A vivência da amamentação em “mães de primeira viagem”

L'allaitement dépasse la limite du biologique, en nous insérant aussi de contextes social et psychologique. Cette étude, réalisée à la Clinique Obstétrique de ICHC-FMUSP, a utilisé la méthodologie qualitative pour interviewer en profondeur dix « mères de premier voyage », afin de comprendre des aspects psychologiques impliqués dans l'allaitement, dans la première semaine de vie du bébé, et comme ces mères traitent avec les orientations des arrivées de l'équipe de santé. Des entrevues individuelles et de l'analyse qualitative des données ont été réalisées. L'allaitement est apparu comme une expérience ambivalente, avec des sentiments de pouvoir et complétude, de féminité, mais aussi une expérience pénible. La moitié des interviewées a reçu des orientations de l'équipe de santé, senties comme une aide et une sécurité émotionnelle. Ainsi, l'allaitement, quand il n'est pas imposé, peut favoriser la rencontre de la mère avec son bébé et le contact avec elle-même. L'équipe de santé peut agir comme une facilitation, en utilisant des connaissances techniques mais en se maintenant ouverte à l'écoute de ces femmes.A amamentação ultrapassa o limite do biológico, inserindo-se também nos âmbitos social e psicológico. Esse estudo, realizado na Clínica Obstétrica do ICHC-FMUSP, utilizou a metodologia qualitativa para entrevistar em profundidade dez "mães de primeira viagem", a fim de compreender aspectos psicológicos envolvidos na amamentação, na primeira semana de vida do bebê, e como essas mães lidam com as orientações vindas da equipe de saúde. Foram realizadas entrevistas individuais e análise qualitativa dos dados. A amamentação apareceu como uma vivência ambivalente, com sentimentos de poder e completude, feminilidade, mas também uma experiência dolorosa. Metade das entrevistadas recebeu orientações da equipe de saúde, sentidas como um apoio e segurança emocional. Assim, a amamentação, quando não é imposta, pode favorecer o encontro da mãe com seu bebê e o contato com ela mesma. A equipe de saúde pode atuar como facilitadora, utilizando conhecimentos técnicos, mas mantendo-se aberta à escuta dessas mulheres.El amamantamiento sobrepasa el límite biológico, haciendo parte también de los ámbitos social y psicológico. Este estudio, realizado en la Clínica Obstétrica del ICHC-FMUSP, utilizó la metodología cualitativa para entrevistar con detenimiento a diez "madres de primer viaje", con la finalidad de comprender aspectos psicológicos vinculados al amamantamiento en la primera semana de vida del bebé, y cómo esas madres manejan las orientaciones recibidas del equipo de salud. Fueron realizadas entrevistas individuales y análisis cualitativo de los datos. El amamantamiento apareció como una experiencia ambivalente, con sentimientos de poder y sensación de plenitud, femineidad, pero también una experiencia dolorosa. La mitad de las entrevistadas recibió orientaciones del equipo de salud, las cuales fueron evaluadas como un apoyo y seguridad emocional. Así, el amamantamiento, cuando no es impuesto, puede favorecer el encuentro de la madre con su bebé y el contacto con ella misma. El equipo de salud puede actuar como facilitador, utilizando conocimientos técnicos pero manteniéndose de oídos abiertos hacia esas mujeres.Breast-feeding exceeds the boundaries of biology, inserting itself also in the social and psychological scopes. This study, taken place in the Obstetric Clinic of the ICHC-FMUSP, used the qualitative methodology to interview in depth ten "first-time mothers", in order to understand the psychological aspects involved in breast-feeding, during the baby’s first week of life, and how these mothers dealt with the guidance given by the health team. Individual interviews and qualitative analysis of the data has been carried through. Breast-feeding appeared as an ambivalent experience, with feelings of power and completeness, femininity, but also appeared as a painful experience. Half of the interviewed mothers received guidance from the health team, and felt it as an emotional support and security. Thus, breast-feeding, when it is not imposed, may favor the meeting of mother and child, as well as the contact of the mother with herself. The health team can act as a facilitator, using technical knowledge, but always keeping themselves opened to listening to these women

Chironomidae (Insecta: Diptera) no Estado do Rio de Janeiro, Brasil: Situação Atual, Lista de Espécies e Novos Registros

The species of the family Chironomidae (Insecta: Diptera) recorded to Rio de Janeiro State, southeastern Brazil, are listed, including taxonomic information, geographic distribution and references. Thirty-six species have been recorded in the state. The list was compiled after bibliographic research, faunistic check-lists and catalogs. All references with the original descriptions were investigated, as well as further descriptions and taxonomic changes.As espécies da família Chironomidae (Insecta: Diptera) registradas para o Estado do Rio de Janeiro, região Sudeste do Brasil, são listadas, incluindo informações taxonômicas, distribuição geográfica e referências bibliográficas. Trinta e seis espécies foram registradas até o presente momento para o Estado. A lista foi feita a partir de consultas à bibliografia, catálogos e listas. Foram avaliadas todas as referências com as descrições, além de descrições e mudanças taxonômicas posteriores

First determination of mineral composition of the leaf Chicory (Cichorium intybus L.) used in human nourishment in the Midwest of Brazil and comparasion with dietary reference intakes for children and adults

Introduction: Radicchio (Cichorium intybus L.) is a leaf chicory and is grown as a leaf vegetable which usually has white-veined red or purple leaves and it belongs to the Asteraceae family. In several countries is consumed mainly as salad, but no studies on their elemental composition  has been done, principally in Brazil. Objective: The aim of present work was to measure the macroelements (Na, K, Ca, Mg and P) and microelements (Cr, Cu, Fe, Mn, Mo, Zn, Al, Cd, Ni, Co and Si) in the leaf Chicory used as human nourishment in the Campo Grande, State of Mato Grosso do Sul, Brazil. Method: Chemical digests of samples were prepared using HNO3 and H2O2 and then placed in the microwave digestion system. After digestion, the concentrations of the elements in Leaf Chicory were determined by the technique of Inductively Coupled Plasma - Optical Emission Spectrometer (ICP–OES, Thermo Scientific - iCAP 6000 Series). Results obtained of the concentrations of leaf chicory were compared with the dietary reference intakes. Results: Detected concentration of macroelements in leaf Chicory decreases in the order: K > P > Ca > Mg > Na. As well as the concentration of microelements decreases in the order: Fe > Al > Si > Mn > Zn > Cu > Cr > Ni > Cd > Mo > Co. Leaf Chicory is excellent source of K, Ca, Mg, P, Cr, Cu, Fe, Mn, Mo and Zn for children and adults. On the other hand, leaf chicory is not considered a source of sodium for children and adults. Concentration of K, Cr, Fe, and Al are above the limit recommended limit by FAO/WHO (1984) and others countries. Conclusions: Leaf Chicory has macro and microelements in ample amount; it can be used as an important part of people's diets. Since it not exceed allowable limits set by WHO and FAO, RDA/AI and UL. Competent organs have not evaluated concentrations of elements as Al, Cd, Ni, Co and Si in order to establish a tolerable upper intake level or RDA/AI for human. The lack of studies of adverse effects following excess intake of a nutrient does not mean that adverse effects do not occur. Keywords: Leaf Chicory; Radicchio; Inductively Coupled Plasma Mass Spectrometry (ICP-OES)

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

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 &lt;= 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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries