ABSTRACT Dysfunction of the arteriovenous fistula for hemodialysis is a challenge for the nephrologist and the vascular surgeon. Although experience is limited, the use of the forearm basilic vein as outflow of the radiocephalic fistula has been considered. We report the case of a 60-year-old male, with cardiovascular comorbidities and a history of ischemic complications induced by the hemodialysis access. Drainage problems were present in the radiocephalic fistula and the forearm basilic vein was used in the vascular access repair. The procedure was successful, and the patient maintains a functional fistula, with secondary patency of 32 months, with no cardiac complications or hand access-induced distal ischaemia syndrome.

Resumen: Introducción. Los estudios de cohortes han sido fundamentales para describir la evolución de múltiples enfermedades. El Grupo de estudio Uruguayo de VIH, comenzó en 2018 el seguimiento de una cohorte de personas con VIH de diferentes prestadores de salud. Objetivo . Describir las características epidemiológicas y clínicas de las personas incluidas en la cohorte GeUVIH. Pacientes y métodos. Estudio descriptivo, observacional, multicéntrico transversal y prospectivo. Desde 1 de julio de 2018 hasta 31 de mayo de 2021. Se analizaron 795 personas con VIH de centros con consultas ambulatorias públicas y privadas de Montevideo-Uruguay. Resultados. Se analizaron 795. Relación hombre/ mujer 2 a 1. Mediana de edad 46 años. El 56,6% tenía entre 39 y 58 años. Motivaron al diagnóstico de VIH sobre todo controles en salud y enfermedades oportunistas. Al ingresar a la cohorte el 49% llevaba más de 10 años viviendo con VIH y el 25% estaba en estadio SIDA. El 98.4% estaban recibiendo antirretrovirales y de ellos 84% tenían carga viral indetectable. El 1,3% estaba co-infectado con el VHB y 3,9% con el VHC. Fallecieron 4 pacientes de la cohorte. Conclusiones. Se observó una población vinculada a los servicios de salud, que recibe TAR y es adherente. El envejecimiento de la población nos obliga a diagnosticar y tratar precozmente las comorbilidades. Se debe estimular el diagnóstico de VIH durante el control en salud y/o campañas preventivas. El mantenimiento de la cohorte prospectivamente dará información fundamental para la toma de decisiones.

Abstract: Introduction: cohort studies are essential to describe the evolution of multiple diseases. In 2018 the Uruguayan group for the study of HIV started to monitor a cohort of individuals infected with HIV in different health care Institutions. Objective: to describe the epidemiological and clinical characteristics of individuals included in an HIV cohort (GeUVIH). Patients and method: descriptive, observational, multi-transversal and prospective study. From July 1, 2018 to May 31, 2021. 795 individuals infected with HIV were analyzed in private and public outpatient consultations in Montevideo, Uruguay. Results: the case of 795 patients was analyzed. Men/women ratio was 2/1. Median age was 46 years old. 65.6% was between 39 and 58 years old. HIV diagnosis mainly resulted from health control and opportunistic diseases. Upon inclusion in the cohort group, 49% of patients had been living with HIV for over 10 years and were in the AIDS stage of infection. 98.3% were under antiretroviral treatment and in 84% of them viral load could not be detected. 1.3% of patients presented HIV-HIB coinfection and 3.9% HIV-HIC coinfection. 4 patients in the cohort died. Conclusions: the studied population was found to be related to the health care services, receiving antiretroviral therapy and showing good adherence to treatment. The aging of population makes it mandatory for the early diagnosis and treatment of comorbilities. Diagnosis of HIV must be encouraged in health care controls or preventive campaigns. The prospective maintenance of the cohort will provide key data for the making of decisions.

Resumo: Introdução: estudos de coorte têm sido essenciais para descrever a evolução de múltiplas doenças. O Grupo Uruguaio de Estudos de HIV começou a monitorar uma coorte de pessoas com HIV de diferentes prestadores de serviços de saúde em 2018. Objetivo: descrever as características epidemiológicas e clínicas das pessoas incluídas na coorte GeUVIH. Pacientes e métodos : estudo descritivo, observacional, multicêntrico, transversal e prospectivo. No período 1º de julho de 2018 a 31 de maio de 2021 foram analisadas 795 pessoas com HIV de unidades ambulatoriais públicas e privadas em Montevidéu-Uruguai. Resultados: foram incluídas 795 pessoas. A proporção homem/mulher foi 2 para 1, a mediana de idade 46 anos sendo que 56,6% tinham entre 39 e 58 anos. O diagnóstico do HIV foi motivado especialmente por controles de saúde e pela detecção de doenças oportunistas. Ao ingressar na coorte, 49% viviam com HIV há mais de 10 anos e 25% encontravam-se na fase de AIDS. 98,4% estavam recebendo antirretrovirais e 84% deles tinham carga viral indetectável. 1,3% estavam co-infectados com HBV e 3,9% com HCV. Quatro pacientes da coorte morreram. Conclusões: observou-se uma população vinculada aos serviços de saúde, que recebe TARV com adesão ao tratamento. O envelhecimento da população obriga-nos a diagnosticar e tratar precocemente as comorbilidades. O diagnóstico de HIV deve ser incentivado durante controles de saúde e/ou campanhas preventivas. Manter a coorte prospectivamente fornecerá informações essenciais para a tomada de decisões.

Abstract Introduction: In Portugal, more than 30% of adults have chronic pain and acute pain is the main reason for hospital admission, representing 5 billion euros annually, 2.7% of Gross Domestic Product. Objetives: Assess the practices and factors involved in pain management by nurses in an Emergency Department.; Methods: Cross-sectional, analytic study, conducted in an emergency setting. Sample consisted of 96 nurses. The data collection instrument contained questions of socio-professional characterisation, the Scale of Nursing Practices in Pain Management of Catarina António and the Visual Pain Code of Grünenthal. Results: The pain assessment scale most commonly used by nurses was the Numerical Rating Scale (88.5%); nurses with more experience in the Emergency Department (>=11 years) showed a greater lack of knowledge (37.5%) and the majority (53.8%) of those with good knowledge about this code worked between 6-10 years (p=0.021). Conclusions: We believe that nurses need to deepen their knowledge about the principles of pain assessment and management. The constant and targeted updating of training will contribute to a better daily clinical practice.

Resumen Introducción: En Portugal, más del 30% de los adultos tienen dolor crónico y el dolor agudo es el principal motivo de ingreso hospitalario, representando 5.000 millones de euros anuales, el 2,7% del Producto Interno Bruto. Objetivos: Evaluar las prácticas y los factores que intervienen en el manejo del dolor por parte de las enfermeras de un Departamento de Emergencia; Métodos: Estudio transversal, analítico realizado en un contexto de emergencia. La muestra consistió de 96 enfermeras. El instrumento de recolección de datos contenía preguntas de caracterización socio-profesional, la Escala de Prácticas de Enfermería en el Tratamiento del Dolor de Catarina António y el Código de Dolor Visual de Grünenthal. Resultados: La escala de valoración del dolor más utilizada por las enfermeras fue la de evaluación numérica (88,5%); las enfermeras con más experiencia en el servicio de urgencias (>=11 años) mostraron un mayor desconocimiento (37,5%) y la mayoría (53,8%) de las que tenían un buen conocimiento de este código trabajaron entre 6-10 años (p=0,021). Conclusiones: Creemos que las enfermeras necesitan profundizar su conocimiento sobre los principios de evaluación y manejo del dolor. La actualización constante y dirigida de la formación contribuirá a una mejor práctica clínica diaria.

Resumo Introdução: Em Portugal mais de 30% dos adultos apresenta dor crónica e a dor aguda assume-se como o principal motivo de admissão hospitalar, o que representa, anualmente, 5 mil milhões de euros, 2.7% do Produto Interno Bruto. Objetivos: Avaliar as práticas e os fatores intervenientes na gestão da dor pelos enfermeiros num Serviço de Urgência. Métodos: Estudo transversal analítico realizado em contexto de urgência. Amostra constituída por 96 enfermeiros. O instrumento de recolha de dados continha questões de caracterização socioprofissional, a Escala de Práticas de Enfermagem na Gestão da Dor de Catarina António e o Código Visual da Dor de Grünenthal. Resultados: A escala de avaliação da dor mais utilizada pelos enfermeiros foi a de Avaliação Numérica (88,5%); os enfermeiros com mais experiência no Serviço de Urgência (>=11 anos) manifestaram maior défice de conhecimentos sobre a gestão da dor (37,5%); a maioria (53.8%) dos que apresentava bons conhecimentos trabalhava entre 6-10 anos no serviço de urgência (p=0,021). Conclusões: Consideramos que os enfermeiros necessitam de aprofundar conhecimento sobre os príncipios de avaliação e gestão da dor. A constante e direcionada atualização de formação contribuirá para uma melhor prática clínica.

Abstract Purpose This study aims to analyze the media coverage of the impact of extreme weather events (EWE) and related risk management activities in Brazil. Design/methodology/approach Using a documentary analysis, the authors examined the media coverage of droughts and floods from 2003 to 2013 with concomitant official reports. Findings The results indicate that although media coverage conveys the direct impact of floods and droughts on society, it underemphasizes the importance of risk management activities. Moreover, the private sector rarely engages in risk management and mitigation activities, despite the documented supply chain disruptions. Research limitations/implications This study focuses solely on media coverage as provided by wide-circulation newspaper in Brazil and would benefit by being extended to all media platforms. Practical implications The results highlight the need for private sector involvement in risk management activities to facilitate the adaptation to climate change. Social implications The study reveals the deficiency of existing reports and lack of awareness regarding EWE. Originality/value The study contributes by focusing on climate awareness and how society can adapt to climate change, as well as how businesses can improve supply chain operations to facilitate smoother risk management.

Sarcoidosis is a rare multisystem disease that is characterized by the formation of inflammatory granulomatous processes. The lung is the most frequently affected organ, but kidney injury can also occur. It is a disease with a highly variable course and prognosis and non-consensual treatment. This report describes the successful case of a patient with sarcoidosis presenting with pulmonary, cutaneous and renal injury, who presented with adequate diagnostic timing and optimal therapy response.

RESUMO As aplicações de big data têm remodelado vários modelos de negócios e provocado grandes transformações na gestão da cadeia de suprimentos (GCS). Apoiado pela literatura emergente de big data, GCS e teoria unificada de aceitação e uso de tecnologia (UTAUT), este estudo tem como objetivo avaliar as variáveis que influenciam os profissionais brasileiros que atuam na GCS a adotar big data. Assim, nós adaptamos e validamos um modelo UTAUT previamente desenvolvido. Um total de 152 profissionais que atuam na gestão de cadeias de suprimentos revelou que condições facilitadoras (como a infraestrutura de TI) têm uma grande influência na adoção de big data. Por outro lado, a influência social e a expectativa de desempenho não apresentaram efeito significativo. Este estudo contribui para a prática, com conhecimentos valiosos para os tomadores de decisão que estão considerando projetos de big data. Além disso, ele ajuda a minimizar a lacuna em relação aos estudos de big data no contexto brasileiro.

ABSTRACT Big data applications have been remodeling several business models and provoking strong radical transformations in supply chain management (SCM). Supported by the literature on big data, supply chain management, and the unified theory of acceptance and use of technology (UTAUT), this study aims to evaluate the variables that influence the intention of Brazilian SCM professionals to adopt big data. To this end, we adapted and validated a previously developed UTAUT model. A survey of 152 supply chain respondents revealed that facilitating conditions (e.g., IT infrastructure) have a high influence on their intention to adopt big data. However, social influence and performance expectancy showed no significant effect. This study contributes to the practical field, offering valuable insights for decision-makers considering big data projects. It also contributes to the literature by helping minimize the research gap in big data in the Brazilian context.

RESUMEN Las aplicaciones de big data han estado remodelando varios modelos de negocios y han provocado fuertes transformaciones en la cadena de suministro (CS). Con el apoyo de la literatura de big data, CS y la teoría unificada de aceptación y uso de la tecnología (UTAUT), este estudio tiene objetivo evaluar las variables que afectan a los profesionales brasileños para adoptar big data. Por lo tanto, adaptamos y validamos un modelo UTAUT previamente desarrollado. Un total de 152 encuestados de CS revelaron que las condiciones de facilitación (por ejemplo, la infraestructura de TI) tienen una gran influencia en la adopción de big data. Por otro lado, la influencia social y la expectativa de desempeño no mostraron un efecto significativo. Este estudio contribuye a la práctica, con información valiosa para los responsables de la toma de decisiones que están considerando proyectos de big data. Además, ayudamos a minimizar la brecha con respecto a los estudios de big data en el contexto brasileño.

Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis commonly involves kidney, lung, upper respiratory tract, skin, gastrointestinal and occasionally peripheral nervous system. Central nervous system is less commonly affected and is generally part of a multi-organ scenario. We present a case of a 21-year-old female with chronic kidney disease secondary to myeloperoxidase ANCA associated vasculitis, diagnosed at age 19. She then presented with pulmonary-renal syndrome with stage 5 CKD. Three months’ cyclophosphamide and prednisone were instituted, followed by azathioprine, but she remained dialysis dependent. After 2 years, while on maintenance treatment, she was admitted to the emergency department with tonic-clonic seizures. She had started oral ciprofloxacin 2 days before for acute gastroenteritis. No illicit drugs were noticed. Blood tests showed an increased myoglobin but were otherwise unremarkable. No anomalies were reported on cerebral computed tomography or cerebrospinal fluid analysis. Magnetic resonance imaging showed diffuse cortico-subcortical lesions with T2 and proton density hypersignal suggesting recent ischemia, and segmental irregularities of various cerebral and vertebral arteries, consistent with small and medium size vessel vasculitis. Intravenous methylprednisolone and oral cyclophosphamide were started. Anti-myeloperoxidase ANCA levels were increased (>200 RU/mL), reinforcing our diagnostic hypothesis of central nervous system (CNS) recurrence of ANCA vasculitis. The patient had a favorable clinical course, with no neurological sequelae. Conclusions: This is a case of ANCA associated vasculitis that presented with kidney and lung but no CNS involvement and recurred with primarily cerebral disease. Favorable outcome was seen with standard immunosuppression. Awareness of this rare but severe complication is critical for timely recognition and prompt treatment.

Resumo Com base na teoria das tensões da gestão da sustentabilidade, este trabalho original tem como objetivo analisar as tensões que emergiram durante o processo de inserção da sustentabilidade nos principais processos de uma importante universidade brasileira. Onze entrevistas foram realizadas e analisadas através da categorização temática e uso do software Atlas-ti. Uma análise documental também foi realizada. Os resultados sugerem que: (a) houve predominância de tensões provenientes da dimensão organizacional; (b) a dimensão do desempenho está associada à pluralidade de resultados esperados pelas partes interessadas; (c) a assimetria existente entre a expectativa dos sujeitos e os resultados concretos visualizados na universidade Unisul contribuíram para o fato de que os pontos de tensão convergiram para a dimensão de desempenho; e desafiam os gerentes a encontrarem mecanismos para minimizar os dilemas e conflitos que emergem e alinharem as expectativas dos diferentes stakeholders da Unisul Sustentável.

Abstract Drawing on the theory of tensions of sustainability management, this original work aims at analysing tensions that emerged during the process of inserting sustainability at core processes of an important Brazilian university. Eleven interviews were conducted and analysed through the thematic categorisation and the Atlas ti software was used. A documental analysis was also carried out. The results suggested that: (a) there was a predominance of tensions originating from the organizational dimension; (b) the performance dimension was associated with the plurality of outcomes expected by stakeholders; (c) the existing asymmetry between the expectation of the subjects and the concrete results visualized in the Unisul University as contributed to the fact that the points of tension converged towards the performance dimension. And it challenged managers to find mechanisms to minimize the dilemmas and conflicts that emerged and to align the expectations of the different stakeholders of the Unisul Sustainable enterprise.

RESUMO Neste artigo são discutidas as representações sobre o ensino da gramática na aula de português L1, a partir dos resultados de um estudo exploratório que envolveu professores e futuros professores em diferentes situações de formação: professores do Ensino Básico, estudantes em estágio profissional e estudantes de licenciatura. O estudo centrou-se nas orientações curriculares para o ensino da gramática propostas em Reis et al. (2009), que veicularam uma clara mudança de paradigma no ensino da língua. Embora surja um claro contraste entre professores e estudantes, no que respeita a familiaridade com as orientações curriculares e estratégias de ensino, constituem pontos convergentes a importância atribuída à gramática e a frágil formação no domínio da linguística. Os resultados da análise permitem discutir a relação entre as conceções dos professores e as suas práticas, evidenciando quer fragilidades na formação de professores quer mudanças conceptuais que podem conduzir a efetivas mudanças na prática de sala de aula.

ABSTRACT The goal of this paper is to discuss representations about grammar teaching of Portuguese L1 teachers. It draws on the exploratory study designed to identify the invariants and divergences in self-perceptions about L1 grammar teaching of trainees in different training situations: in-service teachers, pre-service teachers and bachelor’s students. The study focus on student’s and teacher’s acknowledgment of the Portuguese L1 Curriculum (Reis et al. 2009), which conveys a clear paradigm change in Portuguese language education, assuming that grammar teaching is based upon language awareness development. The results show an evident gap between students and teachers in what concerns the familiarity with the Portuguese L1 Curriculum and teaching strategies. However, some puzzling convergent points are the importance attributed to grammar and poor linguistics background. The results analysis draws attention to the relationship between teacher cognition and practice, highlighting fragilities in teacher education and potential conceptual changes that may lead to effective changes in classroom practices.

Introduction: The benefits of dialysis in the elderly are dubious. A shared decision-making process, helped by adequate prognostic tools, is essential to determine which patients are better candidates for conservative care. Based on a recent USRDS validated score, this study aimed to identify risk factors associated with early mortality (first 90 days) in a Portuguese cohort of patients. Methods: A total of 197 patients who initiated hemodialysis treatments in a Portuguese facility between 2005 and 2015 were included. Clinical and laboratory data were collected at time of admission to center. Multiple regression models were performed and fitted to identify potential predictors of early mortality. Findings: Total of 93 (47.2%) deaths with 23 (11.7%) deaths occurring in first year. In the first three months, there were 15 (7.6%) deaths. Of those who died in first three months, most were men (n=10; 5.1%), mean age 73.5 ± 6.82 years. Almost half (n=7; 3.6%) were dependent and the majority (n=12; 6.1%) had history of hospitalizations in previous year before admission. They had a higher prevalence of hypoalbuminemia and cardiovascular risk factors. Mortality associated factors were albumin level low (<3.5 g/dL) or unknown (OR 5.73; p<0.05), ischemic cardiomyopathy (OR 4; p<0.05) and history of hospitalizations in previous year before admission (OR 4.3; p<0.05). Absence of history hypertension was associated with a reduction of risk (OR 0, 18, p<0.05). Discussion: Some elements of USRDS score were associated with greater risk for early mortality in this Portuguese cohort of patients. Further investigations are needed in order to validate a specific prognostic tool in Europeans

Introduction: Survival rates of haemodialysis patients have increased worldwide over the last decade. The purposes of this study were to analyze the 10-year survival rate and to identify mortality risk factors in a Portuguese cohort. Subjects and Methods: Data was collected from 273 incident patients on facility haemodialysis treatments between 2005 and 2015. Sociodemographic data, medical history, clinical and analytic parameters were collected. A statistical analysis using Kaplan-Meier survival analysis and Cox regression were performed. Results: Median age was 71 ± 15.5 [22; 91] years, 56.8% were male. Fistula was the first access in 68.5%. Median survival rate was 89 ± 8.8 months. There were 93 deaths (34%). Of the 23 deaths occurring in the first year, 65% (n=15) were during the first 90 days. Mortality risk factors were residence in a nursing home (OR 2.8; p<0.05), coronary heart disease (OR 2.3; p<0.05), central venous catheter use (OR 2.1; p<0.05), history of hospitalizations in year prior to dialysis admission (OR 1.9; p<0.05) and advanced age (OR 1.5; p<0.05). Conclusions: Patients starting haemodialysis in the last decade are mainly elderly and have a prolonged lifespan, reflecting good levels of care. Functional status and dependence, extremes of age, central venous catheter use and high cardiovascular burden are related with greater mortality and should prompt consideration for a more conservative approach

Introduction: Chronic kidney disease (CKD) is strongly associated with hypertension (HTN) and each can cause or aggravate the other. Misclassification of BP control is an important problem in hypertensive patients with CKD, making ambulatory blood pressure monitoring (ABPM) an important tool. The aim of our study was to review the influence of ABPM results in antihypertensive treatment and BP control in hypertensive CKD patients. Methods: Retrospective observational study; inclusion of hypertensive CKD patients stages 1 to 5 not on dialysis who performed ABPM in our department; data collected from clinical records and ABPM reports. Results: A total of 54 hypertensive CKD patients were reviewed. Reasons appointed for requesting ABPM included suspicion of resistant hypertension (40.7%), uncontrolled hypertension (29.6%), white coat hypertension (16.7%), hypotension (9.2%) and masked hypertension (3.8%). Interestingly, pre-ABPM clinical interpretation of BP control was found inadequate in 55.6% of patients. Conclusion: Misclassification of BP was a significant problem. As a result of these findings our department incorporated ABPM more routinely as recommended best practice

Resumo Justificativa: Estão descritas várias técnicas locorregionais para a abordagem da dor aguda e dor crônica após cirurgia de mama. O ideal seria uma técnica fácil de fazer, reprodutível, com pouco desconforto para as doentes, com poucas complicações e que permitirá um bom controle da dor aguda e uma diminuição da incidência de dor crônica, notadamente dor neuropática do intercostobraquial, por ser a entidade mais frequente. Objetivos: Estudar a aplicação de bloqueio paravertebral com picada única no pré-operatório de cirurgia mamária de grande porte. Avaliar numa primeira fase o controle de dor aguda e náuseas-vômitos no pós-operatório (NVPO) nas primeiras 24 horas e numa segunda fase a incidência de dor neuropática na região do nervo intercostobraquial seis meses após a cirurgia. Métodos: Foram incluídas 80 doentes do sexo feminino, ASA I-II, entre 18 e 70 anos, submetidas a cirurgia mamária de grande porte sob anestesia geral, estratificadas em dois grupos: anestesia geral (anestesia geral inalatória com opioides segundo resposta hemodinâmica) e paravertebral (bloqueio paravertebral com picada única em T4 com ropivacaína 0,5% + adrenalina 3 µg/mL com um volume de 0,3 mL/kg pré-operatoriamente e posterior indução e manutenção com anestesia geral inalatória). No pós-operatório imediato foi colocada PCA (Patient-controlled analgesia) de morfina programada com bolus a demanda durante 24 horas. Foram registados fentanil intraoperatório, consumo de morfina pós-operatória, complicações relacionadas com as técnicas, dor em repouso e ao movimento a 0, 1 h, 6 h e 24 h, assim como os episódios de NVPO. Foram analisadas todas as variáveis identificadas como fatores de cronificação da dor idade, tipo de cirurgia, ansiedade segundo escala de HADS (Hospital Anxiety and Depression scale), dor pré-operatória; acompanhamento no domicílio; índice de massa corporal (IMC), tratamentos adjuvantes de quimioterapia/radioterapia e foi verificada a homogeneidade das amostras. Aos seis meses da cirurgia foi avaliada, segundo escala DN4, a incidência de dor neuropática na área do nervo intercostobraquial. Resultados: O grupo paravertebral teve valores de VAS (Escala Visual Analógica) em repouso mais baixos ao longo das 24 horas de estudo 0 h 1,90 (± 2,59) versus 0,88 (± 1,5); 1 h 2,23 (± 2,2) versus 1,53 (± 1,8); 6 h 1,15 (± 1,3) versus 0,35 (± 0,8); 24 h 0,55 (± 0,9) versus 0,25 (± 0,8) com significado estatístico às 0 e às 6 horas. Em relação ao movimento o grupo paravertebral teve valores de VAS mais baixos e com significância estatística nos quatro momentos de avaliação: 0 h 2,95 (± 3,1) versus 1,55 (± 2,1); 1 h 3,90 (± 2,7) versus 2,43 (± 1,9) 6 h 2,75 (± 2,2) versus 1,68 (± 1,5); 24 h 2,43 (± 2,4) versus 1,00 (± 1,4). O grupo paravertebral consumiu menos fentanil (2,38 ± 0,81 µg/Kg versus 3,51 ± 0,81 µg/Kg) e menos morfina no pós-operatório (3,5 mg ± 3,4 versus 7 mg ± 6,4), com diferença estatisticamente significativa. Na avaliação de dor crônica aos seis meses no grupo paravertebral houve menos casos de dor neuropática na região do nervo intercostobraquial (três versus sete) embora sem significância estatística. Conclusões: O bloqueio paravertebral com picada única permite um adequado controle da dor aguda com menor consumo de opioides intraopreatórios e pós-operatórios, mas aparentemente não consegue evitar a cronificação da dor. Mais estudos são necessários para esclarecer o papel do bloqueio paravertebral na cronificação da dor em cirurgia mamária de grande porte.

Abstract Background: Several locoregional techniques have been described for the management of acute and chronic pain after breast surgery. The optimal technique should be easy to perform, reproducible, with little discomfort to the patient, little complications, allowing good control of acute pain and a decreased incidence of chronic pain, namely intercostobrachial neuralgia for being the most frequent entity. Objectives: The aim of this study was to evaluate the paravertebral block with preoperative single needle prick for major breast surgery and assess initially the control of postoperative nausea and vomiting (PONV) and acute pain in the first 24 h and secondly the incidence of neuropathic pain in the intercostobrachial nerve region six months after surgery. Methods: The study included 80 female patients, ASA I-II, aged 18-70 years, undergoing major breast surgery, under general anesthesia, stratified into 2 groups: general anesthesia (inhalation anesthesia with opioids, according to hemodynamic response) and paravertebral (paravertebral block with single needle prick in T4 with 0.5% ropivacaine + adrenaline 3 µg mL−1 with a volume of 0.3 mL kg−1 preoperatively and subsequent induction and maintenance with general inhalational anesthesia). In the early postoperative period, patient-controlled analgesia (PCA) was placed with morphine set for bolus on demand for 24 h. Intraoperative fentanyl, postoperative morphine consumption, technique-related complications, pain at rest and during movement were recorded at 0 h, 1 h, 6 h and 24 h, as well as episodes of PONV. All variables identified as factors contributing to pain chronicity age, type of surgery, anxiety according to the Hospital Anxiety and Depression Scale (HADS), preoperative pain, monitoring at home; body mass index (BMI) and adjuvant chemotherapy/radiation therapy were analyzed, checking the homogeneity of the samples. Six months after surgery, the incidence of neuropathic pain in the intercostobrachial nerve was assessed using the DN4 scale. Results: The Visual Analog Scale (VAS) values of paravertebral group at rest were lower throughout the 24 h of study 0 h 1.90 (±2.59) versus 0.88 (±1.5) 1 h 2.23 (±2.2) versus 1.53 (±1.8) 6 h 1.15 (±1.3) versus 0.35 (±0.8); 24 h 0.55 (±0.9) versus 0.25 (±0.8) with statistical significance at 0 h and 6 h. Regarding movement, paravertebral group had VAS values lower and statistically significant in all four time points: 0 h 2.95 (±3.1) versus 1.55 (±2.1); 1 h 3.90 (±2.7) versus 2.43 (±1.9) 6 h 2.75 (±2.2) versus 1.68 (±1.5); 24 h 2.43 (±2.4) versus 1.00 (±1.4). The paravertebral group consumed less postoperative fentanyl (2.38 ± 0.81 µg kg−1 versus 3.51 ± 0.81 µg kg−1) and morphine (3.5 mg ± 3.4 versus 7 mg ± 6.4) with statistically significant difference. Chronic pain evaluation of at 6 months of paravertebral group found fewer cases of neuropathic pain in the intercostobrachial nerve region (3 cases versus 7 cases), although not statistically significant. Conclusions: Single-injection paravertebral block allows proper control of acute pain with less intraoperative and postoperative consumption of opioids but apparently it cannot prevent pain chronicity. Further studies are needed to clarify the role of paravertebral block in pain chronicity in major breast surgery.

Objetivos: Compreender a realidade da avaliação do desenvolvimento psicomotor no âmbito das consultas de vigilância de saúde infantil nas unidades de cuidados de saúde primários dos ACES Gaia e Espinho/Gaia. Tipo de estudo: Observacional, transversal e descritivo. Local: ACES Gaia e Espinho/Gaia. População: Médicos de família dos ACES Gaia e Espinho/Gaia. Métodos: Aplicação de um questionário de autopreenchimento elaborado pelos autores, com 18 perguntas de resposta múltipla relativas à avaliação do desenvolvimento psicomotor, no âmbito das consultas de saúde infantil. Os dados foram analisados com recurso ao programa Microsoft Excel 2010®. Este estudo é reportado de acordo com as linhas de orientação STROBE. Resultados: Participaram no estudo 112 dos 193 médicos dos ACES Gaia e Espinho/Gaia. Noventa e nove por cento dos inquiridos avaliam o desenvolvimento psicomotor dos seus utentes e 84% despendem mais de cinco minutos nessa avaliação; 97% utilizam a Escala de Mary Sheridan Modificada. Setenta e dois por cento dos inquiridos julgam necessitar de formação sobre a aplicação desta escala; 50% sentem dúvidas relativamente à referenciação. Setenta e seis por cento consideram a falta de tempo e 66% a falta de material como sendo as principais dificuldades na avaliação do desenvolvimento. Conclusões: Tendo em conta o papel fulcral dos médicos de família na avaliação do desenvolvimento psicomotor de lactentes e crianças, torna-se essencial proporcionar a estes profissionais condições de tempo, formação e material adequadas para o cabal desempenho desta tarefa.

Goals: To assess the current status of the evaluation of psychomotor development in children by family doctors during regular clinic visits in two primary healthcare groupings, ACES Gaia and Espinho/Gaia. Study design: Cross-sectional study. Location: ACES Gaia and Espinho/Gaia. Population: Family medicine specialists of ACES Gaia and Espinho/Gaia. Methods: We distributed a self-administered questionnaire written by the authors consisting of 18 multiple-choice questions about the evaluation of psychomotor development during well child consultations. Data were analyzed with Microsoft Excel 2010®. This study is reported according to the STROBE guidelines. Results: Completed questionnaires were received from 112 of the 193 specialists (58%) in these two healthcare groupings. The assessment of psychomotor development is performed by 99% and 84% take more than five minutes in doing so. The Modified Mary Sheridan Scale is used by 97% and 72% of respondents considered that they need more training on the use of this scale, while 50% have doubts related to referrals. A lack of time (76% of respondents) and a lack of material (66% of respondents) are considered to be the main difficulties encountered when assessing psychomotor development. Conclusions: Given the role that family doctors play in the assessment of the psychomotor development of infants and children, it is essential to provide these professionals with adequate time, training, and material conditions to complete this task.