A investigação-ação No Brasil: uma análise do Encontro Nacional de Pesquisa em Educação em Ciências (Enpec)

Discutir a Investigação-Ação (IA) na docência se torna intrínseco aos processos de reflexão sobre a prática de professores, seja em formação inicial, seja em formação continuada. Atualmente, a IA ganhou espaço em encontros formativos de professores de Ciências, gerando ciclos de reflexão, formação e aprendizagem, trazendo oportunidades aos sujeitos que utilizam a IA. Assim, esta pesquisa tem como objetivo compreender de que maneira a IA é abordada nos trabalhos publicados nos Anais do Encontro Nacional de Pesquisa em Educação em Ciências (Enpec) entre os anos de 1997 a 2019. A metodologia utilizada é qualitativa, especificamente de investigação documental. A partir das análises dos trabalhos, evidenciamos a importância da IA voltada às concepções de IA-crítica, IA-técnica e IA-prática, sendo cada vez mais relevante e presente na formação de professores. Os trabalhos também apresentaram temáticas referentes à formação de professores, a processos/práticas educacionais, a processos reflexivos e à pesquisa-ação como metodologia de pesquisa.&nbsp

O papel da reflexão na formação inicial de professores de ciências

During the initial formation in Sciences, considering the context analyzed in this research, the teacher goes through processes of investigation and reflection seeking improvements in its practice. Thus, we aim to understand the role of unreflection in the process of research-training-action as a way to learn during the initial training experiences. In this way, we analyze and categorize the training journals of 14 graduates participating in the Tutorial Education Program (PET) Subproject PETCiências of the Federal University of the South Frontier (UFFS), Campus Cerro Largo. We aim to understand the reflexive paths and development of the narratives of the subjects participating in the study. The categories of analysis were defined a priori following two thematic axes i) levels of reflection, ii) types of reflection. The PETCiências Program uses the training journal from the beginning of the graduation with the intention of being a guide for the learning of the reflection promoting autonomy and improvements in its practice. Based on the analyzes, we highlight the role of the training diary in the initial formation, bringing opportunities to the individuals who reflect on themselves through the formative process of action research (IA), being this a construction that is done in the collective that assists in the development critical, self-reflective and adds to teacher development.Durante a formação inicial em Ciências, tendo em vista o contexto analisado nesta pesquisa, o professor passa por processos de investigação e reflexão buscando melhorias em sua prática. Sendo assim, temos como objetivo compreender o papel da irreflexão no processo de investigação-formação-ação como via para a aprendizagem no decorrer das experiências de formação inicial. Desta forma, analisamos e categorizamos os diários de formação de 14 licenciandos participantes do Programa de Educação Tutorial (PET) Subprojeto PETCiências da Universidade Federal da Fronteira Sul (UFFS), Campus Cerro Largo. Temos como objetivo compreender os caminhos reflexivos e desenvolvimento das narrativas dos sujeitos participantes do estudo. As categorias de análise foram definidas a priori seguindo dois eixos temáticos i) níveis de reflexão, ii) tipos de reflexão. O Programa PETCiências utiliza o diário de formação desde o inicio da graduação com o intuito de ser um guia para a aprendizagem da reflexão promovendo autonomia e melhorias em sua prática. A partir das análises, evidenciamos o papel do diário de formação na formação inicial trazendo oportunidades aos sujeitos que refletem sobre si mesmos por meio do processo formativo da investigação-ação (IA), sendo essa uma construção que se faz no coletivo que auxilia no desenvolvimento critico, autorreflexivo e agrega ao desenvolvimento docente

Violencia doméstica contra la mujer: contexto sociocultural y salud mental de la víctima

O presente estudo objetiva a verificação na literatura científica dos impactos da violência doméstica contra mulher no contexto familiar e na saúde mental da vítima. Diante disso, realizou-se uma pesquisa bibliográfica de cunho qualitativo. Adotou-se como critério de inclusão artigos científicos publicados em língua portuguesa, com informações de maior relevância para a pesquisa, sendo realizadas considerações a respeito da violência contra mulher e seus impactos a saúde mental. Os resultados do estudo apontam que há um contexto sociocultural que considera a desigualdade de gêneros, propiciando a prática da violência. Acerca disso, cabe ressaltar também que além de dificuldades da vítima de tentar abandonar o contexto de violência, constataram-se inúmeros impactos psicológicos. Conclui-se que através de um levantamento de questões referentes a temática da violência doméstica, buscou-se possibilitar reflexões e questionamentos referentes ao contexto em que se dá a violência, como os danos à saúde mental das vítimas, visando um olhar acolhedor em relação à mulher violentada, principalmente no atendimento no âmbito da saúde.This study aims to verify in the scientific literature the impacts of domestic violence against women in the family context and the mental health of the victim. Therefore, a qualitative bibliographic research was carried out. The inclusion criterion was scientific articles published in Portuguese, with more relevant information for the research, and considerations were made regarding violence against women and its impacts on mental health. The results of the study indicate that there is a sociocultural context that considers gender inequality, favoring the practice of violence. In this regard, it should also be noted that in addition to the difficulties of the victim to try to abandon the violent context, there were numerous psychological impacts. It is concluded that through a survey of questions related to the theme of domestic violence, we sought to enable reflections and questions regarding the context in which violence occurs, such as damage to the mental health of victims, seeking a welcoming look in relation to woman raped, especially in health care.Este estudio tiene como objetivo verificar en la literatura científica los impactos de la violencia doméstica contra las mujeres en el contexto familiar y la salud mental de la víctima. Por lo tanto, se realizó una investigación bibliográfica cualitativa. El criterio de inclusión fueron los artículos científicos publicados en portugués, con información más relevante para la investigación, y se hicieron consideraciones con respecto a la violencia contra las mujeres y sus impactos en la salud mental. Los resultados del estudio indican que existe un contexto sociocultural que considera la desigualdad de género y favorece la práctica de la violencia. En este sentido, también debe tenerse en cuenta que, además de las dificultades de la víctima para tratar de abandonar el contexto violento, hubo numerosos impactos psicológicos. Se concluye que a través de una encuesta de preguntas relacionadas con el tema de la violencia doméstica, buscamos permitir reflexiones y preguntas sobre el contexto en el que ocurre la violencia, como el daño a la salud mental de las víctimas, buscando una mirada acogedora en relación con mujer violada, especialmente en el cuidado de la salud

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt