Profissionais do sexo: a cumplicidade como enfrentamento das vulnerabilidades

Este artigo objetiva analisar as vulnerabilidades do trabalho de profissionais do sexo atuantes na rua e suas formas de enfrentamento. Trata-se de um estudo qualitativo, transversal e reflexivo. Dez mulheres participaram de dois encontros que aconteceram na modalidade roda de conversa, em abril de 2017, em motéis do tipo drive in, no município de Chapecó, Santa Catarina, Brasil. As informações foram coletadas por meio de questionário, registradas em diário de campo e submetidas à análise de conteúdo do tipo temática. A interpretação dos dados se deu mediante subjetividade e análise reflexiva crítica dos autores, desvelando-se dois temas: “As vulnerabilidades do ofício” e o “Enfrentamento das vulnerabilidades”. As profissionais do sexo relataram vulnerabilidades de ordem individual, social e programática, incluindo aspectos ligados a questões de gênero e de poder, de situações que envolvem violência física, sexual e moral, além de exposição a agravos relacionados à saúde física e emocional. Observou-se uma complexidade de variáveis influenciando nas situações de vulnerabilidade, mas também muitas formas de enfrentamento perante as diferentes situações vivenciadas. A partir das experiências e vivências de cada mulher, destacam-se as estratégias de cumplicidade e apoio utilizadas entre as profissionais como importante forma de enfrentamento e de proteção

O uso da palhaçaria para crianças e adolescentes que demandam de hospitalização: uma revisão integrativa da literatura / The effect of the use of clowning for children and adolescents who require hospitalization: an integrative literature review

O processo de hospitalização infanto-juvenil resulta em situações estressantes advindas de inúmeras condições inerentes ao processo, favorecendo traumas no decorrer da experiência. Nessa perspectiva, a inserção de palhaços em hospitais pode ser considerada uma proposta amenizadora desses fatores estressantes. Analisar, nas evidências científicas disponíveis, como tem sido desenvolvido o conhecimento sobre o uso da palhaçaria em crianças e adolescentes hospitalizados. Trata-se de uma Revisão Integrativa da Literatura, a coleta dos estudos ocorreu em janeiro e fevereiro de 2022 nas seguintes bases de dados: na Biblioteca Virtual em Saúde - BVS, na Web of Science, PubMed e na SciVerse Scopus. Após a aplicação dos critérios de inclusão e exclusão foram selecionados 26 artigos baseados na leitura integral do texto. Nestes ocorreu um levantamento de delineamento de pesquisa, ano, linguagem e país de publicação e analisados por temáticas, oferecendo um panorama geral da palhaçaria hospitalar, enfatizando nos resultados benéficos da utilização desta intervenção na redução do cortisol, modificação de parâmetros de sinais vitais, redução do nível de dor, da ansiedade e dos sentimentos negativos. O percurso do conhecimento científico acerca da temática investigada tem sido permeado por estudos que evidenciam os benefícios do uso da palhaçaria com crianças em ambientes hospitalares, sejam por avaliação dos sinais vitais, nível de estresse, percepção das emoções e sentimentos ou pela ótica dos demais agentes atuantes nesse processo (pais, profissionais da saúde, acadêmicos de cursos da área)

Repercussões da covid-19 para a saúde de adolescentes

Objective: understanding the Repercussions of the Coronavirus Disease 2019 Pandemic for Adolescent Health. Method: study quality, action-participant type, based on the assumptions of Paulo Freire. A Virtual Culture Circle was held, with the participation of 11 adolescents, covering the stages of the Research Itinerary: Thematic Investigation; Encoding and Decoding and Critical Unveiling. Results: emerged two main themes: “Coronavirus Disease 2019 in adolescence: transformations of the present” and “What will tomorrow be like?” It was discussed the need to stay only at home, without going to school or seeing friends. They also reflected on the future, showing insecurity and concern about the family situation and the appreciation of what is important in life. Conclusion: the need for social distancing or, in some cases, social isolation, imposed by the pandemic, resulted in sudden changes in the routine of adolescents and the entire family group.Objetivo: compreender as repercussões da pandemia da Coronavirus Disease 2019 para a saúde do adolescente. Método: estudo qualitativo, do tipo ação-participante, fundamentado nos pressupostos de Paulo Freire. Realizou-se um Círculo de Cultura Virtual, com a participação de 11 adolescentes, sendo percorrido as etapas do Itinerário de Pesquisa: Investigação Temática; Codificação e Descodificação e Desvelamento Crítico. Resultados: emergiram dois temas geradores: “A Coronavirus Disease 2019 na adolescência: transformações do presente” e “Como será o amanhã?” Discutiu-se sobre a necessidade de ficar somente em casa, sem ir à escola e nem ver os amigos. Também refletiram sobre o futuro, demonstrando insegurança e preocupação com a situação da família e a valorização do que é importante na vida. Conclusão: A necessidade do afastamento social ou, alguns casos, do isolamento social, impostas pela pandemia, resultaram em mudanças bruscas na rotina dos adolescentes e de todo o grupo familiar

Antiproliferative activity of flavonoids from croton Sphaerogynus baill. (euphorbiaceae)

Croton sphaerogynus is a shrub from the Atlantic Rain Forest in southeastern Brazil. A lyophilized crude EtOH extract from leaves of C. sphaerogynus, obtained by maceration at room temperature (seven days), was suspended in methanol and partitioned with hexane. The purified MeOH phase was fractionated over Sephadex LH-20 yielding five fractions (F1-F5) containing flavonoids, as characterized by HPLC-DAD and HPLC-MS analyses. The antiproliferative activity of the crude EtOH extract, MeOH and hexane phases, and fractions F1-F5 was evaluated on in vitro cell lines NCI-H460 (nonsmall cell lung), MCF-7 (breast cancer), and U251 (glioma). The MeOH phase showed activity (mean log GI(50) 0.54) higher than the hexane phase and EtOH extract (mean log GI(50) 1.13 and 1.19, resp.). F1 exhibited activity against NCI-H460 (nonsmall cell lung) (GI(50) 1.2 mu g/mL), which could be accounted for the presence of flavonoids and/or diterpenes. F4 showed moderate activity (mean log GI(50) 1.05), while F5 showed weak activity (mean log GI(50) 1.36). It is suggested that the antiproliferative activity of the crude EtOH extract and MeOH phase is accounted for a synergistic combination of flavonoids and diterpenes2015COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPsem informação2012/10079-

Intervenção assistida por animais na hospitalização de crianças e adolescentes: uma revisão integrativa da literatura / Animal assisted intervention in children's and adolescents hospitalization: an integrative literature review

Objetivo: analisar as evidências científicas, acerca da utilização da intervenção assistida por animais na hospitalização de crianças e adolescentes. Método: trata-se de um estudo de revisão integrativa. A busca foi realizada nas seguintes bases de dados: Scopus, Web of Science, Pubmed, Medline, e Lilacs, tendo como critérios de inclusão: os estudos que tivessem seus resumos disponíveis nas bases de dados, na íntegra, online e gratuitos, que fossem em português, inglês ou espanhol. Foram excluídos os estudos não oriundos de pesquisa de campo. A coleta dos estudos ocorreu em dezembro de 2020. Resultados: atendendo aos critérios de inclusão, foram selecionados 19 estudos. A análise do nível de evidência identificou: cinco estudos nível 2; seis nível 3; cinco nível 4 e três nível 6. Nove artigos falavam sobre Terapia Assistida por Animais (TAA), quatro sobre Atividade Assistida por Animais (AAA) e seis sobre Intervenção Assistida por Animais (IAA). Três buscavam programar, protocolar e padronizar a utilização de animais, quatro descreveram a opinião e conhecimentos dos pacientes, acompanhantes ou profissionais da área da saúde, onze eram sobre a redução da dor, medo, ansiedade, estresse referentes à hospitalização e procedimentos médicos, e um tratava acerca da diminuição dos sinais fisiológicos, psicológicos e comportamentais dos pacientes. Considerações finais: A presente revisão consistiu na análise dos estudos com as principais condutas usuais de rotina adotadas nas instituições, e a estratégia utilizada foi referente à interação do humano com o animal

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

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 <= 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

Multiple Scenario Generation of Subsurface Models:Consistent Integration of Information from Geophysical and Geological Data throuh Combination of Probabilistic Inverse Problem Theory and Geostatistics

Neutrinos with energies above 1017 eV are detectable with the Surface Detector Array of the Pierre Auger Observatory. The identification is efficiently performed for neutrinos of all flavors interacting in the atmosphere at large zenith angles, as well as for Earth-skimming \u3c4 neutrinos with nearly tangential trajectories relative to the Earth. No neutrino candidates were found in 3c 14.7 years of data taken up to 31 August 2018. This leads to restrictive upper bounds on their flux. The 90% C.L. single-flavor limit to the diffuse flux of ultra-high-energy neutrinos with an E\u3bd-2 spectrum in the energy range 1.0 7 1017 eV -2.5 7 1019 eV is E2 dN\u3bd/dE\u3bd < 4.4 7 10-9 GeV cm-2 s-1 sr-1, placing strong constraints on several models of neutrino production at EeV energies and on the properties of the sources of ultra-high-energy cosmic rays

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)