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This study aimed to estimate the prevalence of psychoactive substance use by adolescents from public schools. This is a cross-sectional study that used a random sample of adolescents from five public schools located in a municipality in the central-west region of the São Paulo Metropolitan Area, Brazil. Information on demographic, socioeconomic, and drug use was collected using self-report questionnaires. The sample consisted of 1,460 students, 716 (49%) males, aged 10-19 years (13.19±2.04 years). The prevalence of psychoactive substance use in the last month was 51% for analgesics; 48.8% for alcohol; 37.3% for tobacco; 30.8% for tranquilizers; 23.1% for marijuana; 22.6% for anabolic steroids; 21.6% for ecstasy; 15.3% for amphetamines/stimulants; 13.4% for phencyclidine; 12.9% for cocaine/crack; 12.6% for inhalants/solvents; 11.5% for opiates; 11.4% for hallucinogens; and 16.2% for other unclassified drugs. Elementary and middle school students were more likely to consume tobacco (OR = 2.306; 95%CI: 1.733-3.068; p < 0.001), and male students were more likely to consume any type of substance. We identified a high use of psychoactive substances among this study participants, with a higher prevalence among male students.

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This study aimed to estimate the prevalence of psychoactive substance use by adolescents from public schools. This is a cross-sectional study that used a random sample of adolescents from five public schools located in a municipality in the central-west region of the São Paulo Metropolitan Area, Brazil. Information on demographic, socioeconomic, and drug use was collected using self-report questionnaires. The sample consisted of 1,460 students, 716 (49%) males, aged 10-19 years (13.19±2.04 years). The prevalence of psychoactive substance use in the last month was 51% for analgesics; 48.8% for alcohol; 37.3% for tobacco; 30.8% for tranquilizers; 23.1% for marijuana; 22.6% for anabolic steroids; 21.6% for ecstasy; 15.3% for amphetamines/stimulants; 13.4% for phencyclidine; 12.9% for cocaine/crack; 12.6% for inhalants/solvents; 11.5% for opiates; 11.4% for hallucinogens; and 16.2% for other unclassified drugs. Elementary and middle school students were more likely to consume tobacco (OR = 2.306; 95%CI: 1.733-3.068; p < 0.001), and male students were more likely to consume any type of substance. We identified a high use of psychoactive substances among this study participants, with a higher prevalence among male students.

O objetivo foi estimar a prevalência de uso de substâncias psicoativas por adolescentes de escolas públicas. Trata-se de um estudo transversal com uma amostra aleatória de adolescentes de cinco escolas públicas localizadas em um município da zona centro-oeste da Região Metropolitada de São Paulo, Brasil. Informações sobre as características demográficas, socioeconômicas e de uso de drogas foram coletadas por meio de questionários autorreferidos. A amostra foi composta por 1.460 estudantes, sendo 716 (49%) meninos, com idade entre 10 e 19 anos (13,19±2,04 anos). A prevalência de uso de substâncias psicoativas no último mês foi de 51,0% para analgésicos; álcool 48,8%; tabaco 37,3%; tranquilizantes 30,8%; maconha 23,1%; esteroides anabolizantes 22,6%; ecstasy 21,6%; anfetaminas/estimulantes 15,3%; fenciclidina 13,4%; cocaína/crack 12,9%; inalantes/solventes 12,6%; opiáceos 11,5%; alucinógenos 11,4%; e outras drogas não classificadas 16,2%. Alunos do Ensino Fundamental foram mais propensos a consumir tabaco (OR = 2,306; IC95%: 1,733-3,068; p < 0,001), e os estudantes do sexo masculino foram mais propensos a consumir qualquer tipo de substância. Identificou-se um alto uso de substâncias psicoativas entre os participantes deste estudo, com maior prevalência entre os estudantes do sexo masculino.

El objetivo de este estudio fue estimar la prevalencia de consumo de sustancias psicoactivas por adolescentes de escuelas públicas brasileñas. Se trata de un estudio transversal, realizado con una muestra aleatoria de adolescentes de cinco escuelas públicas, ubicadas en una ciudad de la región centro-oeste de la Región Metropolitana de São Paulo, Brasil. La información sobre las características demográficas, socioeconómicas y de consumo de drogas se recabó de cuestionarios autoinformados. La muestra estuvo compuesta por 1.460 estudiantes; 716 (49%) de los cuales eran varones, con edades entre 10 y 19 años (13,19±2,04 años). La prevalencia de consumo de sustancias psicoactivas en el último mes fue: para analgésicos 51%; alcohol 48,8%; tabaco 37,3%; tranquilizantes 30,8%; marihuana 23,1%; esteroides anabólicos 22,6%; éxtasis 21,6%; anfetaminas/estimulantes 15,3%; fenciclidina 13,4%; cocaína/crack 12,9%; inhalantes/disolventes 12,6%; opiáceos 11,5%; alucinógenos 11,4%; y otras drogas no clasificadas 16,2%. Los estudiantes de primaria fueron los más propensos a consumir tabaco (OR = 2,306; IC95%: 1,733-3,068; p < 0,001), y los varones los más propensos a consumir cualquier tipo de sustancia. Se identificó un alto consumo de sustancias psicoactivas entre los participantes, con mayor prevalencia entre los estudiantes del sexo masculino.

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BACKGROUND: As general spontaneous movements at the writhing and fidgety ages have been important for the early identification of neurodevelopmental impairment of both full-term and preterm infants, the knowledge of the spontaneous orofacial movements at these ages also seems to be important for the diagnosis of oral function, particularly in preterm infants. Therefore, we decided to first classify preterm and full-term infants according to general movements ages, and then to record, describe, compare, and discuss their spontaneous orofacial movements. METHODS: This cross-sectional study included 51 preterm infants (born between 28 and 36 weeks) and 43 full-term infants who were classified at the writhing and fidgety ages of Prechtl's method of general movements assessment. Their spontaneous orofacial movements were recorded on video, and The Observer XT software (Noldus) was used to record the quantitative values of the movements. RESULTS: Poor repertoires of writhing movements were more frequent in the preterm infants (90.9%) compared to full-term ones (57.9%). Positive fidgety movements were observed in 100% of both preterm and full-term infants. Oral movements were similar for both preterm and full-term infants, regardless of their movement stage. CONCLUSION: All spontaneous orofacial movements were present both in preterm and full-term infants, albeit with higher frequency, intensity, and variability at fidgety age.

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SUMMARY Objective: to assess the nutritional practices in neonatal intensive care units (NICU) associated with growth retardation in premature (preterm) infants. Methods: retrospective study of preterm infants weighing between 500 and 1,499g admitted to NICU. Evolution of growth and parenteral (PN) and enteral (EN) nutrition practices were analyzed. Results: among 184 preterm infants divided into G1 (500 to 990g; n=63) and G2 (1000 to 1499g; n=121), 169 received PN (G1=63, G2=106). Compared with the recommendations, PN was started late, its progress was slow and the maximum glucose, amino acid, lipid and energy supplies were low in both groups. The initial supply of amino acid and lipid and initial and maximum glucose and energy were lower in G1. The onset of EN was early (1-2 days), the time to reach exclusive EN was appropriate (11-15 days) and the use of human milk was possible in a reasonable amount of time (7-13 days). The multivariate analysis showed that respiratory distress syndrome and obtaining a supply of 120 kcal/kg/day too late increased the chance of weight loss greater than 10%. Sepsis, maximum energy supply for PN <60 kcal/kg/day and obtaining a supply of 120 kcal/kg/day too late increased the chance of regaining birth weight after 14 days, while small for gestational age (SGA) at birth reduced this chance. SGA at birth, sepsis and achieving exclusive enteral nutrition after 14 days increased the chance of being SGA at post-conceptual age of term. Conclusion: improving nutritional practices in the NICU can reduce the growth deficit in premature infants of very low birth weight.

RESUMO Objetivo: avaliar as práticas nutricionais em unidade de cuidados intensivos neonatais (UCIN) associadas a déficit de crescimento em recém-nascidos pré-termo (RNPT). Métodos: estudo retrospectivo de RNPT com peso entre 500 e 1.499 g internados em UCIN. Analisaram-se: evolução do crescimento e práticas de nutrição parenteral (NP) e enteral (NE). Resultados: dentre 184 RNPT divididos em G1 (500 a 990 g; n=63) e G2 (1.000 a 1.499 g; n=121), 169 receberam NP (G1=63; G2=106). Comparando-se com as recomendações, a NP foi iniciada tardiamente, sua progressão foi lenta e as ofertas máximas de glicose, aminoácidos, lipídios e energia foram baixas nos dois grupos. A oferta inicial de aminoácido e lipídio e a inicial e máxima de glicose e energia foram menores no G1. O início da NE foi precoce (1 a 2 dias), o tempo para atingir NE exclusiva foi adequado (11 a 15 dias), e o uso de leite humano foi possível por tempo razoável (7 a 13 dias). A análise multivariada mostrou que a síndrome do desconforto respiratório e o alcance tardio da oferta de 120 kcal/kg/dia aumentaram a chance de perda de peso superior a 10%. Sepse, oferta energética máxima por NP < 60 kcal/kg/dia e alcance tardio da oferta de 120 kcal/kg/dia aumentaram a chance de recuperar o peso de nascimento após 14 dias, enquanto a condição de pequeno para idade gestacional (PIG) ao nascimento reduziu essa chance. PIG ao nascimento, sepse e alcance de NE exclusiva após 14 dias aumentaram a chance de ser PIG na idade pós-conceptual de termo. Conclusão: aprimorar as práticas nutricionais em UCIN pode reduzir o déficit de crescimento em prematuros de muito baixo peso ao nascer.

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Objetivo ­ Analisar a educação odontológica em âmbito universitário voltada aos cuidados com pacientes portadores de necessidades especiais, considerando que tais indivíduos requerem cuidados especiais para atendimento odontológico por apresentarem uma ou mais limitações, temporárias ou permanentes, de ordem mental, física, sensorial e emocional, que os impedem de serem submetidos a atendimento convencional. Indivíduos com necessidades especiais constituem população heterogênea, que apresenta parcial ou completa dependência e cuja vulnerabilidade tende a torná-los suscetíveis a distúrbios bucais e a comorbidades passíveis de comprometer sua qualidade de vida. Esses pacientes necessitam de adaptações especiais para as práticas da vida diária. Preparo e qualificação profissional são essenciais para os serviços de saúde que atendem essa população. Métodos ­ Foi realizado levantamento bibliográfico acerca de como procede o ensino da disciplina de Pacientes Especiais nas Faculdades de Odontologia em nosso país, procurou-se identificar também, estudos nos quais políticas públicas foram empregadas, visando amplificar a disseminação desses conhecimentos academicamente. Resultados ­ Averiguou-se que a disciplina geralmente não é obrigatória na graduação e que quando a disciplina está presente, têm-se carga horária variável, por vezes insuficiente, existindo oferta de formação complementar em cursos paralelos. Conclusão ­ Concluiu-se que o atendimento odontológico a pacientes especiais exige aporte de conhecimentos específicos e que não há regularidade e garantia desses conhecimentos serem adquiridos na graduação, implicando que políticas públicas de acesso a serviços de saúde para pacientes especiais ofereçam programas de capacitação e aperfeiçoamento aos profissionais da Odontologia para atuação nesses serviços

Objective ­ To analyze the dental education in university environment geared to the care of patients with special needs, considering that such individuals require special care for dental care because they have one or more limitations, temporary or permanent mental order, physical, sensory and emotional, that prevent them from being subjected to conventional care. Individuals with special needs are heterogeneous population with partial or complete dependency and vulnerability which tends to make them susceptible to oral disorders and comorbidities likely to compromise their quality of life. These patients need special adaptations to the practices of everyday life. Preparation and professional training are essential to the health services that serve this population. Methods ­ literature review was conducted on how proceeds the teaching of Special Patients discipline in dental schools in our country, we tried to identify also studies in which public policies were applied, in order to amplify the spread of this knowledge academically. Results ­ An examination was that the discipline usually is not mandatory at graduation and when discipline is present, have been variable hours, sometimes insufficient, existing supply of additional training in parallel courses. Conclusions ­ It was concluded that dental care to patients requires special contribution of expertise and there is no guarantee regularity and such knowledge be acquired during their studies, implying that public policies of access to health services for special patients provide training and improvement programs to dental professionals to operate these services.

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OBJECTIVE: to assess the nutritional practices in neonatal intensive care units (NICU) associated with growth retardation in premature (preterm) infants. METHODS: retrospective study of preterm infants weighing between 500 and 1,499 g admitted to NICU. Evolution of growth and parenteral (PN) and enteral (EN) nutrition practices were analyzed. RESULTS: among 184 preterm infants divided into G1 (500 to 990 g; n=63) and G2 (1000 to 1499 g; n=121), 169 received PN (G1=63, G2=106). Compared with the recommendations, PN was started late, its progress was slow and the maximum glucose, amino acid, lipid and energy supplies were low in both groups. The initial supply of amino acid and lipid and initial and maximum glucose and energy were lower in G1. The onset of EN was early (1-2 days), the time to reach exclusive EN was appropriate (11-15 days) and the use of human milk was possible in a reasonable amount of time (7-13 days). The multivariate analysis showed that respiratory distress syndrome and obtaining a supply of 120 kcal/kg/day too late increased the chance of weight loss greater than 10%. Sepsis, maximum energy supply for PN <60 kcal/kg/day and obtaining a supply of 120 kcal/kg/day too late increased the chance of regaining birth weight after 14 days, while small for gestational age (SGA) at birth reduced this chance. SGA at birth, sepsis and achieving exclusive enteral nutrition after 14 days increased the chance of being SGA at post-conceptual age of term. CONCLUSION: improving nutritional practices in the NICU can reduce the growth deficit in premature infants of very low birth weight.

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OBJECTIVE: To analyze and to interpret the psychological repercussions generated by the presence of parents in the Neonatal Intensive Care Unit for residents in Neonatology. METHODS: Study based on the psychoanalytic theory, involving a methodological interface with qualitative surveys in Health Sciences. Twenty resident physicians in Neonatology, from five public institutions of São Paulo state, responded to a single semi-structured interview. Based on several readings of the material, achieving the core of emergent meanings that would be significant to the object of the survey, six categories were elected for analysis and interpretation: parents' staying at the Neonatal Intensive Care Unit and its effects on the neonatologists' professional practice; communication of the diagnosis and what parents should know; impasses between parents and doctors when the diagnosis is being communicated; doctor's identification with parents; communication of the child's death and their participation in the interview. RESULTS: The interpretation of the categories provided an understanding of the psychic mechanisms mobilized in doctors in their relationships with the children's parents, showing that the residents experience anguish and suffering when they provide medical care and during their training process, and also that they lack psychological support to handle these feelings. CONCLUSIONS: There is a need of intervention in neonatologists training and education, which may favor the elaboration of daily experiences in the Unit, providing a less anguishing and defensive way out for young doctors, especially in their relationship with patients and parents.

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Objective: To analyze and to interpret the psychological repercussions generated by the presence of parents in the Neonatal Intensive Care Unit for residents in Neonatology. Methods: Study based on the psychoanalytic theory, involving a methodological interface with qualitative surveys in Health Sciences. Twenty resident physicians in Neonatology, from five public institutions of São Paulo state, responded to a single semi-structured interview. Based on several readings of the material, achieving the core of emergent meanings that would be significant to the object of the survey, six categories were elected for analysis and interpretation: parents' staying at the Neonatal Intensive Care Unit and its effects on the neonatologists' professional practice; communication of the diagnosis and what parents should know; impasses between parents and doctors when the diagnosis is being communicated; doctor's identification with parents; communication of the child's death and their participation in the interview. Results: The interpretation of the categories provided an understanding of the psychic mechanisms mobilized in doctors in their relationships with the children's parents, showing that the residents experience anguish and suffering when they provide medical care and during their training process, and also that they lack psychological support to handle these feelings. Conclusions: There is a need of intervention in neonatologists training and education, which may favor the elaboration of daily experiences in the Unit, providing a less anguishing and defensive way out for young doctors, especially in their relationship with patients and parents. .

Objetivo: Analizar e interpretar las repercusiones psicológicas suscitadas en el médico neonatologista en formación debido a la entrada y a la permanencia de los padres en la Unidad de Terapia Intensiva Neonatal. Métodos: Estudio sustentado en la teoría psicoanalítica, manteniéndose una interlocución metodológica con la investigación cualitativa en salud. Veinte residentes en Neonatología, de cinco instituciones públicas de la provincia de São Paulo (Brasil), participaron de una entrevista semiestructurada individual. A partir de innúmeras lecturas del material, objetivando los núcleos de sentido emergentes, significativos para el objeto de investigación, se eligieron categorías para análisis e interpretación: permanencia de los padres en la Unidad de Terapia Intensiva Neonatal y su repercusión en la actuación del neonatologista; comunicación del diagnóstico y qué los padres deben saber; impases entre los médicos y los padres de los bebés en la comunicación del diagnóstico; situaciones de identificación con los padres; comunicación de la muerte y participación en la entrevista. Resultados: La interpretación de las categorías propició la comprensión de los mecanismos psíquicos movilizados en los médicos en la relación con los padres de los bebés y expuso la angustia y el sufrimiento suscitados en los residentes en la atención asistencial y en el proceso de formación, para los que están desprovistos de anclajes psíquicos. Conclusiones: A partir del contenido que se explicitó en el análisis de las entrevistas, se verificó la necesidad de una propuesta de intervención en la formación de esos profesionales que favorezca la elaboración de las experiencias vividas en el cotidiano de la Unidad, ...

Objetivo: Analisar e interpretar as repercussões psicológicas suscitadas no médico neonatologista em formação devido à entrada e à permanência dos pais na Unidade de Terapia Intensiva Neonatal. Métodos: Estudo sustentado na teoria psicanalítica, mantendo-se uma interlocução metodológica com a pesquisa qualitativa em saúde. Vinte residentes de Neonatologia, de cinco instituições públicas do estado de São Paulo, participaram de uma entrevista semiestruturada individual. A partir de inúmeras leituras do material, objetivando-se os núcleos de sentido emergentes, significativos para o objeto de pesquisa, elegeram-se seis categorias para análise e interpretação: permanência dos pais na Unidade de Terapia Intensiva Neonatal e sua repercussão na atuação do neonatologista; comunicação do diagnóstico e o que os pais devem saber; impasses entre os médicos e os pais dos bebês na comunicação do diagnóstico; situações de identificação com os pais; comunicação da morte e participação na entrevista. Resultados: A interpretação das categorias propiciou a compreensão dos mecanismos psíquicos mobilizados nos médicos na relação com os pais dos bebês e expôs a angústia e o sofrimento suscitados nos residentes no atendimento assistencial e no processo de formação, para os quais estão desprovidos de ancoragens psíquicas. Conclusões: A partir do conteúdo que se explicitou na análise das entrevistas, verificou-se a necessidade de uma proposta de intervenção na formação desses profissionais que favoreça a elaboração das experiências vividas no cotidiano da Unidade, a fim de propiciar uma saída menos angustiante ...

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OBJETIVO: Avaliar a prevalência de atraso e fatores associados aos escores de desenvolvimento em crianças nascidas prematuras. MÉTODOS: Estudo transversal para avaliar o desenvolvimento por escalas Bayley III, incluindo-se prematuros de muito baixo peso de 18 a 24 meses de idade corrigida, acompanhados no Ambulatório de Prematuros da instituição. Excluíram-se: malformação congênita, síndrome genética, infecção congênita sintomática ao nascimento, surdez e cegueira. As variáveis numéricas foram comparadas por teste t de Student ou Mann-Whitney, e as categóricas, por qui-quadrado ou teste exato de Fisher. Para análise dos fatores associados aos escores de desenvolvimento, utilizou-se a regressão linear, considerando-se significante p < 0,05. RESULTADOS: Das 58 crianças avaliadas, quatro (6,9%) apresentaram alteração cognitiva; quatro (6,9%), motora; 17 (29,3%), de linguagem; 16 (27,6%), socioemocional; e 22 (37,9%), de comportamento adaptativo. À regressão linear múltipla, os fatores classe socioeconômica CDE (-13,27; IC95% -21,23 a -5,31) e dependência de oxigênio com 36 semanas de idade corrigida (-8,75; IC95% -17,10 a -0,39) diminuíram o escore cognitivo. A leucomalácia periventricular diminuiu o escore cognitivo (-15,21; IC95% -27,61 a -2,81), motor (-10,67; IC95% -19,74 a -1,59) e de comportamento adaptativo (-21,52; IC95% -35,60 a -7,44). O sexo feminino se associou ao maior escore motor (10,67; IC95% 2,77-12,97), de linguagem (15,74; IC95% 7,39-24,09) e socioemocional (10,27; IC95% 1,08-19,46). CONCLUSÕES: Prematuros de muito baixo peso apresentaram com maior frequência alterações na linguagem, comportamento adaptativo e socioemocional. As variáveis classe socioeconômica CDE, leucomalácia periventricular, displasia broncopulmonar e sexo masculino contribuíram para reduzir os escores de desenvolvimento.

OBJECTIVE: To evaluate the prevalence of delay and factors associated with neurodevelopmental scores in premature infants. METHODS: Cross-sectional study to assess the development by Bayley Scales III, including very low birth weight preterm infants aged 18 to 24 months who were under follow-up at the outpatient clinic for preterm infants. Congenital malformation, genetic syndrome, symptomatic congenital infection at birth, deafness, and blindness were excluded. Numerical variables were compared by Mann-Whitney or Student t test and categorical variables by chi-square or Fisher's exact test. Factors associated with developmental scores were analyzed by linear regression, and statistical significance level was established at p < 0.05. RESULTS: Out of the 58 children included, four (6.9%) presented cognitive delay, four (6.9%) motor, 17 (29.3%) language, 16 (27.6%) social-emotional and 22 (37.0%) adaptive-behavior delay. By multiple linear regression, the variables: social classes CDE (-13.27; 95%CI: -21.23 to -5.31), oxygen dependency at 36 weeks of corrected age (-8.75; 95%CI: -17.10 to -0.39) decreased the cognitive developmental score. Periventricular leukomalacia decreased the cognitive (-15.21; 95%CI: -27.61 to -2.81), motor (-10.67; 95%CI:-19.74 to -1.59) and adaptive-behavior scores (-21.52; 95%CI: -35.60 to -7.44). The female sex was associated with higher motor (10.67; 95%CI: 2.77 to 12.97), language (15.74; 95%CI: 7.39 to 24.09) and social-emotional developmental scores (10.27; 95%CI: 1.08 to 19.46). CONCLUSIONS: Very low birth weight preterm infants aged from 18 to 24 months of corrected age presented more frequently language, social-emotional and adaptive-behavior delays. The variables: social classes CDE, periventricular leukomalacia, bronchopulmonary dysplasia and male sex reduced the neurodevelopmental scores.

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OBJECTIVE: To evaluate the prevalence of delay and factors associated with neurodevelopmental scores in premature infants. METHODS: Cross-sectional study to assess the development by Bayley Scales III, including very low birth weight preterm infants aged 18 to 24 months who were under follow-up at the outpatient clinic for preterm infants. Congenital malformation, genetic syndrome, symptomatic congenital infection at birth, deafness, and blindness were excluded. Numerical variables were compared by Mann-Whitney or Student t test and categorical variables by chi-square or Fisher's exact test. Factors associated with developmental scores were analyzed by linear regression, and statistical significance level was established at p < 0.05. RESULTS: Out of the 58 children included, four (6.9%) presented cognitive delay, four (6.9%) motor, 17 (29.3%) language, 16 (27.6%) social-emotional and 22 (37.0%) adaptive-behavior delay. By multiple linear regression, the variables: social classes CDE (-13.27; 95%CI: -21.23 to -5.31), oxygen dependency at 36 weeks of corrected age (-8.75; 95%CI: -17.10 to -0.39) decreased the cognitive developmental score. Periventricular leukomalacia decreased the cognitive (-15.21; 95%CI: -27.61 to -2.81), motor (-10.67; 95%CI:-19.74 to -1.59) and adaptive-behavior scores (-21.52; 95%CI: -35.60 to -7.44). The female sex was associated with higher motor (10.67; 95%CI: 2.77 to 12.97), language (15.74; 95%CI: 7.39 to 24.09) and social-emotional developmental scores (10.27; 95%CI: 1.08 to 19.46). CONCLUSIONS: Very low birth weight preterm infants aged from 18 to 24 months of corrected age presented more frequently language, social-emotional and adaptive-behavior delays. The variables: social classes CDE, periventricular leukomalacia, bronchopulmonary dysplasia and male sex reduced the neurodevelopmental scores.

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