clanata@iin.sld.pe / Introduction: Pneumonia and diarrhoea are leading causes of death in children. There is a need to develop effective interventions. Objective: We present the design and baseline findings of a community-randomised controlled trial in rural Peru to evaluate the health impact of an Integrated Home-based Intervention Package in children aged 6 to 35 months. Methods: We randomised 51 communities. The intervention was developed through a community-participatory approach prior to the trial. They comprised the construction of improved stoves and kitchen sinks, the promotion of hand washing, and solar drinking water disinfection (SODIS). To reduce the potential impact of non-blinding bias, a psychomotor stimulation intervention was implemented in the control arm. The baseline survey included anthropometric and socio-economic characteristics. In a sub-sample we determined the level of faecal contamination of drinking water, hands and kitchen utensils and the prevalence of diarrhoegenic Escherichia coli in stool specimen. Results: We enrolled 534 children. At baseline all households used open fires and 77% had access to piped water supplies. E. coli was found in drinking water in 68% and 64% of the intervention and control households. Diarrhoegenic E. coli strains were isolated from 45/139 stool samples. The proportion of stunted children was 54%. Conclusions: Randomization resulted in comparable study arms. Recently, several critical reviews raised major concerns on the reliability of open health intervention trials, because of uncertain sustainability and non-blinding bias. In this regard, the presented trial featuring objective outcome measures, a simultaneous intervention in the control communities and a 12- month follow up period will provide valuable evidence. / This study received financial support of the UBS Optimus Foundation, through a grant given to the IIN and Swiss TPH. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. / Revisión por pares

As mães de recém-nascidos prematuros vivenciam a ansiedade oriunda da fragilidade e incerteza sobre as condições de vida de seu filho e a convivência com o estressante ambiente hospitalar, com implicações no aleitamento materno. Na tentativa de amenizar esta situação, o objetivo deste estudo foi avaliar o efeito da acupuntura na ansiedade de mães de recém-nascidos de muito baixo peso (RNMBP). Trata-se de um ensaio clínico randomizado realizado em um hospital universitário do norte do Paraná. A pesquisa foi aprovada pelo Comitê de Ética e Pesquisa da instituição na qual foi realizado o estudo e foi submetida a registro em base de dados para ensaios clínicos Australian New Zealand Clinical Trials Registry. Todas as participantes assinaram o Termo de Consentimento Livre e Esclarecido. A coleta de dados ocorreu no Banco de Leite Humano da instituição, entre agosto de 2011 e novembro de 2012. As participantes foram alocadas em dois grupos: grupo acupuntura (GA) e grupo placebo (GP) e receberam sessões semanais de acupuntura auricular chinesa nos pontos Shenmen, Tensão, Ansiedade 1 e 2 e Relaxamento Muscular. A acupuntura placebo foi realizada com agulhas auriculares adaptadas, sem perfurar a pele. Houve cegamento entre as participantes e o estatístico que realizou a análise dos dados. Utilizaram-se o Inventário de Ansiedade Traço-Estado e a mensuração do cortisol salivar, antes e após a intervenção. Participaram do estudo 29 mães de RNMBP, 14 pertencentes ao GA e 15 pertencentes ao GP. A idade das participantes variou entre 16 e 40 anos, com mediana de 27 anos. A maioria tinha escolaridade até o ensino médio (57%), vivia com o companheiro (72%) e possuía trabalho remunerado (65%). Quanto às variáveis de aleitamento materno, 48% relataram experiência prévia com amamentação, sendo que 13% apresentaram intercorrências durante este período. A incidência de aleitamento materno exclusivo entre as participantes, na data da alta do recém-nascido, foi de 76%, nove pertencentes ao GA (64%) e 13, ao GP (87%), sem relevância estatística entre estes valores (p=0,215). Os resultados para o cortisol salivar, antes da intervenção, variaram entre 0,02 e 0,33 ug/dL para o total de participantes, com média de 0,13 para ambos os grupos (DP=0,08). Após a intervenção, ambos os grupos apresentaram média de 0,14 ug/dL (DP=0,12), variando entre 0,02 e 0,49 ug/dL. A diferença média entre as medidas de cortisol salivar, antes e após a intervenção, foi de -0,02 ug/dL (DP=0,11), mostrando que os níveis de cortisol aumentaram após a intervenção em ambos os grupos, sem significância estatística (p=0,480), e contrariando o esperado. Após a intervenção, o escore de ansiedade-estado das participantes teve redução média de oito pontos, não havendo diferença estatística entre os grupos (p=0,888), com a possibilidade de que tanto a acupuntura real quanto a placebo tenham produzido resultados positivos na redução da ansiedade. Sugere-se que estudos com maior amostra e um terceiro grupo controle sejam conduzidos para melhor esclarecer os efeitos da acupuntura para a redução da ansiedade nesta população. / Mothers of preterm infants experience anxiety due to the child\'s frail and uncertain health condition. Spending time in a stressful hospital environment has implications to lactation and breastfeeding. In the attempt to diminish this situation, the aim of this study was to assess the effect of acupuncture in mothers with very low birth weight infants (VLBW). This is a randomized, patient-assessor blind, sham-controlled clinical trial, conducted in a school hospital in northern Paraná. This research has been approved by the ethics review board of the institution where it took place. The trial is registered at Australian New Zealand Clinical Trials Registry, number 12611000025932. All participants signed the written informed consent. Data was collected at the institution\'s Human Milk Bank from August 2011 to November 2012. Subjects were allocated into two groups: acupuncture - AG or placebo-acupuncture - PG and treatment sessions occurred once a week. The Chinese ear acupoints used were Shenmen, Tension, Anxiety 1 and 2, Muscle relaxation. For placebo- acupuncture, custom-designed noninvasive ear needles were used. Participants were submitted to the STAI-Y scale and salivary cortisol measurements before and after treatment. Twenty-nine mother\'s with VLBW infants took part in the study (GA = 14, GP = 15). Participants\' age ranged from 16 to 40, median age was 27 years old. Most subjects had high school educational levels (57%); lived with their partners (72%) and had paid jobs (65%). 48% mothers had previous experiences with breastfeeding and 13% mentioned some problems while doing so. Exclusive breastfeeding rate at infant\'s hospital discharge was 76%, AG = 9 (64%), PG = 13 (87%), not significant (p=0,215). Salivary cortisol levels before intervention ranged from 0,02 to 0,33 ug/dL and both groups presented mean 0,13 ug/dL (SD = 0,08). After treatment both groups had 0,14 ug/dL (SD = 0,12) mean levels, with a 0,02 - 0,49 ug/dL range. Mean difference between salivary cortisol levels before and after treatment was -0,02 ug/dL (SD = 0,11), showing increase in cortisol levels after treatment for both groups, not significant and contrary to expected. After treatment, mean STAI-Y1 (state) scores dropped 8 points, not significant between groups (p=0,888). This result indicate that both real and placebo acupuncture may have produced positive effects in anxiety reduction. We suggest other studies are conducted with bigger sample sizes and that include a third arm with routine care as control group to better understand the effects of acupuncture for anxiety in this population.

O presente trabalho apresenta um estudo sobre a continuidade da tortura no atual Estado Democrático de Direito existente no Brasil, destacando a dissonância entre a criminalização da tortura no ordenamento jurídico e político e a efetividade da punição desse crime pelo sistema de justiça criminal. Destaca-se o fato de que a lei 9.455/97, que tipifica o crime de tortura no Brasil, considera que qualquer pessoa pode ser responsabilizada por crime de tortura. Ela difere da Convenção Contra a Tortura e Outros Tratamentos ou Penas Cruéis, Desumanos e Degradantes, que especifica que a tortura é todo o ato praticado por agentes do Estado, restringindo a penalidade apenas para esses agentes. Sendo assim, a lei brasileira pode servir para punir tanto os agentes do Estado como os não agentes. Este dado é importante porque existe uma distinção entre os julgamentos em que figuram como réus os agentes do Estado daqueles em que os réus são não agentes do Estado. Essas distinções revelam que os julgamentos de crimes de tortura não se dirigem somente ao ato criminoso, mas aos agressores, vítimas e testemunhas. A pesquisa sustenta que a continuidade da tortura não está baseada apenas na recorrência e dinâmica dessa prática em delegacias, presídios e unidades de internação. Ela está ligada à forma como a tortura é interpretada, não somente pela sociedade, mas pelas instituições de segurança e justiça. Essa interpretação leva em conta o perfil dos acusados e das vítimas, as condições em que esses supostos crimes de tortura ocorreram, em que circunstâncias, quem são os responsáveis pelas denúncias, quem são os acusados, quem são as vítimas, etc. Desse modo, podemos dizer que o que está em julgamento não é o ato criminoso da tortura contra um ser humano, mas se este ser humano é titular de um direito, se ele é considerado um membro da comunidade, de um mundo comum em que as pessoas são vistas como iguais e como cidadãs. / This dissertation presents a study of the continual use of torture within Brazils contemporary democratic regime, drawing attention to the discord between the criminalization of torture in political and judicial ordinances and the effectiveness of punishment for that crime under the criminal justice system. The work highlights the fact that the Law 9.455/1997 (Torture Act), which categorizes torture in Brazil, considers that any individual can be held responsible for the crime of torture. This law differs from the 1984 Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment which specifies that torture is an act that can only be committed by agents of the State, thus restricting penalty only to those agents. Therefore, Brazilian Law can serve to punish both State agents and non-State agents. This is an important fact because there is a distinction between trials where the defendants are State Law Enforcement Officials and those where the defendants are not State agents. These distinctions reveal that trials for crimes of torture do not only address the criminal action but also the perpetrators, victims and witnesses. Research shows that the persistence of torture is not only based on the recurrence and dynamic of these practices in police stations, prisons, facilities belonging to the armed forces and juvenile detention centers. It is linked to the way torture is interpreted not only by society but also by the security and justice institutions. This interpretation takes into account the profile of the accused and of the victims, the conditions in which the alleged crimes occurred, in what respective circumstances, who are responsible for the denunciations, who are the accused, who are the victims, etc. Consequently, one can say that what is on trial is not the criminal act of torturing a human being but whether this human being is entitled to have rights, whether he or she is considered a member of the community, of a common world in which all people are should be seen as equal and as citizens.

Background. Depression and anxiety are common and debilitating disorders, and at least one third of patients do not respond to available interventions. Morita Therapy, a Japanese psychological therapy which contrasts with established Western approaches, is currently untested in the UK and may represent a potentially effective alternative approach. Aim. To optimise and investigate the feasibility and acceptability of Morita Therapy as a treatment for depression and anxiety in the UK. Design. Three studies were undertaken in line with the MRC framework (2008) for complex interventions. Study One: scoping and systematic review to describe the extent, range and nature of Morita Therapy research activity reported in English. Study Two: intervention optimisation study, integrating literature synthesis with qualitative research, to develop the UK Morita Therapy outpatient protocol. Study Three: mixed methods feasibility study encompassing a pilot randomised controlled trial (RCT) and embedded qualitative interviews to prepare for a fully-powered RCT of Morita Therapy versus treatment as usual (TAU). Results. Study One: 66 papers meeting the inclusion criteria highlighted heterogeneity in the implementation of Morita Therapy, and an absence of both UK-based research and relevant unbiased RCTs. Study Two: a potentially deliverable and acceptable therapy protocol and tailored therapist training programme were developed for a UK population. Study Three: 68 participants were recruited and 94% retained at four month follow-up; 70.6% of Morita Therapy participants adhered to the minimum treatment dose, and 66.7% achieved remission in depressive symptoms (compared to 30.0% in TAU). Qualitative and mixed methods findings indicated that Morita Therapy was broadly acceptable to therapists and participants, and highlighted potential moderators of acceptability, treatment adherence and outcomes. Conclusions. Patients in the UK can accept the premise of Morita Therapy and find the approach beneficial. It is feasible to conduct a large-scale UK-based trial of Morita Therapy with minor modifications to the pilot trial protocols.

La rhétorique peut-elle et doit-elle assurer l’épiphanie d’une justice définitivement et idéalement satisfaisante, d’une justice juste ? C’est autour de cette interrogation que s’articule la présente thèse. En s’appuyant sur les réquisitoires et les plaidoiries prononcés dans les cours d’assises et en en scrutant les représentations télévisuelles, cette étude s’applique à questionner la prégnance et l’efficience de la geste oratoire dans le rituel judiciaire. Juridiction exceptionnelle dans le système judiciaire français, la cour d’assises offre en effet un terrain d’investigation particulièrement fertile pour qui s’intéresse au champ rhétorique, en même temps qu’elle contient l’essence même de la justice dans l’imaginaire collectif. Un corpus diachronique, dont les conditions de conservation et de circulation dans le social ont conditionné la constitution, est ainsi soumis à l’examen, tiraillé entre l’idéal de Vérité et son immanquable renoncement inhérent au vraisemblable. Il s’agira ensuite de questionner les métamorphoses de la parole judiciaire, ses « fuites » dans d’autres sphères et ses réinvestissements génériques. / Does rhetoric have the ability and duty to ensure the epiphany of a definitive and, ideally, fair justice? This questioning is central to the present thesis. Using defence and prosecution discourse in criminal courts and analysing its TV representations, this study endeavours to address the resonance and efficiency of oratory gesture in judicial ritual. As an exceptional jurisdiction within the French legal system, criminal courts provide rhetoric with a particularly fertile field of research. Criminal courts commonly encapsulate the essence of justice itself in the society’s collective vision of the field. A diachronic research corpus, based on the available related data and archives, is thus investigated, divided between the ideal of truth and the inevitable renouncement inherent to the plausible. This study thus questions the metamorphosis of judicial discourse, as it enters other spheres and is reinvested in other rhetorical genres.

Obesity is a major public health problem. Bariatric surgery is currently the only available treatment that offers sufficient weight-loss and metabolic benefits over time. Although bariatric surgery is considered safe now, serious complications still occur. The aim of this thesis was to identify factors associated with an increased risk for postoperative complication after laparoscopic gastric bypass surgery. Study I included patients operated with laparoscopic gastric bypass surgery in Sweden from May 2007 until September 2012. The risk for serious complication was low (3.4%). Suffering an intraoperative adverse event or conversion of the operation to open surgery were the strongest risk factors for postoperative complication. The annual operative volume and experience of the procedure at the institution were also important risk factors. Patient-specific risk factors appeared to be less important although age was associated with an increased risk. In Study II, a raised glycated haemoglobin A1c (HbA1c) was evaluated as a risk factor for serious postoperative complications in non-diabetics. A higher incidence of serious postoperative complications was seen with elevated HbA1c values, even at levels classified as ‘‘pre-diabetic’’. Study III was a multicentre, randomised clinical trial (RCT). 2507 patients planned for laparoscopic gastric bypass surgery were randomised to either mesenteric defects closure or non-closure. Closure of the mesenteric defects reduced the rate of reoperation for small bowel obstruction from 10.2% to 5.5% at 3 years after surgery. A small increase in the rate of serious postoperative complication within the first 30 days was seen with mesenteric defects closure. This relatively small increase in risk was however outweighed by the marked reduction of later reoperations for small bowel obstruction. Study IV was a comparison between study III and an observational study on the same population under the same period of time. Although the observational study reached the same conlusion as the RCT, the efficacy of mesenteric defects closure was less pronounced. Observational studies may thus be an alternative to RCTs under situations when RCTs are not feasible. The efficacy may however be underestimated.

There are no large-scale outcome studies of music therapy in secure hospital settings for people who have committed serious offences. These patients have a right to expect evidence-based multi-disciplinary treatment (Duggan et al. 2006); NICE (2010). Music therapy therefore should take a form which can be integrated into the treatment pathway. A single site implementation of a mixed-methods patient preference randomised controlled trial investigated the clinical effectiveness of a manualised music therapy model called Group Cognitive Analytic Music Therapy (G-CAMT). This context-specific, time limited intervention incorporates theories from Group Analysis (Foulkes 1964) and Cognitive Analytic Therapy (Ryle and Kerr 2003). The central research question was ‘Is G-CAMT feasible and effective for offenders in a secure multi-disciplinary treatment setting?’ The research process followed the Medical Research Council framework for developing and evaluating complex interventions (Campbell et al. 2000, 2007). Twenty patients were recruited; those expressing no preference were randomised to treatment or control arms. The two music therapists and the principal investigator were masked to their allocation status. Those in the treatment arm were allocated to one of two treatment groups of five, each run individually by one of the music therapists. Each group had sixteen ninety minute weekly sessions with followup at eight weeks. Treatment and control groups received standard care. The primary measure was the Person’s Relating to Others Questionnaire (Birtchnell and Evans 2004) Secondary measures were the Basic Empathy Scale (Jolliffe and Farrington 2006a), The Multi-Scale Dissociation Inventory (Briere, 2002) and an observational measure, the Chart of Interpersonal Reactions in Closed Living Environments (Blackburn and Glasgow, 1993). Quantitative data from these measures were examined for associations with qualitative data from semi-structured interviews administered to the music therapists and analyzed using Interpretative Phenomenological Analysis (Smith et.al. 2009) Findings from the results of the primary measure demonstrated statistically significant (Mann Whitney U: p<.05) reductions in favour of the treatment group compared to the control, in intrusive, restrictive and possessive behaviors and helpless or self-denigrating behaviours. There were improvements over time within the treatment group in the domains of sociability and hostility (Friedman Test :p<.04). The use of a manual was shown to help the music therapists manage the risk of violence without constraining their creativity. Two years after the end of the treatment 78% of treatment participants had moved to conditions of lower security over a mean period of 19 months compared with 66% of control subjects over a mean period of 25.5 months. The thesis concludes by situating G-CAMT amongst contemporary music therapy models.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A Tintura de Jalapa à um fitoterÃpico extraÃdo da planta Operculina alata (Ham) Urban conhecida popularmente como aguardente alemà e de uso bastante extenso pela populaÃÃo. Este fitoterÃpico tem aÃÃes laxativas e purgativas e pertence à famÃlia Convolvulaceae composta de 51 gÃneros com ampla distribuiÃÃo em regiÃes tropicais e subtropicais. à uma planta de uso bastante antigo no nordeste do Brasil. Este estudo teve como objetivo avaliar a seguranÃa clÃnica do extrato hidroalcoÃlico de Operculina alata em voluntÃrios com quadro de constipaÃÃo intestinal funcional. O ensaio clÃnico consistiu de um estudo randomizado, duplo-cego, placebo controlado, com 76 voluntÃrios. Foram administrados 15 mL da Tintura de Jalapa uma vez ao dia, durante sete dias consecutivos. Os voluntÃrios foram divididos em dois grupos, Jalapa e Placebo (com 38 voluntÃrios cada). Os voluntÃrios sà foram incluÃdos no estudo apÃs avaliaÃÃo clinica e laboratorial e se apÃs esta fossem considerados saudÃveis. A avaliaÃÃo laboratorial incluiu anÃlise hematolÃgica, hepÃtica e bioquÃmica. Os exames laboratoriais foram realizados nos perÃodos de prà e pÃs-estudo. Para a anÃlise estatÃstica foram realizadas comparaÃÃes nos dois grupos em cada fase do estudo (anÃlise intergrupo) como tambÃm dentro de um mesmo grupo nas duas fases do estudo (anÃlise intragrupo). Na anÃlise intergrupos, nÃo foram encontradas diferenÃas estatisticamente significativas entre os dois grupos em qualquer fase do estudo, nem na anÃlise intragrupo, houve diferenÃas estatisticamente significativas entre os perÃodos. Alguns eventos adversos foram observados em 13 (34,21%) voluntÃrios do grupo teste e 14 (36,84%) voluntÃrios no grupo do placebo. Foram relatados eventos adversos como tonturas, dor abdominal, cefalÃia, pirose, dor no peito, erupÃÃes cutÃneas, sonolÃncia, astenia, febre, obstruÃÃo nasal, nÃusea e dor epigÃstrica. Este estudo mostrou que o fitoterÃpico, Tintura de Jalapa foi bem tolerado pelos voluntÃrios. A avaliaÃÃo clÃnica e os exames laboratoriais nÃo evidenciaram sinais de toxicidade. Alguns eventos adversos foram observados com o uso da tintura de Jalapa, e classificados como possÃvel, provÃvel e nÃo atribuÃdo ao medicamento. Quanto ao grau de severidade os eventos adversos foram considerados de intensidade leve. / The Tincture Jalapa is a phytotherapic extracted from plant Operculina alata (Ham) Urban; know populary as Aguardente Alemàand extensively used by the population. This phytotherapic has laxative and purgative properties and belongs to the family of Convolvulaceae composed of 51 genders, with wide distribution in tropical and subtropical regions. It is ancient plant use in folk medicine in the Northeast of Brazil. This study aimed to evaluate the clinical safety of the acute use of hydroalcoholic extract of Operculina alata in patients with functional constipation. The clinical trial consisted in a randomized study, double blind, placebo-controlled, with 76 volunteers, who were administered an oral dose of 15 mL of tincture Jalapa for one time a day for seven consecutive days. The volunteers were divided into two groups, Jalapa and placebo (with 38 volunteers each). The volunteers were included only if considered healthy, after clinical examination and exams complementary preceding the study. The laboratory evaluation included hematological analysis, and liver biochemistry. The assessment was made during the run-in period and post-study. Comparisons were made between the two groups in each phase of the study (intergroup analysis) as well as between the two phases in the same group (intragroup analysis). In the intergroup analysis, no statistically significant differences were found between the two groups at any stage of the study, nor in the intragroup analysis, there statistically significant differences between the periods. Some adverse events were observed in 13 (34.21%) volunteers in the test group and 14 (36.84%) volunteers in the placebo group. Adverse events were found as dizziness, abdominal pain, headache, heartburn, chest pain, rash, drowsiness, asthenia, fever, nasal obstruction, nausea, epigastric pain. This study showed that this phytotherapic was well tolerated by volunteers. The clinical and laboratorial exams didnât evidenced toxicity signs. Some adverse events were observed with the use of the tincture of Jalapa, and classified as possible, probable and not be attributed to the phytomedicine. Regarding the degree of severity adverse events were of mild intensity.

O uso de álcool na gestação traz sérios riscos à saúde da mãe e do bebê. As prevalências do uso de risco de álcool entre gestantes encontradas em estudos nacionais giram em torno de 20%. Nos EUA, estudos sobre avaliação das intervenções breves têm mostrado uma na redução do uso de álcool em gestantes. O objetivo deste estudo foi elaborar um protocolo de intervenção breve (IB) para gestantes e avaliar sua eficácia na redução do consumo de álcool comparativamente ao recebimento de um folheto informativo sobre os riscos do uso de álcool na gestação. Foi realizado um ensaio clínico, cego, comparativo e prospectivo, com distribuição randômica das participantes em dois grupos (IB e folheto), com dois tempos de coleta de dados (T1 e T2). Foram recrutadas 86 gestantes em serviços de saúde de Ribeirão Preto e Araraquara com uso de risco de álcool utilizando o instrumento T-ACE (pontuação maior ou igual a dois). As gestantes eram maiores de 18 anos e possuíam até 16 semanas de gestação. Todas responderam a um questionário incluindo avaliação do padrão de uso de álcool e receberam IB ou um folheto informativo sobre os riscos do uso de álcool na gestação. Foram excluídas gestantes com diagnóstico prévio de dependência de álcool ou drogas, as que pontuaram acima de 20 no instrumento AUDIT, as que declararam uso, nos últimos três meses, de outras drogas, exceto tabaco e aquelas incapazes de compreender e fornecer informações aos pesquisadores. No segundo tempo da pesquisa (a partir da 25ª semana gestacional) compuseram a amostra 80 gestantes, sendo 39 do grupo folheto e 41 do grupo IB. As gestantes do grupo IB apresentaram menor média de doses consumidas e maior prevalência de abstinentes. Contudo, não foram observadas diferenças estatisticamente significativas entre os grupos em relação ao padrão de consumo de álcool. A avaliação intra-grupos também não detectou diferenças no padrão de consumo de álcool entre T1 e T2 seja para o grupo folheto ou para o grupo IB. Apesar disso, a autoavaliação das gestantes tanto no grupo folheto quanto no grupo IB sobre a mudança no comportamento de consumo de bebidas alcoólicas indicou uma diminuição estatisticamente significativa do consumo (Grupo folheto, Wilcoxon, Z=-2,74; p<0,01; r=0,31) (Grupo IB, Wilcoxon, Z=-4,43; p<0,001; r=0,49). / Alcohol use during pregnancy causes serious health risks to the mother and baby. National studies indicate prevalence around 20% of risky drinking by pregnant women. In the U.S., researches on evaluation of brief interventions have shown a reduction in alcohol consumption among pregnants. A prospective, blind and randomized clinical trial was developed to evaluate the efficacy of a brief intervention (BI) protocol in reducing alcohol use among pregnant women. Participants were randomized by opaque and sealed envelopes in two groups (IB and brochure), with two periods of data collection (T1 and T2). We recruited 86 risky drinking and pregnant women in health care services using T-ACE (score more than two points). Women were older than 18 years and had up to 16 weeks of gestation. All completed a questionnaire including evaluation of standard alcohol and received IB (IB group) or information leaflet about the risks of alcohol use during pregnancy (brochure group). We excluded women with (1) a previous diagnosis of alcohol or drugs dependence, (2) those scored above 20 points in AUDIT instrument, (3) those reported drugs use (except tobacco) in the past three months, and (4) those unable to understand and provide information to researchers. In T2 period (up 24 weeks gestation), 80 participants remained in the study (39 brochure group and 41 IB group). IB group presented a lower average doses consumed and a higher prevalence of abstinent. However, there were no statistically significant differences between the groups in relation to the pattern of alcohol consumption. Intra-group evaluation also did not detect differences in the pattern of alcohol consumption between T1 and T2 in both groups. Nevertheless, self-assessment of pregnant women about the change in drinking behavior indicated a statistically significant decrease of alcohol consumption in brochure group (Wilcoxon, Z= -2.74, p <0, 01, r = 0.31) and IB group (Wilcoxon, Z= -4.43, p <0.001, r = 0.49).

A hipotermia perioperatória está associada a diferentes complicações, tais como: aumento da incidência de infecção de sítio cirúrgico, arritmias cardíacas, aumento do sangramento no período intraoperatório e desconforto térmico do paciente na sala de recuperação pós-anestésica, entre outras. Na literatura há evidências de que o pré- aquecimento da superfície corporal do paciente antes da indução anestésica é efetivo para a redução da hipotermia, pela diminuição do gradiente de temperatura entre os compartimentos central e periférico do organismo humano. Assim o objetivo do estudo foi avaliar o efeito do pré-aquecimento na manutenção da temperatura corporal de pacientes submetidas a cirurgias ginecológicas eletivas. Trata-se de ensaio clínico controlado randomizado, com a participação de 86 pacientes submetidas a cirurgia ginecológica eletiva, aleatorizadas em dois grupos. Na sala de admissão do Centro Cirúrgico, as participantes do grupo experimental (n=43) foram aquecidas durante 20 minutos com o sistema de ar forçado aquecido (manta térmica para o corpo todo), o equipamento foi ligado na temperatura de 38o C, e as participantes do grupo controle (n=43) foram cobertas com lençol de algodão e cobertor, durante o mesmo tempo. No período intraoperatório, todas as pacientes foram aquecidas com o sistema de ar forçado aquecido (manta térmica para a parte superior do corpo). A temperatura timpânica foi mensurada com termômetro timpânico infravermelho nos períodos pré e intraoperatório. A partir da entrada da paciente na sala de operação, a temperatura e umidade do ar da sala cirúrgica foram mensuradas. As médias da temperatura e umidade do ar da sala cirúrgica, entre os grupos experimental e controle, foram analisadas por meio do teste t- Student. As médias da temperatura corporal, entre os grupos experimental e controle, foram analisadas por meio de modelo linear de regressão de efeitos mistos. Na análise descritiva dos dados relativos às características sociodemográficas e clínicas das pacientes e do procedimento anestésico-cirúrgico, evidenciou-se similaridade entre os grupos experimental e controle. Após o pré-aquecimento, a média da temperatura corporal foi de 38o C no grupo experimental e de 37,8o C no grupo controle, com diferença estatisticamente não significante (p=0,27). No T150 (150 minutos após o início da cirurgia), houve diferença estatisticamente significante entre os grupos (p=0,01). No final da cirurgia, a temperatura média dos grupos estudados foi igual, ou seja, 36,8o C, com diferença estatisticamente não significante (p=0,66). Os resultados da média da temperatura da sala de operação, nos diferentes períodos mensurados, não apresentaram diferença estatisticamente significante entre os grupos estudados. Em relação à umidade do ar da sala de operação, somente no período T120 (120 minutos após o início da cirurgia), os resultados evidenciaram diferença estatisticamente significante entre os grupos (p=0,03). O pré-aquecimento com o sistema de ar forçado aquecido não teve efeito na temperatura corporal de pacientes submetidas a cirurgias ginecológicas eletivas / Perioperative hypothermia is associated with various complications, such as an increased incidence of surgical site infection, cardiac arrhythmias, increased bleeding in the intraoperative period, and thermal discomfort of the patient in the post- anesthetic recovery room, among others. In the literature there is evidence that prewarming the body surface of the patient prior to induction of anesthesia is effective in reducing hypothermia, by lowering the temperature gradient between the central and peripheral compartments of the human organism. Thus, the objective of the present study was to evaluate the effects of prewarming on maintaining the body temperature of patients undergoing elective gynecological surgery. This is a randomized controlled clinical trial involving 86 patients undergoing elective gynecological surgery, randomized into two groups. In the admission room of the Surgical Center, participants in the experimental group (n=43) were warmed for 20 minutes using the forced air heating system (thermal blanket over the whole body), the equipment was turned on at a temperature of 38o C, and the control group (n = 43) were covered with a cotton sheet and blanket for the same period. During the intraoperative period, all patients were warmed using the forced air heating system (thermal blanket for the upper body). The tympanic temperature was measured using an infrared tympanic thermometer in the pre- and intraoperative periods. From the moment of each patient\'s entry into the operating room, the temperature and humidity of the air in the room were measured. The mean temperatures and humidity levels of the operating room, between the experimental and control groups, were analyzed using the Student t-test. The mean body temperatures between the experimental and control groups were analyzed using a linear mixed effects regression model. The descriptive analysis of data on the sociodemographic and clinical characteristics of the patients and the surgical anesthetic procedure demonstrated similarity between the experimental and control groups. After prewarming, the mean body temperature was 38o C in the experimental group and 37.8ºC in the control group, with no statistically significant difference (p = 0.27). At T150 (150 minutes after the start of surgery) there was no statistically significant difference between the groups (p = 0.01). At the end of surgery, the mean temperature of the studied groups was the same, i.e., 36.8o C, with no statistically significant difference between the groups (p = 0.66). The results of the mean operating room temperatures, in the different periods measured, presented no statistically significant differences between groups. In relation to the humidity of the operating room, the results demonstrated a statistically significant difference between groups (p = 0.03) only in the period T120 (120 minutes after the start of surgery). Prewarming with the forced air heating system had no effect on body temperature of patients undergoing elective gynecological surgery