Os impactos da violência obstétrica na saúde de mulheres

This is an integrative literature review that aimed to systematize scientific findings on the impacts of obstetric violence on women's health. The searches took place in the databases of the Virtual Health Library and Google Scholar in September 2022. The results of the selected articles show that the process of institutionalization of childbirth had consequences for the health of women, among them, obstetric violence. The woman victim of this type of violence becomes prone to negative feelings, psychological suffering and other repercussions with direct impacts on her health and on the mother-child interaction. Considering the traumatic content of this process in the daily lives of women, it is urgent to reinforce the adoption of measures to prevent obstetric violence with a focus on raising awareness among the professionals who assist them.Trata-se de uma revisão integrativa de literatura que objetivou sistematizar achados científicos sobre impactos da violência obstétrica na saúde de mulheres. As buscas ocorreram nas bases de dados da Biblioteca Virtual em Saúde e Google Acadêmico em setembro de 2022. Os resultados dos artigos selecionados mostram que o processo de institucionalização dos partos trouxe consequências para a saúde de mulheres, dentre elas, a violência obstétrica. A mulher vítima desse tipo de violência se torna propensa a sentimentos negativos, sofrimento psicológico e outras repercussões com impactos diretos para sua saúde e para a interação mãe-filho(a). Considerando o teor traumático desse processo no cotidiano das mulheres, é urgente reforçar a adoção de medidas de prevenção à violência obstétrica com foco na sensibilização das(os) profissionais que as assistem

O manejo dos sangramentos uterinos anormais em pacientes em idade reprodutiva: The management of abnormal uterine bleeding in patients of reproductive age

O sangramento uterino anormal refere ao sangramento uterino de quantidade, duração ou cronograma anormal, pode ser causado por patologia estrutural uterina ou causas não uterinas. As definições padrão de sangramento menstrual normal e anormal são devido às anormalidades na frequência, tais como sangramento menstrual frequente refere-se a períodos que começam em intervalos <24 dias, sangramento menstrual infrequente refere-se a períodos que começam em intervalos >38 dias, ausência de menstruação é amenorreia primária (ausência de menarca aos 15 anos) ou secundária (ausência de sangramento menstrual espontâneo por seis meses em uma paciente que teve sangramento menstrual anteriormente).   As pacientes com sangramento uterino anormal devem ter história e exame físico completos, informações sobre a frequência, duração e volume do sangramento uterino, bem como a presença de sintomas associados e fatores precipitantes. A gravidez deve ser excluída em todas as pacientes.  As pacientes com sangramento menstrual intenso geralmente são submetidas a exames de imagem pélvica para avaliar lesões estruturais, um hemograma completo e medição do nível de ferritina. Os laboratórios adicionais são solicitados se houver suspeita de um distúrbio hemorrágico, como doença de von Willebrand ou endócrino, como hipotireoidismo. A amostragem endometrial é realizada para pacientes com obesidade ou outros fatores de risco para hiperplasia ou carcinoma endometrial.&nbsp

As atividades realizadas pelo PET no desenvolvimento do curso de ciência da computação / The activities carried out by PET in the development of the computer science course

Undergraduate in the country is going through a crisis that goes from the high dropout rate to the low level of schooling of the students, passing through the low income level of the graduates. In this context, the Tutorial Education Program (PET) brings in its guidelines the search for improvements in teaching-learning in graduate courses in the country. In this sense, the objective of this work is to present the initiatives of PET Computer Science in the fight against these adversities. As a result, it can be seen that the actions promoted, besides developing the PET members both academically and as citizens, it is observed that these activities have also played an important role in divulgation and promoting the course with the community.

Avaliação e tratamento do Transtorno Pedofílico / Assentment and treatment of Pedophilic Disorder

INTRODUÇÃO: Conforme o Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-V), pedofilia caracteriza-se por “fantasias sexualmente excitantes, impulsos sexuais ou comportamentos recorrentes envolvendo atividade sexual com crianças” em indivíduos com no mínimo 16 anos que possuam pelo menos 5 anos a mais que a criança envolvida. METODOLOGIA: Estudo de revisão narrativa através da base de dados PubMed, o qual objetiva transcorrer sobre avaliação e tratamento do transtorno pedofílico. RESULTADOS: Foram selecionados 21 artigos que evidenciaram programas terapêuticos efetivos. A maioria utiliza métodos psicoterapêuticos e farmacológicos e conseguem auxiliar pacientes a reduzirem chances de cometerem agressão sexual contra crianças. DISCUSSÃO: O diagnóstico do transtorno pedofílico é clínico e envolve a identificação de indivíduos experimentando sofrimento significativo por fantasias sexualmente estimulantes e impulsos sexuais, incluindo consumo de pornografia infantil. O critério de persistência de sinais e sintomas de pedofilia por 6 meses ou mais tem o intuito de assegurar que a atração sexual por crianças não seja transitória, permitindo diagnóstico mais acurado do transtorno. CONCLUSÃO: Os pacientes diagnosticados com pedofilia devem receber, além da psicoterapia e farmacoterapia recomendada, tratamento para outras eventuais comorbidades psiquiátricas concomitantes e psicoeducação, a fim de promover ao paciente um maior entendimento sobre sua condição e terapêutica

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Impactos da vida urbana sobre a qualidade da água e comunidade de larvas de peixes em dois igarapés da Amazônia brasileira

This study investigated the impact of anthropogenic activities in Belém City, Brazilian Amazon, by comparing water quality and fish larvae communities in two creeks that flow into the Guamá River. One creek crossed a poor and crowded suburb of Belém while the other was located in an island section that was declared an Environmental Protected Area in 1997. Two sampling points were set in each creek and monitored over eight hours once every three months over a one-year period. Strong variations of water quality were registered all year long and at all tides in Belém's mainland creek, along with, among other things, a very high number of thermotolerant coliforms. Few larvae were found. The water was considered unsuitable for human use and activities as well as for aquatic life. The island creek presented early signs of bacterial and nutrient contaminations during the rainy season, probably partly related to non-point source pollution. In both creeks, larvae communities were almost exclusively composed of clupeiforms. All larval development stages were encountered. Higher densities and proportion of newly hatched larvae were registered during the dry season and associated with the presence of nitrate. The results of the study show that adequate sewage and drainage systems must be developed in the city and suggest that it would be useful to conduct an integrated ambient monitoring study in Combú Creek.Este estudo teve como objetivo investigar o impacto das atividades antropogênicas da cidade de Belém pela comparação da qualidade da água e das comunidades de larvas de peixes em dois igarapés que desembocam no rio Guamá. Um dos igarapés atravessa um subúrbio pobre e populoso de Belém, enquanto o outro é localizado em uma ilha de Belém, declarada Área de Proteção Ambiental desde 1997. Dois pontos de coletas foram definidos em cada igarapé e monitorados durante oito horas, a cada três meses e durante um ano. O igarapé em região urbana apresentou fortes alterações na qualidade da água, durante o ano todo e em todas as marés, e isto deve se essencialmente a presença de um elevado número de coliformes termotolerantes. Poucas larvas foram encontradas. A água foi considerada imprópria para uso e atividades humanas, assim como para a vida aquática. O igarapé da ilha apresentou primeiros sinais de contaminação por nutrientes e bactéria durante o período chuvoso, parcialmente decorrente de fontes de poluição difusa. Em ambos os córregos, as comunidades larvais foram quase exclusivamente compostas de clupeiformes. Todos os estágios de desenvolvimento larval foram encontrados. Densidades e proporções mais elevadas de larvas recém eclodidas foram registradas durante a estação seca e associadas à presença de nitrato. Resultados apontam a necessidade de desenvolver um sistema de drenagem urbano para esgoto e água pluvial na maior brevidade, e recomenda um estudo de monitoramento integrado do igarapé na Área de Proteção Ambiental

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN