Resumo Objetivo Utilizar a Classificação de Dez Grupos de Robson (RTGC, na sigla em inglês) para analisar as taxas de cesárea (CS, na sigla em inglês) em uma maternidade hondurenha. Métodos Estudo de corte transversal em uma maternidade em Honduras. As mulheres internadas para o parto (agosto de 2017 a outubro de 2018) foram classificadas segundo a RTGC. Calculou-se a taxa de CS para cada grupo e a contribuição para a taxa geral de CS, com análises adicionais da indução do trabalho de parto entre as primíparas a termo (grupo 2a), multíparas a termo (grupo 4a) e casos com uma CS anterior (grupo 5.1). Resultados foram consideradas 4.356 mulheres, com uma taxa geral de CS de 26.1%. O Grupo 3 foi o maior grupo, com 38,.6% (1.682/4.356) dos casos; seguido pelo Grupo 1, com 30,8% (1.342/4.356), e pelo Grupo 5, com 10,3% (450/4,356). Considerando a contribuição para as taxas globais de CS por grupo, o Grupo 5 contribuiu com 30,4% (345/1,136) das CS, dos quais 286 (82.9%) tinha uma CS anterior, com um índice de CS > 70%. Os grupos 1 e 3, com 291/1.136 (26.6%) e 153/1.136 (13,5%), respectivamente, foram o segundo e terceiro maiores contribuintes para a taxa de CS. Os grupos 2a e 4a tiveram alto sucesso de indução, com baixas taxas de CS (18.4 e 16.9%, respectivamente). Conclusão O RTGC é uma ferramenta útil para avaliar as taxas de CS em diferentes unidades de saúde. Os grupos 5, 1 e 3 foram os principais contribuintes para a taxa de CS. Estes achados podem apoiar intervenções futuras para reduzir as CS desnecessárias, especialmente entre primíparas e em mulheres com uma CS anterior.

Abstract Objective To use the Robson Ten Group Classification (RTGC) to analyze cesarean section (CS) rates in a Honduran maternity hospital, with focus in groups that consider induction of labor. Methods Cross-sectional study. Women admitted for childbirth (August 2017 to October 2018) were classified according to the RTGC. The CS rate for each group and the contribution to the overall CS rate was calculated, with further analyses of the induction of labor among term primiparous (group 2a), term multiparous (group 4a), and cases with one previous CS (group 5.1). Results A total of 4,356 women were considered, with an overall CS rate of 26.1%. Group 3 was the largest group, with 38.6% (1,682/4,356) of the cases, followed by Group 1, with 30.8% (1,342/4,356), and Group 5, with 10.3% (450/4,356). Considering the contribution to overall CS rates per group, Group 5 contributed with 30.4% (345/1,136) of the CSs and within this group, 286/345 (82.9%) had 1 previous CS, with a CS rate > 70%. Groups 1 and 3, with 26.6% (291/1,136) and 13.5% (153/1,136), respectively, were the second and third larger contributors to the CS rate. Groups 2a and 4a had high induction success, with low CS rates (18.4 and 16.9%, respectively). Conclusion The RTGC is a useful tool to assess CS rates in different healthcare facilities. Groups 5, 1, and 3 were the main contributors to the CS rate, and groups 2 and 4 showed the impact and importance of induction of labor. These findings may support future interventions to reduce unnecessary CS, especially among primiparous and in women with previous CS.

Resumo Introdução: A preocupação com a morte é uma contemplação consciente da realidade da morte combinada com uma avaliação negativa dessa realidade. A Death Concern Scale (DCS) aborda o pensamento, o medo da morte ou a ansiedade em relação à morte. O objetivo deste estudo foi desenvolver uma versão da DCS na língua persa e explorar suas propriedades psicométricas em uma amostra de enfermeiros iranianos. Métodos: Um estudo transversal foi conduzido para investigar a confiabilidade, validade e estrutura fatorial da versão persa da DCS em uma amostra de conveniência de 106 enfermeiros iranianos em dois hospitais de Teerã, no Irã. Os enfermeiros completaram os seguintes instrumentos: DCS, Collett-Lester Fear of Death Scale (CLFDS), Death Anxiety Scale (DAS), Reasons for Death Fear Scale (RDFS), Death Depression Scale (DDS) e Death Obsession Scale (DOS). Resultados: Para a DCS, o α de Cronbach foi 0,77, o coeficiente de Spearman-Brown 0,63, o coeficiente split-half de Guttman 0,62 e a confiabilidade teste-reteste de duas semanas 0,77. A DCS apresentou correlação de 0,51 com CLFDS, 0,52 com DAS, 0,34 com RDFS, 0,40 com DDS e 0,48 com a DOS, indicando a qualidade do construto e a validade dos critérios relacionados. Os resultados de uma análise fatorial exploratória para a DCS identificaram sete fatores, respondendo por 64,30% da variância e indicando uma heterogeneidade considerável no conteúdo dos itens. Conclusões: A versão persa da DCS tem boa validade e confiabilidade e pode ser usada em contextos clínicos, educacionais e de pesquisa para avaliar preocupação com a morte na sociedade iraniana.

Abstract Introduction: Death concern is a conscious contemplation of the reality of death combined with a negative evaluation of that reality. The Death Concern Scale (DCS) is related to thinking, and death fear or anxiety about death. The aim of the present study was to develop a Farsi version of the DCS and to explore its psychometric properties in a sample of Iranian nurses. Methods: A cross-sectional study was conducted to investigate the reliability, validity, and factorial structure of the Farsi version of the DCS in a convenience sample of 106 Iranian nurses in two hospitals in Tehran, Iran. The nurses completed the DCS, the Collett-Lester Fear of Death Scale (CLFDS), the Death Anxiety Scale (DAS), the Reasons for Death Fear Scale (RDFS), the Death Depression Scale (DDS), and the Death Obsession Scale (DOS). Results: For the DCS, Cronbach's α was 0.77, the Spearman-Brown coefficient 0.63, the Guttman split-half coefficient 0.62, and two-week test-retest reliability 0.77. The DCS correlated at 0.51 with the CLFDS, 0.52 with the DAS, 0.34 with the RDFS, 0.40 with the DDS, and 0.48 with the DOS, indicating good construct and criterion-related validity. The results of an exploratory factor analysis for the DCS identified seven factors, accounting for 64.30% of the variance and indicating considerable heterogeneity in the content of the items. Conclusions: The Farsi version of the DCS has good validity and reliability, and it can be used in clinical, educational, and research settings to assess death concerns in the Iranian society.

Resumo Introdução: O Patient Health Questionnaire-9 (PHQ-9) é uma ferramenta breve de triagem e diagnóstico para depressão. Tem sido usado em pesquisa e na prática clínica primária e em outros contextos clínicos e não clínicos. O PHQ-9 não teve sua validade examinada em contextos psiquiátricos e psicológicos no Irã. Métodos: Um estudo transversal foi conduzido para investigar a validação da versão persa do PHQ-9. Uma amostra de conveniência de 130 pacientes psiquiátricos ambulatoriais iranianos foi selecionada em clínicas psiquiátricas e psicológicas. Os pacientes completaram o PHQ-9, Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5) e a forma abreviada do Beck Depression Inventory-13 (BDI-13). Os dados foram analisados por estatística descritiva, α de Cronbach, coeficiente de correlação de Pearson, análise de componentes principais e análise fatorial exploratória e confirmatória. Resultados: O escore médio do PHQ-9 foi 12,83 (desvio padrão=6,25), indicando depressão moderadamente severa na amostra. O α de Cronbach para PHQ-9 foi 0,88, e a confiabilidade teste-reteste de uma semana 0,79. O PHQ-9 apresentou correlação de 0,64 com PHQ-15, −0,35 com WHO-5 e 0,70 com BDI-13, indicando boa validade do construto e dos critérios relacionados. Os resultados da análise fatorial dos itens do PHQ-9 identificaram, e a análise fatorial confirmatória confirmou, um único fator, chamado depressão geral. Conclusões: O PHQ-9 parece ter uma estrutura unidimensional, validade e confiabilidade adequadas, e pode ser útil em contextos epidemiológicos e de pesquisa. Com base na literatura prévia e neste estudo, o PHQ-9 pode ter aplicabilidade em outros contextos na população estudada, mas isso precisa ser confirmado.

Abstract Introduction: The Patient Health Questionnaire-9 (PHQ-9) is a brief screening and diagnostic tool for depression. It has been used in research and clinical practice in primary care and other clinical and non-clinical settings. The PHQ-9 has not had its validity examined in psychiatric and psychological settings in Iran. Methods: A cross-sectional study was conducted to investigate the validation of the Farsi version of the PHQ-9. A convenience sample of 130 Iranian volunteer psychiatric outpatients was selected from psychiatric and psychological clinics. They completed the PHQ-9, the Patient Health Questionnaire-15 (PHQ-15), the World Health Organization-five Well-Being Index (WHO-5), and the short form of the Beck Depression Inventory-13 (BDI-13). Data were analyzed by descriptive statistics, Cronbach's α, Pearson correlation coefficient, principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Results: Mean score of the PHQ-9 was 12.83 (standard deviation = 6.25), indicating moderately severe depression in the sample. Cronbach's α coefficient for PHQ-9 was 0.88, and one-week test-retest reliability 0.79. The PHQ-9 correlated 0.64 with PHQ-15, −0.35 with WHO-5, and 0.70 with BDI-13, indicating good construct and criterion-related validity. The results of the factor analysis of PHQ-9 items identified and confirmatory factor analysis confirmed a single factor labeled general depression. Conclusions: The PHQ-9 appears to have a unidimensional structure, adequate validity and reliability, and can be useful in epidemiological/research settings. Based on previous literature and on the present findings, the PHQ-9 may have applicability to other contexts in the studied population, but this needs to be confirmed by other studies.

The purpose of this work was to assess the contribution of the storm drainage system of the Ancon hotel over the erosion of its beach sector and to propose a plan of corrective measures for their mitigation. A procedure based on the eight steps in the solution of a problem was designed, complemented with specific methodologies and tools. The water origin of the erosion was predominating, with manifestations of the gully erosion type. Rain erosive power, enhanced by technical and organizational deficiencies in the storm drainage system, as well as the influence of the erodibility of the land and constructed elements, increases flow and velocity rates. A corrective action plan to mitigate erosion based on hydraulic and coastal engineering solutions was designed.

El propósito del trabajo fue evaluar la contribución del drenaje pluvial del hotel Ancón sobre la erosión de su sector de playa y proponer un plan de medidas correctivas para su mitigación. Se diseñó un procedimiento basado en ocho pasos en la solución de un problema, complementado con metodologías y herramientas específicas. Se demostró que predomina el origen hídrico de la erosión, con manifestaciones de arroyamiento del tipo cárcavas. La erosividad de la lluvia, potenciada por deficiencias técnicas y organizativas en el sistema de drenaje pluvial, así como la influencia de la erosionabilidad del terreno y de los elementos construidos, incrementan los caudales y las velocidades de flujo. Se diseñó un plan de medidas correctivas para mitigar la erosión, basado en soluciones de ingeniería hidráulica y costera.

O objetivo foi avaliar a correlação entre homicídio, suicídio e variáveis sociodemográficas num estudo ecológico. Os dados foram coletados a partir de registros oficiais disponibilizados pelo Ministério da Saúde e IBGE (2010), agregados por estado. Os dados foram analisados usando técnicas de correlação, análise fatorial, análise de componentes principais com rotação varimax e regressão linear múltipla. As taxas de suicídio padronizadas por idade para o total, homens e mulheres foram 5,0; 8,0 e 2,2 por 100.000, respectivamente. A taxa de suicídio variou de 2,7 no Pará a 9,1 no Rio Grande do Sul. As taxas de homicídio para o total, homens e mulheres foram 27,2; 50,8 e 4,5 por 100.000, respectivamente. A taxa de homicídio variou de 13,0 em Santa Catarina a 68,9 em Alagoas. Suicídio e homicídio foram negativamente associados, a significância persistiu entre os homens. O desemprego foi negativamente correlacionado com o suicídio e positivamente com o homicídio. Diferentes variáveis sociodemográficas foram correlacionadas com o suicídio e homicídio nas regressões. Suicídio apresentou um padrão, sugerindo que no Brasil está relacionado com alto nível socioeconômico. Homicídio parece seguir o padrão encontrado em outros países, associado com baixo nível socioeconômico.

The objective was to evaluate correlations between suicide, homicide and socio-demographic variables by an ecological study. Mortality and socio-demographic data were collected from official records of the Ministry of Health and IBGE (2010), aggregated by state (27). The data were analyzed using correlation techniques, factor analysis, principal component analysis with a varimax rotation and multiple linear regression. Suicide age-adjusted rates for the total population, men and women were 5.0, 8.0, and 2.2 per 100,000 inhabitants respectively. The suicide rates ranged from 2.7 in Pará to 9.1 in Rio Grande do Sul. Homicide for the total population, men and women were 27.2, 50.8, and 4.5 per 100,000, respectively. The homicide rates ranged from 13.0 in Santa Catarina to 68.9 in Alagoas. Suicide and homicide were negatively associated, the significance persisted among men. Unemployment was negatively correlated with suicide and positively with homicide. Different socio-demographic variables were found to correlate with suicide and homicide in the regressions. Suicide showed a pattern suggesting that, in Brazil, it is related to high socioeconomic status. Homicide seemed to follow the pattern found in other countries, associated with lower social and economic status.

O objetivo foi avaliar a correlação entre homicídio, suicídio e variáveis sociodemográficas num estudo ecológico. Os dados foram coletados a partir de registros oficiais disponibilizados pelo Ministério da Saúde e IBGE (2010), agregados por estado. Os dados foram analisados usando técnicas de correlação, análise fatorial, análise de componentes principais com rotação varimax e regressão linear múltipla. As taxas de suicídio padronizadas por idade para o total, homens e mulheres foram 5,0; 8,0 e 2,2 por 100.000, respectivamente. A taxa de suicídio variou de 2,7 no Pará a 9,1 no Rio Grande do Sul. As taxas de homicídio para o total, homens e mulheres foram 27,2; 50,8 e 4,5 por 100.000, respectivamente. A taxa de homicídio variou de 13,0 em Santa Catarina a 68,9 em Alagoas. Suicídio e homicídio foram negativamente associados, a significância persistiu entre os homens. O desemprego foi negativamente correlacionado com o suicídio e positivamente com o homicídio. Diferentes variáveis sociodemográficas foram correlacionadas com o suicídio e homicídio nas regressões. Suicídio apresentou um padrão, sugerindo que no Brasil está relacionado com alto nível socioeconômico. Homicídio parece seguir o padrão encontrado em outros países, associado com baixo nível socioeconômico.

The objective was to evaluate correlations between suicide, homicide and socio-demographic variables by an ecological study. Mortality and socio-demographic data were collected from official records of the Ministry of Health and IBGE (2010), aggregated by state (27). The data were analyzed using correlation techniques, factor analysis, principal component analysis with a varimax rotation and multiple linear regression. Suicide age-adjusted rates for the total population, men and women were 5.0, 8.0, and 2.2 per 100,000 inhabitants respectively. The suicide rates ranged from 2.7 in Pará to 9.1 in Rio Grande do Sul. Homicide for the total population, men and women were 27.2, 50.8, and 4.5 per 100,000, respectively. The homicide rates ranged from 13.0 in Santa Catarina to 68.9 in Alagoas. Suicide and homicide were negatively associated, the significance persisted among men. Unemployment was negatively correlated with suicide and positively with homicide. Different socio-demographic variables were found to correlate with suicide and homicide in the regressions. Suicide showed a pattern suggesting that, in Brazil, it is related to high socioeconomic status. Homicide seemed to follow the pattern found in other countries, associated with lower social and economic status.

Background and Objectives: Neuroimaging studies have found higher rates of white matter hyperintensities (WMHs) in patients with bipolar disorder (BD) of all ages, although whether BD is associated with increased rates of WMHs independently from age and cerebrovascular risk factors is still matter of debate. The outcome of BD associated with severe WMHs is generally poor, but several authors have suggested that some factors could have a protective role in BD. The aim of the present study was to report the two-year follow-up of a woman with BD type I and severe WMH/PWMH lesions who was taking high concentrations of vitamin-D in her nutrition, as well as taking lithium and haloperidol as treatment. Case presentation: A 76-year-old woman was hospitalized for a mixed state BD. She had severe WMHs. She took lithium and haloperidol during the hospitalization and was euthymic at discharge as well as after two-years of follow-up. Her nutrition had a high concentration of Vitamin-D. Unfortunately, it was not possible to give her a second MRI. Conclusions: Although there was probable persistence of WMHs, the patient improved in both mood and quality of life. The possible protective effect of lithium and Vitamin-D is discussed.

Internal hernias cause 1% of intestinal obstructions with aproximately 50% of these hernias been paraduodenal hernias. Paraduodenal hernias are the product of a malrotation of the midgut during embryogenesis or a non-fusion of the peritoneal folds. These type of internal hernia are more cornmon in males and on the left side of the abdomen. The usual presentation age is in the 4th decade of life. The clinical presentation of these patients is non specific and varies, ranging from mild dyspepsia to intestinal perforation and septic shock. The radiographic studies of these patients show a dumping of the intestinal loops on the upper quadrant of the abdomen with an image of abdominal compartamentalization. The surgical management of these patients should follow three simple principles. The intestines should be reduced, their perfusion and viability must be verified and the hernia sack entrance should be repaired with interrupted non absorbable sutures.

Las hernias internas causan el 1% de las obstrucciones intestinales. De estas, aproximadamente la mitad son causadas por hernias paraduodenales. Las hernias paraduodenales son producto de una embriogénesis defectuosa, donde el intestino no rota o los pliegues mesentéricos no se fusionan adecuadamente. Estas hernias son más comunes en el género masculino, del lado izquierdo y por lo general se diagnostican en la cuarta década de la vida. La presentación clínica es inespecífica con manifestaciones que varían desde la dispepsia hasta la perforación intestinal y el choque séptico. Los estudios de imagen muestran el agrupamiento de las asas intestinales en el abdomen superior dando una imagen de compartamentalización de la cavidad abdominal. Para el manejo quirúrgico de estos pacientes se debe reducir el intestino herniado, verificar que este sea viable y posea una adecuada perfusión y reparar el orificio hemiario con material no absorbible.

Abstract The understanding of infection and colonization rates of soilborne pathogens on perennial crops is critical for determining proper timing of appropriate control measures. Studies were conducted to evaluate symptoms and colonization of roots of containerized apple trees by Phymatotrichopsis omnivora (Duggar) Hennebert during 1997 and 1998 at College Station, TX (USA). Three-year-old trees growing in 114 L containers were inoculated with sclerotia. Symptoms were detected after nine weeks, and 100% of the inoculated trees showed symptoms after 15 weeks. In another set of trees inoculated the second study year, there were only 80% showing symptoms of infection after 12 weeks. A separate experiment was developed to evaluate pathogen movement along live roots, dead roots, and through bare soil from an infected tree to adjacent healthy trees. Although fungal strands were visible within 10 days after inoculation and the viability of sclerotia was still around 83%, the experiment failed to produce extensive colonization and spread of the fungus on roots of apple trees or through the soil.

Resumen El conocimiento de las tasas de de infección y colonización de patógenos de suelo en cultivos perennes es importante debido a que contribuye a determinar medidas de control de manera oportuna. Se llevaron a cabo estudios para evaluar los síntomas y colonización de raíces de manzano por Phymatotrichopsis omnivora (Duggar) Hennebert en contenedor durante 1997 y 1998 en College Station, Texas (EE.UU.). Árboles de tres años de edad en contenedores de 114 L fueron inoculados usando esclerocios. Los síntomas se detectaron después de nueve semanas y 100% de los árboles inoculados presentaron síntomas después de 15 semanas; en otros árboles inoculados al año siguiente sólo hubo 80% con síntomas de infección que se presentaron después de 12 semanas. En otro experimento se evaluó el movimiento del patógeno de raíces infectadas a raíces saludables de árboles adyacentes a través de raíces vivas, raíces muertas, y del suelo. A pesar de que se detectaron cordones miceliales 10 d después de la inoculación y que la viabilidad de esclerocios permaneció en 83% al final del experimento, no ocurrió una transmisión considerable ni la dispersión del hongo a través de las raíces de manzano o del suelo.