(Ser)cenário: redescobrindo a cidade

Trabalho de Conclusão de Curso, apresentado para obtenção do grau de Bacharel no curso de Artes Visuais da Universidade do Extremo Sul Catarinense, UNESC.A presente pesquisa acontece a partir da questão: como meu corpo sujeito pode ser integrado ao espaço/cenário urbano como arte? Vincula-se à linha de pesquisa de Processos e Poéticas: Linguagens do Curso de Artes Visuais Bacharelado da Universidade do Extremo Sul Catarinense. Caracteriza-se como uma pesquisa cartográfica, na qual se baseia no conceito de rizoma criado por Deleuze e Guattari (1975), onde o caminhar da pesquisa encontra deslizamentos, cria e (re)cria percursos, sem uma ideia linear, dura, vertical, mas sim numa perspectiva horizontal com muitos pontos de bifurcação. Com isso, crio um rizomas que mapeiam o decorrer das minhas investigações que giram em torno da cidade, do corpo e da fotografia. Esses conceitos se confluem na medida em que vou tentando decifrá-los. Cria-se diálogos poéticos com alguns autores promovendo ressonâncias e dissonâncias na tentativa de exprimi-los na produção final que une texto e produção artística. Autores como Rolnik (2004) para falar sobre a cidade e sua construção social, Peixoto (2004) que escreve sobre a paisagem das cidades e o papel da fotografia na arte contemporânea, Bachelard (2000) para falar sobre a poética do espaço. Além deles encontro diálogo com as pesquisas de Marzano-Parisoli (2004) quando aborda as questões do corpo e das regras impostas pela sociedade. Para dialogar sobre minha produção artística, amparo-me nos escritos de Salles (2009) e das artistas Francesca Woodman e Lela Martorano para dialogar sobre a estética e técnicas presentes na produção artística. Autores estes que, muitas vezes, são dispersos uns dos outros, mas que na minha pesquisa criam um emaranhado de ideias que se unem para achar o ponto crucial que une a cidade e o corpo, na tentativa de fazer com que o sujeito habite e seja o espaço por completo. Por fim, a produção final torna-se um híbrido de conceitos, ideias e técnicas para falar o modo como a cidade e sua acelerada urbanização influenciam diretamente nas nossas vidas, nos nossos corpos e na construção da memória de uma sociedade

ADVERSIDADES VIVENCIADAS POR PROFISSIONAIS DE ENFERMAGEM EM UNIDADES DE TERAPIA INTENSIVA EM TEMPOS DE COVID-19

Objetivo: descrever adversidades vivenciadas por profissionais de enfermagem em unidades de terapia intensiva em tempos de COVID-19. Método: pesquisa descritiva e exploratória, de abordagem qualitativa, envolvendo 28 profissionais de enfermagem de unidades de terapia intensiva no estado do Rio de Janeiro em abril de 2020. Dados processados no Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: pela Classificação Hierárquica Descendente, obtiveram-se três classes: medo do desconhecido e falta de equipamentos de proteção individual e suporte aos profissionais de enfermagem; falta de fluxos, protocolos, informações, materiais e treinamento das equipes para promoção de uma assistência com segurança; e estresse no cuidar do paciente com COVID-19 positivo, risco de contaminação e morte e necessidade constante de orientações sobre medidas preventivas. Considerações finais: tais adversidades impactavam na prática assistencial e na saúde psicoemocional dos profissionais de enfermagem, sendo necessárias políticas públicas e estratégias gerenciais e assistenciais para minimizá-las.Descritores: Enfermagem. Profissionais de Enfermagem. Unidades de Terapia Intensiva. Infecções por Coronavírus. Assistência à Saúde

Desafios de profissionais de Enfermagem Pediátrica frente à pandemia da COVID-19

Objetivo identificar os desafios de profissionais de Enfermagem Pediátrica frente à pandemia da COVID-19. Método pesquisa qualitativa, desenvolvida por meio de formulário eletrônico semiestruturado entre profissionais de Enfermagem que atuam em unidades pediátricas no Estado do Rio de Janeiro. Os dados foram submetidos à análise lexicográfica, com o auxílio do software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires, pelo método de Nuvem de Palavras e Análise de Similitude. Resultados distintos desafios referentes à pandemia da COVID-19 foram relatados, dentre eles, a promoção de uma assistência integral e de qualidade frente à preocupação quanto à proteção de si e do outro, com destaque para o sentimento de medo. A falta de equipamentos de proteção individual, treinamentos, testes diagnósticos e conhecimentos/informações relacionados à doença, o número reduzido de profissionais de Enfermagem e a desvalorização da categoria também foram sinalizados. Conclusão é primordial a adoção de diretrizes gerenciais para a adequada alocação de recursos humanos e materiais na área da saúde, inclusive, nos serviços pediátricos, incluindo treinamentos sobre as precauções-padrão. Além disso, são essenciais ações de incentivo, valorização, motivação e apoio à equipe de Enfermagem, durante e após a pandemia, para proteger a saúde física e mental desses profissionais.Objetivo identificar los retos a los que se enfrentan los trabajadores de enfermería pediátrica como resultado de la pandemia de COVID-19. Método estudio cualitativo, utilizando un formulario electrónico semiestructurado aplicado a trabajadores de enfermería de servicios pediátricos en el estado de Río de Janeiro, Brasil. Los datos fueron sometidos al análisis lexicográfico utilizando la Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaire, la técnica de Word Cloud y el Análisis de Similitud. Resultados se informaron diferentes retos relacionados con la pandemia de COVID-19, incluida la necesidad de promover una atención integral y de calidad mientras preocupándose por protegerse a sí mismo y a los demás, con énfasis en el miedo. También se informó de la falta de equipo de protección, capacitación, pruebas diagnósticas e información sobre la enfermedad, además de un número reducido de trabajadores de enfermería y una falta de apreciación por la profesión. Conclusión se deben adoptar directrices gerenciales para asignar adecuadamente los recursos humanos y materiales en el campo de la salud, incluidos los servicios pediátricos, además de proveer capacitación sobre las precauciones estándar. Se necesitan acciones para alentar, valorar, motivar y apoyar al personal de enfermería durante y después de la pandemia para proteger la salud física y mental de estos profesionales.Objective to identify the challenges pediatric nursing workers face as a result of the COVID-19 pandemic. Method qualitative study, using a semi-structured electronic form applied to nursing workers from pediatric services in the state of Rio de Janeiro, Brazil. Data were submitted to lexicographic analysis using the Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires, Word Cloud technique, and Similitude Analysis. Results different challenges concerning the COVID-19 pandemic were reported, including the need to promote comprehensive and quality care while being concerned with protecting oneself and others, with an emphasis on fear. A lack of protective equipment, training, diagnostic tests, and knowledge/information concerning the disease was also reported, in addition to a reduced number of nursing workers and a lack of appreciation for the profession. Conclusion managerial guidelines need to be adopted for properly allocating human and material resources in the health field, including the pediatric services, in addition to providing training on standard precautions. Actions to encourage, value, motivate, and support the nursing staff are needed during and after the pandemic to protect the physical and mental health of these professionals

Doença diverticular do cólon: manifestações clínicas e conduta cirúrgica

Diverticular disease of the colon is a condition that affects the large intestine and can cause inflammation, infection or perforation. Treatment depends on the severity of symptoms and complications. In general, treatment includes antibiotics, painkillers, bowel rest and a low-residue diet. In more serious cases, surgery may be necessary to remove the affected part of the intestine. Surgery can be performed with primary intestinal resection or colostomy. Objective: to evaluate the clinical manifestations and surgical management of colonic diverticular disease, as well as the associated risk, prognosis and prevention factors. Methodology: followed the PRISMA checklist, the databases consulted were PubMed, Scielo, Web of Science, using the descriptors: diverticular disease, colon, clinical manifestations, surgical management and systematic review. Articles published in the last 10 years, in Portuguese or English, that addressed colon diverticular disease in adults were included. Articles that were not systematic reviews or meta-analyses, that dealt with other diseases of the large intestine or that did not present data on the clinical manifestations or surgical management of diverticular disease of the colon were excluded. Results: 15 studies were selected. The most common clinical manifestation of diverticular disease of the colon is abdominal pain in the left lower quadrant, which may be accompanied by fever, leukocytosis, changes in bowel habits and signs of peritoneal irritation. Surgery is indicated for cases refractory to conservative treatment, cases complicated by perforation, abscess, fistula or intestinal obstruction, or recurrent cases with disabling symptoms. Surgery can be performed open or laparoscopically, the latter being associated with lower morbidity and shorter hospital stays. The most commonly used surgical technique is primary intestinal resection with primary anastomosis, which consists of removing the affected part of the intestine and joining the remaining ends. In cases of diffuse peritonitis or hemodynamic instability, colostomy with deferred intestinal resection may be chosen. Conclusion: Diverticular disease of the colon is a common and potentially serious condition that requires an accurate diagnosis and appropriate treatment. Clinical manifestations range from mild symptoms to serious complications that can lead to death. Surgical management must be individualized according to the patient's clinical picture and conditions. Preventing diverticular disease of the colon involves adopting healthy lifestyle habits, such as a diet rich in fiber and practicing regular physical activity.A doença diverticular do cólon é uma condição que afeta o intestino grosso e pode causar inflamação, infecção ou perfuração. O tratamento depende da gravidade dos sintomas e das complicações. Em geral, o tratamento inclui antibióticos, analgésicos, repouso intestinal e dieta com pouco resíduo. Em casos mais graves, pode ser necessária uma cirurgia para remover a parte afetada do intestino. A cirurgia pode ser feita com ressecção intestinal primária ou com colostomia. Objetivo: avaliar as manifestações clínicas e a conduta cirúrgica da doença diverticular do cólon, bem como os fatores de risco, prognóstico e prevenção associados. Metodologia: seguiu o checklist PRISMA, as bases de dados consultadas foram PubMed, Scielo, Web of Science, utilizando os descritores: diverticular disease, colon, clinical manifestations, surgical management and systematic review. Foram incluídos artigos publicados nos últimos 10 anos, em português ou inglês, que abordassem a doença diverticular do cólon em adultos. Foram excluídos artigos que não fossem revisões sistemáticas ou meta-análises, que tratassem de outras doenças do intestino grosso ou que não apresentassem dados sobre as manifestações clínicas ou a conduta cirúrgica da doença diverticular do cólon. Resultados: Foram selecionados 15 estudos. A manifestação clínica mais comum da doença diverticular do cólon é a dor abdominal no quadrante inferior esquerdo, que pode ser acompanhada de febre, leucocitose, alteração do hábito intestinal e sinais de irritação peritoneal. A cirurgia é indicada para casos refratários ao tratamento conservador, casos complicados com perfuração, abscesso, fístula ou obstrução intestinal, ou casos recorrentes com sintomas incapacitantes. A cirurgia pode ser realizada por via aberta ou laparoscópica, sendo esta última associada a menor morbidade e menor tempo de internação. A técnica cirúrgica mais utilizada é a ressecção intestinal primária com anastomose primária, que consiste na retirada da parte afetada do intestino e na união das extremidades remanescentes. Em casos de peritonite difusa ou instabilidade hemodinâmica, pode-se optar pela colostomia com ressecção intestinal diferida. Conclusão: a doença diverticular do cólon é uma condição frequente e potencialmente grave, que requer um diagnóstico preciso e um tratamento adequado. As manifestações clínicas variam desde sintomas leves até complicações graves que podem levar à morte. A conduta cirúrgica deve ser individualizada de acordo com o quadro clínico e as condições do paciente. A prevenção da doença diverticular do cólon envolve a adoção de hábitos de vida saudáveis, como uma dieta rica em fibras e a prática de atividade física regular

Atuação do Programa de Extensão “Centro Colaborador de Alimentação e Nutrição Escolar – CECANE-UNIRIO” durante a pandemia pela Covid-19

A pandemia do novo coronavírus levou a necessidade de adaptações na execução do Programa Nacional de Alimentação Escolar (PNAE). Nesse sentido, o Fundo Nacional de Desenvolvimento para Educação (FNDE) por meio de leis e normativas, autorizou a distribuição de kits de gêneros alimentícios de modo a assegurar a Segurança Alimentar e Nutricional (SAN) e o Direito Humano à Alimentação Adequada (DHAA) ao alunado. Dessa forma, considerando os desafios impostos pela Covid-19, o presente artigo tem como objetivo mostrar as modificações para o cumprimento do PNAE e as ações do CECANE-UNIRIO durante este período. As atividades de formação para atores sociais, assim como a assessoria e o monitoramento às Entidades Executoras (EEx) ocorreram de maneira remota, da mesma maneira que outras atividades nas quais o programa de extensão esteve envolvido para além do plano de trabalho. De modo geral, as atividades desenvolvidas disseminaram conhecimento para a comunidade como um todo

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe