Resumo em Português:

Resumo Objetivos: avaliar resultados gestacionais de pacientes diagnosticadas com câncer na gestação comparados com gestantes sem câncer. Métodos: foi realizada uma revisão sistemática com meta-análise, incluindo estudos em bancos de dados PubMed, Lilacs, SciELO e Cochrane, publicações entre 2019 e 2024 com artigos em português, inglês ou espanhol que continham grupo controle. A busca utilizou descritores combinados pelos operadores booleanos AND e OR, abrangendo os termos relacionados a gestação e neoplasias. Foram excluídos artigos não recuperados, relatos ou série de casos ou comentários de especialistas. O protocolo foi registrado no banco de dados PROSPERO sob número CRD42024534208. O risco de viés de cada estudo foi avaliado pelas diretrizes ROBINS-I, e os resultados foram apresentados de forma descritiva. Resultados: foram incluídos 9 estudos observacionais, com um total de 13.316 gestantes com câncer. Os riscos de viés de confusão e seleção foram altos. Os resultados mostraram maior risco de morte materna (OR=82,11; IC95%=20,27-332,69), transfusão sanguínea materna (OR=4,45; IC95%=3,48-5,68) e cesariana (OR=1,96; IC95%= 1,61-2,38). Conclusão: mulheres com câncer associado à gestação apresentam maior morbimortalidade materna. Devido à heterogeneidade dos estudos e alto risco de viés, os achados devem ser interpretados com cautela. Cuidados multidisciplinares e pesquisas mais robustas são necessários.

Resumo em Inglês:

Abstract Objectives: to evaluate outcomes in pregnant patients diagnosed with cancer compared to pregnant women without cancer. Methods: a systematic review with meta-analysis was conducted, including studies from PubMed, Lilacs, Scielo, and Cochrane databases, published between 2019 and 2024, in Portuguese, English, or Spanish, and containing a control group. The search used descriptors combined with the Boolean operators AND and OR, covering terms related to pregnancy and neoplasms. Unretrievable articles, case reports, case series, or expert commentaries were excluded. The study protocol was registered in the PROSPERO database with the number CRD42024534208. Risk of bias for each study was assessed using the ROBINS-I guidelines, and results were presented descriptively. Results: Nine observational studies were included, a total of 13,316 pregnant women with cancer. The risk of confounding and selection bias was high. Findings showed an increased risk of maternal death (OR=82.11; 95%CI=20.27-332.69), maternal blood transfusion (OR=4.45; 95%CI=3.48-5.68), and cesarean (OR=1.96; 95%CI= 1.61-2.38). Conclusion: pregnant women with cancer have increased maternal morbidity and mortality. Due to study heterogeneity and high risk of bias, these findings should be interpreted with caution. Multidisciplinary care and more robust research are necessary.

Resumo em Português:

Resumo Objetivos: analisar a efetividade da acupuntura e da laserterapia, associadas ou não, no suporte e apoio à amamentação, incluindo seus efeitos na dor e cicatrização. Métodos: foi realizada uma revisão sistemática nas bases Pubmed, LILACS, IBECS e BDENF, através da Biblioteca Virtual em Saúde (BVS), e Scielo utilizando descritores orientados pela metodologia Prisma, sendo incluídos artigos que avaliaram a acupuntura e/ou terapia de luz de baixa intensidade no suporte à amamentação. Resultados: os artigos encontrados tiveram como desfechos a diminuição da dor mamária em sintomas inflamatórios, ingurgitamento mamário, produção de leite e taxa de aleitamento materno exclusivo. A acupuntura foi analisada na aplicação por agulhas, Gua-sha e Tuiná. O uso da Laserterapia de Baixa Intensidade Focal (LLLT) obteve redução da dor em dois ensaios clínicos. Um estudo não encontrou diferença entre laserterapia e grupo controle na redução de dor em mulheres com lesões mamilares após única aplicação local. Conclusões: os resultados desta revisão indicam evidência limitada e heterogênea de redução da dor mamária e para o apoio à amamentação. Esses achados embasam-se em poucos ensaios clínicos, com amostras reduzidas, intervenções e protocolos distintos, o que impede, por sua vez, inferências robustas ou recomendações clínicas. Estudos adicionais, com expresso rigor metodológico e padronização das intervenções, são cruciais para com o esclarecimento do papel dessas terapias no contexto da amamentação.

Resumo em Inglês:

Abstract Objectives: to analyze the effectiveness of acupuncture and laser therapy, either alone or in combination, in supporting and promoting breastfeeding, including their effects on pain reduction and wound healing. Methods: a systematic review was conducted using the PubMed, LILACS, IBECS, and BDENF databases through the Virtual Health Library (VHL), as well as SciELO. Search descriptors were guided by the PRISMA methodology. Studies evaluating acupuncture and/or low-level laser therapy in the context of breastfeeding support were included. Results: The reviewed studies assessed outcomes such as the reduction of breast pain associated with inflammatory symptoms, breast engorgement, milk production, and exclusive breastfeeding rates. Acupuncture was evaluated using different techniques, including needle acupuncture, Gua Sha, and Tuina. Low-Level Laser Therapy (LLLT) led to pain reduction in two clinical trials. However, one study found no difference between laser therapy and the control group regarding pain reduction in women with nipple trauma after a single local application. Conclusions: the findings of this review indicate limited and heterogeneous evidence regarding breast pain reduction and breastfeeding support. Current evidence relies on a small number of clinical trials with small sample sizes, heterogeneous interventions, and distinct protocols, which precludes robust inferences or clinical recommendations. Further studies with rigorous methodological designs and standardized interventions are essential to clarify the role of these therapies in the clinical breastfeeding practice.

Resumo em Português:

Resumo Objetivos: identificar características epidemiológicas dos óbitos maternos associados à COVID-19 no estado de São Paulo entre 2020 e 2022. Métodos: estudo transversal com dados secundários do Sistema de Informação sobre Mortalidade. Foram analisados 854 óbitos maternos, classificados segundo a presença (n=288) ou ausência (n=566) de COVID-19. Comparou-se variáveis sociodemográficas, momento do óbito e causas associadas. Estimaram-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) por regressão de Poisson com variância robusta. Resultados: o coeficiente de mortalidade materna atingiu 65,7 por 100.000 nascidos vivos em 2021, comparado a valores em torno de 43,5 no período pré-pandêmico. Entre os óbitos por COVID-19, 82,2% ocorreram no puerpério (RP=2,14; IC95%=1,64-2,80). Observou-se maior prevalência entre mulheres com ≥12 anos de escolaridade (RP=1,57; IC95%=1,11-2,22) e com companheiro (RP=1,39; IC95%=1,14-1,69). A maioria dos óbitos por COVID-19 não apresentou causas obstétricas associadas (RP=0,33; IC95%=0,25-0,44), porém a diabetes gestacional mostrou-se fator agravante (RP=1,51; IC95%=1,06-2,10). Conclusão: a pandemia elevou significativamente a mortalidade materna no estado, com maior impacto no puerpério e entre mulheres com maior escolaridade e com companheiro, reforçando a necessidade de vigilância qualificada no período pós-parto.

Resumo em Inglês:

Abstract Objectives: to identify the epidemiological characteristics of maternal deaths associated with COVID-19 in the state of São Paulo, Brazil, between 2020 and 2022. Methods: a cross-sectional study was conducted using secondary data from the Mortality Information System. A total of 854 maternal deaths were analyzed and classified according to the presence (n=288) or absence (n=566) of COVID-19. Sociodemographic characteristics, timing of death and associated causes were compared. Prevalence ratios (PRs) and 95% confidence intervals (95% CI) were estimated using Poisson regression with robust variance. Results: the maternal mortality ratio peaked at 65.7 per 100,000 live births in 2021, compared to approximately 43.5 during the pre-pandemic period. Among COVID-19-related maternal deaths, 82.2% occurred during the postpartum period (PR=2.14; 95%CI=1.64-2.80). Higher prevalence was observed among women with ≥12 years of formal education (PR=1.57; 95%CI=1.11-2.22) and those with a partner (PR=1.39; 95%CI=1.14-1.69). Most COVID-19-related deaths had no associated obstetric causes (PR=0.33; 95%CI=0.25-0.44); however, gestational diabetes was an aggravating factor (PR=1.51; 95%CI=1.06-2.10). Conclusion: COVID-19 pandemic significantly increased maternal mortality, with greater impact during the postpartum period, underscoring the need for enhanced postpartum surveillance.

Resumo em Português:

Resumo Objetivos: avaliar as mudanças no cuidado do câncer de mama entre mulheres atendidas em um hospital público na Paraíba, Brasil, durante a pandemia de COVID-19. Métodos: coorte retrospectiva com usuárias do SUS atendidas no Hospital Napoleão Laureano (PB), diagnosticadas com carcinoma ductal in situ ou invasivo, nos períodos pré-pandêmico (2017–2018) e pandêmico (2020). Foram coletados dados sociodemográficos, clínicos e assistenciais. As diferenças entre períodos foram avaliadas por qui-quadrado, teste exato de Fisher para variáveis categóricas e t de Student ou Mann-Whitney, para variáveis contínuas (p<0,05). Resultados: entre 218 pacientes incluídas, 114 foram tratadas antes e 104 durante a pandemia. A maioria dos casos apresentava tumores palpáveis e carcinoma invasivo. A mastectomia foi o procedimento predominante, com reconstrução imediata em 24,8% das pacientes. O intervalo entre o diagnóstico histopatológico e a primeira consulta com especialista aumentou durante a pandemia (p=0.04), e menos mulheres de fora da capital conseguiram acessar o serviço (RR=0.63; IC95%= 0,4–0,9; p=0.01). Houve também maior atraso nas consultas e abandono do tratamento durante a pandemia, enquanto a reconstrução mamária imediata diminuiu. Conclusão: a pandemia prejudicou o cuidado ao câncer de mama, aumentando atrasos, interrupções no tratamento e reduzindo as reconstruções imediatas. Achados evidenciam a vulnerabilidade das pacientes dependentes dos serviços públicos de saúde durante crises sanitárias.

Resumo em Inglês:

Abstract Objectives: to evaluate changes in breast cancer care among women assisted at a public hospital in Paraíba, Brazil, during the COVID-19 pandemic. Methods: retrospective cohort of women using the Sistema Único de Saúde (SUS) (Brazilian Public Health Service) at Hospital Napoleão Laureano (PB), and were diagnosed with in situ or invasive ductal carcinoma in the pre-pandemic (2017–2018) and pandemic (2020) periods. Sociodemographic, clinical and care-related data were collected. Differences between periods were assessed using chi-square or Fisher’s exact test for categorical variables and Student’s t or Mann-Whitney tests, for continuous variables (p<0.05). Results: among 218 women included, 114 were treated before the pandemic and 104 during. Most cases were palpable tumors and invasive carcinoma. Mastectomy was the predominant procedure, with immediate reconstruction in 24.8%. The interval between histopathological diagnosis and the first consultation with a specialist increased during the pandemic (p=0.04), and few women outside the capital could access the service (RR=0.63; 95%CI= 0.4–0.9; p=0.01). Delays on the appointment and abandonment of treatment were also higher during the pandemic, whereas immediate breast reconstruction decreased. Conclusion: the pandemic hindered breast cancer care, increasing delays, interruptions of treatment, and reducing immediate reconstructions. These findings highlight the vulnerability of patients dependent of the public health services during health crises.

Resumo em Inglês:

Abstract Objectives: to develop and conduct a pilot test of a risk detection instrument for sexual domestic violence among schoolchildren aged 9 to 11 years, entitled the Risk Detection Instrument – Sexual Domestic Violence (IDR-VSD). Methods: this is a mixed method study conducted between January 2019 and December 2022, following the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. The qualitative phase included a consensus technique with nine interprofessional experts and cognitive interviews with the target population, including schoolchildren with impairment. A pilot test was conducted with 109 participants, and internal consistency, reliability, and factor structure were analyzed. Results: the initial version comprised 22 items with playful elements, distributed across four dimensions (biological, psycho-relational, social, and ecological). The intraclass correlation coefficient was 0.602 (95%CI=0.48–0.70; p<0.001). The overall Cronbach’s alpha was 0.602. After correcting the item–total correlations, the overall alpha increased to 0.654 for 18 items. One item with a measure of sampling adequacy below 0.50 was removed. Exploratory factor analysis was performed with 17 items, distributed across five factors that explained 53.76% of the total cumulative variance, in accordance with the theoretical model. Conclusion: the IDR-VSD demonstrates favorable measures of reliability and factor structure, despite the complexity of the studied phenomenon.

Resumo em Inglês:

Abstract Objectives: to evaluate pregnant women’s knowledge on oral health and its association with sociodemographic characteristics. Methods: this exploratory cross-sectional study included a convenience sample of 69 women attended at a prenatal referral outpatient clinic in a Brazilian city. Data were collected using an oral health questionnaire adapted from Bianco (2010); higher scores indicated better knowledge. The outcome “knowledge on oral health “ was dichotomized at the sample mean (less/more). Sociodemographic and oral health–related variables were obtained from the questionnaire, and associations were tested using Pearson’s chi-square/Fisher’s exact tests (α=0.05). Results: most participants who were unemployed, had completed secondary education, and had low family income; 50.7% had less knowledge on oral health. Lower scores involved primary and permanent dentition, tooth eruption and exfoliation, and causes of dental caries, halitosis, and oral cancer. In bivariate analyses, women with lower family income and lower schooling were more frequently classified as having lower knowledge on oral health, whereas employed women were more frequently classified as having higher knowledge. Conclusion: pregnant women showed limited knowledge on oral health, especially among those in socioeconomically more vulnerable groups. Given the cross-sectional design and the use of an unvalidated instrument for pregnant women, findings should be interpreted cautiously and may inform educational strategies in similar services.

Resumo em Português:

Resumo A pediatria no século XXI atravessa um período de profundas transformações, impulsionadas por avanços científicos, tecnológicos e mudanças sociais. A expressiva redução da mortalidade infantil, especialmente por meio dos progressos da neonatologia, das imunizações e do cuidado humanizado, modificou de forma significativa o perfil epidemiológico da infância. Paralelamente, observa-se o aumento das doenças crônicas, dos transtornos do neurodesenvolvimento e das afecções mentais, reforçando a importância do cuidado integral e precoce da criança, conforme os princípios das Origens Desenvolvimentistas da Saúde e da Doença (DOHaD). A incorporação da genética e da medicina de precisão permitiu maior acurácia diagnóstica, especialmente em doenças raras, ao passo que terapias gênicas e alvo-moleculares abriram novas perspectivas terapêuticas. Tecnologias digitais, como a telepediatria e a inteligência artificial, passaram a apoiar decisões clínicas, ampliar o acesso e otimizar a gestão em saúde infantil. Contudo, esses avanços impõem desafios éticos e ampliam o debate sobre equidade no acesso a tecnologias de alto custo. Entre os principais desafios contemporâneos destacam-se a obesidade infantil, a hesitação vacinal, o impacto das mudanças climáticas, a vulnerabilidade social e o aumento do sofrimento psíquico em crianças e adolescentes. As perspectivas para as próximas décadas apontam para uma pediatria mais preditiva, preventiva e personalizada, centrada nos primeiros mil dias de vida, na integração com políticas públicas e na preservação da relação médico-criança-família como eixo fundamental do cuidado.

Resumo em Inglês:

Abstract A Pediatrics in the 21st century is traversing a period of profound transformation, driven by scientific breakthroughs, technological innovation, and shifting social dynamic. The significant reduction in infant mortality - driven primarily by progress in neonatology, immunization, and humanized care - has fundamentally altered the epidemiological profile of childhood. Concurrently, there is a rising prevalence of chronic diseases, neurodevelopmental disorders, and mental health conditions, reinforcing the importance of comprehensive and early childhood care, aligned with the principles of the Developmental Origins of Health and Disease (DOHaD). The integration of genetics and precision medicine has enhanced diagnostic accuracy, particularly for rare diseases, while gene and molecular-targeted therapies have opened new therapeutic horizons. Digital technologies, such as telepediatrics and artificial intelligence, now support clinical decision-making, expand access, and optimize pediatric health management. However, these advances pose ethical challenges and intensify the debate on equitable access to high-cost technologies. Key contemporary challenges include childhood obesity, vaccine hesitancy, the impact of climate change, social vulnerability, and the escalating psychological distress among children and adolescents. Perspectives for the coming decades point toward a more predictive, preventive, and personalized pediatrics, centered on the first thousand days of life, integration with public policies, and the preservation of the physician-child-family relationship as the fundamental axis of care.

Resumo em Português:

Resumo A violência obstétrica é um problema antigo revestido de um termo relativamente novo - e é precisamente o termo que incomoda. Em 2014, a Organização Mundial da Saúde reconheceu que mulheres em todo o mundo sofrem tratamento desrespeitoso e abusivo durante o parto. Desde então, o reconhecimento internacional do conceito avançou de forma inequívoca: a Inter-American Court of Human Rights reconheceu explicitamente o conceito em sua jurisprudência (2022), a Parliamentary Assembly of the Council of Europe o classificou como violência de gênero (2019) e o European Parliament’s Committee on Women’s Rights o reconheceu como violência institucional e de gênero em 2024, enquanto a produção acadêmica global sobre o tema cresceu de forma expressiva. No Brasil, entretanto, o cenário caminha na direção oposta. Dados da pesquisa Nascer no Brasil II revelam prevalência de 65,3% de violência obstétrica no estado do Rio de Janeiro. Enquanto a Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), Associação Médica Brasileira (AMB) e Conselho Federal de Medicina (CFM) unem-se publicamente para rejeitar o termo e combater projetos de lei que buscam tipificá-la como crime. Este artigo reflete sobre a importância de nomear a violência obstétrica, analisa os avanços internacionais e o retrocesso brasileiro, e defende que silenciar o nome não apaga a violência - apenas protege quem a perpetua.

Resumo em Inglês:

Abstract Obstetric violence is an old problem wrapped in a relatively new term - and it is precisely the term that is troubling. In 2014, the World Health Organization acknowledged that worldwide women experience disrespectful and abusive treatment during childbirth. Since then, international recognition of the concept has advanced unequivocally: the Inter-American Court of Human Rights explicitly recognized the concept in its jurisprudence (2022), the Parliamentary Assembly of the Council of Europe classified it as gender-based violence (2019), and the European Parliament’s Committee on Women’s Rights recognized it as institutional and gender-based violence in 2024, while global academic production on the topic has grown markedly. However, in Brazil, the scenario moves to the opposite direction. Data from the Nascer no Brasil II (Born in Brazil II) survey reveal a 65.3% prevalence of obstetric violence in the State of Rio de Janeiro, while the Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo) (Brazilian Federation of Gynecology and Obstetrics Associations), the Associação Médica Brasileira (AMB) (Brazilian Medical Association), and the Conselho Federal de Medicina (CFM) (Federal Council of Medicine) have publicly united to reject the term and to oppose legislative initiatives aimed to classify it as a crime. This article reflects on the importance of naming obstetric violence, analyzes international advances and the Brazilian setback, and defends that silencing the name does not erase the violence - it merely protects those who perpetuate it.

Resumo em Inglês:

Abstract Cervical cancer remains a significant public health challenge in Brazil, characterized by pronounced regional disparities in both incidence and mortality rates. For several decades, the country has predominantly relied on opportunistic cervical cytology (Pap smears) for cervical cancer screening. While cytology-based screening served as a cornerstone of preventive measures, its effectiveness has been hindered by limited coverage, opportunistic administration, and deficiencies in follow-up protocols. Brazil is now undergoing a transition towards primary HPV DNA testing, commencing at age 25, in accordance with international guidelines. This perspective article critically examines the potential implications of this transition for cervical cancer prevention over the next 25 years. Evidence suggests that HPV testing provides enhanced sensitivity, facilitates earlier detection of precancerous lesions, and enables the implementation of organized, population-based screening programs. However, challenges persist, including the risk of over-referral among younger women, existing health system inequalities, and the necessity for rigorous quality assurance and follow-up mechanisms. If successfully implemented, the new strategy could enable the detection of high-grade lesions up to a decade earlier, increase screening coverage, and reduce mortality rates, particularly in underserved regions. Nevertheless, the success of this initiative will depend on sustained financial investment, integration with vaccination efforts, and the assurance of equitable access to screening services.