Desafios Contemporâneos na Gestão de Doenças Cardiovasculares: uma perspectiva de Saúde Coletiva

Objective: The aim of this article is to analyze and present a comprehensive understanding of contemporary challenges in the management of cardiovascular diseases, with a special emphasis on the perspective of public health. Seeking to identify and discuss factors contributing to the complexity of managing these diseases, considering epidemiological, social, and technological nuances.Methodology: This involves a comprehensive literature review of scientific literature across databases such as PubMed, Scielo, Latindex, and Medline. Health Science Descriptors (DeCS) were utilized, including “Cardiology,” “Public Health,” and “Health-Disease Process.” No restrictions were applied regarding time and metrology. Results: Exploration of how the public health approach can provide valuable insights and innovative strategies to address these challenges. The integration of care, the application of health technologies, and the promotion of equity are crucial elements to be addressed in light of the collective perspective, aiming to provide a holistic and effective view in managing these conditions. Conclusion: In summary, an in-depth analysis of contemporary challenges in the management of cardiovascular diseases was provided, highlighting the crucial perspective of public health. By exploring epidemiological, social, and technological factors, we identified the complexity involved in managing these conditions. The collective approach, integrating care, technology, and promoting equity, emerges as a fundamental strategy to address these challenges and promote a more effective and comprehensive management of cardiovascular diseases.Objetivo: O objetivo deste artigo é analisar e apresentar uma compreensão aprofundada dos desafios contemporâneos na gestão de doenças cardiovasculares, com uma ênfase especial na perspectiva de saúde coletiva. Buscando identificar e discutir os fatores que contribuem para a complexidade da gestão dessas doenças, considerando as nuances epidemiológicas, sociais e tecnológicas. Metodologia: Trata-se de uma revisão bibliográfica abrangente da literatura científica em bases de dados como PubMed, Scielo, Latindex e Medline. Com a utilização dos DeCs (descritores de saúde): “Cardiology”; “Public Health”; Health-Disease Process”. Sem restrições de tempo e de metrologia. Resultados: Exploração de como a abordagem de saúde coletiva pode oferecer insights valiosos e estratégias inovadoras para enfrentar esses desafios. A integração de cuidados, a aplicação de tecnologias em saúde e a promoção da equidade são elementos cruciais que serão abordados à luz da perspectiva coletiva, visando proporcionar uma visão holística e eficaz na gestão dessas condições. Conclusão: Em suma, proporcionou-se uma análise aprofundada dos desafios contemporâneos na gestão de doenças cardiovasculares, destacando a perspectiva crucial da saúde coletiva. Ao explorar fatores epidemiológicos, sociais e tecnológicos, identificamos a complexidade envolvida na gestão dessas condições. A abordagem coletiva, integrando cuidados, tecnologia e promovendo a equidade, emerge como uma estratégia fundamental para enfrentar esses desafios e promover uma gestão mais eficaz e abrangente das doenças cardiovasculares

CUIDADOS PERIOPERATÓRIOS: ESTRATÉGIAS PARA MELHORAR OS RESULTADOS EM CIRURGIA GERAL

Objective: To understand how perioperative care impacts improvements in general surgery outcomes. Methodology: A systematic literature review was conducted spanning from September 2001 to December 2023. The research was guided by the question "How do perioperative care strategies enhance outcomes in general surgery?" Virtual health databases such as PubMed were utilized, employing specific MeSH descriptors including "Perioperative Care," "Perioperative Period," and "General Surgery." Additionally, the search extended to the Scielo platform, using DeCS terms "General Surgery," "Perioperative Period," and "Perioperative Assistance." Results: Emphasis is placed on the importance of personalized perioperative care, effective interdisciplinary communication, precise fluid management, active patient education, effective antibiotic prophylaxis protocols, multidisciplinary involvement in rehabilitation, and continuous improvement based on indicators. These elements were identified as crucial for achieving more positive surgical outcomes in general surgeries. Conclusion: The outcomes of this systematic review underscore the imperative need for ironic approaches, synergistic interdisciplinary collaboration, and an interactive perspective in enhancing perioperative care in general surgery. These elements not only positively corroborate surgical outcomes but also fortify the framework for a more effective and patient-centered clinical practice.Objetivo: Entender como o cuidado perioperatório impacta no melhorias dos resultados em cirurgia geral. Metodologia: Realizou-se uma revisão sistemática da literatura abrangendo setembro de 200 a dezembro de 2023. A pesquisa teve como norteamento a pergunta "Como os cuidados perioperatórios são estratégias para melhorar os resultados das cirurgias gerais?". Utilizaram-se bases de dados virtuais em saúde, como o PubMed, com descritores MeSH específicos, incluindo "Perioperative Care", "Perioperative Period" e "General Surgery". Além disso, a pesquisa foi estendida à plataforma Scielo, utilizando os DeCs "Cirurgia Geral", "Período Perioperatório" e "Assistência Perioperatório". Resultados: Destaca-se  a importância de cuidados perioperatórios personalizados, comunicação interdisciplinar efetiva, gestão precisa de fluidos, educação ativa do paciente, protocolos de antibioticoprofilaxia eficazes, envolvimento multidisciplinar na reabilitação e melhoria contínua com base em indicadores. Esses elementos foram identificados como cruciais para alcançar resultados cirúrgicos mais positivos em cirurgias gerais. Conclusão: Os desdobramentos desta revisão sistemática ressaltam a imperatividade de abordagens irônicas, colaboração interdisciplinar sinergética e uma perspectiva interativa no aprimoramento dos cuidados perioperatórios em cirurgia geral. Estes elementos não só corroboram positivamente nos resultados cirúrgicos, mas também potencializam a estrutura para uma praxis clínica mais eficaz e centrada no paciente

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Efeitos da relação metionina + cistina: lisina sobre os desempenhos produtivo e econômico e a qualidade interna e externa dos ovos antes e após 28 dias de armazenamento Effects of methionine + cystine: lysine ratio on the productive and economic performance and internal and external egg quality, before and 28 days after storage

Avaliou-se o efeito de diferentes relações metionina + cistina (Met+Cis):lisina (Lis) total sobre o desempenho e a qualidade de ovos para poedeiras semipesadas. Foram utilizadas 120 aves da linhagem Lohmann Brown com 44 semanas de idade, alimentadas com rações isonutritivas (17% PB, 2.774 kcal EMAn, 4,28% de Ca e 0,375% Pd) e distribuídas em um delineamento inteiramente casualizado, com cinco repetições e quatro tratamentos, constituídos da seguinte forma: T1 = relação 0,76 ou 0,70% de Met+Cis e 0,92% de Lis total; T2 = relação 0,83 ou 0,71% de Met+Cis e 0,85% de Lis total; T3 = relação 0,85 ou 0,64% Met+Cis e 0,75% de Lis total; T4 = relação 0,86 ou 0,70% de Met+Cis e 0,81% de Lis total. As variáveis de desempenho e o resultado da análise econômica foram estudadas no período de 44 a 56 semanas de idade das poedeiras. Ao término do experimento, dez ovos por tratamento foram coletados e armazenados por 28 dias para avaliação da qualidade interna e externa dos ovos antes e após a armazenagem. À exceção da massa de ovos, os tratamentos não afetaram o consumo de ração, a produção, o peso, a conversão por massa e por dúzia de ovos e a gravidade específica da casca. A relação Met+Cis: Lis de 0,76 ou a estimativa de 0,70% de Met+Cis total e 0,92% de Lis total podem ser recomendadas para alimentação de poedeiras semipesadas. Concluiu-se que o armazenamento afeta a qualidade interna dos ovos.<br>The effect of different methionine + cystine (Met+Cis):total lysine (Lis) ratios on performance and egg quality for semi-heavily laying hens was evaluated. One hundred and twenty Lohmann Brown hens with 44 weeks old were allotted to a completely randomized design with with five replicates and four treatments, as follows: T1= 0.76 Met+Cys:total Lys ratio or 0.70% of Met+Cys and 0.92% of total Lys; T2 = 0.83 Met+Cys: total Lis ratio or 0.71% of Met+Cys and 0.85% of total Lys; T3 = 0.85 Met+Cys: total Lys ratio or 0.64% of Met+Cys and 0.75% of total Lys; T4 = 0.86 Met+Cys: total Lys ratio or 0.70% of Met+Cys and 0.81% of total Lys. The performance variables and economical analysis were evaluated from 44 to 56 weeks old. At the end of trial, ten eggs per treatment were collected ad stored during 28 days for evaluation of internal/external egg quality before and after storage. With the exception of egg mass, no treatment effect on feed intake, egg production, egg weight and egg:mass ratio and egg:dozen ratio and egg shell specific quality was observed. The Met+Cys:Lys ratio of 0.76 or the estimate of 0.70% of total Met+Cys and 0.92% of total Lys can be recommended for the feeding of semiheavily laying hens. It was concluded that the storage affect internal egg quality

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally