Prática segura para partos em hospital universitário

Objective: to identify the application of the essential practices of the World Health Organization Checklist for Safe Births (CLSB) performed in a University Hospital. Method: a descriptive cross-sectional study, carried out from January to October 2018, with 51 professionals who assist in labor, delivery and puerperium. To identify the applied practices, a semi-structured questionnaire and statistical analysis were used. Results: practices related to the use of drugs, availability of material resources, identification of abnormal bleeding, skin-to-skin contact, breastfeeding and reproductive planning are as recommended. However, there was no standardization regarding the evaluations in the partogram and the orientations to women and companions about the signs of worsening. Conclusions: the CLSB presents itself as an innovative tool in obstetric care. It offers opportunities for improvement and qualification of care, standardizing essential conducts, such as guidelines on clinical signs and registration in the partogram, favoring the safety of the mother-baby binomial.Objetivo: identificar a aplicação das práticas essenciais da Lista de Verificação para Partos Seguros (LVPS) da Organização Mundial da Saúde realizadas em Hospital Universitário. Método: estudo transversal descritivo, realizado no período de janeiro a outubro de 2018, com 51 profissionais que assistem o trabalho de parto, parto e puerpério. Para identificar as práticas aplicadas, utilizou-se um questionário semiestruturado e análise estatística. Resultados: práticas relacionadas ao uso de fármacos, disponibilidade de recursos materiais, identificação de sangramento anormal, contato pele à pele, amamentação e planejamento reprodutivo estão conforme o preconizado. Contudo, não houve padronização quanto às avaliações no partograma e às orientações às mulheres e acompanhantes sobre os sinais de agravamento. Conclusões: a LVPS apresenta-se como uma ferramenta inovadora na assistência obstétrica. Oferece oportunidade de melhorias e qualificação dos cuidados, padronizando condutas essenciais, como as orientações sobre os sinais clínicos e registro no partograma, favorecendo a segurança do binômio mãe-bebê

Os Objetivos de Desenvolvimento do Milênio e o compromisso social das pesquisas de Enfermagem

No ano 2000, a Organização das Nações Unidas (ONU) reuniu representantes de 191países, chefes de Estado e de governo, na reunião "Cúpula do Milênio da ONU". Nasdiscussões foram traçados oito "Objetivos de Desenvolvimento do Milênio (ODM)”pactuados até 2015. Reflexo da crescente preocupação com a sustentabilidade do planeta ecom os graves problemas que afetavam a humanidade, a comunidade internacionalestabeleceuobjetivos dirigidos a áreas prioritárias para melhorar as condições de saúde, deeducação, bem como eliminar a extrema pobreza nas nações

Elucidating how the saprophytic fungus Aspergillus nidulans uses the plant polyester suberin as carbon source

Lipid polymers in plant cell walls, such as cutin and suberin, build recalcitrant hydrophobic protective barriers. Their degradation is of foremost importance for both plant pathogenic and saprophytic fungi. Regardless of numerous reports on fungal degradation of emulsified fatty acids or cutin, and on fungi-plant interactions, the pathways involved in the degradation and utilisation of suberin remain largely overlooked. As a structural component of the plant cell wall, suberin isolation, in general, uses harsh depolymerisation methods that destroy its macromolecular structure. We recently overcame this limitation isolating suberin macromolecules in a near-native state.work partially supported by a grant from Iceland, Liechtenstein and Norway through the EEA financial mechanism (Project PT015), FCT: grant (PEst-OE/EQB/LA0004/2013) and fellowships (SFRH/BD/38378/2007, SFRH/BD/66396/2009, SFRH/BD/66030/2009, SFRH/BD/48286/2008), Fundação Calouste Gulbenkian fellowship (21-95587-B)

Surface Accumulation of Cerium, Self-Assembling Peptide, and Fluoride on Sound Bovine Enamel

The accumulation of caries-preventive compounds on sound enamel is crucial in order to improve the inhibition of carious lesion initiation. The aim of this research was to investigate the initial accumulation of cerium, oligopeptide p11-4, and fluoride from NaF or amine fluoride (AmF) on sound enamel in vitro by means of energy dispersive X-ray spectroscopy (EDX). Polished bovine enamel specimens (n = 120 from 60 teeth) were fabricated. Out of these, 12 specimens each were treated with CeCl3 (cerium(III) chloride heptahydrate 25%), oligopeptide p11-4 (Curodont Repair, Credentis), NaF (10,000 ppm F−), AmF (amine fluoride, Elmex Fluid, CP-GABA GmbH, 10,000 ppm F−), or Aqua demin (control). After rinsing with water, the surface elemental composition (Ce, N, F, Ca, P, O, Na, Mg) was measured (EDX; EDAX Octane Elect detector, APEX v2.0), expressed in atomic percent (At%) and analyzed (non-parametric statistics, α = 0.05, error rates method). Another 12 specimens per treatment group were fabricated and used for analyzing accumulation in cross-sections with EDX linescans and two-dimensional EDX-mappings. The surface median atomic percent of cerium (At%Ce) was 0.8 for CeCl3, but no Ce was found for any other group. N, specifically for oligopeptide p11-4, could not be detected. Fluorine could only be detected on fluoridated surfaces. The median atomic percent of fluorine (At%F) was 15.2 for NaF and 17.0 for AmF. The Ca/P ratio increased significantly compared to the control following the application of NaF and AmF (p < 0.001), but decreased significantly for CeCl3 (p < 0.001). In cross-sectioned specimens of the CeCl3-group, 12.5% of the linescans revealed cerium at the enamel surface, whereas 83.3% of the NaF linescans and 95.8% of the AmF linescans revealed fluorine at the enamel surface. Following the application of oligopeptide p11-4, no traces of N were detectable. In the depth of the samples, no signal was detected for any of the corresponding elements exceeding the background noise. Cerium and fluorine (from both NaF and AmF), but not the oligopeptide p11-4, precipitated on sound enamel

Discontinuation of infliximab treatment in patients with inflammatory bowel disease who retransitioned to originator and those who remained on biosimilar

BACKGROUND: Many patients with inflammatory bowel disease (IBD) have transitioned from an infliximab originator to a biosimilar. However, some patients retransition to the originator (i.e. stop biosimilar and reinitiate the originator). Whether this sign of potential unsatisfactory treatment response is specifically related to the infliximab biosimilar or the patient and/or the disease including patients' beliefs on the biosimilar is unclear. OBJECTIVES: We aimed to compare the risk of and reasons for infliximab discontinuation between retransitioned patients and those remaining on biosimilar. DESIGN: Non-interventional, multicentre cohort study. METHODS: IBD patients who transitioned from infliximab originator to biosimilar between January 2015 and September 2019 in two Dutch hospitals were eligible for this study. Retransitioned patients (retransitioning cohort) were matched with patients remaining on biosimilar (biosimilar remainder cohort). Reasons for discontinuation were categorised as the unwanted response (i.e. loss of effect or adverse events) or remission. Risk of unwanted discontinuation was compared using Cox proportional hazards models. RESULTS: Patients in the retransitioning cohort ( n  = 44) were younger (median age 39.9 versus 44.0 years), more often female (65.9% versus 48.9%) and had shorter dosing intervals (median 48.5 versus 56.0 days) than in the biosimilar remainder cohort ( n  = 127). Infliximab discontinuation due to unwanted response was 22.7% in the retransitioning and 13.4% in the biosimilar remainder cohort, and due to remission was 2.3% and 9.4%, respectively. Retransitioned patients are at increased risk of discontinuing due to unwanted response compared with biosimilar remainder patients (adjusted HR 3.7, 95% CI: 1.0-13.9). Patients who retransitioned due to an increase in objective disease markers had higher discontinuation rates than patients who retransitioned due to symptoms only (66.7% versus 23.7%). CONCLUSION: Retransitioned patients are at increased risk of infliximab discontinuation due to unwanted response. Retransitioning appeared related to the patient and/or disease and not the product. Clinicians might switch patients opting for retransitioning to other treatment regimens

Discontinuation of infliximab treatment in patients with inflammatory bowel disease who retransitioned to originator and those who remained on biosimilar

BACKGROUND: Many patients with inflammatory bowel disease (IBD) have transitioned from an infliximab originator to a biosimilar. However, some patients retransition to the originator (i.e. stop biosimilar and reinitiate the originator). Whether this sign of potential unsatisfactory treatment response is specifically related to the infliximab biosimilar or the patient and/or the disease including patients' beliefs on the biosimilar is unclear. OBJECTIVES: We aimed to compare the risk of and reasons for infliximab discontinuation between retransitioned patients and those remaining on biosimilar. DESIGN: Non-interventional, multicentre cohort study. METHODS: IBD patients who transitioned from infliximab originator to biosimilar between January 2015 and September 2019 in two Dutch hospitals were eligible for this study. Retransitioned patients (retransitioning cohort) were matched with patients remaining on biosimilar (biosimilar remainder cohort). Reasons for discontinuation were categorised as the unwanted response (i.e. loss of effect or adverse events) or remission. Risk of unwanted discontinuation was compared using Cox proportional hazards models. RESULTS: Patients in the retransitioning cohort (n = 44) were younger (median age 39.9 versus 44.0 years), more often female (65.9% versus 48.9%) and had shorter dosing intervals (median 48.5 versus 56.0 days) than in the biosimilar remainder cohort (n = 127). Infliximab discontinuation due to unwanted response was 22.7% in the retransitioning and 13.4% in the biosimilar remainder cohort, and due to remission was 2.3% and 9.4%, respectively. Retransitioned patients are at increased risk of discontinuing due to unwanted response compared with biosimilar remainder patients (adjusted HR 3.7, 95% CI: 1.0-13.9). Patients who retransitioned due to an increase in objective disease markers had higher discontinuation rates than patients who retransitioned due to symptoms only (66.7% versus 23.7%). CONCLUSION: Retransitioned patients are at increased risk of infliximab discontinuation due to unwanted response. Retransitioning appeared related to the patient and/or disease and not the product. Clinicians might switch patients opting for retransitioning to other treatment regimens

Cultura de seguridad del paciente en el área materno-infantil de un hospital universitario

Objetivo: Avaliar a cultura de segurança do paciente na perspectiva de enfermeiros e médicos atuantes na área materno-infantil. Método: Estudo transversal, realizado de janeiro a setembro de 2018, com 41 profissionais do Centro Obstétrico e internação obstétrica de hospital universitário do sul do país, utilizando o Hospital Survey on Patient Safety Culture, com 12 dimensões da cultura de segurança, mensuradas por meio de um escore geral (0 a 10) e percentuais de respostas positivas para aferir fortalezas e fragilidades. Resultados: A ação de supervisores/chefes foi considerada uma fortaleza, tendo 78,2% de respostas positivas; já no que diz respeito à comunicação, considerou-se uma fragilidade, pontuando 13,2%. A nota geral de segurança do paciente foi de muito boa, nota 4, num intervalo de confiança de 95%. Conclusão: Com a identificação das fortalezas e fragilidades da segurança do paciente é possível planejar ações de melhoria. Destacamos que a abordagem não punitiva é essencial.Objective: To describe the safety culture of the patient from the perspective of nurses and physicians working in the maternal-child area. Method: A cross-sectional study conducted from January to September 2018 with 41 professionals of the Obstetrics Center and obstetric hospitalization of a university hospital in the south of the country. The Hospital Survey on Patient Safety Culture was used, with 12 dimensions of the safety culture, measured by means of a general score (0 to 10) and of positive answer percentages to assess strengths and weaknesses. Results: The action of supervisors/bosses can be considered a strength of patient safety, with 78.2% of positive answers; already regarding communication, it was considered a fragility, punctuating 13.24%. The general safety grade of the patient assigned to the work’s unit was very good, in a confidence interval of 95%. Conclusion: With the identification of the strengths and weaknesses of patient safety, it is possible to plan improvement actions. We emphasize that the non-punitive approach is essential.Objetivo: Describir la cultura de seguridad del paciente en la perspectiva de enfermeros y médicos actuantes en el área materno- infantil. Método: Estudio transversal realizado de enero a septiembre de 2018 con 41 profesionales del Centro de Obstetricia y del área de internación obstétrica de un hospital universitario del sur del país. Se utilizó la Hospital Survey on Patient Safety Culture (Encuesta hospitalaria sobre la cultura de la seguridad), con 12 dimensiones de la cultura de seguridad, medidas por medio de un puntaje general (0 a 10) y de porcentajes de respuestas positivas para evaluar fortalezas y debilidades. Resultados: La acción de supervisores/jefes puede ser considerada una fortaleza de la seguridad del paciente, con el 78,2% de respuestas positivas; en lo referente a la comunicación, se la consideró una debilidad, con el 13,24%. La nota general de seguridad del paciente asignada a la unidad de trabajo fue muy buena, en un intervalo de confianza del 95%. Conclusión: Al identificar las fortalezas y debilidades en la seguridad del paciente es posible planificar acciones de mejora. Destacamos que el enfoque no punitivo es esencial

Cultura de segurança do paciente na área materno-infantil de hospital universitário

Objetivo: Avaliar a cultura de segurança do paciente na perspectiva de enfermeiros e médicos atuantes na área materno-infantil. Método: Estudo transversal, realizado de janeiro a setembro de 2018, com 41 profissionais do Centro Obstétrico e internação obstétrica de hospital universitário do sul do país, utilizando o Hospital Survey on Patient Safety Culture, com 12 dimensões da cultura de segurança, mensuradas por meio de um escore geral (0 a 10) e percentuais de respostas positivas para aferir fortalezas e fragilidades. Resultados: A ação de supervisores/chefes foi considerada uma fortaleza, tendo 78,2% de respostas positivas; já no que diz respeito à comunicação, considerou-se uma fragilidade, pontuando 13,2%. A nota geral de segurança do paciente foi de muito boa, nota 4, num intervalo de confiança de 95%.Conclusão: Com a identificação das fortalezas e fragilidades da segurança do paciente é possível planejar ações de melhoria. Destacamos que a abordagem não punitiva é essencial. Palavras-chave: Segurança do paciente. Cultura organizacional. Qualidade da assistência à saúde. Saúde materno-infantil

Zum Zusammenhang von Geschlechterungleichheiten in Bildung, Beruf und Karriere : ein Ausblick

Ziel der folgenden Ausführungen im abschliessenden Teil dieses Sammelbands zur Entwicklung und Genese von geschlechtsspezifischen Bildungsungleichheiten ist es, den Blick zu öffnen in Richtung Berufsleben. Wie sind die verbesserten Bildungsmöglichkeiten von Frauen zu interpretieren? Ist es in den letzten Jahrzehnten gelungen, eines der grundlegendsten gesellschaftlichen Ungleichheitsverhältnisse zu beseitigen? Oder beginnt sich dieses sogar zu verkehren in eine gesellschaftliche Benachteiligung der Männer? Wir gehen bei unseren Überlegungen von der These aus, dass ein Abbau von Benachteiligungen der Frauen im Bildungssystem für sich genommen noch wenig aussagekräftig ist, wenn wir uns mit der klassischen soziologischen Frage der Persistenz bzw. des Wandels von gesellschaftlichen Ungleichheiten befassen wollen. Erst wenn die ganze Verknüpfung von Bildung und gesellschaftlicher Ungleichheit in den Blick genommen wird und sich dabei zeigt, dass Frauen ihre Bildungsgewinne auch in entsprechende Chancen im Beschäftigungssystem umsetzen können, sind ihre verbesserten Bildungschancen ein Gewinn für die Individuen und ein Fortschritt für die Gesellschaft – und erst dann könnten mögliche Bildungsvorteile von Frauen, wie sie in den vorliegenden Aufsätzen z.T. diagnostiziert werden, gar als neue gesellschaftliche Benachteiligungen von Männern skandalisiert werden