Conhecimentos e práticas de um grupo de médicos sobre o consumo de álcool na gravidez : estudo qualitativo

Apesar da disponibilidade de diretrizes nacionais e internacionais sobre a intervenção com grávidas relativamente ao consumo de álcool, os estudos apontam que parece existir uma falha entre estas diretrizes e os conhecimentos e a prática profissional dos médicos. O presente estudo exploratório tem como objetivo geral explorar as perspetivas de um grupo de médicos que fazem o acompanhamento de grávidas acerca do consumo de álcool durante a gravidez. Os participantes foram oito médicos selecionados através de um processo de amostragem não probabilística por conveniência. Seguindo uma metodologia qualitativa foram realizadas entrevistas através de um guião semiestruturado, procedendo-se posteriormente a uma abordagem semi indutiva dos dados com recurso ao software NVivo. Os resultados principais indicam a informação insuficiente por parte dos próprios participantes, o desconhecimento de dados atuais sobre o tema e o desconhecimento de linhas orientadoras para a intervenção neste contexto. Demonstraram ainda diferentes opiniões sobre o que é um consumo de risco na gravidez e também uma prática inconsistente entre médicas, relatando o não cumprimento das normas internacionais e nacionais. Os resultados mostram a necessidade de aperfeiçoar e atualizar a informação e a prática dos médicos relativamente ao tema, a fim de melhorarem a qualidade da sua intervenção.Despite the availability of the national and international guidelines on the intervention with pregnant women regarding alcohol consumption, studies indicate that there seems to be a gap between these guidelines and the knowledge and professional practice of doctors. The present exploratory study aims to explore the perspectives about alcohol consumption during pregnancy with a group of doctors who follow up pregnant women. The participants were eight doctors selected through a non-probabilistic convenience sampling. Following a qualitative methodology, interviews were conducted through a semi-structured script, subsequently proceeding to a semi-inductive approach to the data using the NVivo software. The main results indicate insufficient information on the part of the participants, the lack of current data on the topic and the lack of guidelines for intervention in this context. They have also demonstrated different opinions about what is a risky consumption in pregnancy and an inconsistent practice among doctors, reporting the non-compliance with the international and national guidelines. The results show the need to improve and update doctors' information and practice about alcohol consumption during pregnancy, in order to improve quality of their intervention

'Space to talk': a Portuguese focus group study of parents' experiences, needs and preferences in parenting support during prenatal and well-child care

OBJECTIVE: To explore the experiences, needs and preferences of a group of parents regarding the parenting support received during prenatal and well-child care in the Portuguese National Health Service. DESIGN AND SETTING: We undertook descriptive-interpretive qualitative research running multiple focus groups in Porto, Northern Portugal. PARTICIPANTS, DATA COLLECTION AND ANALYSIS: Purposive sampling was used between April and November 2018. Focus groups were conducted with 11 parents of a 0-3 years old with well-child visits done in primary care units. Thematic analysis was performed in a broadly inductive coding strategy and findings are reported in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Three main themes were identified to describe parents' experience when participating in their children's healthcare: (1) logistics/delivery matter, including accessibility, organisation and provision of healthcare activities, unit setting and available equipment; (2) prenatal and well-child care: a relational place to communicate, with parents valuing a tripartite space for the baby, the family and the parent himself, where an available and caring health provider plays a major role and (3) parenting is challenging and looks for support, based on key points for providers to watch for and ask about, carefully explained and consensual among health providers. CONCLUSION: This study provides insight into parents' needs and healthcare practices that affect the parenting experience. To meet parents' preferences, sensitive health providers should guarantee a relational place to communicate and person-centredness, accounting for the whole family system to support healthy parenting collaboratively. Future studies are warranted to further strengthen the knowledge in the field of a population-based approach for parenting support.info:eu-repo/semantics/publishedVersio

Práticas artísticas no ensino básico e secundário

O crescimento carece de uma pedagogia, e educar é ao mesmo tempo algo de muito antigo, e de muito diferente. Neste ensejo, assinalam-se dois polos: o professor, os alunos. Mas a educação faz-se num contexto social, cultural, tecnológico, ambiental. Sobre isto conhecem-se alguns pontos de fixação que tornam a educação mais consequente e humanista. A Matéria-Prima, na Educação Artística, é exatamente o que parece: os materiais à espera de serem utilizados, os processos experimentados, as vivências significadas e sentidas. O professor de artes tem uma grande possibilidade de diferença.info:eu-repo/semantics/publishedVersio

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Early nCPAP versus intubation in very low birth weight infants

For many years endotracheal intubation and mechanical ventilation have been the standard of care for very low birth weight infants but, in the last decade, nasal continuous positive airway pressure (nCPAP) has been described in many studies as an option for the treatment of preterm infants with respiratory distress syndrome. In fact, recent studies have shown that early nCPAP is not associated with higher rates of morbidity and mortality and does not imply more days of ventilation support when compared to traditional ventilation techniques. The authors conducted a study to compare the outcomes (in terms of mortality, morbidity and need for medical support) of very low birth weight infants treated with nCPAP or endotracheal intubation and mechanical ventilation. One hundred and four newborns were enrolled in this study, 44 (42.3%) were treated with nCPAP and 60 (57.7%) with endotracheal intubation followed by mechanical ventilation. A subgroup analysis of newborns with gestational age between 28 and 31 weeks was also performed. It included 57 newborns with similar demographic characteristics, 29 (50.9%) treated with nCPAP and 28 (49.1%) with endotracheal intubation followed by mechanical ventilation. No statistically significant differences were found in the frequency of death or bronchopulmonary dysplasia. Statistically significant differences were found in the prevalence of hyaline membrane disease (p = 0.033) and surfactant administration (p = 0.021) with lower rates in the nCPAP group. No other differences were found in the prevalence of other morbidities or in the need for medical support after birth. These results suggests that nCPAP might be chosen as primary ventilatory support choice in very low birth weight preterm, when there are no contraindications to its use

New content management models: use of digital technologies by Mídia NINJA

O presente artigo reflete acerca da utilização das novas tecnologias de rede pelo meio de comunicação independente e ativista Mídia NINJA (Narrativas Independentes, Jornalismo e Ação) como modelo alternativo de gestão de conteúdos que utiliza o tripé: produção, circulação e distribuição. A pesquisa tem como objetivo compreender como funciona este modelo e de que forma ele atrai o público. Para tanto, o método utilizado foi a netnografia (ramo da Etnografia que analisa o comportamento de indivíduos e grupos sociais na internet e as dinâmicas desses grupos no ambiente online), para observar as dinâmicas de dois grupos do Telegram da Mídia NINJA (NINJASP e NINJADF) e a página do Instagram deste meio alternativo. Complementámos a metodologia com uma entrevista semiestruturada. Constatou-se, através da análise dos conteúdos das ferramentas estudadas, que as novas tecnologias de media digital como modelo de produção e distribuição utilizado pela Mídia NINJA provocam no público o interesse na leitura dos conteúdos deste medium, além de promover a participação e a interação.This article reflects on the use of new network technologies by the independent communication and activist Mídia NINJA (Independent Narratives, Journalism and Action) as an alternative model of content management that uses the tripod: production, circulation and distribution. The research aims to understand how this model works and how it attracts the public. For that, the method used is netnography (a branch of Ethnography that analyzes the behavior of individuals and social groups on the internet and the dynamics of these groups in the online environment), to observe the dynamics of two groups of the Telegram of the Mídia NINJA (NINJASP and NINJADF) and the Instagram page of this alternative medium. We complemented the methodology with a semi-structured interview. It was found, through the analysis of the contents of the studied tools, that the new technologies of digital media as a production and distribution model used by the Mídia NINJA provokes in the public an interest in reading the contents of this medium, in addition to promoting participation and interaction

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)