41 research outputs found
Arte, escola e museu: anĂĄlise de uma experiĂȘncia em arte/educação no Museu UniversitĂĄrio de Arte - MUnA
Resumo A partir de uma perspectiva teĂłrica e empĂrica, o artigo analisa uma experiĂȘncia em arte/educação desenvolvida com estudantes da rede pĂșblica de ensino na cidade de UberlĂąndia, Minas Gerais, no Museu UniversitĂĄrio de Arte - MUnA. De abordagem qualitativa e de carĂĄter descritivo e interpretativo, a pesquisa constatou que o contato com museu de arte possibilita ao estudante nĂŁo apenas ampliar o seu conhecimento de mundo, mas enriquecer sua formação cultural e melhorar a sua capacidade de expressĂŁo, alĂ©m de possibilitar aos estudantes uma melhor interação com o meio social em que vivem. O conhecimento em arte Ă© um aprendizado que começa na observação de uma obra de arte, da sua leitura e da prĂĄtica artĂstica. As leituras e comportamentos que cada estudante tem ao apreciar uma obra de arte estĂŁo relacionados Ă sua experiĂȘncia com diferentes manifestaçÔes artĂsticas. Ă indispensĂĄvel que escolas, professores de arte e açÔes educativas em museus sejam importantes mediadores para a produção do conhecimento em arte aos estudantes. Construir esse conhecimento a partir do acesso constante a esses espaços artĂsticos e educacionais, alĂ©m do desenvolvimento de atividades artĂsticas nesses espaços, possibilita ao estudante elevar a sua compreensĂŁo da cultura nacional. Verificamos, ainda, que os estudantes produziram trabalhos artĂsticos significativos durante a ação educativa no museu, o que contribuiu para que ampliassem sua experiĂȘncia com a arte
Fatores de risco para quedas em pacientes adultos hospitalizados: um estudo caso-controle
Objective: to identify risk factors for falls in hospitalized adult patients. Methods: a matched case-control study (one control for each case). A quantitative study conducted in clinical and surgical units of a teaching hospital in Southern Brazil. The sample comprised 358 patients. Data were collected over 18 months between 2013-2014. Data analysis was performed with descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 18.0. Results: risk factors identified were: disorientation/confusion [OR 4.25 (1.99 to 9.08), p<0.001]; frequent urination [OR 4.50 (1.86 to 10.87), p=0.001]; walking limitation [OR 4.34 (2.05 to 9.14), p<0.001]; absence of caregiver [OR 0.37 (0.22 to 0.63), p<0.001]; postoperative period [OR 0.50 (0.26 to 0.94), p=0.03]; and number of medications administered within 72 hours prior the fall [OR 1.20 (1.04 to 1.39) p=0.01]. Conclusion: risk for falls is multifactorial. However, understanding these factors provides support to clinical decision-making and positively influences patient safety.Objetivo: identificar los factores de riesgo para la ocurrencia de caĂdas en pacientes adultos hospitalizados. MĂ©todos: un estudio caso-control emparejado (un control para cada caso). InvestigaciĂłn cuantitativa llevada a cabo en unidades clĂnicas y quirĂșrgicas de un hospital universitario en el Sur de Brasil. La muestra constĂł de 358 pacientes. Se recopilaron datos durante 18 meses, entre 2013-2014. El anĂĄlisis de los datos se realizĂł mediante estadĂstica descriptiva y regresiĂłn logĂstica condicional, utilizando el Microsoft Excel y el SPSS versiĂłn 18.0. Resultados: los factores de riesgo identificados fueron: desorientaciĂłn/confusiĂłn [OR 4,25 (1,99 a 9,08), p<0,001]; micciĂłn frecuente [OR 4,50 (1,86 a 10,87), p=0,001]; limitaciĂłn para caminar [OR 4,34 (2,05 a 9,14), p<0,001]; ausencia de cuidadores [OR 0,37 (0,22 a 0,63), p<0,001]; perĂodo postoperatorio [OR 0,50 (0,26 a 0,94), p=0,03]; y nĂșmero de medicamentos administrados dentro de las 72 horas previas a la caĂda [OR 1,20 (1,04 a 1,39) p=0,01]. ConclusiĂłn: los riesgos de caĂdas son multifactoriales. Sin embargo, la comprensiĂłn de estos factores respalda la toma de decisiones clĂnicas y tiene un impacto positivo en la seguridad del paciente.Objetivo: identificar os fatores de risco para a ocorrĂȘncia de quedas em pacientes adultos hospitalizados. MĂ©todos: estudo do tipo caso-controle pareado (um controle para cada caso). Pesquisa quantitativa realizada em unidades clĂnicas e cirĂșrgicas de um hospital universitĂĄrio da regiĂŁo Sul do Brasil. A amostra incluiu 358 pacientes. Os dados foram coletados durante 18 meses, entre 2013-2014. A anĂĄlise dos dados foi realizada por meio de estatĂstica descritiva e regressĂŁo logĂstica condicional, utilizando o Microsoft Excel e o SPSS versĂŁo 18.0. Resultados: os fatores de risco identificados foram: desorientação/confusĂŁo [OR 4,25 (1,99 a 9,08), p<0,001]; micção frequente [OR 4,50 (1,86 a 10,87), p=0,001]; limitação para caminhar [OR 4,34 (2,05 a 9,14), p<0,001]; ausĂȘncia de cuidador [OR 0,37 (0,22 a 0,63), p<0,001]; perĂodo pĂłs-operatĂłrio [OR 0,50 (0,26 a 0,94), p=0,03]; e o nĂșmero de medicamentos administrados nas 72 horas anteriores Ă queda [OR 1,20 (1,04 a 1,39) p=0,01]. ConclusĂŁo: os riscos para quedas sĂŁo multifatoriais. Todavia, conhecĂȘ-los dĂĄ suporte Ă decisĂŁo clĂnica do enfermeiro, o que contribui para a busca das melhores intervençÔes preventivas e impacta positivamente na segurança dos pacientes
Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990â2021: a systematic analysis for the Global Burden of Disease Study 2021
Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44â2·85) in 2010 to 2·88 billion (2·64â3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7â17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8â6·3) in 2020 and 7·2% (4·7â10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0â234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7â198·3]), neonatal disorders (186·3 million [162·3â214·9]), and stroke (160·4 million [148·0â171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3â51·7) and for diarrhoeal diseases decreased by 47·0% (39·9â52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54â1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5â9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0â19·8]), depressive disorders (16·4% [11·9â21·3]), and diabetes (14·0% [10·0â17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7â27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6â63·6) in 2010 to 62·2 years (59·4â64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6â2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprungâs disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprungâs disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36â39) and median bodyweight at presentation was 2·8 kg (2·3â3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
pâ€0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88â4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59â2·79], p<0·0001), sepsis at presentation (1·20
[1·04â1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4â5 vs ASA 1â2, 1·82 [1·40â2·35], p<0·0001; ASA 3 vs ASA 1â2, 1·58, [1·30â1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02â1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41â2·71], p=0·0001; parenteral nutrition 1·35, [1·05â1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47â0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50â0·86], p=0·0024) or percutaneous central line (0·69 [0·48â1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Recommended from our members
Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9â27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6â16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2â1.8), stage II (OR 1.6; 95% CI 1.4â1.9), and stage III or worse (OR 2.8; 95% CI 2.3â3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat