Atividades educativas no período pré-natal como estratégia de empoderamento da parturiente

The aim was to analyze and discuss how educational activities during the prenatal period can contribute to the construction of women's autonomy and empowerment during labor and delivery. This is an integrative literature review, which enables the study, summary, and analysis of scientific knowledge already carried out on the topic covered. The databases Latin American and Caribbean Literature in Sciences, Nursing Database, CUMED, and Scientific Electronic Library Online were consulted. There are several ways to carry out educational activities as a strategy for building the empowerment of pregnant women during prenatal care. Most articles mention the conversation circle; a group of pregnant women and individualized care; in addition to the need for continuing education actions for this multidisciplinary team. Educational activities allow women in the pregnancy-puerperal period to have the capacity and confidence to make critical decisions; in the process of building autonomy and empowerment; seeing themselves as the protagonist of their labor; labor and birth.Objetivou-se analisar e discutir como as atividades educativas durante o período de pré-natal podem contribuir para a construção da autonomia e empoderamento da mulher no período de trabalho de parto e parto. Trata-se de uma revisão integrativa de literatura, que viabiliza o estudo, resumo e a análise do conhecimento científico já realizado sobre o tema abordado. Foram consultadas as bases de dados Literatura Latino-Americana e do Caribe em Ciências, Banco de Dados em Enfermagem, CUMED e Scientific Electronic Library Online. São diversas as maneiras de realizar atividades educativas como estratégia para a construção do empoderamento da gestante no pré-natal. A maioria dos artigos citam a roda de conversa; grupo de gestantes e um atendimento individualizado; além da necessidade de ações de educação continuada dessa equipe multiprofissional. As atividades educativas permitem que a mulher no período-gravídico-puerperal possa ter a capacidade e segurança na tomada de decisões de forma crítica; no processo de construção da autonomia e empoderamento; se vendo como protagonista do seu trabalho de parto; parto e nascimento

Lung dendritic cells induce migration of protective T cells to the gastrointestinal tract

Developing efficacious vaccines against enteric diseases is a global challenge that requires a better understanding of cellular recruitment dynamics at the mucosal surfaces. The current paradigm of T cell homing to the gastrointestinal (GI) tract involves the induction of alpha 4 beta 7 and CCR9 by Peyer's patch and mesenteric lymph node (MLN) dendritic cells (DCs) in a retinoic acid-dependent manner. This paradigm, however, cannot be reconciled with reports of GI T cell responses after intranasal (i.n.) delivery of antigens that do not directly target the GI lymphoid tissue. To explore alternative pathways of cellular migration, we have investigated the ability of DCs from mucosal and nonmucosal tissues to recruit lymphocytes to the GI tract. Unexpectedly, we found that lung DCs, like CD103(+) MLN DCs, up-regulate the gut-homing integrin alpha 4 beta 7 in vitro and in vivo, and induce T cell migration to the GI tract in vivo. Consistent with a role for this pathway in generating mucosal immune responses, lung DC targeting by i.n. immunization induced protective immunity against enteric challenge with a highly pathogenic strain of Salmonella. The present report demonstrates novel functional evidence of mucosal cross talk mediated by DCs, which has the potential to inform the design of novel vaccines against mucosal pathogens.open8

Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

Background: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods: An individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. Results: The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0–6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. Conclusion: The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575

Developing Criteria for Health Economic Quality Evaluation Tool

Objectives: Because existing publication guidelines and checklists have limitations when used to assess the quality of cost-effectiveness analysis, we developed a novel quality assessment tool for cost-effectiveness analyses, differentiating methods and reporting quality and incorporating the relative importance of different quality attributes. Methods: We defined 15 quality domains from a scoping review and identified 72 methods and reporting quality attributes (36 each). After designing a best-worst scaling survey, we fielded an online survey to researchers and practitioners to estimate the relative importance of the attributes in February 2021. We analyzed the survey data using a sequential conditional logit model. The final tool included 48 quality attributes deemed most important for assessing methods and reporting quality (24 each), accompanied by a free and web-based scoring system. Results: A total of 524 participants completed the methodology section, and 372 completed both methodology and reporting sections. Quality attributes pertaining to the "modeling" and "data inputs and evidence synthesis" domains were deemed most important for methods quality, including "structure of the model reflects the underlying condition and intervention's impact" and "model validation is conducted." Quality attributes pertaining to "modeling" and "Intervention/comparator(s)" domains were considered most important for reporting quality, including "model descriptions are detailed enough for replication." Despite its growing prominence, "equity considerations" were not deemed as important as other quality attributes. Conclusions: The Criteria for Health Economic Quality Evaluation tool allows users to differentiate methods and reporting as well as quantifies the relative importance of quality attributes. Alongside other considerations, it could help assess and improve the quality of cost-effectiveness evidence to inform value-based decisions.</p

Fauna invertebrada e atributos físicos e químicos do solo em sistemas de integração lavoura-pecuária.

O objetivo deste trabalho foi avaliar o efeito do sistema de integração lavoura-pecuária (ILP) nos principais grupos da macrofauna invertebrada do solo e a relação destes organismos com os atributos físicos e químicos do solo. Foram comparados: sistema de manejo convencional, sistema integração lavoura-pecuária, sistema plantio direto, pastagem cultivada continuamente e fragmentos naturais de Cerrado e de floresta semidecídua. O experimento foi conduzido em Dourados, MS, em um Latossolo Vermelho distroférrico típico, disposto em faixas. A maior densidade, riqueza e diversidade das famílias foi observada no sistema de ILP, em plantio direto, e no sistema em pastagem cultivada continuamente. O sistema convencional promoveu maior redução na comunidade dos organismos invertebrados do solo. O sistema de ILP favorece a manutenção da diversidade da fauna invertebrada, a formação dos agregados estáveis e a fertilidade do solo. A família Sthaphylinidae é um potencial bioindicador de qualidade do solo, principalmente na floresta semidecídua e no sistema de ILP.201