Fatores sociodemográficos e clínicos associados ao tempo de decisão para a procura de atendimento no infarto agudo do miocárdio

OBJETIVO: analizar la interacción del género en la asociación entre el tiempo de decisión para la búsqueda de servicio de salud y las variables sociodemográficas y clínicas. MÉTODO: estudio exploratorio, transversal, con 100 individuos entrevistados en hospitales de Salvador-BA. En el análisis se empleó el test Chi-cuadrado o Exacto de Fisher y el modelo de regresión linear robusto. La significancia estadística adoptada fue de 5%. RESULTADOS: hombres y mujeres presentaron tiempos de decisión elevados. Hubo menor tiempo de decisión para tabaquistas, con dolor constante y de fuerte intensidad. Hubo interacción entre género y tabaquismo y entre género y dolor irradiado para el cuello o mandíbula para el desenlace del tiempo de decisión. CONCLUSIÓN: los tiempos de decisión fueron elevados y sufrieron influencia de variables clínicas y de género. El estudio ofrece subsidios para prácticas de cuidar en enfermería enfocadas en la especificidad de esos factores y de los géneros objetivando obtener éxito en la reducción del tiempo de decisión.OBJETIVO: analisar a interação do sexo na associação entre o tempo de decisão para a procura de serviço de saúde e as variáveis sociodemográficas e clínicas. MÉTODO: estudo exploratório, transversal, com 100 indivíduos entrevistados em hospitais de Salvador, BA. Na análise, empregou-se o teste qui-quadrado ou exato de Fisher e o modelo de regressão linear robusto. A significância estatística adotada foi de 5%. RESULTADOS: Resultados: homens e mulheres apresentaram tempos de decisão elevados. Houve menor tempo de decisão para tabagistas, com dor constante e de forte intensidade. Houve interação entre sexo e tabagismo e entre sexo e dor irradiada para o pescoço ou a mandíbula para o desfecho tempo de decisão. CONCLUSÃO: os tempos de decisão foram elevados e sofreram influência de variáveis clínicas e do sexo. O estudo oferece subsídios para práticas de cuidar em enfermagem, focalizadas na especificidade desses fatores e dos gêneros, visando-se obter êxito na redução do tempo de decisão.OBJECTIVE: this study aimed to analyze the interaction of gender in the association between decision time for seeking healthcare services and the sociodemographic and clinical variables. METHOD: this exploratory, cross-sectional study was performed with 100 individuals interviewed in hospitals in Salvador, Bahia. The chi-square test or Fisher's exact test and the robust linear regression model were used in the analysis. A statistical significance of 5% was adopted. RESULTS: men and women presented long decision times. The decision time was less for smokers and those with constant and/or severe pain. There was an interaction between gender and smoking and between gender and pain radiating to the neck or jaw for the decision time outcome. CONCLUSION: decision times were long and were influenced by clinical and gender variables. The study provides support for nursing care practices focused on the specificity of these factors and of the genders aiming to reduce the decision time

Heterofucans from the Brown Seaweed Canistrocarpus cervicornis with Anticoagulant and Antioxidant Activities

Fucan is a term used to denominate a family of sulfated polysaccharides rich in sulfated l-fucose. We extracted six fucans from Canistrocarpus cervicornis by proteolytic digestion followed by sequential acetone precipitation. These heterofucans are composed mainly of fucose, glucuronic acid, galactose and sulfate. No polysaccharide was capable of prolonging prothrombin time (PT) at the concentration assayed. However, all polysaccharides prolonged activated partial thromboplastin time (aPTT). Four sulfated polysaccharides (CC-0.3/CC-0.5/CC-0.7/CC-1.0) doubled aPTT with only 0.1 mg/mL of plasma, only 1.25-fold less than Clexane®, a commercial low molecular weight heparin. Heterofucans exhibited total antioxidant capacity, low hydroxyl radical scavenging activity, good superoxide radical scavenging efficiency (except CC-1.0), and excellent ferrous chelating ability (except CC-0.3). These results clearly indicate the beneficial effect of C. cervicornis polysaccharides as anticoagulants and antioxidants. Further purification steps and additional studies on structural features as well as in vivo experiments are needed to test the viability of their use as therapeutic agents

Scale to Assess Leaders' Perceptions about their Workers' Digital Addiction

Background: With the evolution of technologies and the mobility factor, new digital devices have emerged, influencing human behavior and provoking diverse dependencies due to their abusive use. Collective environments begin to exhibit the symptoms of such dependencies, compromising people's quality of life (QOL). The objective of the present study was to validate the scale to evaluate the perception of leaders on digital employee addiction (EPLDDE) initially with 17 questions. Methods:The scale was constructed with real situations of digital addiction and through the evaluation of the semantic comprehension and consistency of the items by judges until final formatting of the instrument. Data collection was done via the internet. The sample consisted of 312 volunteers from a federal state-owned company. After data collection, a database was created for statistical analysis. Statistical program R was used. Findings: Bartlett’s and Kaiser-Meyer-Olkin (KMO) tests confirmed adequacy for factorial analysis. Three statistical criteria were used, and scree plot presented adequate commonalities indicating 5 factors and the withdrawal of 3 questions from the scale. In the second AF, results ratified 14 questions. Cronbach's alpha showed a positive result of 0.8131717. Conclusion: The 14-item EPLDDE scale was validated for the evaluation of the perception of leaders regarding digital dependence of employees in organizations. This scale can contribute to studies on organizational QOL. The limitations found did not compromise the results

Aleitamento Materno e COVID-19: Revisão Sistemática da Literatura / Breastfeeding and COVID -19: Systematic Literature Review

Introdução: A amamentação é uma potencial via de infecção para o recém-nascido, devido a transmissibilidade vertical de algumas doenças. Devido a isso, em determinadas circunstâncias, a lactante deve ser orientada a não promover a amamentação. No entanto, ao passo que existe a necessidade de se evitar o aleitamento, existe a discussão acerca da importância desse processo para a criação de laços afetivos com a figura materna e para o desenvolvimento biológico e psíquico da criança. Nesse contexto, considerando-se a realidade da pandemia, surge a necessidade de investigação dos impactos do SARS-CoV-2 no aleitamento. Objetivo: Compreender os impactos do SARS-CoV-2 no aleitamento materno. Metodologia: Buscou-se por artigos e revisões no PubMED, utilizando os descritores “breastfeeding” e “COVID-19”. Preliminarmente, os artigos e revisões foram selecionados por meio da leitura do título e resumo. Ao final da busca, foram encontrados 6 artigos que satisfaziam os critérios de análise utilizados nesta pesquisa, sendo estes publicados no período de abril de 2020 a maio de 2020. Resultados: O novo coronavírus, o SARS-CoV-2, surgiu na China em dezembro de 2019, e a hipótese da possível transmissão vertical surgiu após o primeiro teste positivo de um recém-nascido, em fevereiro deste ano. Neste mesmo mês, a NHFPC recomendou que os neonatos de mães com exames positivos para o COVID-19 fossem isolados e sua amamentação proibida por pelo menos 2 semanas. Em contrapartida, a OMS defende que a amamentação nesses casos deverá ser coordenada a partir de uma decisão entre os profissionais de saúde e a família, ressaltando a necessidade também de todos os procedimentos de higiene e distanciamento já recomendados. Existem, atualmente, apenas 8 estudos analisando a presença de código génetico do SARS-CoV-2 no leite materno, em um total de 24 gestantes com diagnóstico positivo para o novo coronavírus no terceiro trimestre da gestação. Todas as amostras de leite analisadas por meio do teste RT-PCR deram resultado negativo. Conclusão: Dessa forma, não há indícios de transmissão do COVID-19 pelo aleitamento materno. Apesar disso, são necessários estudos com maior amostragem para que se forme uma orientação padrão

INFARTO AGUDO DO MIOCÁRDIO E SEUS MANEJOS NA EMERGÊNCIA CARDIOLÓGICA REVISÃO SISTEMÁTICA

Acute ST-Segment Elevation Myocardial Infarction (STEMI) is a serious condition related to coronary artery disease, characterized by high morbidity and mortality. In this study, carried out with the aim of a comprehensive approach to STEMI, a methodology was adopted that included a systematic literature review, with the selection of nine relevant scientific articles published between 2018 and 2023. The critical analysis of these studies provided an in-depth understanding of the diagnosis, pathophysiology, epidemiology, morbidity and mortality, complications and management of STEMI. The primary therapeutic intervention, coronary angioplasty, was highlighted as crucial in effective reperfusion for affected patients, while fibrinolysis therapy was presented as an alternative in specific situations. The results and discussion derived from this analysis have contributed significantly to the advancement of clinical and scientific knowledge, providing valuable insights to optimize clinical practices and thus improve clinical outcomes in this acute cardiovascular emergency.O Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST (IAMCSST) é uma condição grave relacionada à doença arterial coronariana, caracterizada por elevada morbimortalidade. Neste estudo, realizado com o objetivo de uma abordagem abrangente do IAMCSST, adotou-se uma metodologia que incluiu revisão sistemática de literatura, com a seleção de nove artigos científicos relevantes publicados entre 2018 e 2023. A análise crítica desses estudos proporcionou uma compreensão aprofundada do diagnóstico, fisiopatologia, epidemiologia, morbimortalidade, complicações e manejo do IAMCSST. A intervenção terapêutica primordial, a angioplastia coronária, foi destacada como crucial na reperfusão eficaz para pacientes afetados, enquanto a terapia de fibrinólise se apresentou como alternativa em situações específicas. Os resultados e a discussão derivados desta análise contribuíram significativamente para o avanço do conhecimento clínico e científico, fornecendo insights valiosos para otimizar as práticas clínicas e, assim, melhorar os desfechos clínicos nesta emergência cardiovascular aguda. &nbsp

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial.

There is no specific antiviral therapy recommended for coronavirus disease 2019 (COVID-19). In vitro studies indicate that the antiviral effect of chloroquine diphosphate (CQ) requires a high concentration of the drug.To evaluate the safety and efficacy of 2 CQ dosages in patients with severe COVID-19. This parallel, double-masked, randomized, phase IIb clinical trial with 81 adult patients who were hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted from March 23 to April 5, 2020, at a tertiary care facility in Manaus, Brazilian Amazon. - Patients were allocated to receive high-dosage CQ (ie, 600 mg CQ twice daily for 10 days) or low-dosage CQ (ie, 450 mg twice daily on day 1 and once daily for 4 days). - Label: Main Outcomes and Measures Primary outcome was reduction in lethality by at least 50% in the high-dosage group compared with the low-dosage group. Data presented here refer primarily to safety and lethality outcomes during treatment on day 13. Secondary end points included participant clinical status, laboratory examinations, and electrocardiogram results. Outcomes will be presented to day 28. Viral respiratory secretion RNA detection was performed on days 0 and 4. Out of a predefined sample size of 440 patients, 81 were enrolled (41 [50.6%] to high-dosage group and 40 [49.4%] to low-dosage group). Enrolled patients had a mean (SD) age of 51.1 (13.9) years, and most (60 [75.3%]) were men. Older age (mean [SD] age, 54.7 [13.7] years vs 47.4 [13.3] years) and more heart disease (5 of 28 [17.9%] vs 0) were seen in the high-dose group. Viral RNA was detected in 31 of 40 (77.5%) and 31 of 41 (75.6%) patients in the low-dosage and high-dosage groups, respectively. Lethality until day 13 was 39.0% in the high-dosage group (16 of 41) and 15.0% in the low-dosage group (6 of 40). The high-dosage group presented more instance of QTc interval greater than 500 milliseconds (7 of 37 [18.9%]) compared with the low-dosage group (4 of 36 [11.1%]). Respiratory secretion at day 4 was negative in only 6 of 27 patients (22.2%). - Label: Conclusions and Relevance The preliminary findings of this study suggest that the higher CQ dosage should not be recommended for critically ill patients with COVID-19 because of its potential safety hazards, especially when taken concurrently with azithromycin and oseltamivir. These findings cannot be extrapolated to patients with nonsevere COVID-19

Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention

BackgroundAround 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model.MethodsThe Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods.InterventionBBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI.ResultsTwo years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period.ConclusionsImplementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio