Análisis del una Clínica de Familia, la visión de las enfermeras de servicio

Objetivo conhecer a prática da Clínica da Família em Cuiabá e sua relação com os preceitos da clínica ampliada, sob a perspectiva dos enfermeiros do serviço. Método pesquisa descritiva qualitativa, coleta de dados com entrevista semi-estruturada e resultados analisados segundo o método de análise de conteúdo do tipo temática. Resultados para os enfermeiros atuantes no serviço, este assume uma proposta diferenciada e inovadora, no qual busca se correlacionar com a gestão compartilhada em suas três esferas. Apesar de a maioria não conhecer o termo Clínica Ampliada em suas falas citaram seus principais preceitos e suas ferramentas. As maiores potencialidades descritas foram a relação com o Núcleo de Apoio à Saúde da Família e a participação popular, e como desafios, a falta de agente comunitário de saúde, do cadastro nacional de estabelecimento de saúde e a dificuldade de atuação devido ao perfil dos profissionais de nível técnico advindos da atenção secundária. Conclusão a clínica possui aspectos positivos que podem contribuir para o progresso da profissão, para a formação de profissionais da saúde e para um modelo de assistência de nível primário inovador. Logo, enfatiza-se a necessidade de implantação da educação permanente com o objetivo de concretizar sua proposta, além de estudos posteriores no local.Objective to know the practice of the Family Clinic in Cuiaba and its relationship with the precepts of the expanded clinic, from the perspective of the service nurses. Method qualitative descriptive research, data collection with semi-structured interviews and results analyzed according to the method of thematic content analysis. Results for nurses working in the service, this assumes a differentiated and innovative proposal, which seeks to correlate with shared management in its three spheres. Although most do not know the Enlarged Clinic term in his speech cited its main principles and its tools. The greatest potential described were related to the Support Center for Health and popular participation, and as challenges, the lack of community health worker, the national health establishment registration and the difficulty of operation due to the profile of the professionals technical level arising from secondary care. Conclusions The clinic has positive aspects that can contribute to the advancement of the profession, to train health professionals and an innovative primary care model. Therefore, it emphasizes the need for implementation of continuing education in order to realize its proposal, and further studies on site.Objetivo conocer la práctica de la Clínica Familiar en Cuiaba y su relación con los preceptos de la clínica ampliada, desde la perspectiva de las enfermeras de servicio. Método: investigación descriptiva cualitativa, la recopilación de datos con entrevistas y resultados semiestructuradas analizadas según el método de análisis de contenido temático. Método investigación descriptiva cualitativa, la recopilación de datos con entrevistas y resultados semiestructuradas analizadas según el método de análisis de contenido temático. Resultados para las enfermeras que trabajan en el servicio, esto supone una propuesta diferenciada e innovadora, que busca que se correlaciona con la gestión compartida en sus tres esferas. Aunque la mayoría no sabe el término Clínica ampliada en su discurso citó sus principios y sus herramientas. El mayor potencial descrito se relaciona con el Centro de Apoyo a la Salud y la participación popular, y como desafíos, la falta de personal de salud de la comunidad, el registro nacional de establecimientos de salud y la dificultad de la operación debido al perfil de los profesionales nivel técnico derivado de la atención secundaria. Conclusión La clínica cuenta con aspectos positivos que pueden contribuir al avance de la profesión, para capacitar a profesionales de la salud y un innovador modelo de atención primaria. Por lo tanto, se hace hincapié en la necesidad de implementación de la educación permanente, para darse cuenta de su propuesta, y estudios adicionales en el lugar

COMPOSIÇÃO FLORÍSTICO-ESTRUTURAL AO LONGO DE UM GRADIENTE DE BORDA EM FRAGMENTO DE FLORESTA OMBRÓFILA MISTA ALTO-MONTANA EM SANTA CATARINA

http://dx.doi.org/10.5902/1980509821027The objectives of this study were to characterize the floristic and structure of the tree component in Upper Montane Araucaria Forest fragment and to evaluate the influence of the edge effects on tree species organization, structure, richness and diversity. For this, a total of 50, 10 x 20 m, permanent plots divided in five transects spaced, at least, 100 m from each other, were established in the a forest fragment, located in the municipality of Bom Jardim da Serra, SC. The trees with circumference at breast height (CBH) ≥ 15,7 cm were measured (CBH and total height), identified and classified according to the regeneration guilds. The data were analyzed through the index of importance values (IVI), a NMDS analysis (Nonmetric Multidimensional Scaling), a generalized additive model and simple linear regressions. A total of 1,457 individuals, distributed in 29 families, 43 genera and 55 species were surveyed. The most relative important species was Dicksonia sellowiana Hook. There was no influence of edge effect on tree community organization, structure (average diameter, average height and density) and guilds participation. However, values of diversity, richness and evenness were higher at edge areas. We conclude that part of the variation in values related to tree species diversity in the Upper Montane Araucaria Forest was determined by edge distance.http://dx.doi.org/10.5902/1980509821097O objetivo desse estudo foi caracterizar a composição florística e a estrutura do componente arbóreo em fragmento de Floresta Ombrófila Mista Alto-Montana e avaliar a influência do efeito de borda sobre a organização, estrutura, riqueza e diversidade de espécies. Foram alocadas 50 parcelas permanentes de 10 x 20 m, divididas em cinco transeções distanciadas, no mínimo, 100 m entre si, em um fragmento florestal, no município de Bom Jardim da Serra - SC. As árvores com circunferência ≥ 15,7 cm na altura do peito (CAP) foram mensuradas (CAP e altura total), identificadas e classificadas quanto às guildas de regeneração (pioneiras, climácicas exigentes em luz e climácicas tolerantes à sombra). Os dados foram analisados por meio dos índices de valor de importância (IVI), NMDS (Nonmetric Multidimensional Scaling), modelo aditivo generalizado e regressões lineares simples. Foram observados 1.457 indivíduos arbóreos, distribuídos em 29 famílias, 43 gêneros e 55 espécies. A espécie com maior valor de importância foi Dicksonia sellowiana Hook. Não foi observada influência do efeito de borda sobre a organização, a estrutura (diâmetro médio, altura média e densidade) da comunidade e participação relativa das guildas de regeneração. No entanto, ficaram evidenciados maiores valores de diversidade, riqueza e equabilidade nas áreas de borda. Desta forma, concluí-se que parte das variações dos valores relativos à diversidade de espécies arbóreas na Floresta Ombrófila Mista Ato-Montana foi determinada pela distância da borda

FLORISTIC-STRUCTURAL COMPOSITION ALONG AN EDGE GRADIENT IN UPPER MONTANE MIXED OMBROPHILOUS FOREST FRAGMENT IN SANTA CATARINA

O objetivo desse estudo foi caracterizar a composi\ue7\ue3o flor\uedstica e a estrutura do componente arb\uf3reo em fragmento de Floresta Ombr\uf3fila Mista Alto-Montana e avaliar a influ\ueancia do efeito de borda sobre a organiza\ue7\ue3o, estrutura, riqueza e diversidade de esp\ue9cies. Foram alocadas 50 parcelas permanentes de 10 x 20 m, divididas em cinco transe\ue7\uf5es distanciadas, no m\uednimo, 100 m entre si, em um fragmento florestal, no munic\uedpio de Bom Jardim da Serra - SC. As \ue1rvores com circunfer\ueancia 65 15,7 cm na altura do peito (CAP) foram mensuradas (CAP e altura total), identificadas e classificadas quanto \ue0s guildas de regenera\ue7\ue3o (pioneiras, clim\ue1cicas exigentes em luz e clim\ue1cicas tolerantes \ue0 sombra). Os dados foram analisados por meio dos \uedndices de valor de import\ue2ncia (IVI), NMDS (Nonmetric Multidimensional Scaling), modelo aditivo generalizado e regress\uf5es lineares simples. Foram observados 1.457 indiv\uedduos arb\uf3reos, distribu\ueddos em 29 fam\uedlias, 43 g\ueaneros e 55 esp\ue9cies. A esp\ue9cie com maior valor de import\ue2ncia foi Dicksonia sellowiana Hook. N\ue3o foi observada influ\ueancia do efeito de borda sobre a organiza\ue7\ue3o, a estrutura (di\ue2metro m\ue9dio, altura m\ue9dia e densidade) da comunidade e participa\ue7\ue3o relativa das guildas de regenera\ue7\ue3o. No entanto, ficaram evidenciados maiores valores de diversidade, riqueza e equabilidade nas \ue1reas de borda. Desta forma, conclu\ued-se que parte das varia\ue7\uf5es dos valores relativos \ue0 diversidade de esp\ue9cies arb\uf3reas na Floresta Ombr\uf3fila Mista Ato-Montana foi determinada pela dist\ue2ncia da borda.The objectives of this study were to characterize the floristic and structure of the tree component in Upper Montane Araucaria Forest fragment and to evaluate the influence of the edge effects on tree species organization, structure, richness and diversity. For this, a total of 50, 10 x 20 m, permanent plots divided in five transects spaced, at least, 100 m from each other, were established in the a forest fragment, located in the municipality of Bom Jardim da Serra, SC. The trees with circumference at breast height (CBH) 65 15,7 cm were measured (CBH and total height), identified and classified according to the regeneration guilds. The data were analyzed through the index of importance values (IVI), a NMDS analysis (Nonmetric Multidimensional Scaling), a generalized additive model and simple linear regressions. A total of 1,457 individuals, distributed in 29 families, 43 genera and 55 species were surveyed. The most relative important species was Dicksonia sellowiana Hook. There was no influence of edge effect on tree community organization, structure (average diameter, average height and density) and guilds participation. However, values of diversity, richness and evenness were higher at edge areas. We conclude that part of the variation in values related to tree species diversity in the Upper Montane Araucaria Forest was determined by edge distance

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

BackgroundFuture trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050.MethodsUsing forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.FindingsIn the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]).InterpretationGlobally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions.FundingBill & Melinda Gates Foundation.</p