Prevalence of depression and associated factors in women covered by Family Health Strategy

Objective To assess the prevalence of depression and its associated factors in women aged 20 to 59 years at some areas with the coverage of Family Health Strategy in a city located at Zona da Mata Mineira. Methods It is a cross-sectional study with women aged 20-59 enrolled in two Primary Health Care Units making use of a questionnaire containing socio-demographic variables, social support, self-assessment of general health status, lifestyle, morbidity and women’s health. Depression was evaluated according to Patients Health Questionnaire-9 (PHQ-9). Results From 1,958 women included in this analysis, 28,5% are aged 30-39; 15,4% did not finish High School; 54,5% do not work or have never worked and 44,2% defined themselves as not white. Factors associated with depression episodes in the population studied: lower educational background, currently having a job, previous diagnosis of psychiatric disorders. Protective factors which were observed: being married or living with a partner, practicing physical activities in a regular basis and reporting positive self-assessed health. Conclusion The results of this study reveal a prevalence of depression of 19.7% in women aged 20 to 59 years covered by the Family Health Strategy, pointing to the need for special care in primary health care for women with low schooling, who work, have mental illness, and do not exercise so that they can reduce suffering and promote health. It was observed a significant gap related to managing specific tools designed to screening depressive episodes in primary care.Objetivo Avaliar a prevalência de depressão e os fatores associados em mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família de município da Zona da Mata Mineira. Métodos Trata-se de um estudo transversal, com mulheres de 20 a 59 anos cadastradas em duas Unidades de Saúde da Família, que utilizou um questionário contendo variáveis sociodemográficas, apoio social, autoavaliação de estado de saúde, estilo de vida, morbidade e saúde da mulher. O desfecho depressão foi avaliado segundo o Patients Health Questionnaire-9 (PHQ-9). Resultados Das 1.958 mulheres incluídas nesta análise, 28,5% encontram-se na faixa etária entre 30 e 39 anos; 15,4% não concluíram o ensino elementar; 54,5% não trabalham ou nunca trabalharam; 44,2% declararam não ser da raça branca. Fatores associados à ocorrência de depressão na população estudada: possuir baixa escolaridade, trabalhar atualmente e ter doença mental prévia. Como fatores de proteção observaram-se: ser casada ou viver com companheiro, realizar atividades físicas regularmente e relatar autoavaliação positiva de saúde. Conclusão Os resultados deste estudo revelam prevalência de depressão de 19,7% nas mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família, apontando para a necessidade de um cuidado especial na atenção primária à saúde às mulheres com baixa escolaridade, que trabalham, apresentam doença mental e não praticam exercícios físicos, de modo que se possa reduzir o sofrimento e promover a saúde. Ressalta-se a lacuna na utilização de instrumentos de rastreamento dos casos de depressão na atenção primária

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Jeca Tatu, Macunaíma, laziness and Brazilianism

Esta tese se dedica ao estudo de dois personagens de destaque na literatura brasileira, Jeca Tatu, personagem que surge nos primeiros artigos publicados por Monteiro Lobato em 1914 em O Estado de S. Paulo e o acompanha durante toda sua trajetória como escritor, e Macunaíma, protagonista do romance homônimo publicado por Mário de Andrade em 1928. Cada um a seu modo, os dois autores buscam apresentar um retrato da essência brasileira por meio da construção desses personagens, dando relevo a uma característica em comum: a preguiça. O principal objetivo deste trabalho é rastrear a criação desses dois ícones da brasilidade, analisando as circunstâncias histórico-culturais em meio às quais eles foram gestados e buscando captar em que medida e por que ambos os autores colocam a preguiça no coração dos personagens, como elemento central do seu comportamento.This work presents a study about two well-known Brazilian literary characters, Jeca Tatu, which appears in Monteiro Lobato\'s first texts, published in 1914 in O Estado de S. Paulo, and will be an ongoing character until his death, and Macunaíma, main character of the homonym novel published by Mário de Andrade in 1928. In different ways, the two writers aim to present a portrait of brazilian cultural essence through these literary characters, emphasizing a shared characteristic: the laziness. The main purpose of this work is trying to trace the conception of these both characters, analyzing their historical and cultural contexts and searching for the reasons for laziness being chosen as one of main characteristics of both Jeca Tatu and Macunaíma

Jeca Tatu, Macunaíma, laziness and Brazilianism

Esta tese se dedica ao estudo de dois personagens de destaque na literatura brasileira, Jeca Tatu, personagem que surge nos primeiros artigos publicados por Monteiro Lobato em 1914 em O Estado de S. Paulo e o acompanha durante toda sua trajetória como escritor, e Macunaíma, protagonista do romance homônimo publicado por Mário de Andrade em 1928. Cada um a seu modo, os dois autores buscam apresentar um retrato da essência brasileira por meio da construção desses personagens, dando relevo a uma característica em comum: a preguiça. O principal objetivo deste trabalho é rastrear a criação desses dois ícones da brasilidade, analisando as circunstâncias histórico-culturais em meio às quais eles foram gestados e buscando captar em que medida e por que ambos os autores colocam a preguiça no coração dos personagens, como elemento central do seu comportamento.This work presents a study about two well-known Brazilian literary characters, Jeca Tatu, which appears in Monteiro Lobato\'s first texts, published in 1914 in O Estado de S. Paulo, and will be an ongoing character until his death, and Macunaíma, main character of the homonym novel published by Mário de Andrade in 1928. In different ways, the two writers aim to present a portrait of brazilian cultural essence through these literary characters, emphasizing a shared characteristic: the laziness. The main purpose of this work is trying to trace the conception of these both characters, analyzing their historical and cultural contexts and searching for the reasons for laziness being chosen as one of main characteristics of both Jeca Tatu and Macunaíma

Qualidade de vida no trabalho da enfermagem: segurança, saúde e motivação

Nursing activities culminate in a final objective, which is the patient's health and recovery. Motivation for work will depend on health and safety in the environment, leading to levels of efficiency and commitment, which will result in quality of life, health safety and motivation in nursing work. This study aimed to analyze the production of knowledge about quality of life, safety, health and motivation in nursing work. A brief survey about publications in the form of articles, national and international periodical manuals, Internet, books, and magazines. A time limit between the years 2000 to 2018/2019 was considered.As atividades da enfermagem culminam num objetivo final que é a saúde e restabelecimento do paciente. A motivação para o trabalho vai depender da saúde e segurança no ambiente, acarretando níveis de eficiência e comprometimento, o que vem resultar na qualidade de vida, saúde segurança e motivação no trabalho da enfermagem. Esse estudo objetivou analisar a produção do conhecimento acerca da qualidade de vida, segurança, saúde e motivação no trabalho de enfermagem. Uma breve pesquisa a respeito das publicações na forma de artigos, manuais periódicos nacionais e internacionais, Internet, livros e revistas. Foi considerado um limite temporal entre os anos de 2000 a 2018/2019

El tiempo en el cuidador del paciente con cáncer, un abordaje cualitativo

The time as a physical magnitude in its most classical conception, is for the human being, a construction and a subjective mental representation that molds its perception related to its velocity. From there it is susceptible to variation according to the multiplicity of concepts, including beliefs, the state of mind and the perception of physical and mental health. Similarly, the past, the future and the present are subjective representations that depend on factors such as time perception, culture and biological time of each person. Based on this, the objective of this article was to refl ect on the concept of time and its importance for the caregiver of a patient diagnosed with cancer, during the phases of the disease. To accomplish this objective a qualitative research was performed though the narrative, the bibliographical story, and the intertextual reading, relying on the book “The Dreams of Einstein”. It was found that a unique form to measure time as a rigid, lineal, and sequential measure does not exist, but that each person defines and lives its own concept of time throughout their own experiences and temporal history, with the processes of health-disease being a possible determinant. It is concluded, then, that the perception of time is constructed through the interaction of external time, the events throughout life and the internal time that allows the human being to adapt and face the daily challenges