Atresia biliar e seus impactos para a criança acometida e sua família: revisão integrativa

Objective: To identify through literature the impacts that biliary atresia causes in affected children and their families. Method: This is an integrative review of literature carried out between July and September 2022, using databases and libraries: SCOPUS, PUBMED, and EBSCO. The descriptors for the search were adjusted according to the database or library, being caregivers, “biliary atresia”, “child care”, family, child, “child care subject”, combined with the boolean operator AND. The studies were selected in a careful and systematic way and evaluated for the level of evidence. Results: In the primary search, 1441 articles were identified, and after careful selection, 7 studies were selected to compose the qualitative analysis. The main results of the impacts of biliary atresia for children refer to the consequences arising from the disease regarding the need for surgical procedures that negatively impact quality of life. The impacts for the family relate to consequences for mental health and low quality of life, combined with lack of knowledge about caring for the child and excessive worry. Conclusion: This study made it possible to identify the impacts that biliary atresia causes in affected children and their families, pointing to significant contributions to nursing care.Objetivo: Identificar a través de la literatura los impactos que la atresia biliar provoca en los niños afectados y en su familia. Método: Se trata de una revisión integradora de la literatura, realizada entre julio y septiembre de 2022, utilizando como bases de datos y bibliotecas SCOPUS, PUBMED y EBSCO. Se realizó la adecuación de los descriptores en busca de concordancia con la base o biblioteca, siendo estos: caregivers, “biliary atresia”, “child care”, family, child, “child care subject”, combinados con el operador booleano AND. Los estudios fueron seleccionados de forma juiciosa y sistematizada, evaluados en cuanto al nivel de evidencia. Resultados: En la búsqueda primaria fueron identificados 1441 artículos y, después de una cuidadosa selección, 7 estudios fueron seleccionados para componer el análisis cualitativo. Los principales resultados de los impactos de la atresia biliar para los niños son las consecuencias de la enfermedad con relación a la necesidad de cirugía, que impactan negativamente en la calidad de vida. Por otro lado, los impactos para la familia están relacionados a las consecuencias para la salud mental y baja calidad de vida, asociados a la falta de conocimiento sobre el cuidado del niño y preocupación excesiva. Conclusión: Este estudio permitió identificar los impactos que la atresia biliar provoca en los niños afectados y su familia, y aporta contribuciones significativas para el cuidado en enfermería.Objetivo: Identificar através da literatura impactos que a atresia biliar provoca em crianças acometidas e em sua família. Método: Trata-se de uma revisão integrativa da literatura realizada entre julho e setembro de 2022, utilizando bases de dados e bibliotecas SCOPUS, PUBMED e EBSCO. Realizou-se adequação dos descritores para busca de acordo com a base ou biblioteca, sendo estes: caregivers, “biliary atresia”, “child care”, family, child, “child care subject”, combinados com o operador booleano AND. Os estudos foram selecionados de forma criteriosa e sistematizada, avaliados quanto ao nível de evidência. Resultados: Na busca primária, identificou-se 1441 artigos e após criteriosa seleção, 7 estudos foram selecionados para compor a análise qualitativa. Obteve-se como principais resultados dos impactos da atresia biliar para as crianças, dizem respeito as consequências oriundas da doença no que se refere a necessidade de procedimento cirúrgico que impactam negativamente na qualidade de vida. Já os impactos para a família dizem respeito a consequências para a saúde mental e baixa qualidade de vida aliados ao desconhecimento sobre cuidados com a criança e excesso de preocupação. Conclusão: Este estudo possibilitou a identificação dos impactos que a atresia biliar provoca em crianças acometidas e em sua família, apontando contribuições significativas para o cuidado em enfermagem

Digital postcompensation using volterra series transfer function

We propose a noniterative digital backward propagation technique, based on an inverse modified Volterra series transfer function to postcompensate transmission linear and nonlinear impairments in the presence of optical noise. Using a single-channel 40-Gb/s nonreturn-to-zero quadrature phase-shift-keying optical signal propagated over 20 x 80 km of standard single-mode fiber, and performing digital postcompensation around the Nyquist rate, our compensation algorithm is able to surpass the maximum accuracy obtained with a symmetric split-step Fourier method, enabling us to increase the nonlinear tolerance by approximately 2 dB

Percutaneous transluminal angioplasty in the treatment of stenosis of arteriovenous fistulae for hemodialysis

<p>Abstract</p> <p>Background</p> <p>Thrombosis following stenosis of arteriovenous fistulae resulting in the loss of vascular access for hemodialysis is an important complication in patients with chronic renal failure. Percutaneous transluminal angioplasty is being used more frequently in the treatment of stenosis aiming at increasing the patency of arteriovenous fistulae.</p> <p>Objective</p> <p>To evaluate the primary patency of arteriovenous fistulae following percutaneous transluminal angioplasty.</p> <p>Patients and method</p> <p>Patients submitted to percutaneous transluminal angioplasty in the Angiology service of Hospital de Base in 2004 were analyzed over an average follow-up of 10 months (2 to 16 months).</p> <p>Results</p> <p>A total of 22 angioplasties were performed in 20 fistulae of 19 patients. Of the 19 patients, one did not complete follow-up and one presented with a rupture of the fistulae. The following complications occurred in the remaining 18 fistulae, three deaths with two fistulae patent until death; one exeresis of prosthesis due to infection (53 days after the procedure); two thromboses (3 and 49 days after the procedure) and four restenosis (3 were submitted to a second angioplasty and one treated surgically). At the end of the follow-up, 11 fistulae (55%) were patent and with a flow rate in hemodialysis > 300 mL/min. Primary patency was 82.4% over three months; 81.2% over six months; 54.5% over 9 months and 50% over 1 year.</p> <p>Conclusion</p> <p>Percutaneous transluminal angioplasty is an efficacious method for the correction of stenosis of arteriovenous fistulae for hemodialysis, prolonging the patency of the fistula and enabling new interventions.</p

Pressupostos políticos e teóricos do curso de formação “Melhor gestão, Melhor ensino” da SEE/SP (2013-2017)

Este artigo objetiva identificar e discutir os pressupostos políticos e teóricos do curso de formação de diretores “Melhor Gestão, Melhor Ensino” da SEE/SP oferecido entre os anos de 2013 e 2017. Metodologicamente, os pressupostos da Pedagogia Histórico- Crítica guiaram uma abordagem histórica do projeto de formação do diretor a partir da análise de decretos e leis em vigor entre 1996 e 2016. Os resultados consideram o contexto histórico, político e teórico em que o curso foi proposto e permitem perceber a influência da mundialização da cultura do capital e da “Pedagogia do Aprender a Aprender”

Are we following the guidelines on non-muscle invasive bladder cancer?

To evaluate the clinical practice of non-muscle invasive bladder cancer (NMIBC) treatment in Brazil in relation to international guidelines: Sociedade Brasileira de Urologia (SBU), European Association of Urology (EAU) and American Urological Association (AUA). Cross-sectional study using questionnaires about urological practice on treatment of NMIBC during the 32nd Brazilian Congress of Urology. A total of 650 question forms were answered. There were 73% of complete answers (total of 476 question forms). In total, 246 urologists (51.68%) lived in the southeast region and 310 (65.13%) treat 1 to 3 cases of NMIBC per month. Low risk cancer: Only 35 urologists (7.5%) apply the single intravesical dose of immediate chemotherapy with Mitomicin C recommended by the above guidelines. Adjuvant therapy with BCG 2 to 4 weeks after TUR is used by 167 participants (35.1%) and 271 urologists (56.9%) use only TUR. High risk tumors: 397 urologists (83.4%) use adjuvant therapy, 375 (78.8%) use BCG 2 to 4 weeks after TUR, of which 306 (64.3%) referred the use for at least one year. Intravesical chemotherapy with Mitomicin C (a controversial recommendation) was used by 22 urologists (4.6%). BCG dose raised a lot of discrepancies. Induction doses of 40, 80 and 120mg were referred by 105 (22%), 193 (40.4%) and 54 (11.3%) respectively. Maintenance doses of 40, 80 and 120mg were referred by 190 (48.7%), 144 (37.0%) and 32 (8.2%) urologists, respectively. Schemes of administration were also varied and the one cited by SWOG protocol was the most used: 142 (29.8%). SBU, EAU and AUA guidelines are partially respected by Brazilian urologists, particularly in low risk tumors. In high risk tumors, concordance rates are comparable to international data. Further studies are necessary to fully understand the reasons of such disagreement421222

Blends of Poly(3-Hydroxybutyrate-co-3-Hydroxyvalerate) with Fruit Pulp Biowaste Derived Poly(3-Hydroxybutyrate-co-3-Hydroxyvalerate-co-3-Hydroxyhexanoate) for Organic Recycling Food Packaging

[EN] In the present study, a new poly(3-hydroxybutyrate-co-3-hydroxyvalerate-co-3-hydroxyhexanoate) [P(3HB-co-3HV-co-3HHx)] terpolyester with approximately 68 mol% of 3-hydroxybutyrate (3HB), 17 mol% of 3-hydroxyvalerate (3HV), and 15 mol% of 3-hydroxyhexanoate (3HHx) was obtained via the mixed microbial culture (MMC) technology using fruit pulps as feedstock, a processing by-product of the juice industry. After extraction and purification performed in a single step, the P(3HB-co-3HV-co-3HHx) powder was melt-mixed, for the first time, in contents of 10, 25, and 50 wt% with commercial poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV). Thereafter, the resultant doughs were thermo-compressed to obtain highly miscible films with good optical properties, which can be of interest in rigid and semirigid organic recyclable food packaging applications. The results showed that the developed blends exhibited a progressively lower melting enthalpy with increasing the incorporation of P(3HB-co-3HV-co-3HHx), but retained the PHB crystalline morphology, albeit with an inferred lower crystalline density. Moreover, all the melt-mixed blends were thermally stable up to nearly 240 degrees C. As the content of terpolymer increased in the blends, the mechanical response of their films showed a brittle-to-ductile transition. On the other hand, the permeabilities to water vapor, oxygen, and, more notably, limonene were seen to increase. On the overall, this study demonstrates the value of using industrial biowaste derived P(3HB-co-3HV-co-3HHx) terpolyesters as potentially cost-effective and sustainable plasticizing additives to balance the physical properties of organic recyclable polyhydroxyalkanoate (PHA)-based food packaging materialsThis research was supported by the Spanish Ministry of Science and Innovation (MICI) project RTI2018-097249-B-C21 and by the EU H2020 BBI JU project USABLE PAKAGING (reference number 836884)Melendez-Rodriguez, B.; Torres-Giner, S.; Reis, MAM.; Silva, F.; Matos, M.; Cabedo, L.; Lagarón, JM. (2021). Blends of Poly(3-Hydroxybutyrate-co-3-Hydroxyvalerate) with Fruit Pulp Biowaste Derived Poly(3-Hydroxybutyrate-co-3-Hydroxyvalerate-co-3-Hydroxyhexanoate) for Organic Recycling Food Packaging. Polymers. 13(7):1-19. https://doi.org/10.3390/polym13071155S11913

Speed, agility, and musculoskeletal fitness are independently associated with areal bone mineral density in children

Background: There is still little understanding of the associations between physical fitness variables and bone health in children taking into account key confounders. Aim: The aim of this study was to analyze the associations between performance in tests of speed, agility, and musculoskeletal fitness (power of the upper and lower limbs) with bone mass of different regions in children, considering the adjustment to maturity-offset, lean percentage, and sex. Methods: Cross-sectional study design: the sample consisted of 160 children aged 6–11 years. The physical fitness variables tested were 1) speed, assessed with the running test at a maximum speed of 20 m; 2) agility, assessed through the 4×4-m square test; 3) lower limb power, assessed using the standing long jump test, and 4) upper limb power, assessed using the 2-kg medicine ball throw test. Areal bone mineral density (aBMD) was obtained from the analysis of body composition by dualenergy X-ray absorptiometry (DXA). Simple and multiple linear regression models were performed using the SPSS software. Results: In the crude regression analyses, the results indicated a linear relationship between all the physical fitness variables and aBMD in all body segments, but maturity-offset, sex, and lean mass percentage seemed to have an effect on these relationships. Except for the upper limb power, the other physical capacities (speed, agility, and lower limb power) were associated with aBMD in at least three body regions in the adjusted analyses. These associations occurred in the spine, hip, and leg regions, and the aBMD of the legs presented the best association magnitude (R2 ). Conclusion: There is a significant association between speed, agility, and musculoskeletal fitness, specifically the lower limb power and aBMD. That is, the aBMD is a good indicator of the relationship between fitness and bone mass in children, but it is essential to consider specific fitness variables and skeletal regions

Gestão de recursos das unidades de terapia intensiva em tempos de pandemia por COVID-19

Objective: To analyze resource management aspects in intensive care units (ICU) in times of COVID-19 in Cariri microregion of Ceará. Methods: Descriptive cross-sectional study in four hospitals in the Cariri microregion, with 91 professionals from interdisciplinary teams who have been working in the ICU since the beginning of the pandemic. Research was conducted through email, Instagram and/or WhatsApp and the data were analyzed in the chi-square test, T-test and cluster chart. Results: Regarding human resources, 73.6 % of professionals took a course on patient management in ICU during COVID-19 and 67.0 % on control of healthcare-associated infections. Of these professionals, 64.8 % were able to deal with the difficulties in the ICU, 69.2 % were relocated from other hospital sectors to meet ICU demands and most professionals (76.9 %) did not have psychological support for the pandemic. In structural resources, 100 % of adult ICU beds were occupied during the pandemic, presenting a difference between before and during, during and after the crisis with an exponential increase in bed capacity (p&lt;0.001), and showing no significant differences in moments before and after the pandemic (p=0.035). Material resources were in short supply and decreased, such as personal protective equipment, oxygen, medicines, among others. Conclusion: Identifying the reorganization of human, material and structural resources was possible in the researched hospitals. There has been an exponential increase in beds during the pandemic crisis when compared to the capacity reported by staff from moments before the pandemic. Therefore, this research contributes to the knowledge of health management and hospital restructuring in pandemic times.Objetivo: Analizar aspectos de la gestión de recursos de las unidades de cuidados intensivos (UCI) en tiempos de COVID-19 en la microrregión de Cariri, Ceará. Método: Estudio descriptivo transversal en cuatro hospitales de la microrregión de Cariri, con 91 profesionales del equipo interdisciplinario que trabajan en UCI desde el inicio de la pandemia. La encuesta se realizó por correo electrónico, Instagram y/o WhatsApp y los datos se analizaron mediante la prueba chi-cuadrado, prueba T y gráfico de conglomerados. Resultados: Respecto a los recursos humanos, el 73.6 % de los profesionales realizó un curso de manejo de pacientes en UCI durante la COVID-19 y el 67.0 % sobre control de infecciones relacionadas con los servicios sanitarios. El 64.8 % pudo hacer frente a las dificultades en la UCI, el 69,2 % fue reasignado de otros sectores hospitalarios para atender las demandas de la UCI y la mayoría de los profesionales (76.9 %) no tuvo apoyo psicológico para la pandemia. En cuanto a los recursos organizativos, el 100 % de las camas de la UCI de adultos estuvieron ocupadas durante la pandemia, con una diferencia entre antes y durante, durante y después de la crisis, con un aumento exponencial de la capacidad de camas (p&lt;0,001), y sin diferencias significativas entre antes y después de la pandemia (p=0,035). Los recursos materiales escasearon y disminuyeron, como equipos de protección personal, oxígeno, medicamentos, entre otros. Conclusión: Se pudo identificar la gestión de los recursos humanos, materiales y organizativos en los hospitales encuestados. Hubo un aumento exponencial de camas durante la crisis pandémica en comparación con la capacidad reportada por los profesionales antes de la pandemia. Por lo tanto, esta investigación contribuye al conocimiento de la gestión sanitaria y la reestructuración hospitalaria en tiempos de pandemia.Objetivo: Analisar aspectos de gestão em recursos das unidades de terapia intensiva (UTI) em tempos de COVID-19 na microrregião Cariri cearense. Método: Estudo descritivo do tipo transversal em quatro hospitais da microrregião do Cariri, com 91 profissionais da equipe interdisciplinar que atuam em UTI desde o início da pandemia. A pesquisa foi realizada através de e-mail, Instagram e/ou WhatsApp e os dados analisados em teste do qui-quadrado, teste-T e gráfico de clusters. Resultados: Acerca dos recursos humanos, 73,6 % dos profissionais realizaram curso de manejo do paciente em UTI durante a COVID-19 e 67,0 % sobre controle de infecções relacionados a serviços de saúde. Um 64,8 % conseguiram lidar como as dificuldades na UTI, 69,2 % foram remanejados de outros setores hospitalares para atender demandas da UTI e grande parte dos profissionais (76,9 %) não tiveram aporte psicológico para a pandemia. Nos recursos estruturais, 100 % dos leitos de UTI adulto foram ocupados durante a pandemia, apresentando diferença entre antes e durante, durante e após a crise com aumento exponencial da capacidade de leitos (p&lt;0,001), e não apresentando diferenças significativas em momentos antes e após a pandemia (p=0,035). Recursos materiais estiveram em escassez e diminuição, como equipamentos de proteção individual, oxigênio, medicamentos, entre outros. Conclusão: Foi possível identificar a reorganização dos recursos humanos, materiais e estruturais dos hospitais da pesquisa. Houve aumento exponencial de leitos durante a crise pandêmica quando comparado a capacidade relatada pelos profissionais de momentos antes da pandemia. Portanto, esta pesquisa contribui para o conhecimento de gestão em saúde e reestruturação hospitalar em tempos de pandemia

Práticas de promoção do aleitamento materno no contexto hospitalar brasileiro: Revisão integrativa

Objective: Identify breastfeeding promotion practices in the Brazilian hospital context. Method: This study is an integrative literature review in which the following databases were used: LILACS, BDENF, MEDLINE and PUBMED. Using the descriptors in Health Sciences: Breast Feeding; Hospital; Health Promotion, which are crossed using the Boolean operator AND. Results: Fourteen studies were selected in this integrative review, which allowed the identification of the following breastfeeding promotion practices in hospital settings: skin-to-skin contact after birth, type of delivery, nursing care, and pain management during the breastfeeding process. Conclusion: It was observed that this study identified the practice of breastfeeding promotion in the hospital context, described in the results in a systematized way. This practice needs to be changed in hospitals and be correctly implemented.Objetivo: identificar las prácticas de promoción de la lactancia materna en el contexto hospitalario brasileño. Método: Este estudio es una revisión bibliográfica integradora que utiliza las siguientes bases de datos: LILACS, BDENF, MEDLINE y PUBMED. Basado en los descriptores de Ciencias de la Salud: Breast Feeding; Hospital; Health Promotion, que se cruzarán utilizando el operador booleano AND. Resultados: En esta revisión integradora se seleccionaron 14 estudios que permitieron identificar las siguientes prácticas de promoción del parto materno en el contexto hospitalario: el contacto de la piel con la piel después del nacimiento, el tipo de parto, la asistencia enfermera y el manejo del dolor durante el proceso de amamantamiento. Conclusión: Se observó que este estudio identificó la práctica de promoción de la salud materna en el contexto hospitalario, descrita en los resultados de forma sistematizada. Esta práctica hace necesario realizar cambios dentro de los hospitales y se implantan de forma correcta.Objetivo: Identificar práticas de promoção ao aleitamento materno no contexto hospitalar brasileiro. Método: O presente estudo trata-se de uma revisão integrativa da literatura na qual foram utilizadas as bases de dados: LILACS, BDENF, MEDLINE e PUBMED. Também foi realizado a partir dos Descritores em Ciências da Saúde: Breast Feeding; Hospital; Health Promotion, os quais foram cruzados utilizando o operador booleano AND. Resultados: Foram selecionados nesta revisão integrativa 14 estudos que permitiram a identificação das seguintes práticas de promoção ao aleitamento materno no contexto hospitalar: o contato pele a pele após o nascimento, o tipo do parto, a assistência de enfermagem e o manejo da dor durante o processo da amamentação. Conclusão: Observou-se que este estudo identificou a prática de promoção ao aleitamento materno no contexto hospitalar, descrito nos resultados de forma sistematizada. Constatamos que há a necessidade de mudanças dessas práticas dentro dos hospitais e que sejam implantadas de maneira correta

VIGIPÉ®: FOOT RISK STRATIFICATION TECHNOLOGY FOR PATIENTS WITH DIABETES MELLITUS

Objective: to create and validate an app that establishes the diabetic foot risk degree by associating the patients' health conditions.Methodology: a methodological study conducted between March 2019 and December 2021 in Crato – CE – Brazil, and divided into three phases: 1) Review of the national and international guidelines; 2) Creation of the educational technology; and 3) Face and content validation of the technology. This study followed the guidelines set forth in the Revised Standards for Quality Improvement Reporting Excellence guide.Results: in the review phase, similar content was identified between the guidelines for designing and organizing the content. The technology that was created enabled data collection, as well as diabetic foot risk assessment and classification. A total of 18 judges evaluated the instrument in the validation stage, obtaining a CVI value of 0.96.Conclusion: the study may contribute to improving the indicators referring to hospitalizations, amputations, reduced mobility, dependence, frailty and mortality resulting from diabetic foot