Interdisciplinarity: Perception of the participants of a promotional and health care program

As autoras analisam as percepções que os integrantes de um programa de promoção e atenção à saúde têm sobre o significado, perfil do profissional, vantagens e dificuldades do trabalho interdisciplinar. Numa abordagem qualitativa, os dados foram coletados em entrevista semi-estruturada com profissionais e acadêmicos de enfermagem, nutrição e psicologia e categorizados com a técnica de análise de conteúdo. Percebeu-se que os sujeitos caracterizam a sua prática como interdisciplinar. Necessitam superar obstáculos institucionais, epistemológicos, psicossociais, culturais e materiais para desenvolver, de forma mais explicitada e efetiva, uma metodologia do trabalho interdisciplinar.The authors analyze the perceptions that participants of a promotional and health care program have about the meaning, the professional profile, advantages and difficulties of the interdisciplinary work. In a qualitative approach, the data have been collected through semistructured interviews with professionals and students of nursing, nutrition and psychology, categorized with the technique of content analysis. It was perceived that the subjects characterize their practice as an interdisciplinary interaction. However, they need to overcome institutional, epystemological, psychosocial, cultural and material obstacles, in order to develop a methodology for the interdisciplinary work in a more explicit and effective way.Las autoras analizan las percepciones que tienen los que integran un programa interdisciplinar de salud, sobre el significado, perfil del profesional, ventajas y dificultades de la labor interdisciplinar. En un abordaje cualitativo, los datos fueron recogidos mediante una entrevista semiestructurada, con profesionales y estudiantes de la Universidad y categorizados según la Técnica de Análisis de Contenido. Al final de la investigación, fue posible percibir que los sujetos caracterizan a su propia práctica como interdisciplinar, en la cual hay una búsqueda concreta de interacción de las asignaturas. Sin embargo, necesitan ser superados obstáculos institucionales, psicosociales, culturales y las dificultades materiales para desarrollar, de manera más explícita y efectiva, una metodología del trabajo interdisciplinar

O cuidado humano: ação de purificação

This article was originated by a request of some professors of the Masters Course in Nursing. The theme “bath”, as an act of care, was developed, initially, on the meaning of moves. The esthetic of body movement, to the sound of music, was represented graphically, allowing to reach constructs as: relationship, physical contact, sharing, pleasure, satisfaction, cleanliness, reaproximation. The concept of “bath”, understood through research in different bibliography and idioms, was translated as “purification”. The meaning of “purification” was studied with an anthropological view. Many practices and rituals were perceived through history and human experience and bring with them tools that may help Nursing to create and recreate the experience and concept of human care. These elements and some contributions to comprehend care are shown in this study.El origen – el génesis – de ese trabajo resulta de solicitación de las maestras para que el grupo representara acción de cuidado. El tema “baño”, sugió con espontaneidad y fue acepto por el grupo. El movimiento, la estética del movimiento corpóreo, al sonido de música, fue retratado gráficamente y permitió llegar a constructos como: relación, contacto físico, compartir, placer, satisfacción, limpieza, reaproximacción. El concepto de “baño” obtenido por medio de estudios y investigación en diferentes en bibliografías y idiomas, fue traducido como “purificación”. La purificación que fue estudiada com la ayuda de la Antropología. Nosotros notamos varias prácticas y rituales a lo largo de la historia y de la experiencia humana. Ellos trajeron consigo elementos que pueden ayudar el enfermería para crear y recrear la práctica y el concepto del cuidado humano. En este trabajo presentamos estes elementos.Este estudo tem origem numa disciplina de mestrado. O tema “banho”, como ato de cuidado, foi desenvolvido, inicialmente, na forma de movimentos. A estética do movimento corporal, ao som de música foi retratado graficamente, permitindo chegar aos construtos como: relação, contato físico, compartilhamento, prazer, satisfação, limpeza, reaproximação. A conceitualização de “banho” compreendida através de pesquisa em diferentes bibliografias e idiomas, foi traduzida por “purificação”. O significado de “purificação” foi estudado com o auxílio da antropologia. Percebemos que diversas práticas e rituais ao longo da história e da experiência humana trouxeram consigo elementos que podem auxiliar a enfermagem a criar e recriar a vivência e o conceito do cuidado humano. Estes elementos e algumas contribuições para a compreensão de cuidado são apresentadas neste trabalho

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Estando com meninos de rua: conhecendo e aprendendo as diferenças.

Resum

Interdisciplinaridade: percepção de integrantes de um programa de promoção e atenção à saúde

The authors analyze the perceptions that participants of a promotional and health care program have about the meaning, the professional profile, advantages and difficulties of the interdisciplinary work. In a qualitative approach, the data have been collected through semistructured interviews with professionals and students of nursing, nutrition and psychology, categorized with the technique of content analysis. It was perceived that the subjects characterize their practice as an interdisciplinary interaction. However, they need to overcome institutional, epystemological, psychosocial, cultural and material obstacles, in order to develop a methodology for the interdisciplinary work in a more explicit and effective way.Las autoras analizan las percepciones que tienen los que integran un programa interdisciplinar de salud, sobre el significado, perfil del profesional, ventajas y dificultades de la labor interdisciplinar. En un abordaje cualitativo, los datos fueron recogidos mediante una entrevista semiestructurada, con profesionales y estudiantes de la Universidad y categorizados según la Técnica de Análisis de Contenido. Al final de la investigación, fue posible percibir que los sujetos caracterizan a su propia práctica como interdisciplinar, en la cual hay una búsqueda concreta de interacción de las asignaturas. Sin embargo, necesitan ser superados obstáculos institucionales, psicosociales, culturales y las dificultades materiales para desarrollar, de manera más explícita y efectiva, una metodología del trabajo interdisciplinar.As autoras analisam as percepções que os integrantes de um programa de promoção e atenção à saúde têm sobre o significado, perfil do profissional, vantagens e dificuldades do trabalho interdisciplinar. Numa abordagem qualitativa, os dados foram coletados em entrevista semi-estruturada com profissionais e acadêmicos de enfermagem, nutrição e psicologia e categorizados com a técnica de análise de conteúdo. Percebeu-se que os sujeitos caracterizam a sua prática como interdisciplinar. Necessitam superar obstáculos institucionais, epistemológicos, psicossociais, culturais e materiais para desenvolver, de forma mais explicitada e efetiva, uma metodologia do trabalho interdisciplinar

Interdisciplinarity: perception of the participants of a promotional and health care program

As autoras analisam as percepções que os integrantes de um programa de promoção e atenção à saúde têm sobre o significado, perfil do profissional, vantagens e dificuldades do trabalho interdisciplinar. Numa abordagem qualitativa, os dados foram coletados em entrevista semi-estruturada com profissionais e acadêmicos de enfermagem, nutrição e psicologia e categorizados com a técnica de análise de conteúdo. Percebeu-se que os sujeitos caracterizam a sua prática como interdisciplinar. Necessitam superar obstáculos institucionais, epistemológicos, psicossociais, culturais e materiais para desenvolver, de forma mais explicitada e efetiva, uma metodologia do trabalho interdisciplinar.The authors analyze the perceptions that participants of a promotional and health care program have about the meaning, the professional profile, advantages and difficulties of the interdisciplinary work. In a qualitative approach, the data have been collected through semistructured interviews with professionals and students of nursing, nutrition and psychology, categorized with the technique of content analysis. It was perceived that the subjects characterize their practice as an interdisciplinary interaction. However, they need to overcome institutional, epystemological, psychosocial, cultural and material obstacles, in order to develop a methodology for the interdisciplinary work in a more explicit and effective way.Las autoras analizan las percepciones que tienen los que integran un programa interdisciplinar de salud, sobre el significado, perfil del profesional, ventajas y dificultades de la labor interdisciplinar. En un abordaje cualitativo, los datos fueron recogidos mediante una entrevista semiestructurada, con profesionales y estudiantes de la Universidad y categorizados según la Técnica de Análisis de Contenido. Al final de la investigación, fue posible percibir que los sujetos caracterizan a su propia práctica como interdisciplinar, en la cual hay una búsqueda concreta de interacción de las asignaturas. Sin embargo, necesitan ser superados obstáculos institucionales, psicosociales, culturales y las dificultades materiales para desarrollar, de manera más explícita y efectiva, una metodología del trabajo interdisciplinar

Interdisciplinarity: perception of the participants of a promotional and health care program

As autoras analisam as percepções que os integrantes de um programa de promoção e atenção à saúde têm sobre o significado, perfil do profissional, vantagens e dificuldades do trabalho interdisciplinar. Numa abordagem qualitativa, os dados foram coletados em entrevista semi-estruturada com profissionais e acadêmicos de enfermagem, nutrição e psicologia e categorizados com a técnica de análise de conteúdo. Percebeu-se que os sujeitos caracterizam a sua prática como interdisciplinar. Necessitam superar obstáculos institucionais, epistemológicos, psicossociais, culturais e materiais para desenvolver, de forma mais explicitada e efetiva, uma metodologia do trabalho interdisciplinar.The authors analyze the perceptions that participants of a promotional and health care program have about the meaning, the professional profile, advantages and difficulties of the interdisciplinary work. In a qualitative approach, the data have been collected through semistructured interviews with professionals and students of nursing, nutrition and psychology, categorized with the technique of content analysis. It was perceived that the subjects characterize their practice as an interdisciplinary interaction. However, they need to overcome institutional, epystemological, psychosocial, cultural and material obstacles, in order to develop a methodology for the interdisciplinary work in a more explicit and effective way.Las autoras analizan las percepciones que tienen los que integran un programa interdisciplinar de salud, sobre el significado, perfil del profesional, ventajas y dificultades de la labor interdisciplinar. En un abordaje cualitativo, los datos fueron recogidos mediante una entrevista semiestructurada, con profesionales y estudiantes de la Universidad y categorizados según la Técnica de Análisis de Contenido. Al final de la investigación, fue posible percibir que los sujetos caracterizan a su propia práctica como interdisciplinar, en la cual hay una búsqueda concreta de interacción de las asignaturas. Sin embargo, necesitan ser superados obstáculos institucionales, psicosociales, culturales y las dificultades materiales para desarrollar, de manera más explícita y efectiva, una metodología del trabajo interdisciplinar

Boletín diario del Instituto Central Meteorológico: Año XI Número 363 - 1903 Diciembre 29

Este estudo tem origem numa disciplina de mestrado. O tema “banho”, como ato de cuidado, foi desenvolvido, inicialmente, na forma de movimentos. A estética do movimento corporal, ao som de música foi retratado graficamente, permitindo chegar aos construtos como: relação, contato físico, compartilhamento, prazer, satisfação, limpeza, reaproximação. A conceitualização de “banho” compreendida através de pesquisa em diferentes bibliografias e idiomas, foi traduzida por “purificação”. O significado de “purificação” foi estudado com o auxílio da antropologia. Percebemos que diversas práticas e rituais ao longo da história e da experiência humana trouxeram consigo elementos que podem auxiliar a enfermagem a criar e re-criar a vivência e o conceito do cuidado humano. Estes elementos e algumas contribuições para a compreensão de cuidado são apresentadas neste trabalho.This article was originated by a request of some professors of the Masters Course in Nursing. The theme “bath”, as an act of care, was developed, initially, on the meaning of moves. The esthetic of body movement, to the sound of music, was represented graphically, allowing to reach constructs as: relationship, physical contact, sharing, pleasure, satisfaction, cleanliness, reaproximation. The concept of “bath”, understood through research in different bibliography and idioms, was translated as “purification”. The meaning of “purification” was studied with an anthropological view. Many practices and rituals were perceived through history and human experience and bring with them tools that may help Nursing to create and recreate the experience and concept of human care. These elements and some contributions to comprehend care are shown in this study.El origen – el génesis – de ese trabajo resulta de solicitación de las maestras para que el grupo representara acción de cuidado. El tema “baño”, sugió con espontaneidad y fue acepto por el grupo. El movimiento, la estética del movimiento corpóreo, al sonido de música, fue retratado gráficamente y permitió llegar a constructos como: relación, contacto físico, compartir, placer, satisfacción, limpieza, reaproximacción. El concepto de “baño” obtenido por medio de estudios y investigación en diferentes en bibliografías y idiomas, fue traducido como “purificación”. La purificación que fue estudiada com la ayuda de la Antropología. Nosotros notamos varias prácticas y rituales a lo largo de la historia y de la experiencia humana. Ellos trajeron consigo elementos que pueden ayudar el enfermería para crear y recrear la práctica y el concepto del cuidado humano. En este trabajo presentamos estes elementos