Introdução: Apesar da abordagem farmacológica multimodal profilática, as náuseas e os vômitos pós-operatórios (NVPO) correspondem a uma das principais queixas dos pacientes após procedimentos laparoscópicos. Em pacientes considerados de alto risco pelo critério de Apfel, a incidência de tais eventos pode chegar a 80%. Neste contexto, os antagonistas dos receptores de NK-1 têm sido recomendados para adultos em adição a outras estratégias antieméticas na tentativa de reduzir essa incidência. Entretanto, o efeito da associação do aprepitanto ao regime dexametasona, ondansetrona e propofol permanece indefinido. Nesta pesquisa, como desfecho principal, estudou-se o efeito da associação do aprepitanto em regime antiemético profilático multimodal para redução de risco de NVPO nas primeiras 24 horas do período pós-operatório em pacientes de alto risco pelo critério de Apfel. Como desfechos secundários, foram estudadas intensidade dos eventos de náuseas, incidência dos eventos de vômitos intensos e ocorrência de consumo de antieméticos de resgate nas primeiras 24 horas do período pós-operatório. Métodos: pacientes adultos, estratificados como alto risco pelo critério de Apfel, submetidos a procedimentos laparoscópicos oncológicos, foram alocados aleatoriamente para receber profilaticamente aprepitanto 80 mg (grupo de tratamento) ou amido (grupo controle) associados à dexametasona (4 mg ou 8 mg), ondansetrona (4 mg ou 8 mg) e anestesia venosa alvo-controlada com propofol. A análise estatística do desfecho principal foi realizada utilizando o Teste Exato de Fisher, e a hipótese nula foi descartada se p < 0,05. Resultados: Sessenta e seis pacientes concluíram o estudo. NVPO ocorreram em 13 (40,6%) pacientes nas primeiras 24 horas após emergência da anestesia no grupo controle. No grupo tratamento, ocorreram náusea em 5 pacientes (14,7%, p = 0,03) e vômito em 1 paciente (2,9%, p = 0,0002). A redução de risco relativo foi de 63,8% (IC 95% 9,9% - 86%) para náusea e de 92,7% (IC 95% 61,2% - 98,8%) para vômito. Episódios de náusea intensa ocorreram em 2 (6,3%) pacientes e de vômitos intensos, em 4 (12,5%) pacientes, no grupo controle. Um paciente apresentou vômito intenso no grupo tratamento. Em relação ao consumo de antieméticos, 9 (28,1%) pacientes solicitaram medicamentos antieméticos de resgate no grupo controle e 3 (8,8%) pacientes, no grupo tratamento, nas primeiras 24 horas pós-operatórias (p = 0,02). Conclusão: O aprepitanto (80 mg), como uma quarta estratégia antiemética profilática, pode contribuir para a redução significativa de NVPO e de consumo de antieméticos de resgate em pacientes de alto risco / Background: Despite the use of multimodal pharmacological approach, postoperative nausea and vomiting (PONV) is one of the most important causes of patients discomfort after laparoscopic surgeries. NK-1 receptor antagonists have recently being recommended for prophylaxis of PONV in adults, but the combination with serotonin (5-HT3) receptor antagonists such as ondansetron, corticosteroids such as dexamethasone and propofol, are not yet well established. The primary aim of this randomized and double-blind study was to assess whether the addition of aprepitant to a multimodal management strategy for PONV prophylaxis in a high-risk patient population would further decrease the incidence of PONV in the first 24 postoperative hours. The secondary aims were the quantification of nausea intensity, number of episodes of vomiting and rescue antiemetic consumption in the same period. Methods: patients classified as Apfel Score 3 or 4, scheduled to laparoscopic surgeries to treat cancer, were randomized to receive either oral aprepitant 80mg (treatment group) or matching placebo (control group) before induction of anesthesia. All patients received intravenous dexamethasone 4 mg or 8 mg at induction of anesthesia, ondansetron 4 mg or 8 mg at the end of the surgery and a standardized total intravenous anesthesia (TIVA) technique. Statistical analysis was performed using Fisher\'s Exact Test and the null hypothesis was ruled out if p < 0.05. Results: Sixty-six patients completed the study. Nausea and vomiting occurred in 13 (40.6%) patients during the first 24 hours in the control group (all patients who presented nausea also vomited). In the treatment group, nausea occurred in 5 patients (14.7%, P = 0.03) and vomiting occurred in 1 patient (2.9%, P = 0.0002). The reduction in the relative risk was 63.8% (95%CI 9.9% - 86%) for nausea and 92.7% (95%CI 61.2% - 98.8%) for vomiting. Severe nausea occurred in 2 (6.3%) patients, and severe vomiting occurred in 4 (12.5%) patients in the control group. One patient presented with severe vomiting in the treatment group in the first 24 postoperative hours. The administration of rescue antiemetics occurred in 9 (28.1%) patients in the control group and in 3 (8.8%) patients in the treatment group in the first 24 postoperative hours (P = 0.02). Conclusion: Eighty milligrams of aprepitant added to a three-drug multimodal prophylaxis strategy can bring benefits to a high-risk population by reducing PONV episodes and rescue antiemetic requirements

Abstrakt  Bakgrund: Sexuell ohälsa och våldsutsatthet är vanligt bland ungdomar och kan få allvarliga hälso-och beteendemässiga konsekvenser för unga kvinnor och män. Ungdomsmottagningarnas centrala mål är att främja sexuell och reproduktiv hälsa. Barnmorskors roll innebär bland annat att upptäcka ungdomar med sexuellt riskbeteende och våldsutsatthet. Motiv: Utmaningen i barnmorskors dialog med ungdomar är att få dem att dela med sig av negativa erfarenheter vilket sällan sker spontant. Därav utvecklades bedömningsverktyget SEXIT för att underlätta kommunikationen mellan barnmorskor och ungdomar. Studier i norra Sverige saknas angående barnmorskors upplevelse av bedömningsverktyget SEXIT. Syfte: Syftet med studien var att narrativt undersöka hur barnmorskor på ungdomsmottagning upptäcker och bemöter risk- eller våldsutsatta ungdomar innan, under och efter implementering av bedömningsverktyget SEXIT. Metod: En kvalitativ intervjustudie genomfördes med sex barnmorskor. Intervjuerna analyserades enligt Riessman’s sätt att bilda en narrativ metaberättelse där intervjuerna kodades och tematiserades. Genusperspektiv användes som inspiration.  Resultat: Analysprocessen resulterade i fem narrativa teman som presenterades i en bestämd tidsordning. Första temat, Förtroendeingivande barnmorskor med ambition att fånga upp våldsutsatthet där frågor om våld tappas bort, handlade om hur de fångade upp våld och risktagande innan SEXIT. Tema två, SEXIT en ögonöppnare i teorin men svårare att implementera i praktiken, avser hur barnmorskorna upplevde kursen, resterande tre teman, SEXIT - innebär både motstånd och möjligheter, Tiden - en grundläggande förutsättning för att upptäcka våldsutsatthet och risktagande bland ungdomar, att rutinmässigt utfråga unga kan avslöja sexuell ohälsa, innehöll narrativ som handlade om motstånd, möjligheter, utmaningar som kunde bidra till att upptäcka ungdomar med sexuell ohälsa. Konklusion: Innan SEXIT intog barnmorskorna delvis en undvikande roll gällande riskbeteenden och erfarenhet av våld. Efter SEXIT intog barnmorskorna en mer aktiv roll med direkta frågor baserat på det ifyllda SEXIT-underlaget. SEXIT kan vara ett användbart verktyg, men narrativen tyder på ett visst motstånd mot användning vid dropp-in. / Abstract  Background: Sexual risk taking and violence are common among adolescents and can have serious health and behavioral consequences for them. The youth clinics' central goal is to promote sexual and reproductive health. The role of midwives includes, among other things, detecting adolescence with sexual risk behavior and exposure to violence. Motive: The challenge in midwives' dialogue with adolescence to make them share negative experiences, which rarely happens spontaneously. From this, the SEXIT assessment tool was developed to facilitate communication between midwives and adolescents. Studies in northern Sweden are lacking regarding experience of the assessment tool SEXIT. Aim: The aim was to narratively investigate how midwives at youth clinics discover and meet with at-risk or violent adolescence before, during and after implementation of the SEXIT assessment tool.   Methods: A qualitative interview study was conducted with six midwives. The interviews were analysed according to Riessman's method of forming a narrative meta-narrative where the interviews were coded and thematized. Gender perspective was used as inspiration. Result: The analysis identified five narrative themes presented chronologically. The first theme, "Confidence-inspiring Midwives," focused on midwives detecting violence issues before SEXIT. Theme two, "SEXIT: Theory verses Practice," explored the challenges of implementing SEXIT in real-life situations. The remaining three themes, "SEXIT: Resisting and Embracing," "Time: Essential for Detecting Violence among Adolescence," and "Routine Questioning Reveals Sexual Health Issues in Adolescence," discussed narratives on resistance, opportunities, and challenges in uncovering sexual health concerns in adolescents. Conclusion: Before SEXIT, the midwives partly assumed an avoidant role regarding risk behaviours and experience of violence. After SEXIT, the midwives took a more active role with direct questions based on the SEXIT assessment tool. It can be a useful tool, but the narrative signifies resistance to use SEXIT during drop-in.