A longitudinalidade e a integralidade no cuidado às crianças menores de um ano: avaliação de cuidadores

Objective: This study aimed to evaluate the attributes longitudinality and comprehensive care in Family Health Units in Vitória da Conquista, Bahia, Brazil. Method: quantitative, cross-sectional study with data collected through the use of the Brazilian version of Primary Care Assessment Tool. This instrument covers the essential attributes of the Primary Health Care, including longitudinality and comprehensive care. We interviewed 271 caretakers of children under one year old who use the health facilities, from January to June 2012. Results: longitudinality scores were high (3.07±0.53), demonstrating good experience of caretakers regarding the actions derived from this attribute. On the other hand, the scores for comprehensive care related to available services and services provided were low (2.83±0.36 and 2.81±0.98). Such results demonstrate little awareness of caretakers related to available services, as well as services provided to children by health facilities. Conclusions: Family Health Strategy is a reference for most health needs of the child; it promotes the relationship between caretakers and health professionals, and enables the knowledge about children health status. However, despite the high coverage of the Family Health Strategy in the county, some children´s health actions are not experienced by caretakers. Managers and health professionals should have the priorities for child health in their agendas, as well as planning and implementation of actions which are related to the child health needs.Objetivo: avaliar os atributos longitudinalidade e integralidade da atenção em Unidades de Saúde da Família em Vitória da Conquista, Bahia, Brasil. Método: pesquisa quantitativa, transversal com dados coletados mediante uso do Instrumento de Avaliação da Atenção Primária, versão nacional Primary Care Assessment Tool. Este instrumento contempla os atributos essenciais da APS, dentre eles a longitudinalidade e a integralidade da atenção. Foram entrevistados 271 cuidadores de crianças menores de um ano, usuários dos serviços, no período de janeiro a junho de 2012. Resultados: a longitudinalidade apresentou escore elevado (3,07±0,53), demonstrando boa experiência dos cuidadores com as ações derivadas desse atributo. Por outro lado, os escores para integralidade, tanto para serviços disponíveis quanto para serviços prestados, foram baixos (2,83±0,36 e 2,81±0,98). Tais resultados apontam pouca percepção dos cuidadores sobre serviços disponíveis, como também serviços prestados à criança pelas unidades de saúde. Conclusões: A ESF constitui referência para a maioria das necessidades de saúde da criança, favorece a relação entre cuidadores e profissionais, além de possibilitar o conhecimento da situação de saúde desse público. Entretanto, apesar da alta cobertura da estratégia no município, algumas ações em saúde voltadas às crianças não são vivenciadas pelos cuidadores. Aos gestores e profissionais de saúde que atuam com esta clientela, cabe a sensibilização sobre as prioridades dentro de suas agendas, como também o planejamento e a implementação de ações que estejam dentro das necessidades de saúde da população infantil

N-acetylcysteine use among patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized trials.

BackgroundCardiac surgeries are complex procedures aiming to re-establish coronary flow and correct valvular defects. Oxidative stress, caused by inflammation and ischemia-reperfusion injury, is associated with these procedures, increasing the risk of adverse outcomes. N-acetylcysteine (NAC) acts as an antioxidant by replenishing the glutathione stores, and emerging evidence suggests that NAC may reduce the risk of adverse perioperative outcomes. We conducted a systematic review and meta-analysis to investigate the addition of NAC to a standard of care among adult patients undergoing cardiac surgery.MethodsWe searched four databases (PubMed, EMBASE, CENTRAL, LILACS) from inception to October 2018 and the grey literaure for randomized controlled trials (RCTs) investigating the effect of NAC on pre-defined outcomes including mortality, acute renal insufficiency (ARI), acute cardiac insufficiency (ACI), hospital length of stay (HLoS), intensive care unit length of stay (ICULoS), arrhythmia and acute myocardial infarction (AMI). Reviewers independently screened potentially eligible articles, extracted data and assessed the risk of bias among eligible articles. We used the GRADE approach to rate the overall certainty of evidence for each outcome.ResultsTwenty-nine RCTs including 2,486 participants proved eligible. Low to moderate certainty evidence demonstrated that the addition of NAC resulted in a non-statistically significant reduction in mortality (Risk Ratio (RR) 0.71; 95% Confidence Interval (CI) 0.40 to 1.25), ARI (RR 0.92; 95% CI 0.79 to 1.09), ACI (RR 0.77; 95% CI 0.44 to 1.38), HLoS (Mean Difference (MD) 0.21; 95% CI -0.64 to 0.23), ICULoS (MD -0.04; 95% CI -0.29 to 0.20), arrhythmia (RR 0.79; 95% CI 0.52 to 1.20), and AMI (RR 0.84; 95% CI 0.48 to 1.48).LimitationsAmong eligible trials, we observed heterogeneity in the population and interventions including patients with and without kidney dysfunction and interventions that differed in route of administration, dosage, and duration of treatment. This observed heterogeneity was not explained by our subgroup analyses.ConclusionsThe addition of NAC during cardiac surgery did not result in a statistically significant reduction in clinical outcomes. A large randomized placebo-controlled multi-centre trial is needed to determine whether NAC reduces mortality.RegistrationPROSPERO CRD42018091191