INSEF-ExpoQuim: assessing the exposure of the Portuguese population to chemicals

Introduction: Exposure to hazardous chemicals may endanger human health and pollute the environment. To assess and minimize the risks associated with the use of chemicals it is essential to know whether and to what extent these substances are present in the human body. We report preliminary results of the recruitment phase in the study of Exposure of the Portuguese Population to Environmental Chemicals: a study nested in INSEF 2015 (INSEF-ExpoQuim). Methods: INSEF-ExpoQuim is an epidemiologic study nested in INSEF 2015 targeting 300 non-institutionalized individuals aged 28-39 years, living in Portugal for more than 12 months, able to follow an interview in Portuguese. Fieldwork started in June 2019 and is ongoing. Procedures are according to the guidelines of the HBM4EU project. Selected individuals receive an invitation letter and are later contacted by phone to schedule sample collection and the telephone interview. Urine samples for determination of heavy metals, bisphenols and Polycyclic Aromatic Hydrocarbons are collected, as well as data on socio-demographic characteristics, living conditions and residential history, habits/lifestyle, nutrition, health, occupation and substance specific information covering nearly all exposure pathways. Results: Up to date 384 of the 848 eligible individuals were successfully contacted (45,3%), of which 172 accepted to participate in INSEF-ExpoQuim corresponding to a participation rate of 20%. Conclusions: Results from INSEF-ExpoQuim will contribute to reduce the health impact that could result from the exposure of the population residing in Portugal to environmental chemicals, by producing high quality data on the actual exposure of the Portuguese population to hazardous chemicals, in order to support the development and implementation of policy measures aimed at minimizing exposure to those chemicals.HBM4EU has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733032.N/

Nursing interventions in pediatric care: a contribution to measuring workload

Objetivo Identificar y validar intervenciones/actividades desarrolladas por el equipo de enfermería en una unidad pediátrica. Método Estudio descriptivo, transversal, observacional desarrollado en la Clínica Pediátrica del Hospital Universitario de la Universidad de São Paulo, São Paulo, Brasil, organizado en las siguientes etapas: identificación de las actividades realizadas por el equipo (registros en archivos y observación directa); mapeo y validación de las actividades identificadas en las intervenciones, de acuerdo con la Clasificación de Intervenciones de Enfermería (CIE). Resultados Las 275 actividades identificadas fueron mapeadas en 63 intervenciones, 22 clases y siete dominios de la CIE, 25 actividades asociadas y 13 personales. Después de la validación, el número de actividades pasó para 244, lo que corresponde a 53 intervenciones, 20 clases y seis dominios de la CIE, 30 actividades asociadas y nueve personales. Conclusión la identificación de las intervenciones/actividades realizadas por el equipo de enfermería favorece la medición de la carga de trabajo siendo una importante contribución a la superación de las dificultades relacionadas con la aplicación del proceso de dimensionamiento de profesionales en el área de pediatría.Objective To identify and validate interventions/activities developed by a nursing team in a Brazilian pediatric unit. Method A descriptive, cross-sectional, and observational study was developed in the pediatric clinic of the university hospital of University of São Paulo, São Paulo, Brazil. It was organized in the following stages: identifying activities carried out by the team (from records in patient charts and from direct observation); mapping out and validating activities identified in interventions according to the Nursing Intervention Classification (NIC). Results The 275 identified activities were mapped out into 63 interventions, 22 NIC classes and 7 NIC domains, and 25 associated and 13 personal activities. After validation, the number of activities decreased to 244, corresponding to 53 interventions, 20 NIC classes and 6 NIC domains, and 30 associated activities and 9 personal activities. Conclusion Identifying the interventions/activities performed by the nursing team can help measure workload and is an important contribution to overcoming difficulties when it comes to operationalizing the process of sizing professional teams in the field of pediatrics.Objetivo Identificar e validar as intervenções/atividades desenvolvidas pela equipe de enfermagem em unidade pediátrica. Método Pesquisa descritiva, transversal, observacional, desenvolvida na Clínica Pediátrica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brasil, organizada nas etapas: identificação das atividades realizadas pela equipe (registros em prontuários e observação direta); mapeamento e validação das atividades identificadas em intervenções, segundo a Nursing Intervention Classification (NIC). Resultados As 275 atividades identificadas foram mapeadas em 63 intervenções, 22 classes e sete domínios da NIC, 25 atividades associadas e 13 pessoais. Após validação, o número de atividades passou para 244, correspondendo a 53 intervenções, 20 classes e seis domínios da NIC, 30 atividades associadase nove pessoais. Conclusão A identificação das intervenções/atividades executadas pela equipe de enfermagem favorece a mensuração da carga de trabalho, constituindo importante contribuição para a superação das dificuldades relacionadas à operacionalização do processo de dimensionamento de profissionais na área de pediatria

design, planning and implementation

Background: In Health Examination Surveys interview information is complemented with objective information, providing more accurate indicators than self-reported data. We report the study design, planning and implementation of the first Portuguese Health Examination Survey (INSEF). Methods: INSEF was a cross-sectional population-based study representative at regional and national level. Individuals aged between 25 and 74 years old, residing in Portugal were selected from the national health users' registry through multi-stage stratified probabilistic sampling. Sample size was set at 4200 individuals. Data was collected in primary care units and included blood pressure, height, weight, hip and waist measurements, blood collection for lipid profile, HbA1c and blood count and a general health questionnaire. European HES procedures were followed. Results: A total of 4911 individuals agreed to participate (43.9% participation rate). Participation rate varied by region, sex and age group, being lower in Lisbon and Tagus Valley (32.8%), for men (41.8%) and for those aged 25-34 years old (36%). Conclusions: INSEF has set up an experienced national and regional structure for HES implementation. Nationally representative quality epidemiological data is now available for public health monitoring, planning and research.publishe

Arsenic exposure in the Portuguese population: INSEF-ExpoQuim preliminary results

O arsénio é um elemento naturalmente presente no meio ambiente e que também pode ser libertado em resultado de atividades antropogénicas, podendo encontrar-se na forma de compostos orgânicos ou inorgânicos. O arsénio é considerado pela Organização Mundial de Saúde como um dos dez químicos de maior preocupação para a saúde pública, uma vez que o arsénio e os compostos inorgânicos de arsénio estão classificados como cancerígenos pela Agência Internacional para a Investigação do Cancro. A exposição a arsénio inorgânico ocorre principalmente por via alimentar, através do consumo de água e de alimentos contaminados. Em Portugal são escassos os dados sobre a exposição a arsénio na população geral, pelo que o objetivo do presente estudo é a caracterização da exposição da população adulta portuguesa a arsénio, utilizando amostras de urina colhidas num estudo populacional nacional ( INSEF-ExpoQuim). O presente trabalho incluiu 171 participantes no estudo INSEF-ExpoQuim que forneceram uma amostra de urina para análise da concentração de arsénio total por espectrometria de massa com plasma indutivo acoplado ( ICP-MS ). Observou-se uma média geométrica de 47,1 μg As/L [ IC95%: 41,4-53,5 ] e 8,8% dos indivíduos apresentavam valores de arsénio considerados elevados. Não se observaram diferenças nos níveis de arsénio por sexo, grupo etário, grau de urbanização da área de residência, nível de escolaridade e situação face ao trabalho. Os resultados preliminares obtidos apontam para a necessidade de monitorização dos níveis de arsénio na população portuguesa.Arsenic is an element naturally present in the environment, but it can also be released as a result of anthropogenic activities. In the environment, arsenic can be found in the form of organic compounds and in the form of inorganic compounds. Arsenic is considered by the World Health Organization as one of the ten chemicals of greatest concern for public health, since arsenic and inorganic arsenic compounds are classified as carcinogenic by the International Agency for Research on Cancer. Exposure to inorganic arsenic occurs mainly through food, through consumption of contaminated water and food. In Portugal, data on arsenic exposure in the general population are scarce, so the aim of the present study was to characterize the exposure of the Portuguese adult population to arsenic, using urine samples collected in a national population study ( INSEF-ExpoQuim). The present work included 171 participants in the INSEF-ExpoQuim study who provided a urine sample for analysis of total arsenic concentration by inductively coupled plasma mass spectrometry (ICP-MS). A geometric mean of 47.1 μg As/L [ 95% CI: 41.4-53.5 ] was observed and 8.8% of the individuals had arsenic levels considered high. No differences were observed in arsenic levels by sex, age group, degree of urbanization of the area of residence, educational level and employment situation. The obtained preliminary results point to the need to monitor the levels of arsenic in the Portuguese population.O estudo INSEF-ExpoQuim foi cofinanciado no âmbito do projeto HBM4EU, que recebeu financiamento do programa de investigação e inovação Horizonte 2020 da União Europeia, ao abrigo da convenção de subvenção n.º 733032. O INSEF foi desenvolvido como parte integrante do projeto Improvement of epidemiological health information to support public health decision and management in Portugal Towards reduced inequalities, improved health, and bilateral cooperation, tendo beneficiado de um apoio financeiro de 1 500 000 euros concedido pela Islândia, Liechtenstein e Noruega, através das EEA Grants.info:eu-repo/semantics/publishedVersio

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

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost

Custo direto dos curativos de úlceras por pressão em pacientes hospitalizados

RESUMO Objetivo: identificar o custo direto médio (CDM) relativo à mão de obra direta (MOD) de profissionais de enfermagem e ao consumo de materiais e soluções consumidos na realização de curativos de úlceras por pressão (UPs) em pacientes hospitalizados. Método: estudo de caso único, exploratório-descritivo, realizado em um hospital universitário. Durante seis meses observou-se a realização de 228 curativos para o tratamento de pacientes portadores de UPs. Calculou-se o custo multiplicando-se o tempo despendido por profissionais de enfermagem pelo custo unitário da MOD, somando-se ao custo dos materiais e soluções consumidos. Resultados: o CDM de curativos de UPs correspondeu a US$19.18 (UPs-categoria I); US$ 6.50 (UPs-categoria II); US$12.34 (UPs-categoria III); US$ 5.84 (UPs-categoria IV); US$9.52 (UPs-inclassificáveis) e US$ 3.76 (suspeita de lesão tissular profunda). Conclusão: a metodologia adotada poderá ser reproduzida em diferentes contextos hospitalares para o desenvolvimento de outros estudos visando ampliar e complementar o conhecimento obtido

HEMORRAGIA DIGESTIVA OCASIONAL EM CRIANÇA POR ESTRONGILOIDÍASE: IMPORTÂNCIA DO EXAME PARASITOLÓGICO

RESUMO Objetivo: Descrever um caso incomum de infecção por Strongyloides stercoralis (S. stercoralis) em paciente de quatro meses de idade e ressaltar a importância do diagnóstico precoce. Descrição do caso: Paciente masculino, procedente e residente de Videira, Santa Catarina, Brasil, nasceu pré-termo, parto cesárea, peso de nascimento 1.655 g, e permaneceu na Unidade de Terapia Intensiva neonatal e intermediária por 20 dias. Aos quatro meses de idade, começou a evacuar fezes sanguinolentas e foi feita hipótese de alergia à proteína do leite de vaca, em razão da sintomatologia e do uso da fórmula infantil para o primeiro semestre, para o qual foi indicada a substituição por fórmula infantil com proteína hidrolisada. Foram solicitados a pesquisa de leucócitos e o exame parasitológico das fezes). Ambos se mostraram positivos e o parasitológico revelou a presença de larva rabditoide de S. stercoralis. O clínico manteve a hipótese inicial e a dieta, mas solicitou a coleta de três amostras de fezes, que resultaram em uma amostra para larvas rabditoide, em muda, de S. stercoralis. Como a criança apresentava dor abdominal, vômito e as fezes permaneciam sanguinolentas, foi iniciado o tratamento com tiabendazol - duas vezes/dia por dois dias -, repetido após sete dias, e, em seguida, realizado o exame parasitológico de fezes, tendo sido negativo. Comentários: A estrongiloidíase, apesar de ser uma infecção parasitária frequentemente leve, em pacientes imunocomprometidos pode se apresentar de forma grave e disseminada. Deve-se suspeitar desse agente em pacientes que vivem em áreas endêmicas, sendo o diagnóstico estabelecido por meio da pesquisa das larvas do S. stercoralis na secreção traqueal e nas fezes