Educação Pré-Escolar: um lugar de afetos inclusivo

Este estudo tem como objetivo verificar qual a importância dos afetos por parte do educador de infância, na promoção da inclusão de crianças com NEE, no contexto de educação pré-escolar. São ainda escassos os estudos desta temática, e ainda um conceito um pouco complexo e de reduzida compreensão. Desta forma foi um trabalho relevante na procura de caminhos e hipóteses que poderão ir ao encontro de um ensino verdadeiramente inclusivo, no pré-escolar. Considerou-se este tema oportuno, tanto numa perspetiva profissional e social, como pessoal. A metodologia adotada teve por base uma abordagem não-experimental. Os dados foram recolhidos através de um inquérito por questionário, no sentido de verificar a importância dos afetos dos educadores de infância. Constituiu-se assim uma amostra de cinquenta e sete educadores de infância, do ensino privado, do concelho de Leiria. Constata-se que os educadores de infância inquiridos neste estudo, apresentaram uma concordância média plena com a importância da afetividade, no contexto profissional, assim como esta conduz a um melhor desempenho no processo ensino-aprendizagem, e intensificando que é importante promover a afetividade na relação pedagógica com crianças de jardim-de-infância. Os resultados indicam que, os educadores de infância nomeiam a escuta ativa, o respeito mútuo, o diálogo, o sorriso e o contacto físico, predominantes na sua prática profissional e que vão ao encontro da promoção da afetividade na relação educativa com crianças de jardim-de-infância. Reconhecem a afetividade de uma forma global, através do respeito pelo outro, da manifestação de atitudes de afeto, da interação entre pares, da cooperação, do brincar e do trabalho colaborativo. No que se refere à promoção da inclusão, os educadores de infância definem estratégias e adequam-nas para que a(s) criança(s) prossiga(m) na sua aprendizagem, utilizam o reforço positivo, assim como o apoio de pares: utilizam os pares para ajudar a criança a atingir objetivos importantes (servir de modelo, brincar com a criança, usar elogios e incentivos).This study aims to verify the importance of the affections on the part of the educator in the promotion of the inclusion of children with SEN, in the context of pre-school education. There are still few studies on this subject and it´s still a concept that is a bit complex and hard to understand. In this way, it was a relevant work in the search for ways and hypotheses that could meet a truly inclusive pre-school education. This topic was considered opportune, from a professional and social perspective, as well as personal perspective. The adopted methodology was based on a non-experimental approach. The data was collected through a questionnaire survey, in order to verify the importance of the affections of the educators. The sample was mostly composed of fifty-seven educators of infancy working in the private education in the district of Leiria. It was noticed that the educators who were interviewed in this study presented a full average agreement with the importance of the affectivity, in the professional context, as this leads to a better performance in the learning teaching process, and intensifying that it is important to promote the affectivity in the relation with kindergarten children. The results indicate that the educators name the active listening, mutual respect, dialogue, smile and physical contact, predominant in their professional practice and that they meet the promotion of affectivity in the educative relation with children of kindergarten. They recognize affectivity in a global way, through respect for the other, the manifestation of affective attitudes, pair interaction, cooperation, play and collaborative work. With regard to the promotion of inclusion, the educators define strategies and adapt them so that the child(s) continue with their learning, use the positive reinforcement, as well as the support of pairs: they use pair work to help the child achieve important goals (serving as a model, playing with the child, using praise and encouragement)

Educação Pré-Escolar: um lugar de afetos inclusivo

Este estudo tem como objetivo verificar qual a importância dos afetos por parte do educador de infância, na promoção da inclusão de crianças com NEE, no contexto de educação pré-escolar. São ainda escassos os estudos desta temática, e ainda um conceito um pouco complexo e de reduzida compreensão. Desta forma foi um trabalho relevante na procura de caminhos e hipóteses que poderão ir ao encontro de um ensino verdadeiramente inclusivo, no pré-escolar. Considerou-se este tema oportuno, tanto numa perspetiva profissional e social, como pessoal. A metodologia adotada teve por base uma abordagem não-experimental. Os dados foram recolhidos através de um inquérito por questionário, no sentido de verificar a importância dos afetos dos educadores de infância. Constituiu-se assim uma amostra de cinquenta e sete educadores de infância, do ensino privado, do concelho de Leiria. Constata-se que os educadores de infância inquiridos neste estudo, apresentaram uma concordância média plena com a importância da afetividade, no contexto profissional, assim como esta conduz a um melhor desempenho no processo ensino-aprendizagem, e intensificando que é importante promover a afetividade na relação pedagógica com crianças de jardim-de-infância. Os resultados indicam que, os educadores de infância nomeiam a escuta ativa, o respeito mútuo, o diálogo, o sorriso e o contacto físico, predominantes na sua prática profissional e que vão ao encontro da promoção da afetividade na relação educativa com crianças de jardim-de-infância. Reconhecem a afetividade de uma forma global, através do respeito pelo outro, da manifestação de atitudes de afeto, da interação entre pares, da cooperação, do brincar e do trabalho colaborativo. No que se refere à promoção da inclusão, os educadores de infância definem estratégias e adequam-nas para que a(s) criança(s) prossiga(m) na sua aprendizagem, utilizam o reforço positivo, assim como o apoio de pares: utilizam os pares para ajudar a criança a atingir objetivos importantes (servir de modelo, brincar com a criança, usar elogios e incentivos).This study aims to verify the importance of the affections on the part of the educator in the promotion of the inclusion of children with SEN, in the context of pre-school education. There are still few studies on this subject and it´s still a concept that is a bit complex and hard to understand. In this way, it was a relevant work in the search for ways and hypotheses that could meet a truly inclusive pre-school education. This topic was considered opportune, from a professional and social perspective, as well as personal perspective. The adopted methodology was based on a non-experimental approach. The data was collected through a questionnaire survey, in order to verify the importance of the affections of the educators. The sample was mostly composed of fifty-seven educators of infancy working in the private education in the district of Leiria. It was noticed that the educators who were interviewed in this study presented a full average agreement with the importance of the affectivity, in the professional context, as this leads to a better performance in the learning teaching process, and intensifying that it is important to promote the affectivity in the relation with kindergarten children. The results indicate that the educators name the active listening, mutual respect, dialogue, smile and physical contact, predominant in their professional practice and that they meet the promotion of affectivity in the educative relation with children of kindergarten. They recognize affectivity in a global way, through respect for the other, the manifestation of affective attitudes, pair interaction, cooperation, play and collaborative work. With regard to the promotion of inclusion, the educators define strategies and adapt them so that the child(s) continue with their learning, use the positive reinforcement, as well as the support of pairs: they use pair work to help the child achieve important goals (serving as a model, playing with the child, using praise and encouragement)

Ácidos Orgânicos e Compostos Clorados para Controle de Salmonella spp. em frangos

O objetivo deste trabalho foi avaliar a atividade de ácidos orgânicos e compostos clorados comerciais para o controle de Salmonella spp. A concentração inibitória mínima (CIM) do dióxido de cloro, dicloro isocianurato de sódio e ácidos tricloro isocianúrico, lático e peracético foi determinada para cepas padrões de S. Enteretidis, S. Typhimurium e a S. Heidelberg e avaliada com 54 cepas isoladas de frigorífico e o produto com melhor desempenho foi avaliado em água de chiller artificialmente contaminada com Salmonella spp. Entre os clorados, apenas o dicloro isocianurato (60 ppm) foi capaz de inibir Salmonella spp. A CIM dos ácidos lático e peracético variou de 0,5 a 2,0%. Os ácidos peracético (1,0%) e lático (2,0%) foram capazes de inibir 98,14 e 100% das cepas isoladas, respectivamente. O ácido lático a 2,0% foi capaz de inibir completamente o crescimento das três cepas padrões de Salmonella spp. inoculadas na água do chiller. Os dados reforçam a necessidade de discussões para regulamentar o uso do ácido lático na tecnologia de abate de aves

Relationship between clinical-epidemiological parameters and outcomes of patients with COVID-19 admitted to the intensive care unit: a report from a Brazilian hospital

BackgroundPeople in low-income countries, especially those with low socio-economic conditions, are likelier to test positive for SARS-CoV-2. The unequal conditions of public health systems also increase the infection rate and make early identification and treatment of at-risk patients difficult. Here, we aimed to characterize the epidemiological profile of COVID-19 patients in intensive care and identify laboratory and clinical markers associated with death.Materials and methodsWe conducted an observational, descriptive, and cross-sectional study in a reference hospital for COVID-19 treatment in the Southern Region of Bahia State, in Brazil, to evaluate the epidemiological, clinical, and laboratory characteristics of COVID-19 patients admitted to the intensive care unit (ICU). Additionally, we used the area under the curve (AUC) to classify survivors and non-survivors and a multivariate logistic regression analysis to assess factors associated with death. Data was collected from the hospital databases between April 2020 and July 2021.ResultsThe use of bladder catheters (OR 79.30; p < 0.0001) and central venous catheters (OR, 45.12; p < 0.0001) were the main factors associated with death in ICU COVID-19 patients. Additionally, the number of non-survivors increased with age (p < 0.0001) and prolonged ICU stay (p < 0.0001). Besides, SAPS3 presents a higher sensibility (77.9%) and specificity (63.1%) to discriminate between survivors and non-survivor with an AUC of 0.79 (p < 0.0001).ConclusionWe suggest that multi-laboratory parameters can predict patient prognosis and guide healthcare teams toward more assertive clinical management, better resource allocation, and improved survival of COVID-19 patients admitted to the ICU

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

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

Table_1_Relationship between clinical-epidemiological parameters and outcomes of patients with COVID-19 admitted to the intensive care unit: a report from a Brazilian hospital.DOCX

BackgroundPeople in low-income countries, especially those with low socio-economic conditions, are likelier to test positive for SARS-CoV-2. The unequal conditions of public health systems also increase the infection rate and make early identification and treatment of at-risk patients difficult. Here, we aimed to characterize the epidemiological profile of COVID-19 patients in intensive care and identify laboratory and clinical markers associated with death.Materials and methodsWe conducted an observational, descriptive, and cross-sectional study in a reference hospital for COVID-19 treatment in the Southern Region of Bahia State, in Brazil, to evaluate the epidemiological, clinical, and laboratory characteristics of COVID-19 patients admitted to the intensive care unit (ICU). Additionally, we used the area under the curve (AUC) to classify survivors and non-survivors and a multivariate logistic regression analysis to assess factors associated with death. Data was collected from the hospital databases between April 2020 and July 2021.ResultsThe use of bladder catheters (OR 79.30; p ConclusionWe suggest that multi-laboratory parameters can predict patient prognosis and guide healthcare teams toward more assertive clinical management, better resource allocation, and improved survival of COVID-19 patients admitted to the ICU.</p

Unraveling the genetic background of individuals with a clinical familial hypercholesterolemia phenotype

Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism caused by pathogenic/likely pathogenic variants in LDLR, APOB, and PCSK9 genes. Variants in FH-phenocopy genes (LDLRAP1, APOE, LIPA, ABCG5, and ABCG8), polygenic hypercholesterolemia, and hyperlipoprotein (a) [Lp(a)] can also mimic a clinical FH phenotype. We aim to present a new diagnostic tool to unravel the genetic background of clinical FH phenotype. Biochemical and genetic study was performed in 1,005 individuals with clinical diagnosis of FH, referred to the Portuguese FH Study. A next-generation sequencing panel, covering eight genes and eight SNPs to determine LDL-C polygenic risk score and LPA genetic score, was validated, and used in this study. FH was genetically confirmed in 417 index cases: 408 heterozygotes and 9 homozygotes. Cascade screening increased the identification to 1,000 FH individuals, including 11 homozygotes. FH-negative individuals (phenotype positive and genotype negative) have Lp(a) >50 mg/dl (30%), high polygenic risk score (16%), other monogenic lipid metabolism disorders (1%), and heterozygous pathogenic variants in FH-phenocopy genes (2%). Heterozygous variants of uncertain significance were identified in primary genes (12%) and phenocopy genes (7%). Overall, 42% of our cohort was genetically confirmed with FH. In the remaining individuals, other causes for high LDL-C were identified in 68%. Hyper-Lp(a) or polygenic hypercholesterolemia may be the cause of the clinical FH phenotype in almost half of FH-negative individuals. A small part has pathogenic variants in ABCG5/ABCG8 in heterozygosity that can cause hypercholesterolemia and should be further investigated. This extended next-generation sequencing panel identifies individuals with FH and FH-phenocopies, allowing to personalize each person’s treatment according to the affected pathway