Cobertura vacinal contra hepatite B em pacientes com diabetes mellitus

OBJECTIVE Analyze the factors associated with full hepatitis B vaccination (three doses) in patients with diabetes mellitus. METHOD Cross-sectional study, conducted in a health unit in a city in the state of São Paulo, with 255 patients on outpatient follow-up, in 2014. Data were obtained from the computerized system of the Municipal Health Department and via a structured questionnaire. A logistic regression model was used for analysis. RESULTS Full hepatitis B vaccination was noted in 13.7% of the patients and shown to be directly associated with their educational level (OR=1.30; CI: 1.07-1.57) and current or previous work as a health professional (OR=3.21; CI: 1.16-8.89). CONCLUSION Hepatitis B vaccination coverage was found to be low in patients with diabetes mellitus, indicating their vulnerability to this serious and potentially fatal disease. Higher educational level and working in the field of health were associated with better vaccination coverage.OBJETIVO Analisar os fatores associados à vacinação completa contra hepatite B (3 doses) em pacientes com diabetes mellitus. MÉTODO Estudo transversal, realizado em uma Unidade de Saúde, de uma cidade do interior paulista, com 255 pacientes em seguimento ambulatorial, em 2014. Os dados foram obtidos no sistema informatizado da Secretaria Municipal de Saúde e por meio de um questionário estruturado e, para análise, modelo de regressão logística. RESULTADOS Vacinação completa contra hepatite B foi observada em 13,7% dos pacientes e mostrou-se diretamente associada ao nível de escolaridade (OR=1,30; IC: 1,07-1,57) e ao trabalho atual ou pregresso como profissional da saúde (OR=3,21; IC: 1,16-8,89). CONCLUSÃO A cobertura vacinal contra hepatite B mostrou-se baixa em pacientes com diabetes mellitus, evidenciando a vulnerabilidade a essa doença grave e potencialmente fatal. Maior escolaridade e o trabalho na área da saúde foram associados a melhor cobertura vacinal.OBJETIVO Analizar los factores asociados con la vacunación completa contra hepatitis B (3 dosis) en pacientes con diabetes mellitus. MÉTODO Estudios transversal, llevado a cabo en una Unidad de Salud de una ciudad del interior paulista, con 255 pacientes en seguimiento ambulatorio, en 2014. Los datos fueron obtenidos en el sistema informatizado de la Secretaría Municipal de Salud y mediante un cuestionario estructurado y, para el análisis, un modelo de regresión logística. RESULTADOS Vacunación completa contra hepatitis B fue observada en el 13,7% de los pacientes y se mostró directamente asociada con el nivel de escolaridad (OR=1,30; IC: 1,07-1,57) y con el trabajo actual o anterior como profesional sanitario (OR=3,21; IC: 1,16-8,89). CONCLUSIÓN La cobertura vacunal contra hepatitis B se mostró baja en pacientes con diabetes mellitus, evidenciándose la vulnerabilidad a esa enfermedad severa y potencialmente fatal. Mayor escolaridad y el trabajo en el área sanitaria estuvieron asociados con la mejor cobertura vacunal

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

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost

Student satisfaction in clinical nursing simulation experiences

Objetivo: Identificar a relação entre a satisfação e a percepção de aprendizagem dos estudantes de enfermagem em situações clínicas simuladas. Metodologia: Estudo misto, realizado em dois cursos de graduação em enfermagem de uma Instituição de Ensino Superior pública do estado de São Paulo aprovado pelo Comitê de Ética em Pesquisa, CAAE 90560518.8.0000.5393, ofício n. 2.766.884 de 11 de Julho de 2018. De um total de nove disciplinas que utilizavam a simulação clínica no ensino de graduação em enfermagem, seis delas permitiram a coleta de dados. Participaram 169 estudantes de enfermagem, matriculados no curso de Bacharelado em Enfermagem (86); Bacharelado e Licenciatura em Enfermagem (59), e 24 não especificaram o curso. Ao final das simulações clínicas, foram entregues aos estudantes participantes a Escala de Satisfação em Experiências Clínica Simulada (ESECS), um questionário aberto sobre a percepção de aprendizagem e informações sociodemográficas. Para análise dos dados quantitativos utilizou-se da estatística descritiva e para os dados qualitativos, a análise temática, apoiada no referencial teórico de Zabala. O período de coleta de dados foi de julho de 2018 a julho de 2019. Resultados: participaram da pesquisa 169 estudantes de enfermagem; 87% era do sexo feminino, na faixa etária de 21 a 25 anos (78,7%). Pela aplicação da ESECS foi possível identificar uma maior satisfação pela dimensão cognitiva (9,3) seguida pelo realismo (9,2) e a prática (8,7). Na análise temática emergiram temas sobre facilitação da aprendizagem que incluem atuação do professor no planejamento, participação do aluno, etapas da simulação clínica e atitudes e emoções. Temas semelhantes também emergiram entre os aspectos dificultadores pois planejamento, participação do aluno e emoções foram identificadas nas respostas dos alunos. A infraestrutura também foi citada como dificultador da aprendizagem. Ficou evidente o forte componente teórico-prático atribuído à experiência simulada, relacionado à percepção de aprendizagem além de seus facilitadores, como o momento do pré-briefing e debriefing e o planejamento pedagógico docente. Conclusão: Na percepção dos participantes, aspectos semelhantes podem facilitar ou dificultar a aprendizagem. A simulação como estratégia inovadora impacta no processo de percepção da aprendizagem do estudante, pois tem a capacidade de desenvolver aprendizagens cognitivas, procedimentais e atitudinais, favorecendo a sua satisfação e contribuindo para repensar as práticas docente e investimento institucional. A formação do estudante está fortemente ligada ao compromisso docente no planejamento e avaliação da prática pedagógica, incorporando ação consciente na construção de aprendizagem compartilhada e integrada.Objective: To identify the relationship between nursing student\'s satisfaction and learning perception clinical simulation. Methodology: Mixed method study, carried out in two undergraduate nursing courses at a public Higher Education Institution, state of São Paulo approved by the Research Ethics Committee, CAAE 90560518.8.0000.5393, letter n. 2,766,884 of July 11, 2018. Of a total of nine disciplines using clinical simulation as a teaching strategy, six of them allowed data collection with 169 nursing students, enrolled in the Bachelor of Nursing course (86); Bachelor and Licentiate in Nursing (59) and 24 did not specify the course. At the end of clinical simulations, students filled the Simulated Clinical Experiences Satisfaction Scale (ESECS) questionnaire, an open questions about their perception of learning and sociodemographic information. Descriptive statistics, thematic analysis and theoretical framework of Zabala were used to interpreted data. The data collection was from July 2018 to July 2019. Results: From the 169 nursing students 87% were female, 21 to 25 years (78.7%). According with ESECS results, there is a greater satisfaction with the cognitive dimension (9.3) followed by realism (9.2) and practice (8.7). In the thematic analysis emerged themes about learning facilitation that include teacher\'s performance in planning, student participation, stages of clinical simulation and attitudes and emotions. Similar themes also emerged among the complicating aspects because planning, student participation and emotions were identified in the students\' responses. The infrastructure was also cited as a difficulty in learning. From the responses to the open questionnaire, the strong theoretical-practical component attributed to the simulated experience related to the perception of learning was evident, as well as its facilitators, such as the pre-briefing and debriefing moment and the teaching pedagogical planning. Conclusion: According to the participants\' perception, similar aspects can facilitate or hinder learning. Simulation as an innovative strategy impacts the perception of student learning, as it has the ability to develop cognitive, procedural and athenalytal learning, favoring their satisfaction and contributing to rethink teaching practices and institutional investment. Student education is strongly linked to the teacher\'s commitment in the planning and evaluation of pedagogical practice, incorporating conscious action in the construction of shared and integrated learning

Hepatitis B vaccination coverage in patients with diabetes mellitus

Abstract OBJECTIVE Analyze the factors associated with full hepatitis B vaccination (three doses) in patients with diabetes mellitus. METHOD Cross-sectional study, conducted in a health unit in a city in the state of São Paulo, with 255 patients on outpatient follow-up, in 2014. Data were obtained from the computerized system of the Municipal Health Department and via a structured questionnaire. A logistic regression model was used for analysis. RESULTS Full hepatitis B vaccination was noted in 13.7% of the patients and shown to be directly associated with their educational level (OR=1.30; CI: 1.07-1.57) and current or previous work as a health professional (OR=3.21; CI: 1.16-8.89). CONCLUSION Hepatitis B vaccination coverage was found to be low in patients with diabetes mellitus, indicating their vulnerability to this serious and potentially fatal disease. Higher educational level and working in the field of health were associated with better vaccination coverage

Vacinação em pacientes com diabetes mellitus na atenção primária à saúde: cobertura e fatores associados

RESUMO Objetivo Analisar a cobertura vacinal de pacientes com diabetes mellitus para as vacinas recomendadas pelo Programa Nacional de Imunizações e as variáveis associadas. Método Estudo transversal, com 255 pacientes de unidade básica de saúde, da região sudeste do Brasil, realizado em 2015. Utilizou-se o Sistema Informatizado de Gestão em Saúde para identificação da vacinação contra influenza, pneumococo, hepatite B, febre amarela, sarampo/caxumba/rubéola e difteria/tétano. Realizou-se análise estatística multivariada. Resultados 78,8% foram vacinados contra febre amarela, 65,5% contra difteria/tétano, 27,8% contra pneumococo, 27,5% contra hepatite B, 14,9% contra sarampo/caxumba/rubéola e 14,5% contra influenza. Encontrou-se associação entre sexo feminino e vacinação contra hepatite B, febre amarela e difteria/tétano; maior nível de escolaridade e vacinação contra hepatite B, e menor mediana de idade e vacinação contra sarampo/caxumba/rubéola. Conclusão A cobertura vacinal, em geral, foi baixa. Fatores como sexo, idade e escolaridade devem ser considerados nas recomendações de vacinas e na proposição de estratégias de imunização

Predictive Score for Carbapenem-Resistant Gram-Negative Bacilli Sepsis: Single-Center Prospective Cohort Study

A clinical–epidemiological score to predict CR-GNB sepsis to guide empirical antimicrobial therapy (EAT), using local data, persists as an unmet need. On the basis of a case–case–control design in a prospective cohort study, the predictive factors for CR-GNB sepsis were previously determined as prior infection, use of mechanical ventilation and carbapenem, and length of hospital stay. In this study, each factor was scored according to the logistic regression coefficients, and the ROC curve analysis determined its accuracy in predicting CR-GNB sepsis in the entire cohort. Among the total of 629 admissions followed by 7797 patient-days, 329 single or recurrent episodes of SIRS/sepsis were enrolled, from August 2015 to March 2017. At least one species of CR-GNB was identified as the etiology in 108 (33%) episodes, and 221 were classified as the control group. The cutoff point of ≥3 (maximum of 4) had the best sensitivity/specificity, while ≤1 showed excellent sensitivity to exclude CR-GNB sepsis. The area under the curve was 0.80 (95% CI: 0.76–0.85) and the number needed to treat was 2.0. The score may improve CR-GNB coverage and spare polymyxins with 22% (95% CI: 17–28%) adequacy rate change. The score has a good ability to predict CR-GNB sepsis and to guide EAT in the future