TIPOS DE VIOLÊNCIA OBSTÉTRICA E SUAS RAMIFICAÇÕES NA SAÚDE FEMININA NO CONTEXTO BRASILEIRO

ABSTRACT INTRODUCTION: Obstetric violence is defined as the practice of harmful conduct against women during the care of their sexual and reproductive health, which can be perpetrated by healthcare professionals or others involved in monitoring during the gestational and postpartum periods. OBJECTIVE: To gather the main productions that evidence situations of obstetric violence, highlighting mistreatment and the lack of guarantee of access to the health rights of parturients in the Brazilian healthcare system, as well as its impacts on women's health. METHODOLOGY: The methodology used in this research involved searching and analyzing data in various databases available in the Virtual Health Library (VHL), such as MEDLINE, LILACS, and the Nursing Database (BDENF), focusing specifically on studies related to obstetric violence and its implications for women's health in the Brazilian context. For this, Health Sciences Descriptors (DeCS) were employed, combined with the Boolean operator AND, using terms such as (Obstetric Violence) AND (Women's Health) AND (Brazil). RESULTS AND DISCUSSION: Obstetric violence represents a serious challenge to public health, as many women are not aware of abusive practices, and their bodies are disrespected by self-proclaimed holders of knowledge, exacerbating power dynamics, especially in the context of black women, who continue to be underestimated by the healthcare system. CONCLUSION: By analyzing the selected studies, it is evident that obstetric violence is a reality that affects many women during the gestational-puerperal cycle, resulting in deep physical, emotional, and psychological damage. The diversity of types of obstetric violence identified, along with their implications for women's health, highlights the complexity of this phenomenon and the need for comprehensive and woman-centered interventions.INTRODUCCIÓN: La violencia obstétrica se define como la práctica de conductas perjudiciales contra las mujeres durante el cuidado de su salud sexual y reproductiva, pudiendo ser perpetrada por profesionales de la salud u otros involucrados en el seguimiento durante el período gestacional y posparto. OBJETIVO: Reunir las principales producciones que evidencian situaciones de violencia obstétrica, destacando los malos tratos y la falta de garantía de acceso a los derechos de salud de las parturientas en el sistema de salud brasileño, así como sus impactos en la salud de la mujer. METODOLOGÍA: La metodología utilizada en esta investigación involucró la búsqueda y análisis de datos en diversas bases disponibles en la Biblioteca Virtual en Salud (BVS), como MEDLINE, LILACS y la Base de Datos de Enfermería (BDENF), enfocándose específicamente en estudios relacionados con la violencia obstétrica y sus implicaciones en la salud de las mujeres en el contexto brasileño. Para ello, se emplearon Descriptores en Ciencias de la Salud (DeCS), combinados con el operador booleano AND, utilizando términos como (Violencia Obstétrica) Y (Salud Femenina) Y (Brasil). RESULTADOS Y DISCUSIÓN: La violencia obstétrica representa un serio desafío para la salud pública, ya que muchas mujeres no están al tanto de las prácticas abusivas, y sus cuerpos son despreciados por individuos autodenominados poseedores de conocimiento, exacerbando las dinámicas de poder, especialmente en el contexto de las mujeres negras, que continúan siendo subestimadas por el sistema de salud. CONCLUSIÓN: Al analizar los estudios seleccionados, queda evidente que la violencia obstétrica es una realidad que afecta a muchas mujeres durante el ciclo gestacional-puerperal, resultando en daños físicos, emocionales y psicológicos profundos. La diversidad de tipos de violencia obstétrica identificados, junto con sus implicaciones para la salud de las mujeres, resalta la complejidad de este fenómeno y la necesidad de intervenciones integrales y centradas en la mujer.INTRODUÇÃO: A violência obstétrica é definida como a prática de condutas prejudiciais contra mulheres durante o cuidado da sua saúde sexual e reprodutiva, podendo ser perpetrada por profissionais de saúde ou outros envolvidos no acompanhamento durante o período gestacional e pós-parto OBJETIVO: Reunir as principais produções que evidenciam situações de violência obstétrica, destacando os maus-tratos e a falta de garantia de acesso aos direitos de saúde das parturientes no sistema de saúde brasileiro, bem como seus impactos na saúde da mulher. METODOLOGIA:  A metodologia utilizada nesta pesquisa envolveu a busca e análise de dados em diversas bases disponíveis na Biblioteca Virtual em Saúde (BVS), como o MEDLINE, LILACS e a Base de Dados de Enfermagem (BDENF), focando especificamente em estudos relacionados à violência obstétrica e suas implicações na saúde das mulheres no contexto brasileiro. Para isso, foram empregados Descritores em Ciências da Saúde (DeCS), combinados com o operador booleano AND, usando termos como (Violência Obstétrica) AND (Saúde Feminina) AND (Brasil). RESULTADOS E DISCUSSÃO: A violência obstétrica representa um sério desafio à saúde pública, uma vez que muitas mulheres não estão cientes das práticas abusivas, e seus corpos são desrespeitados por indivíduos autodenominados detentores de conhecimento, agravando as dinâmicas de poder, especialmente no contexto das mulheres negras, que continuam a ser subestimadas pelo sistema de saúde. CONCLUSÃO: Ao analisar os estudos selecionados, fica evidente que a violência obstétrica é uma realidade que afeta muitas mulheres durante o ciclo gravídico-puerperal, resultando em danos físicos, emocionais e psicológicos profundos. A diversidade de tipos de violência obstétrica identificados, juntamente com suas implicações na saúde das mulheres, destaca a complexidade desse fenômeno e a necessidade de intervenções abrangentes e centradas na mulher

Paciente pediátrico portador de transtorno espectro autista em um ambulatório: relato de experiência / Pediatric patient with autistic spectrum disorder in an outpatient clinic: experience report

O transtorno do espectro autista (TEA) é um grupo de distúrbios do desenvolvimento neurológico de início precoce, caracterizado por comprometimento das habilidades sociais e de comunicação, além de comportamentos estereotipados. Este trabalho teve como objetivo relatar a experiência vivenciadas durante o período das aulas práticas em um ambulatório pediátrico, pontuando a assistência de enfermagem para um paciente pediátrico com Transtorno do Espectro Autista (TEA), e os cuidados voltados para as suas enfermidades. Trata-se de um estudo descritivo do tipo relato de experiência, realizado por acadêmicas de enfermagem da Universidade da Amazônia - UNAMA, durante as aulas práticas em um ambulatório infantil em Belém – PA, concluímos que a importância do enfermeiro sobre orientar os pais, e direciona-los a consultar o filho com outros profissionais da equipe multiprofissional de saúde, e para melhorar a qualidade de vida da criança.

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

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

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

The National Student Survey: validation in Portuguese medical students

The UK National Student Survey (NSS) is a sound and widely used instrument for assessing students’ academic experiences. We aimed to translate the NSS for Portuguese students and to validate the instrument in a sample of medical undergraduates. The research team translated and adapted the NSS for Portuguese students (NSS-P). The survey was administered on an online platform to 1,256 final-year students at eight Portuguese medical schools. A total of 329 medical students (69.9% female) replied to the NSS-P, a response rate of 26.2%. Confirmatory factor analysis showed that the original six-factor structure had an adequate fit to the data. Adequate internal consistency was observed for all the subscales. Medium to large correlations were found among all the subscale scores and between the subscale scores and the students’ overall satisfaction. Multiple regression showed that the scores on the Teaching, Organization and Management and Personal Development subscales significantly predicted the students’ overall satisfaction. Approximately 64% of the students reported being satisfied with the quality of their courses. Significant differences among the medical schools in their NSS-P scores were found. The NSS-P is a valid and reliable measure for assessing medical students’ perceptions of academic quality

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

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora