Melhoria da Atenção ao Pré-Natal e Puerpério da Unidade Básica de Saúde Ricardo Monteiro Rola, Acrelândia/AC

Resumo GONGORA, Gisela Cruz. Melhoria da Atenção ao Pré-natal e Puerpério da Unidade Básica de Saúde Ricardo Monteiro Rola, Acrelândia/AC. 2015. 102f. Trabalho de Conclusão de Curso (Curso de Especialização em Saúde da Família) - Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, 2015. A morbimortalidade materna e perinatal ainda são incompatíveis com o atual nível de desenvolvimento socioeconômico do Brasil. Com o objetivo de diminuir essa morbimortalidade, investe-se na melhoria da atenção ao pré-natal e puerpério. Para tanto, na Unidade Básica de Saúde Ricardo Monteiro Rola, no município de Acrelândia, Estado do Acre, realizou-se uma intervenção nesta ação programática, durante 12 semanas. Ações foram desenvolvidas para ampliar cobertura, qualidade, adesão, registro de informações, detecção de fatores de risco e sinais de alerta, promoção de saúde. Os resultados mostram cadastramento de 36 (97,3% de cobertura) gestantes e nove puérperas (100%), gestantes iniciaram o pré-natal no primeiro trimestre de gestação 29 (80,6%) de 36 cadastradas no programa,16 (44,4%) gestante e quatro (44,4%) puérperas tiveram exame ginecológico, 22 (61,1%) gestantes e seis (66,7%) puérperas tiveram as mamas examinadas. 36(100%) gestantes tiveram solicitação de todos os exames laboratoriais de acordo com o protocolo, 30 (83,3%) gestantes com prescrição de sulfato ferroso e ácido fólico, 28 (82,4%) gestantes com o esquema de vacina antitetânica em dia,29 (80,6%) esquema de vacina contra Hepatite B em dia, seis (16,7%) das gestantes tiveram avaliação de atendimento odontológico, quatro (11,1%) das gestantes tiveram a primeira consulta odontológica,35(97,2%) das gestantes tiveram fichas de acompanhamento/espelho de pré-natal, 32 (88,9%) das gestantes foram avaliadas quanto o risco gestacional,30(88,2%)receberam orientação nutricional, 32 (88,9%) das gestantes receberam orientação sobre aleitamento materno,28 (77,8%) gestantes receberam orientação sobre cuidado do recém-nascido, anticoncepção após o parto e higiene bucal de 36 gestantes cadastradas, 22 (61,1%) das gestantes receberam orientação sobre os riscos do tabagismo e do uso de álcool e drogas na gestação, Os registros foram qualificados por meio do preenchimento de fichas-espelhos. A avaliação de risco gestacional ainda não está com os resultados desejados pela equipe devido à falta de disciplina, sistematização de profissionais, a pesar de estar capacitado não foi feita nas consultas agendadas. As orientações acerca do pré-natal e puerpério aprimorou a promoção em saúde oferecida na Unidade de Saúde, com orientações nutricionais, aleitamento materno, cuidados com o recém-nascido, o resultado foi atingido por as capacitações da equipe. Destaca-se que não houve faltosas às consultas, os motivos foi o monitoramento e cumprimento da periodicidade das consultas prevista no protocolo, alem da informação as gestantes sobre a importância do pré-natal e do acompanhamento regular. A intervenção foi muito importante para equipe e para o serviço porque possibilitou a capacitação dos profissionais acerca desta ação programática, promoveu o trabalho integrado da equipe multiprofissional, impactou em outros programas de saúde e destacou a humanização no atendimento à gestante. Palavras-chave: atenção primária à saúde; saúde da família; saúde da mulher; pré-natal; puerpério; saúde bucal

Obesity prevention messages, risk behaviors for eating disorders and body mass index: Cluster analysis

Public health experts have argued that obesity prevention campaigns can have negative health effects such as risk behaviors for eating disorders. This study aimed to identify the relationship between body mass index, the presence of risk behaviors for eating disorders, and hearing to obesity prevention messages. The adolescents were measured to calculate their body mass index. The presence of risk behaviors for eating disorders was evaluated, and the number and frequently of obesity prevention messages they heard was registered. A cluster analysis was used for the statistical analysis. Among the results it was found, that the adolescents reported hearing an average of seven different obesity prevention messages in one week; the most commonly heard message was measure your waist. The most common risk behaviors for eating disorders seen in the adolescents were excessive exercise and fear of gaining weight. One cluster were identified obese adolescents that reported hearing fewer obesity prevention messages and presented various risk behaviors for eating disorders. Other cluster were normal weight adolescents that reported hearing more obesity prevention messages and presented few risk behaviors for eating disorders. In conclusion, it is advisable to design campaigns that simultaneously prevent obesity and risk behaviors for eating disorders.Fil: Cruz Licea, Verónica. Universidad Nacional Autónoma de México; MéxicoFil: Morán Álvarez, Isabel Cristina. Universidad Nacional Autónoma de México; MéxicoFil: Plascencia González, Carmen. Universidad Nacional Autónoma de México; MéxicoFil: Gongora, Vanesa Carina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Palermo. Facultad de Ciencias Sociales. Departamento de Psicología; Argentin

Monitoring tar spot disease in corn at different canopy and temporal levels using aerial multispectral imaging and machine learning

IntroductionTar spot is a high-profile disease, causing various degrees of yield losses on corn (Zea mays L.) in several countries throughout the Americas. Disease symptoms usually appear at the lower canopy in corn fields with a history of tar spot infection, making it difficult to monitor the disease with unmanned aircraft systems (UAS) because of occlusion.MethodsUAS-based multispectral imaging and machine learning were used to monitor tar spot at different canopy and temporal levels and extract epidemiological parameters from multiple treatments. Disease severity was assessed visually at three canopy levels within micro-plots, while aerial images were gathered by UASs equipped with multispectral cameras. Both disease severity and multispectral images were collected from five to eleven time points each year for two years. Image-based features, such as single-band reflectance, vegetation indices (VIs), and their statistics, were extracted from ortho-mosaic images and used as inputs for machine learning to develop disease quantification models.Results and discussionThe developed models showed encouraging performance in estimating disease severity at different canopy levels in both years (coefficient of determination up to 0.93 and Lin’s concordance correlation coefficient up to 0.97). Epidemiological parameters, including initial disease severity or y0 and area under the disease progress curve, were modeled using data derived from multispectral imaging. In addition, results illustrated that digital phenotyping technologies could be used to monitor the onset of tar spot when disease severity is relatively low (< 1%) and evaluate the efficacy of disease management tactics under micro-plot conditions. Further studies are required to apply and validate our methods to large corn fields

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Background and purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT

Combined fit to the spectrum and composition data measured by the Pierre Auger Observatory including magnetic horizon effects

The measurements by the Pierre Auger Observatory of the energy spectrum and mass composition of cosmic rays can be interpreted assuming the presence of two extragalactic source populations, one dominating the flux at energies above a few EeV and the other below. To fit the data ignoring magnetic field effects, the high-energy population needs to accelerate a mixture of nuclei with very hard spectra, at odds with the approximate E$^{-2}$ shape expected from diffusive shock acceleration. The presence of turbulent extragalactic magnetic fields in the region between the closest sources and the Earth can significantly modify the observed CR spectrum with respect to that emitted by the sources, reducing the flux of low-rigidity particles that reach the Earth. We here take into account this magnetic horizon effect in the combined fit of the spectrum and shower depth distributions, exploring the possibility that a spectrum for the high-energy population sources with a shape closer to E$^{-2}$ be able to explain the observations

A Catalog of the Highest-energy Cosmic Rays Recorded during Phase I of Operation of the Pierre Auger Observatory

A catalog containing details of the highest-energy cosmic rays recorded through the detection of extensive air-showers at the Pierre Auger Observatory is presented with the aim of opening the data to detailed examination. Descriptions of the 100 showers created by the highest-energy particles recorded between 1 January 2004 and 31 December 2020 are given for cosmic rays that have energies in the range 78 EeV to 166 EeV. Details are also given of a further nine very-energetic events that have been used in the calibration procedure adopted to determine the energy of each primary. A sky plot of the arrival directions of the most energetic particles is shown. No interpretations of the data are offered

Constraining the sources of ultra-high-energy cosmic rays across and above the ankle with the spectrum and composition data measured at the Pierre Auger Observatory

In this work we present the interpretation of the energy spectrum and mass composition data as measured by the Pierre Auger Collaboration above $6 \times 10^{17}$ eV. We use an astrophysical model with two extragalactic source populations to model the hardening of the cosmic-ray flux at around $5\times 10^{18}$ eV (the so-called "ankle" feature) as a transition between these two components. We find our data to be well reproduced if sources above the ankle emit a mixed composition with a hard spectrum and a low rigidity cutoff. The component below the ankle is required to have a very soft spectrum and a mix of protons and intermediate-mass nuclei. The origin of this intermediate-mass component is not well constrained and it could originate from either Galactic or extragalactic sources. To the aim of evaluating our capability to constrain astrophysical models, we discuss the impact on the fit results of the main experimental systematic uncertainties and of the assumptions about quantities affecting the air shower development as well as the propagation and redshift distribution of injected ultra-high-energy cosmic rays (UHECRs).Comment: Submitted to JCA

The Pierre Auger Observatory Open Data

The Pierre Auger Collaboration has embraced the concept of open access to their research data since its foundation, with the aim of giving access to the widest possible community. A gradual process of release began as early as 2007 when 1% of the cosmic-ray data was made public, along with 100% of the space-weather information. In February 2021, a portal was released containing 10% of cosmic-ray data collected from 2004 to 2018, during Phase I of the Observatory. The Portal included detailed documentation about the detection and reconstruction procedures, analysis codes that can be easily used and modified and, additionally, visualization tools. Since then the Portal has been updated and extended. In 2023, a catalog of the 100 highest-energy cosmic-ray events examined in depth has been included. A specific section dedicated to educational use has been developed with the expectation that these data will be explored by a wide and diverse community including professional and citizen-scientists, and used for educational and outreach initiatives. This paper describes the context, the spirit and the technical implementation of the release of data by the largest cosmic-ray detector ever built, and anticipates its future developments.Comment: 19 pages, 8 figure