A androfobia na educação infantil

O presente estudo objetivou constatar a existência do preconceito sofrido por homens que atuam na educação infantil, bem como esclarecer a gênese desse comportamento humano, com base na análise e interpretação de dados e informações coletadas no decorrer da pesquisa. A pesquisa se justifica por investigar a procedência desse preconceito que atinge a educação infantil, para que então se busquem soluções que amenizem esse fenômeno social. Busca-se descobrir e conhecer quais os motivos que levam a tal comportamento que permeia a sociedade. A pesquisa apresentou abordagem qualitativa, depoimentos de pais e responsáveis no momento em que deixavam seus filhos aos cuidados da figura masculina no ambiente educativo. Além disso, foram realizadas entrevistas abertas com docentes do sexo masculino que atuam ou atuaram em diferentes instituições. Os indivíduos em questão trabalham na rede municipal de ensino, mais precisamente nos CIEIs (Centro Integrado de Educação Infantil) no município de Maracaju/MS onde atuam como professores graduados em Pedagogia ou assistentes pedagógicos. O referencial teórico teve como foco, a pesquisa sobre a atuação masculina na educação de crianças ao longo da história, bem como o possível preconceito sofrido. A pesquisaapresentou como base de interlocução, autores como Sayão (2000), Oriani (1999), Sarat (2001), Almeida (2002), entre outros. Os principais resultados mostram que o preconceito em relação a atuação masculina na educação infantil, ficou evidenciado em todas as entrevistas realizadas. Os três docentes entrevistados afirmaram ter sofrido preconceito ao serem proibidos pelos pais de tocar ou dar banho nas crianças, ou ainda quando são considerados incapazes de cuidar de uma criança. Evidenciando ainda que essas instituições não são locais de trabalho apropriadas para homens, ou ainda por entenderem que um homem mesmo tendo formação, não consegue cuidar de crianças da mesma maneira como uma mulher.  Os limites encontrados referem-se a carência de produções bibliográficas referentes ao tema da pesquisa. A pesquisa demonstrou que é essencial realizar palestras/projetos com a sociedade em geral, mostrando a ela que, a educação infantil tem muito a ganhar com a atuação masculina, afinal, as crianças não dependem somente dos cuidados maternos, mas também da atenção de profissionais preocupados com os seus cuidados e sua aprendizagem efetiva.Palavras-chave: Educação infantil. Homem. Preconceito

Blunt hepatic trauma: comparison between surgical and nonoperative treatment

OBJECTIVE: To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. METHODS: This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. RESULTS: In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. CONCLUSION: A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.OBJETIVO: Analisar a evolução do trauma hepático fechado e comparar o tratamento operatório e não operatório em pacientes admitidos com estabilidade hemodinâmica e nenhuma indicação óbvia de laparotomia. MÉTODOS: Estudo retrospectivo de casos admitidos em um hospital universitário entre 2000 e 2010. Os pacientes submetidos ao tratamento operatório foram distribuídos em dois grupos: a) todos os pacientes submetidos ao tratamento cirúrgico e b) pacientes sem indicações óbvias de laparotomia. RESULTADOS: Neste período, 120 pacientes foram admitidos com trauma hepático fechado. Sessenta e cinco pacientes (54,1%) foram submetidos ao tratamento não operatório e 55 pacientes foram operados. Pacientes submetidos ao tratamento não operatório tiveram melhores parâmetros fisiológicos na admissão, menor gravidade de lesões (exceto pelo grau de lesão hepática), menor necessidade de transfusão sanguínea e menor morbidade e mortalidade quando comparados aos pacientes operados. Os pacientes operados sem indicação óbvia de cirurgia tiveram maiores taxas de complicações e mortalidade do que os pacientes submetidos ao tratamento não operatório. CONCLUSÃO: O tratamento não operatório resultou em menor taxa de complicações, menor necessidade de transfusão sanguínea e menor mortalidade.30731

Serology of Paracoccidioidomycosis Due to Paracoccidioides lutzii

Paracoccidioides lutzii is a new agent of paracoccidioidomycosis (PCM) and has its epicenter localized to the Central-West region of Brazil. Serological diagnosis of PCM caused by P. lutzii has not been established. This study aimed to develop new antigenic preparations from P. lutzii and to apply them in serological techniques to improve the diagnosis of PCM due to P. lutzii. Paracoccidioides lutzii exoantigens, cell free antigen (CFA), and a TCA-precipitated antigen were evaluated in immunodiffusion (ID) tests using a total of 89 patient sera from the Central-West region of Brazil. Seventy-two sera were defined as reactive for P. brasiliensis using traditional antigens (AgPbB339 and gp43). Non-reactive sera for traditional antigens (n = 17) were tested with different P. lutzii preparations and P. lutzii CFA showed 100% reactivity. ELISA was found to be a very useful test to titer anti-P. lutzii antibodies using P. lutzii-CFA preparations. Sera from patients with PCM due to P. lutzii presented with higher antibody titers than PCM due to P. brasiliensis and heterologous sera. in western blot, sera from patients with PCM due to P. lutzii were able to recognize antigenic molecules from the P. lutzii-CFA antigen, but sera from patients with PCM due to P. brasiliensis could not recognize any P. lutzii molecules. Due to the facility of preparing P. lutzii CFA antigens we recommend its use in immunodiffusion tests for the diagnosis of PCM due to P. lutzii. ELISA and western blot can be used as complementary tests.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Microbiol Imunol & Parasitol, Disciplina Biol Celular, São Paulo, BrazilUniv Fed Mato Grosso do Sul UFMS, Fac Med FAMED, Campo Grande, MS, BrazilUniv Fed Mato Grosso UFMT, Nucleo Doencas Infecciosas & Trop, Cuiaba, Mato Grosso, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Microbiol Imunol & Parasitol, Disciplina Biol Celular, São Paulo, BrazilFAPESP: 2012/06593-0FAPESP: 2009/54024-2Web of Scienc

Blunt Hepatic Trauma: Comparison Between Surgical And Nonoperative Treatment.

To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.39307-1

IMPACTOS DO APOIO FAMILIAR FRENTE A GESTAÇÃO NA ADOLESCÊNCIA

OBJECTIVES:  To elucidate the impacts caused by family support during adolescent pregnancy. METHODS: The present work consists of an integrative literature review, using the PICO strategy, with “p” population: pregnant adolescents, “I” Evaluation of the influence of family support through a teenage pregnancy, the “C” and “O” Context: impact of family support during the pregnancy of a teenager. The filter used for the searches was with the descriptors; (Teenage pregnancy) AND (Family Support) AND (Prenatal care). RESULTS: The final sample consisted of 7 studies that resulted in three topics for discussion: Failures in the professional approach during prenatal care; Importance of professional encouragement for the presence of the support network during prenatal consultations; Adolescents' feelings and difficulties due to the absence of family support. CONCLUSION:It was possible to conclude that family support has a great influence on the care of the adolescent during pregnancy, being a source of emotional and financial support, as well as in daily activities, taking into account the need for this family to be aware of the care that the pregnant women need to take to continue the pregnancy in the healthiest way possible.OBJETIVO: Elucidar os impactos causados pelo apoio familiar durante a gestação da adolescente. MÉTODO: O presente trabalho consiste em uma revisão de literatura integrativa, utilizada a estratégia PICO, sendo “p” população: adolescentes gestantes ,“I” Avaliação da influência do apoio familiar mediante uma gestação na adolescência, o “C” e “O” Contexto: impacto do apoio familiar durante a gestação de uma adolescente. O filtro utilizado para as buscas foram com os descritores; (Gravidez na adolescência) AND (Apoio Familiar ) AND (Cuidado pré-natal). RESULTADOS: A amostra final foi constituída por 7 estudos que resultaram em dois tópicos para discussão: Falhas na abordagem profissional durante a atenção pré-natal; Sentimentos e dificuldade das adolescentes mediante a ausência do apoio familiar. CONCLUSÃO: Foi possível concluir que o apoio familiar tem uma grande influência no cuidado da adolescente no momento da gestação, sendo uma fonte de apoio emocional, financeira, tal qual nas atividades diárias, levando em consideração a necessidade desta família estar ciente dos cuidados que a gestante precisa tomar para dá continuidade a gestação da forma mais saudável possível

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe