Assistência ao parto e nascimento sob a ótica de puérperas atendidas em uma maternidade pública

Aim: to analyze labor and birth care, from the point of view of puerperal women cared for at a public maternity hospital. Method: a qualitative, descriptive study performed with ten puerperae at the obstetric center of a public institution in the city of Russas, Ceará, Brazil. Data were collected from recorded interviews, transcribed and analyzed using the collective subject discourse technique. Results: three central ideas emerged from the analysis: lack of humanized care and its limitations; dissatisfaction with the service offered; and information on the benefits of normal birth. Conclusion: this research indicates the need to reflect on health policies and practices directed to labor and birth care and how the different actors are inserted in this dynamic, understanding the limits and potentialities of health care for the highlighted group.Resumen: Objetivo: analizar la asistencia al parto y al nacimiento, a partir del punto de vista de las puérperas atendidas en una maternidad pública. Método: estudio de naturaleza cualitativa, descriptiva, realizado con diez puérperas, en el centro obstétrico de una institución pública, de la ciudad de Russas, Ceará, Brasil. Los datos fueron recolectados a partir de entrevistas grabadas y transcritas y analizadas por la técnica del discurso del sujeto colectivo. Resultados: del análisis surgieron tres ideas centrales: falta de asistencia humanizada y sus limitaciones; insatisfacción con la atención prestada; e información sobre los beneficios del parto normal. Conclusión: esta investigación resalta la necesidad de reflexionar sobre las políticas y prácticas en salud direccionadas a la asistencia al parto y al nacimiento y a la forma como los diferentes actores se insertan en esa dinámica, entendiendo los límites y las potencialidades de la atención en salud a ese grupo destacado. Objetivo: analisar a assistência ao parto e nascimento, sob a ótica de puérperas atendidas em uma maternidade pública. Método: estudo de natureza qualitativa, descritivo, realizado com dez puérperas no centro obstétrico de uma instituição pública da cidade de Russas, Ceará, Brasil. Os dados foram coletados a partir de entrevistas gravadas, transcritas e analisadas mediante a técnica do discurso do sujeito coletivo. Resultados: da análise emergiram três ideias centrais: falta de assistência humanizada e suas limitações; insatisfação com o atendimento prestado; e informação dos benefícios do parto normal. Considerações finais: essa investigação aponta a necessidade de refletir acerca das políticas e práticas em saúde direcionadas para a assistência ao parto e nascimento e a forma como os diferentes atores se inserem nesta dinâmica, entendendo os limites e as potencialidades da atenção em saúde a esse grupo em destaque

O IMPACTO DO SUPORTE À AMAMENTAÇÃO NA DURAÇÃO E EXCLUSIVIDADE DO ALEITAMENTO MATERNO

Studies reinforce the relationship between exclusive breastfeeding (EBF) and infant morbidity and mortality, highlighting the urgency of promoting effective practices. Challenges persist, especially with rates below global recommendations, requiring investigation of contributing factors, such as unnecessary provision of bottles and food. Objective: The frequency of EBF in the first 30 days of life was analyzed, considering the influence of breastfeeding support. The complexity in measuring EBF, the WHO's monitoring proposal and the importance of the initial period are essential elements of this investigation. Methods: A literature review from 2015 to 2024 was conducted, covering studies exploring breastfeeding support and its relationship with the duration and exclusivity of breastfeeding. Using an integrative review approach guided by the PICo method, articles were searched in the Scientific Electronic Library Online (SCIELO), PubMed and Literature in Health Sciences of Latin America and the Caribbean (LILACS) databases. The selection of articles was carried out based on specific criteria, evaluated by independent researchers. Results: Several studies were analyzed, revealing a wide variation in the frequency of EBF at 30 days of life. The implementation of the Baby-Friendly Hospital Initiative demonstrates commitment, but challenges persist. The analysis of 17 longitudinal studies highlights the complexity in measuring EBF and significant variations between investigated locations. Discussion: The lack of adequate support, evidenced in some studies, is associated with additional challenges that negatively affect the breastfeeding experience. Personalized strategies, social support networks and preventive interventions are crucial. The ongoing effectiveness of breastfeeding support programs and policies should be evaluated to identify areas for improvement. Conclusion: The comprehensive analysis highlights persistent challenges in promoting EBF. Despite the global increase, significant disparities persist, especially related to unnecessary bottle and food provision. Effective breastfeeding promotion and support strategies are crucial to overcoming obstacles and achieving global maternal and child health goals. A more sensitive approach is recommended, with longitudinal studies in different population groups, and the constant evaluation of implemented strategies is vital for significant advances. Investing in policies and interventions focused on supporting breastfeeding is fundamental to promoting maternal and child health and well-being on a global scale.Estudos reforçam a relação entre aleitamento materno exclusivo (AME) e morbimortalidade infantil, destacando a urgência de promover práticas eficazes. Desafios persistem, especialmente com índices abaixo das recomendações globais, exigindo investigação dos fatores contribuintes, como oferta desnecessária de mamadeira e alimentos. Objetivo: Analisou-se a frequência do AME nos primeiros 30 dias de vida, considerando a influência do suporte à amamentação. A complexidade na mensuração do AME, proposta da OMS de monitoramento e a importância do período inicial são elementos essenciais desta investigação. Metódos: Uma revisão de literatura nos anos 2015 a 2024 foi conduzida, abrangendo estudos que exploram o suporte à amamentação e sua relação com a duração e exclusividade do aleitamento materno. Utilizando uma abordagem de revisão integrativa guiada pelo método PICo, foram pesquisados artigos nas bases Biblioteca Eletrônica Científica Online (SCIELO), PubMed e Literatura em Ciências da Saúde da América Latina e do Caribe (LILACS). A seleção dos artigos foi realizada com base em critérios específicos, avaliados por pesquisadores independente. Resultados: Diversos estudos foram analisados, revelando uma ampla variação na frequência do AME aos 30 dias de vida. A implementação da Iniciativa Hospital Amigo da Criança demonstra comprometimento, mas desafios persistem. A análise de 17 estudos longitudinais destaca a complexidade na medição do AME e variações significativas entre locais investigados. Discussão: A falta de suporte adequado, evidenciada em alguns estudos, está associada a desafios adicionais que afetam negativamente a experiência de amamentação. Estratégias personalizadas, redes de apoio social e intervenções preventivas são cruciais. A eficácia contínua de programas e políticas de apoio à amamentação deve ser avaliada para identificar áreas de melhoria. Conclusão: A análise abrangente destaca desafios persistentes na promoção do AME. Apesar do aumento global, disparidades significativas persistem, especialmente relacionadas à oferta desnecessária de mamadeira e alimentos. Estratégias eficazes de promoção e apoio à amamentação são cruciais para superar obstáculos e alcançar metas globais de saúde materno-infantil. Recomenda-se uma abordagem mais sensível, com estudos longitudinais em diversos grupos populacionais, e a constante avaliação das estratégias implementadas é vital para avanços significativos. Investir em políticas e intervenções focadas no suporte à amamentação é fundamental para promover a saúde e o bem-estar materno-infantil em escala global

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone

Investigation about the occurrence of transmission cycles of arbovirus in the tropical forest, amazon region

This work was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), established by notice MCTI/CNPq/FNDCT—Ação Transversal n68/2013 Programa de Grande Escala da Biosfera-Atmosfera na Amazônia (Processo n 457664/2013-4) to PFV and Instituto Evandro Chagas SVS/MS. PFV is fellow of the CNPqFederal University of Pará. Institute of Biological Sciences. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Because of its ecological characteristics, the Caxiuanã National Forest (FLONA) is a potential area of arbovirus circulation. The present study aimed to investigate the occurrence of arbovirus transmission cycles at FLONA de Caxiuanã. Five field trips were performed to capture mosquitoes and sylvatic vertebrates. For these vertebrates, we attempted viral isolation by cell monolayer inoculation from blood, and hemagglutination inhibition and further seroneutralization assays from sera. For mosquitoes, we performed tests of viral genome detection. A total of 338 vertebrates were captured, and the greatest representative was birds (251/74.26%). A total of 16,725 mosquitoes were captured, distributed among 56 species. There were no viruses isolated by newborn mouse inoculation. Among birds, antibodies against Ilheus virus were the most prevalent. Catu virus, Caraparu virus, and Mucambo virus were the most prevalent among mammals and reptiles. Fragments of Mucambo virus, Ilheus virus, Bussuquara virus, and Rocio virus genome were detected in a pool of mosquito samples. These results of the study suggest the occurrence of arbovirus transmission cycles in the FLONA of Caxiuanã. The proximity of human populations with elements, involved in transmission cycles, makes surveillance necessary in this population to avoid dispersion of arboviruses to naïve location

The Importance of Entomo-Virological Investigation of Yellow Fever Virus to Strengthen Surveillance in Brazil

The largest outbreak of sylvatic yellow fever virus (YFV) in eight decades was recorded in Brazil between 2016–2018. Besides human and NHP surveillance, the entomo-virological approach is considered as a complementary tool. For this study, a total of 2904 mosquitoes of the Aedes, Haemagogus and Sabethes genera were collected from six Brazilian states (Bahia, Goiás, Mato Grosso, Minas Gerais, Pará, and Tocantins) and grouped into 246 pools, which were tested for YFV using RT-qPCR. We detected 20 positive pools from Minas Gerais, 5 from Goiás, and 1 from Bahia, including 12 of Hg. janthinomys and 5 of Ae. albopictus. This is the first description of natural YFV infection in this species and warns of the likelihood of urban YFV re-emergence with Ae. albopictus as a potential bridge vector. Three YFV sequences from Hg. janthinomys from Goiás and one from Minas Gerais, as well as one from Ae. albopictus from Minas Gerais were clustered within the 2016–2018 outbreak clade, indicating YFV spread from Midwest and its infection in a main and likely novel bridging vector species. Entomo-virological surveillance is critical for YFV monitoring in Brazil, which could highlight the need to strengthen YFV surveillance, vaccination coverage, and vector control measures

The importance of entomo-virological investigation of Yellow Fever Virus to strengthen surveillance in Brazil

Brazilian National Council for Scientific and Technological Development (CNPq), grant numbers 314522/2021-2 to A.C.R.C., 166720/2017-8 and 106256/2018-1, to L.H.A.H, and 310295/2021-1, to P.F.d.C.V. Funding was also provided by National Institute of Science and Technology for Emerging and Reemerging Viruses in partnership with CNPq, grant number 406360/2022-7, to P.F.d.C.V.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Pará State University. Center for Biological and Health Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Pará State University. Center for Biological and Health Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Pará State University. Center for Biological and Health Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Pará State University. Center for Biological and Health Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Federal University of Pará. Institute of Biological Sciences. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Goiás Public Health Laboratory. Goiânia, GO, Brazil.Goiás Public Health Laboratory. Goiânia, GO, Brazil.Ministry of Health. Health and Environment Surveillance Secretariat. Brasília, DF, Brazil.World Health Organization. Pan American Health Organization. Public Health Emergency Department. Brasília, DF, Brazil.Oswaldo Cruz Foundation. René Rachou Institute. Belo Horizonte, MG, Brazil.Oswaldo Cruz Foundation. René Rachou Institute. Belo Horizonte, MG, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.The largest outbreak of sylvatic yellow fever virus (YFV) in eight decades was recorded in Brazil between 2016–2018. Besides human and NHP surveillance, the entomo-virological approach is considered as a complementary tool. For this study, a total of 2904 mosquitoes of the Aedes, Haemagogus and Sabethes genera were collected from six Brazilian states (Bahia, Goiás, Mato Grosso, Minas Gerais, Pará, and Tocantins) and grouped into 246 pools, which were tested for YFV using RT-qPCR. We detected 20 positive pools from Minas Gerais, 5 from Goiás, and 1 from Bahia, including 12 of Hg. janthinomys and 5 of Ae. albopictus. This is the first description of natural YFV infection in this species and warns of the likelihood of urban YFV re-emergence with Ae. albopictus as a potential bridge vector. Three YFV sequences from Hg. janthinomys from Goiás and one from Minas Gerais, as well as one from Ae. albopictus from Minas Gerais were clustered within the 2016–2018 outbreak clade, indicating YFV spread from Midwest and its infection in a main and likely novel bridging vector species. Entomo-virological surveillance is critical for YFV monitoring in Brazil, which could highlight the need to strengthen YFV surveillance, vaccination coverage, and vector control measures

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine