before and after receiving a naming training program, with and without oral comprehension stimulation. Method: Twenty elderly participants, 10 with dementia and 10 neurotypical, were included after interview, screening for cognition and functionality. The naming training was based on retrieval practice and carried out in 5 sessions. Half of the group underwent exclusive naming training, while the other half received naming training associated with oral comprehension stimulation. Results: Elderly people with dementia performed better after training for scores on oral naming and comprehension of oral words, except for object manipulation. The response time for naming trained and untrained stimuli was also better for elderly people with dementia. After the intervention, neurotypical individuals performed statistically better in comprehension time and in the score in oral naming, comprehension of oral words and object manipulation, for trained and untrained words. Conclusion: Naming training, exclusive or associated with oral comprehension, using the recovery technique benefits the language performance of neurotypical and demented elderly, and provides improvements even for untrained stimuli.

Resumo Os distúrbios contra uma batida policial em Nova York no bar Stonewall Inn em junho de 1969 são frequentemente identificados como tendo desencadeado o movimento pelos direitos LGBT e a comemoração dos distúrbios um ano depois, em junho de 1970, inaugurou uma série de eventos do Orgulho LGBT que continuam até hoje em todo o mundo. Neste fórum de duas partes, refletimos sobre os efeitos contraditórios do legado internacional de Stonewall. Nesta segunda parte do Fórum, Ferreira e Belmont investigam as formas pelas quais ‘Stonewall’ foi apropriado especificamente no Brasil, tanto durante a ditadura civil-militar quanto no atual momento político conturbado. Belmont localiza as incompatibilidades atuais entre as lutas LGBT e queer no Brasil ao justapor visões mais convencionais da política LGBT com as margens que elas criam, especialmente a marginalização das travestis. Belmont expõe como o discurso e as práticas LGBT dominantes reforçam a violência contínua sobre corpos dissidentes e propõe que consideremos as experiências e argumentos das travestis como contribuições necessárias para uma política mais radical (queer). Na contribuição final, Ferreira recapitula as demandas políticas dos eventos de Stonewall de Nova York e os compara às reivindicações revolucionárias do que foi chamado de ‘Stonewall brasileiro.’ Considerando o protagonismo dos movimentos lésbicos em eventos como esse no Brasil, sua contribuição analisa, a partir de uma perspectiva queer, o abraço de uma multiplicidade de identificações no ativismo lésbico contemporâneo. Ela argumenta que esse movimento cria potencialidades para responder a violências estruturais, ao mesmo tempo em que aborda questões como a judicialização e comercialização de causas LGBTTI e homonormatividade.

Abstract The riots against a New York City police raid at the Stonewall Inn bar in June, 1969, are often identified as having sparked the movement for LGBT rights, and the commemoration of the riots one year later in June, 1970, inaugurated a series of annual LGBT Pride events that continues to this day worldwide. In this two-part Forum, we reflect on the contradictory effects of Stonewall’s international legacy. In this second part of the Forum, Ferreira and Belmont investigate the ways in which ‘Stonewall’ has been appropriated specifically in Brazil, both during the civil-military dictatorship and in the current fraught political moment. Belmont locates current mismatches between LGBT and queer struggles in Brazil by juxtaposing more mainstream visions of LGBT politics with the margins they create, especially the marginalization of travestis. Belmont exposes the way that dominant LGBT discourse and practices reinforce the continuous violence over dissident bodies and proposes that we look at travestis’ experiences and arguments as necessary contributions to a more radical (queer) politics. In the final contribution, Ferreira recapitulates the political demands of NYC’s Stonewall events and contrast them to the revolutionary claims of what was called a ‘Brazilian Stonewall.’ Considering the protagonism of lesbian movements in such events in Brazil, her contribution analyzes, from a queer perspective, the embrace of a multiplicity of identifications in contemporary lesbian activism. She argues that this move creates potentialities for responding to structural violences, while also speaking to questions such as the judicialization and commercialization of LGBTTI causes and homonormativity.

Resumo A região Norte é grande produtora de mandioca, cuja farinha tem sido consumida como parte diária do hábito alimentar da população, sendo produzida artesanalmente. Devido à escassez de informações técnicas, este trabalho objetivou classificar e caracterizar nutricional e tecnologicamente nove amostras de farinhas de mandioca adquiridas em Belém-PA. Os resultados foram submetidos à análise de variância e, quando significativos (p < 0,05), foi feito o teste de diferença de médias Scott Knott. As farinhas estavam dentro dos padrões da legislação brasileira em relação a umidade e cinzas, e foram classificadas como de alta acidez, sendo que quatro das nove farinhas apresentaram teor de cianetos entre 15 e 31 mg HCN/kg. Apesar de serem seguras para o consumo, recomendam-se melhorias em etapas de processo para diminuir o teor de cianetos. Quanto a cor e granulometria, foram consideradas amarelas (67%) e brancas (33%) e grossas (67%) e médias (33%), respectivamente. Nutricionalmente, podem contribuir como fonte de fibra alimentar (7,67% a 11,26%) e amido cru, sendo benéficas para dar saciedade. Tecnologicamente, apresentaram-se como espessantes, por apresentarem amido cru, tanto no consumo direto quanto em produtos cozidos, formando pastas claras, textura longa e não firmes. Estas variações nas características nutricionais e tecnológicas permitiram verificar que são necessárias modificações no processamento para padronização da qualidade das farinhas utilizadas como ingrediente alimentício sem glúten.

Abstract The northern region of Brazil is a large cassava producer, and cassava flour has been handcrafted and consumed daily by the local population. This study aimed to classify and characterize nine different samples of cassava flour marketed in Belém-PA/ Brazil from a nutritional and technological point of view. The results were subjected to analysis of variance and the averages were compared using the Scott Knott test (p < 0.05). The flours were within the legislation in relation to moisture and ash contents, with high acidity, four out of nine flours evaluated had cyanide content between 15 and 31 mg HCN/kg. Regarding color and particle size, samples varied between yellow (67%) and white (33%); from coarse (67%) to medium (33%), respectively. From a nutritional point of view, the cassava flours are a source of dietary fiber (7.67% to 11.26%) and raw starch, which have satiety benefits. From the technological point of view, the flours are used as thickeners, producing pastes that are clear with a long and less firm texture. These variations in nutritional and technological characteristics allowed to verify that changes in processing are necessary to standardize the quality of flours used as a gluten free food ingredient.

Resumo Objetivo Diferentes ambientes intrauterinos podem influenciar a variação de peso corporal pré-gestacional materno até 6 meses pós-parto. O objetivo do presente estudo foi verificar a associação de fatores sociodemográficos, obstétricos, nutricionais e comportamentais com a variação de peso em mulheres divididas em quatro grupos: hipertensas (HM), diabéticas (DM), tabagistas (SM) e controles (CM). Métodos Amostra de conveniência de 124 puérperas recrutadas em 3 hospitais públicos da cidade de Porto Alegre, Rio Grande do Sul, Brasil, entre 2011 e 2016. Regressões lineares múltiplas e modelos de equações de estimativas generalizadas (GEE) foram realizados para identificar os fatores associados à variação do peso materno. Para todas as GEE, as medidas de peso materno foram ajustadas para a estatura materna, paridade, escolaridade e tipo de parto, e três medidas de peso (prégravidez, anterior ao parto e 15 dias pós-parto) foram fixadas. Resultados Um modelo hierárquico associou o diagnóstico materno de hipertensão e o índice de massa corporal (IMC) pré-gestacional de sobrepeso com ganho de peso materno medido até o 6° mês pós-parto (diferença entre o peso materno aos 6 meses pós-parto e o peso pré-gestacional). Estes resultados mostraram que o grupo HM e mulheres comsobrepeso aumentaram o peso corporal em ~ 5,2 kg 6 meses pós-parto, em comparação com os demais grupos. Além disso, as mulheres classificadas com sobrepeso tiveram uma variação maior de peso corporal, de 3,150 kg. Conclusão Evidenciou-se a necessidade de diretrizes nutricionais específicas para distúrbios hipertensivos gestacionais, bem como de maior atenção dos serviços de saúde públicos para mulheres com excesso de peso em idade fértil.

Abstract Objective Different intrauterine environments may influence the maternal prepregnancy body weight (BW) variation up to 6 months postpartum. The objective of the present study was to verify the association of sociodemographic, obstetric, nutritional, and behavioral factors with weight variation in women divided into four groups: hypertensive (HM), diabetic (DM), smokers (SM), and control mothers (CM). Methods It was a convenience sample of 124 postpartum women recruited from 3 public hospitals in the city of Porto Alegre, state of Rio Grande do Sul, Brazil, between 2011 and 2016.Multiple linear regressions and generalized estimating equations (GEE) were conducted to identify the factors associated with maternal weight variation. For all GEE, the maternal weight measurements were adjusted for maternal height, parity, educational level, and the type of delivery, and 3 weight measurements (prepregnancy, preceding delivery, and 15 days postpartum) were fixed. Results A hierarchical model closely associated the maternal diagnosis of hypertension and a prepregnancy body mass index (BMI) classified as overweight with maternal weight gain measured up to the 6th month postpartum (the difference between the maternal weight at 6months postpartum and the prepregnancy weight). These results showed that the BW of the HM group and of overweight women increased ~ 5.2 kg 6 months postpartum, compared with the other groups. Additionally, women classified as overweight had a greater BW variation of 3.150 kg. Conclusion This evidence supports the need for specific nutritional guidelines for gestational hypertensive disorders, as well as great public attention for overweight women in the fertile age.