O cuidado de crianças em creches: um espaço para a enfermagem

In this article, we discuss the care of newborns and infants in day nurseries. We approach childcare within an historical perspective, emphasizing the current childhood situation. Based on the present conceptions of care and caring, and the Lei das Diretrizes e Bases da Educação Nacional n. 9394/96 (Brazilian Guiding and Bases Law for the National Education no. 9394/96) we discuss the childcarers’ qualification for attending children up to two years old in day nurseries. Considering the education level currently held by nursing professionals, we consider them qualified for the role of providing day care. In this sense, we identify the day nursery as an important social and political space for nursing.En este artículo discutimos el cuidado a recién-nacidos e infantes en las guarderías. Abordamos el cuidado al niño en una perspectiva histórica, destacando la situación actual de la niñez. Basado en las concepciones actuales de cuidar y de cuidado, y en la Lei das Diretrizes e Bases da Educação Nacional nº 9394/96 de Brasil se levantan los argumentos para la formación de puericultoras para la asistencia a los recién-nacidos e infantes en las guarderías. Teniendo en cuenta el actual nivel de la educación de los profesionales de enfermería los consideramos calificados para actuar en las guarderías. De esta manera apuntamos las guarderías como un importante espacio social y político para la enfermería.Neste artigo, discutimos o cuidado a recém-nascidos e lactentes em creches. Abordamos o cuidado à criança em uma perspectiva histórica, destacando a situação atual da infância. Com base em concepções atuais de cuidar e cuidado, e na Lei de Diretrizes e Bases da Educação Nacional n. 9394/96, discutimos a qualificação das cuidadoras para o atendimento de crianças até dois anos. Considerando o nível atual de educação dos profissionais de enfermagem, os consideramos qualificados para atuarem em creches. Deste modo, apontamos a creche como um espaço social e político importante para a enfermagem

A distinção massa e contável na gramática Rikbaktsa (Macro-Jê)

Neste artigo investigamos a distinção massivo-contável na língua Rikbaktsa (Macro-Jê). Partimos do questionário de Lima & Rothstein (2020), o qual procuramos responder levantando os dados em um acervo inédito do qual já dispúnhamos, na pouca literatura sobre a língua (Boswood 1971, 1978; SIL 2007; Silva 2011), e em uma elicitação de dados com um falante nativo. A análise mostrou que há morfologia de plural e que ela não se combina com nomes de massa. Nomes que denotam átomos estáveis se combinam diretamente com numerais. Para serem contados, nomes de substância exigem a presença de sintagmas de medidas.  Esses são indícios de que a língua em questão pode ser caracterizada como uma língua de número marcado (Chierchia 2010, 2015), mesmo que haja alguns nomes de massa que podem ser contados diretamente. Em nenhuma das quinze línguas apresentadas em Lima & Rothstein (2020) há relato de um morfema especializado para marcar massa. Chacon (2012) afirma que o Kubeo (Tukano-Oriental) exibe um demonstrativo de massa. Esse é também o caso em Rikbaktsa, mas nesta língua o demonstrativo na ‘isto’, que seleciona nomes massivos, se espalha pela gramática: aparece com marca de terceira pessoa no pronome pessoal a-na, com proformas interrogativas e em construção atributiva. Este estudo contribui, portanto, para uma melhor compreensão da distinção massivo-contável através das línguas e da gramática desta língua minoritária

Computational reduction strategies for the detection of steady bifurcations in incompressible fluid-dynamics: Applications to Coanda effect in cardiology

We focus on reducing the computational costs associated with the hydrodynamic stability of solutions of the incompressible Navier-Stokes equations for a Newtonian and viscous fluid in contraction-expansion channels. In particular, we are interested in studying steady bifurcations, occurring when non-unique stable solutions appear as physical and/or geometric control parameters are varied. The formulation of the stability problem requires solving an eigenvalue problem for a partial differential operator. An alternative to this approach is the direct simulation of the ow to characterize the asymptotic behavior of the solution. Both approaches can be extremely expensive in terms of computational time. We propose to apply Reduced Order Modeling (ROM) techniques to reduce the demanding computational costs associated with the detection of a type of steady bifurcations in fluid dynamics. The application that motivated the present study is the onset of asymmetries (i.e., symmetry breaking bifurcation) in blood flow through a regurgitant mitral valve, depending on the Reynolds number and the regurgitant mitral valve orifice shape

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Boosting care and knowledge about hereditary cancer: European Reference Network on Genetic Tumour Risk Syndromes

Approximately 27–36 million patients in Europe have one of the ~ 5.000–8.000 known rare diseases. These patients often do not receive the care they need or they have a substantial delay from diagnosis to treatment. In March 2017, twenty-four European Reference Networks (ERNs) were launched with the aim to improve the care for these patients through cross border healthcare, in a way that the medical knowledge and expertise travels across the borders, rather than the patients. It is expected that through the ERNs, European patients with a rare disease get access to expert care more often and more quickly, and that research and guideline development will be accelerated resulting in improved diagnostics and therapies. The ERN on Genetic Tumour Risk Syndromes (ERN GENTURIS) aims to improve the identification, genetic diagnostics, prevention of cancer, and treatment of European patients with a genetic predisposition for cancer. The ERN GENTURIS focuses on syndromes such as hereditary breast cancer, hereditary colorectal cancer and polyposis, neurofibromatosis and more rare syndromes e.g. PTEN Hamartoma Tumour Syndrome, Li Fraumeni Syndrome and hereditary diffuse gastric cancer

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

O cuidado de crianças em creches: um espaço para a enfermagem

In this article, we discuss the care of newborns and infants in day nurseries. We approach childcare within an historical perspective, emphasizing the current childhood situation. Based on the present conceptions of care and caring, and the Lei das Diretrizes e Bases da Educação Nacional n. 9394/96 (Brazilian Guiding and Bases Law for the National Education no. 9394/96) we discuss the childcarers’ qualification for attending children up to two years old in day nurseries. Considering the education level currently held by nursing professionals, we consider them qualified for the role of providing day care. In this sense, we identify the day nursery as an important social and political space for nursing.En este artículo discutimos el cuidado a recién-nacidos e infantes en las guarderías. Abordamos el cuidado al niño en una perspectiva histórica, destacando la situación actual de la niñez. Basado en las concepciones actuales de cuidar y de cuidado, y en la Lei das Diretrizes e Bases da Educação Nacional nº 9394/96 de Brasil se levantan los argumentos para la formación de puericultoras para la asistencia a los recién-nacidos e infantes en las guarderías. Teniendo en cuenta el actual nivel de la educación de los profesionales de enfermería los consideramos calificados para actuar en las guarderías. De esta manera apuntamos las guarderías como un importante espacio social y político para la enfermería.Neste artigo, discutimos o cuidado a recém-nascidos e lactentes em creches. Abordamos o cuidado à criança em uma perspectiva histórica, destacando a situação atual da infância. Com base em concepções atuais de cuidar e cuidado, e na Lei de Diretrizes e Bases da Educação Nacional n. 9394/96, discutimos a qualificação das cuidadoras para o atendimento de crianças até dois anos. Considerando o nível atual de educação dos profissionais de enfermagem, os consideramos qualificados para atuarem em creches. Deste modo, apontamos a creche como um espaço social e político importante para a enfermagem