Percepção de enfermeiras obstetras sobre o modelo e prática assistencial em uma maternidade filantrópica

Objective: to identify the perception of obstetric nurses about the healthcare model and practice in a philanthropic maternity hospital. Method: qualitative study of 13 obstetric nurses working in a Minas Gerais maternity hospital. Researchers used semi-structured interviews for data collection which took place from September 2015 to February 2016. Data analysis used content analysis. Results: the following categories emerged: Performance based on humanization and good practices; Professional autonomy; Professional mentoring during decision making; Teamwork and Performance Model. Discussion: research revealed that nurses are autonomous and work as a team; they did not single out a healthcare model and identified work demand and technocratic model as obstacles. Final considerations: management support is important for the professionals’ performance since it contributes to autonomy at work. Despite the progress made, there are still challenges both in terms of staff and communication, as well as management support.Objetivo: conocer la percepción de las enfermeras obstétricas sobre la práctica y el modelo de atención en una maternidad de beneficencia. Método: estudio cualitativo con 13 enfermeras obstétricas de una maternidad de Minas Gerais; los datos, recogidos de septiembre de 2015 a febrero de 2016 en entrevistas semiestructuradas, se analizaron según el análisis de contenido. Resultados: se identificaron las siguientes categorías: Desempeño basado en la humanización y en las buenas prácticas; Autonomía para trabajar; Coaching para la toma de decisiones; Trabajo en equipo y Modelo de desempeño. Discusión: las enfermeras actúan con autonomía, en equipo, no mencionaron ningún modelo de atención; la demanda de servicios y el modelo tecnocrático representaban obstáculos. Consideraciones finales: el respaldo de la gerencia es fundamental para el desempeño profesional y contribuye a que se trabaje con autonomía. Aún hay retos por superar, tanto a nivel de equipos y comunicación como de respaldo de la gerencia.Objetivo: conhecer a percepção de enfermeiras obstetras sobre o modelo e prática assistencial em uma maternidade filantrópica. Método: estudo qualitativo com 13 enfermeiras obstetras que trabalham em uma maternidade mineira, coleta de dados de setembro de 2015 a fevereiro de 2016 por meio de entrevista semiestruturada, utilizando-se Análise de Conteúdo. Resultados: emergiram com categorias:  Atuação pautada na humanização e nas boas práticas; Autonomia para atuar; Profissional de referência para tomada de decisões; Atuação em equipe e Modelo de atuação. Discussão: verificou-se que as enfermeiras atuam com autonomia em equipe, não nomeiam um modelo de assistência e apontam a demanda de serviço e o modelo tecnocrático como dificultadores. Considerações finais: apoio e suporte dos gestores são importantes para a atuação das profissionais, contribuindo para um trabalho autônomo. Apesar dos avanços, ainda há desafios a serem superados tanto no âmbito da equipe e comunicação, quanto do suporte dos gestores

Ixodíase revelado pelo exame dermatoscópico: Relato de Caso

A ixodíase é uma zoodermatose causada pela picada de ixodídeos. Dos ixodídeos existentes no Brasil, o gênero mais frequente é o Amblyomma, com várias espécies, sendo a mais encontrada a A.cajennense. Relatamos o caso de um paciente que, após 2 dias que retornou da fazenda, iniciou com intenso prurido, aparecimento de inúmeras pápulas eritematosas purpúricas com crosticulas, sendo visualizado à dermatoscopia o carrapato

TRATAMENTO CIRÚRGICO DA SÍNDROME NEFRÓTICA: ESTRATÉGIAS PARA O CONTROLE DA PROTEINÚRIA E PRESERVAÇÃO DA FUNÇÃO RENAL

Nephrotic syndrome is a kidney condition that causes a large loss of protein in the urine, leading to edema, hypoalbuminemia and other symptoms. Surgical treatment may be an option in specific cases to control proteinuria and preserve kidney function. Objectives: To evaluate the different surgical strategies used in the treatment of nephrotic syndrome, with a focus on controlling proteinuria and preserving renal function. Methodology: They consisted of a systematic literature review, where relevant articles were searched in academic databases. The inclusion criteria were defined to select studies that evaluated the surgical treatment of nephrotic syndrome and its strategies to control proteinuria and preserve renal function. For data collection, the following databases were used: Nursing Database (BDENF), Scientific Electronic Library Online (SCIELO), PubMed and Latin American Caribbean Literature in Health Sciences (LILACS). Various types of publications, such as scientific articles, monographs and magazines, were consulted to obtain relevant information on the topic. Results and Discussions: Surgical strategies used to treat nephrotic syndrome have demonstrated variable efficacy in controlling proteinuria and preserving renal function. Interventions are necessary to better understand the benefits and limitations of each surgical approach, considering the different patient profiles and characteristics of the disease. Conclusion: In conclusion, surgical treatment of nephrotic syndrome offers a range of strategies to control proteinuria and preserve renal function. However, the selection of the most appropriate surgical approach must take into account the severity of the disease, the response to conservative treatment and the individual characteristics of the patient. More studies are needed to validate the long-term efficacy and safety of these strategies.A síndrome nefrótica é uma condição renal que causa grande perda de proteínas na urina, levando a edema, hipoalbuminemia e outros sintomas. O tratamento cirúrgico pode ser uma opção em casos específicos para controlar a proteinúria e preservar a função renal. Objetivos: Avaliar as diferentes estratégias cirúrgicas utilizadas no tratamento da síndrome nefrótica, com foco no controle da proteinúria e na preservação da função renal. Materiais e Métodos: Consistiram em uma revisão sistemática da literatura, onde foram pesquisados artigos relevantes nas bases de dados acadêmicas. Os critérios de inclusão foram definidos para selecionar estudos que avaliassem o tratamento cirúrgico da síndrome nefrótica e suas estratégias para controlar a proteinúria e preservar a função renal. Para a coleta de dados, foram utilizados os bancos de dados: Base de dados Scientific Electronic Library Online (SCIELO), PubMed e Literatura Latino-Americana do Caribe em Ciências da Saúde (LILACS). Diversos tipos de publicações, como artigos científicos, monografias e revistas, foram consultados para obter informações relevantes sobre o tema. Resultados e Discussões: As estratégias cirúrgicas empregadas no tratamento da síndrome nefrótica demonstraram eficácia variável no controle da proteinúria e na preservação da função renal. Sendo necessárias intervenções para compreender melhor os benefícios e limitações de cada abordagem cirúrgica, considerando-se os diferentes perfis de pacientes e as características da doença. Conclusão:  Em conclusão, o tratamento cirúrgico da síndrome nefrótica oferece uma gama de estratégias para controlar a proteinúria e preservar a função renal. No entanto, a seleção da abordagem cirúrgica mais adequada deve levar em consideração a gravidade da doença, a resposta ao tratamento conservador e as características individuais do paciente. Mais estudos são necessários para validar a eficácia e segurança dessas estratégias a longo prazo

Uso de álcool durante tratamento medicamentoso

Introdução: Este trabalho aborda a combinação delicada de álcool e medicamentos, destacando os efeitos prejudiciais do álcool no sistema nervoso central e nos órgãos do corpo. O álcool passa por um complexo processo metabólico após a ingestão, afetando a absorção, distribuição, metabolismo e excreção de medicamentos. Essas interações podem comprometer a eficácia do tratamento e aumentar os riscos à saúde, enfatizando a necessidade de conscientização entre profissionais de saúde e pacientes. Evitar o álcool durante o uso de medicamentos é uma escolha sensata e protetora. Metodologia: Este trabalho é uma revisão de literatura com base em artigos de 2019 a 2023, em português, espanhol e inglês, obtidos das plataformas SciELO e PubMed. Foram incluídos textos completos, teses, dissertações, capítulos de livros, monografias e artigos em revistas e periódicos científicos. Foram utilizados descritores em saúde (DeCS) como "Álcool", "Tratamento" e "Medicamento" para avaliação dos textos. Resultados: O álcool tem efeitos prejudiciais no sistema nervoso central e nos órgãos, variando entre indivíduos. Sua absorção ocorre no intestino delgado e no estômago. O álcool afeta diversos órgãos, contribuindo para doenças ou interferindo nos efeitos dos medicamentos. No cérebro, estimula a liberação de serotonina, afetando o humor. No estômago, altera a mucosa e aumenta a produção de ácido gástrico. O álcool também pode inibir a ação do hormônio antidiurético (ADH), aumentando o volume urinário. As interações entre álcool e medicamentos podem ser farmacocinéticas, absortivas, biotransformativas, excretoras ou hipoglicemiantes. Elas impactam a absorção, distribuição, metabolismo e excreção de medicamentos, podendo resultar em efeitos indesejados. Conclusão: O uso combinado de álcool e medicamentos representa um sério risco à saúde e à vida. O álcool tem efeitos prejudiciais e interage de várias maneiras com medicamentos. Profissionais de saúde e pacientes precisam estar cientes desses perigos. Consultas médicas e uso responsável de medicamentos são fundamentais para a eficácia do tratamento e a proteção dos pacientes. Evitar o álcool durante o tratamento é a decisão mais segura e prudente para preservar a vida e o bem-estar

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

CIRURGIA MINIMAMENTE INVASIVA VERSUS PROCEDIMENTOS CONVENCIONAIS: UMA ANÁLISE COMPARATIVA

Objective: This article aims to explore the dichotomy between minimally invasive surgery (MIS) and conventional procedures (PC), analyzing the technological advances and clinical challenges inherent to both approaches. Results: CMI, with its reduced access and innovative technologies, has transformed surgical practice, challenging conventional procedures, which often involve more extensive incisions and prolonged recovery. The evolution of refined instrumentation such as endoscopes and surgical robotics has improved the accuracy of CMI, although challenges such as the learning curve and cost considerations persist. Methodology: The search included several academic databases such as PubMed, Scopus, Scielo, VHL and Web of Science, using specific terms such as "Minimally Invasive Surgery", "Conventional Procedures" and other related terms. Boolean operators were used to optimize the search. The inclusion criteria ensured relevance, covering studies that directly compared clinical results between Minimally Invasive Surgery and conventional procedures. We excluded studies with heterogeneous samples or without pertinent information. Conclusion: The search for a comprehensive understanding of the advantages and limitations of both approaches is constant, encouraging critical reflection on the future of surgery in search of better results for patients.Objetivo: Este artigo tem como objetivo explorar a dicotomia entre cirurgia minimamente invasiva (CMI) e procedimentos convencionais (PC), analisando os avanços tecnológicos e desafios clínicos inerentes a ambas as abordagens. Resultados: A CMI, com seu acesso reduzido e tecnologias inovadoras, transformou a prática cirúrgica, desafiando os procedimentos convencionais, que frequentemente envolve incisões mais extensas e recuperação prolongada. A evolução de instrumentações refinadas, como endoscópios e robótica cirúrgica, aprimorou a precisão da CMI, embora desafios como a curva de aprendizado e considerações de custo persistam. Metodologia: A busca incluiu diversas bases acadêmicas como PubMed, Scopus, Scielo, BVS e Web of Science, usando termos específicos como "Cirurgia Minimamente Invasiva", "Procedimentos Convencionais" e outros relacionados. Operadores booleanos foram empregados para otimizar a busca. Os critérios de inclusão garantiram relevância, abrangendo estudos que compararam diretamente resultados clínicos entre Cirurgia Minimamente Invasiva e procedimentos convencionais. Excluímos estudos com amostras heterogêneas ou sem informações pertinentes. Conclusão: A busca por uma compreensão abrangente das vantagens e limitações de ambas as abordagens é constante, incentivando uma reflexão crítica sobre o futuro da cirurgia em busca de melhores resultados para os pacientes

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

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe