Perturbação do sono no período peri-parto: O papel das intervenções não farmacológicas

Introdução: Durante o período peri-parto, as alterações do ciclo do sono são muito comuns, quer devido a alterações hormonais e físicas normais da gravidez, quer, devido ao aumento da exigência relacionada com o cuidado de um recém-nascido. É importante que os profissionais de saúde sejam capazes de detectar e tratar adequadamente as mulheres grávidas e as novas mães, que demonstrem sinais e sintomas de privação de sono, com possível afetação da saúde mental. A perda excessiva de horas de sono no peri-parto está associada a depressão pós-parto e a distúrbios de ansiedade, incluindo distúrbios obsessivo-compulsivos, com potenciais consequências negativas para o recém-nascido e para toda a família. Objectivo: Esta revisão narrativa pretende explorar quais as terapias não-farmacológicas que podem ser utilizadas para tratar insónia no peri-parto. Métodos: Foi efectuada uma pesquisa bibliográfica nas bases de dados PubMed, Scopus e PsycINFO para artigos originais, revisões ou meta-análises sobre intervenções não-farmacológicas dirigidas à privação do sono no período peri-parto. O prazo de publicação foi de 1999 a 2022 e apenas foram incluídos artigos escritos em inglês, português, espanhol e italiano. Foram utilizadas as seguintes palavras-chave: ("período peri-parto", "pós-parto", "puerpério") e ("insónia", "privação de sono", "perturbação do sono") e ("tratamento não farmacológico", "terapia não farmacológica", "intervenção não farmacológica"). Resultados: Foram identificados dezanove estudos, investigando as seguintes intervenções: terapia cognitivo-comportamental para insónia, psicoterapia interpessoal, aconselhamento de apoio, psicoterapia materno infantil e programas de higiene do sono. Foram encontrados resultados positivos para a intervenção precoce com psicoterapias, especialmente terapia cognitivo-comportamental para a insónia no peri-parto, com elevadas taxas de remissão de insónia. Conclusões: Apesar dos resultados positivos, é necessária investigação futura para melhorar a detecção precoce de perturbações do sono no período peri-parto e estabelecer tratamentos adequados, particularmente intervenções não-farmacológicas. O desenvolvimento de intervenções psicológicas custo-efetivas, específicas para esta população, pode ter um impacto positivo na saúde pública mundial.Introduction: During the peripartum period, sleep cycle alterations are very common, either due to normal hormonal and physical changes of pregnancy, or, due to increased demands related to caring for a newborn. It is important that health professionals are able to detect and properly treat pregnant women and new mothers with impaired sleep cycles and related mental health signs and symptoms. Excessive loss of sleep hours in the peripartum is associated with postpartum depression and anxiety disorders such as obsessive-compulsive disorder, with potential negative consequences to the newborn and the whole family. Objective: This narrative review primarily aimed to explore which non-pharmacological therapies can be used to treat insomnia in the peripartum. Methods: A bibliographic search was carried out on PubMed, Scopus and PsycINFO databases for original articles, reviews or meta-analyses, on non-pharmacological interventions targeting sleep deprivation in the peripartum period. The time limit for publication was since 1999 to 2022 and only articles written in English, Portuguese, Spanish and Italian were included. The following keywords were used: ("peripartum period", "postpartum", "puerperium") and ("insomnia", "sleep deprivation", "Sleep disturbance") and ("non-pharmacological treatment", "non-pharmacological therapy", "non-pharmacological intervention"). Results: Nineteen studies were identified, investigating the following interventions: cognitive-behavioral therapy for insomnia, interpersonal psychotherapy, supportive counseling, mother-infant psychotherapy and sleep hygiene programs. Positive results have been found for early intervention with psychotherapies, especially cognitive-behavioral therapy for insomnia in the peripartum, with high insomnia remission rates. Conclusions: Despite the positive results, future research is needed to enhance early detection of sleep disorders in the peripartum period and establish adequate treatments, particularly non-pharmacological interventions. The development of cost-effective psychological interventions specific to this population may have a positive impact on public health worldwide

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research