Fragilidades e potencialidades na formação de enfermeiros-líderes

Objetivo: Conhecer a percepção dos docentes de enfermagem acerca das fragilidades e potencialidades na formação de enfermeiros-líderes.Método: Estudo de caso múltiplo, de abordagem qualitativa, realizado com 36 docentes de enfermagem de uma universidade pública do Estado da Bahia, Brasil. Os dados foram coletados por meio de entrevistas semiestruturadas, interpretados à luz do referencial teórico de Paulo Freire e analisados conforme a Análise Temática e do software Nvivo®11.Resultados: Destacaram-se como fragilidades a necessidade de aprimorar a transversalidade da liderança ao longo da graduação e o ensino voltado ao modelo bancário. As potencialidades referem-se à inserção dos discentes nos cenários de prática, possibilitando a aproximação com as equipes de enfermagem e multiprofissional, uso de metodologias ativas e participação em grupos de pesquisa.Considerações finais: Os docentes consideram a importância de práticas pedagógicas problematizadoras e investem em estratégias metodológicas capazes de fomentar a formação de enfermeiros-líderes.Palavras-chave: Enfermagem. Liderança. Educação em enfermagem. Gestão em saúde. Educação superior

Inflammatory, synaptic, motor, and behavioral alterations induced by gestational sepsis on the offspring at different stages of life

Abstract: Background: The term sepsis is used to designate a systemic condition of infection and inflammation associated with hemodynamic changes that result in organic dysfunction. Gestational sepsis can impair the development of the central nervous system and may promote permanent behavior alterations in the offspring. The aim of our work was to evaluate the effects of maternal sepsis on inflammatory cytokine levels and synaptic proteins in the hippocampus, neocortex, frontal cortex, and cerebellum of neonatal, young, and adult mice. Additionally, we analyzed the motor development, behavioral features, and cognitive impairments in neonatal, young and adult offspring. Methods: Pregnant mice at the 14th embryonic day (E14) were intratracheally instilled with saline 0.9% solution (control group) or Klebsiella spp. (3 × 108 CFU) (sepsis group) and started on meropenem after 5 h. The offspring was sacrificed at postnatal day (P) 2, P8, P30, and P60 and samples of liver, lung, and brain were collected for TNF-α, IL-1β, and IL-6 measurements by ELISA. Synaptophysin, PSD95, and β-tubulin levels were analyzed by Western blot. Motor tests were performed at all analyzed ages and behavioral assessments were performed in offspring at P30 and P60. Results: Gestational sepsis induces a systemic pro-inflammatory response in neonates at P2 and P8 characterized by an increase in cytokine levels. Maternal sepsis induced systemic downregulation of pro-inflammatory cytokines, while in the hippocampus, neocortex, frontal cortex, and cerebellum an inflammatory response was detected. These changes in the brain immunity were accompanied by a reduction of synaptophysin and PSD95 levels in the hippocampus, neocortex, frontal cortex, and cerebellum, in all ages. Behavioral tests demonstrated motor impairment in neonates, and depressive-like behavior, fear-conditioned memory, and learning impairments in animals at P30 and P60, while spatial memory abilities were affected only at P60, indicating that gestational sepsis not only induces an inflammatory response in neonatal mouse brains, but also affects neurodevelopment, and leads to a plethora of behavioral alterations and cognitive impairments in the offspring. Conclusion: These data suggest that maternal sepsis may be causatively related to the development of depression, learning, and memory impairments in the litter

Zumbido e intolerância a sons : evidência e experiência de um grupo brasileiro

Introdução Zumbido e intolerância a sons são queixas frequentes e subjetivas que podem ter impacto na qualidade de vida do paciente. Objetivo Apresentar uma revisão dos principais pontos, inclusive conceitos, fisiopatologia, diagnóstico e abordagem do paciente com zumbido e sensibilidade a sons. Método Revisão da literatura com levantamento bibliográfico na base de dados da LILACS, SciELO, Pubmed e MEDLINE. Foram selecionados artigos e capítulos de livros sobre zumbido e sensibilidade a sons. Os diversos tópicos foram discutidos por um grupo de profissionais brasileiros e as conclusões, descritas. Resultado A prevalência de zumbido tem aumentado ao longo dos anos, muitas vezes associado a perda auditiva, fatores metabólicos e erros alimentares. A avaliação médica deve ser feita minuciosamente no sentido de orientar a solicitação de exames subsidiários. Os tratamentos disponíveis atualmente variam de medicamentos ao uso de sons com características específicas e técnicas de meditação, com resultados variáveis. Conclusão Foi apresentada uma revisão sobre os temas que permitindo ao leitor uma visão ampla da abordagem dos pacientes com zumbido e sensibilidade auditiva baseada em evidências científicas e experiência nacional.Introduction Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life. Objective To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. Methods Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. Results The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. Conclusion A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Fatores relacionados ao tempo de hospitalização e óbito de recém-nascidos prematuros*

Objetivo: Analizar los factores relacionados con la hospitalización prolongada y la defunción de los recién nacidos prematuros en una región fronteriza. Método: Estudio transversal, con recogida de datos retrospectiva, en el que se analizaron 951 historias clínicas de bebés prematuros hospitalizados entre 2013 y 2017. Las variables independientes fueron la edad materna, la nacionalidad, las consultas prenatales, las intercurrencias de las madres, la edad gestacional, el peso al nacer, Apgar y las complicaciones; las variables dependientes fueron los días de hospitalización, el alta, la defunción y el traslado. Se utilizaron las pruebas Chi-cuadrado de Pearson y Exacto de Fisher. Resultados: Los nacimientos prematuros representaron el 10,3%, de los cuales el 43,3% fueron hospitalizados. La prevalencia de mortalidad fue del 21,3%. Pocas consultas prenatales, las intercurrencias maternas, el Apgar bajo a los 5 minutos y las complicaciones de salud del bebé aumentaron los días de hospitalización. El peso y la edad gestacional más bajos, el Apgar bajo y las complicaciones con el bebé aumentaron la mortalidad. Conclusión: Conocer los aspectos de la hospitalización permitió identificar los factores que desencadenan complicaciones en los bebés prematuros, relevantes para los esfuerzos por superar los resultados desfavorables y enfrentar los desafíos de las secuelas a lo largo de la vida. La integración entre los países y sus fronteras es una condición notoria para acelerar los procesos de asistencia y proporcionar mejores resultados.Objetivo: Analisar fatores relacionados à hospitalização prolongada e ao óbito de recém-nascidos prematuros em uma região de fronteira. Método: Estudo transversal, com coleta retrospectiva de dados, que analisou 951 prontuários de prematuros hospitalizados entre 2013 e 2017. As variáveis independentes foram idade materna, nacionalidade, consultas de pré-natal, intercorrências maternas, idade gestacional, peso ao nascer, Apgar, complicações; as variáveis dependentes foram dias de hospitalização, alta, óbito e transferência. Foram utilizados os testes Qui-quadrado de Pearson e Exato de Fisher. Resultados: O nascimento prematuro representou 10,3%; destes, 43,3% foram hospitalizados. A prevalência da mortalidade foi 21,3%. Poucas consultas de pré-natal, intercorrências maternas, Apgar de 5º minuto baixo e complicações da saúde do bebê aumentaram os dias de hospitalização. Menor peso e idade gestacional, Apgar baixo e complicações com o bebê aumentaram o óbito. Conclusão: Conhecer aspectos da hospitalização permitiu identificar fatores que desencadeiam complicações ao prematuro, relevantes aos esforços para superar os desfechos desfavoráveis e enfrentar desafios das sequelas ao longo da vida. A integração entre países e suas fronteiras torna-se condição notória para acelerar processos assistenciais e proporcionar melhores desfechos.Objective: To analyze factors related to prolonged hospitalization and death in premature newborns in a border region. Method: Cross-sectional study, with retrospective data collection, which analyzed 951 medical records of premature newborns hospitalized between 2013 and 2017. The independent variables were maternal age, nationality, prenatal appointments, maternal intercurrences, gestational age, weight at birth, Apgar, complications; the dependent variables were days of hospitalization, discharge, death, and transference. The tests Pearson Chi-squared and Fisher’s Exact were employed. Results: Premature birth amounted to 10.3%; out of these, 43.3% were hospitalized. The prevalence of mortality was 21.3%. Few prenatal appointments, maternal intercurrences, low fifth minute Apgar, and the baby’s health complications increased days of hospitalization. Lower weight and gestational age, low Apgar and complications with the baby increased death. Conclusion: Understanding hospitalization aspects enabled the identification of factors that lead to complications to the premature newborn, which are relevant to efforts to overcome unfavorable outcomes and face challenges posed by the sequels throughout life. The integration between countries and their borders is a notorious condition to accelerate care processes and promote better outcomes

Immune response of calves immunized with cocktail of DNA vaccine encoding complexed outer membrane proteins from Anaplasma marginale

In the present study, we evaluated a cocktail of recombinant plasmids encoding the major surface proteins (rMSP1a, rMSP1b, rMSP4, rMSP5, VirB9 and VirB10) to improve the humoral and cellular immune response triggered in calves. Ten calves were divided in three groups: Four calves were inoculated with the plasmids/rMSPs (G1); 2 calves were inoculated with empty vector (G2); and 4 calves received saline (G3). Three inoculations were administered at 21-day intervals. In G1, the calves showed significant increases in total IgG level 21 days after the second inoculation, compared to the control group (p<0,05%), and G1 calves remained above the cut-off value 28 days after the third inoculation (p<0,05%). The post-immunized sera from calves in G1 reacted specifically for each of the rMSPs used. Additionally, ELISA detected specific IgG for VirB9 and VirB10. In conclusion, the cocktail of recombinant plasmids induced antigen-specific seroconversion in calves. Therefore, additional testing to explore the protection induced by recombinant plasmids, alone or in conjunction with proteins previously identified as subdominant epitopes, is warranted