O Papel do Enfermeiro na Assistência ao Parto Humanizado

Introduction: The humanization of childbirth care, including the birth of the newborn, demands changes in behavior, attitudes and conduct from the health team that monitors the woman at this moment of utmost importance for the patient, which ensures even more respect and dignity during this process. Objectives: To analyze women's perception regarding the nursing care received during labor. Method: This is a comprehensive literature review, an integrative review that synthesizes scientific knowledge through different databases, systematized and included in the practical application of important discoveries from Google Scholar research sources; BVS, BDENF, SCIELLO. Results: After applying the inclusion and exclusion criteria, the study sample consisted of 14 articles, filtered between the years 2017 and 2023, where these studies address the role of nurses in humanized birth care. Conclusion: The nurse must provide excellent humanized care, seeking to listen to the patient, clarify all doubts, explain step by step the procedures that will be performed.Introdução: A humanização na assistência do parto, incluindo o nascimento do recém-nascido demanda mudanças de comportamento, atitudes e condutas da equipe de saúde que faz o acompanhamento da mulher nesse momento de suma importância para a paciente, isso faz com que garanta ainda mais respeito e dignidade durante este processo. Objetivos: Refletir acerca da atuação do enfermeiro na assistência humanizada ao parto. Método: Trata-se de uma revisão abrangente de literatura, uma revisão integrativa onde sintetiza o conhecimento científico por meio de diferentes bases de dados sistematizado e incluído na aplicação prática de importantes descobertas de fontes de pesquisa do Google Acadêmico; BVS, LILACS, SCIELLO. Resultados: Após a aplicação dos critérios de inclusão e exclusão, a amostra do estudo foi composta por 14 artigos, filtrados entre os anos de 2017 a 2023, onde esses estudos abordam o papel do enfermeiro na assistência do parto humanizado. Conclusão: O enfermeiro deve proporcionar um ótimo atendimento humanizado, buscando ouvir a paciente, esclarecer todas as dúvidas, explicar passo a passo os procedimentos que iram ser realizados

SERVIÇO DE ATENDIMENTO MÓVEL DE URGÊNCIA FRENTE ÀS URGÊNCIAS E EMERGÊNCIAS PSIQUIÁTRICAS

The present study sought scientific evidence on the assistance provided by the Mobile Emergency Care Service (SAMU) in the face of psychiatric urgencies and emergencies. The work carried out is a literature review, where the data for the construction of the article were collected in Google Scholar, Scielo, BVS and LILACS. To search for articles in the databases, the following keywords were used: “mental health”, “psychiatric emergency” and “prompt care”. As inclusion criteria, we used: full articles available in full, published between the years 2017 and 2021, in Portuguese and English. As for the exclusion criteria, the following were excluded: editorials, books, abstracts, descriptors that did not correspond to the theme and repeated articles in the databases used for data collection. The results showed that in recent times, there has been a significant increase in the number of people with psychiatric disorders, thus demanding extra-hospital services that seek to accommodate these patients. Most of the time, professionals provide inhumane care, prioritizing only sedation and immediate referral to hospital, using only these methods to contain the patient. It was concluded that the assistance provided by SAMU in the face of psychiatric urgencies and emergencies is still flawed, and mechanized care is carried out, using coercive means. Showing, through this, that the pre-hospital service has mostly acted against the principles established by the Psychiatric Reform, causing care to become disqualified.El presente estudio buscó evidencia científica sobre la asistencia que brinda el Servicio Móvil de Atención de Urgencias (SAMU) ante las urgencias y emergencias psiquiátricas. El trabajo realizado es una revisión de literatura, donde los datos para la construcción del artículo fueron recolectados en Google Scholar, Scielo, BVS y LILACS. Para la búsqueda de artículos en las bases de datos se utilizaron las siguientes palabras clave: “salud mental”, “emergencia psiquiátrica” y “atención oportuna”. Como criterios de inclusión, se utilizaron: artículos completos disponibles en su totalidad, publicados entre los años 2017 y 2021, en portugués e inglés. En cuanto a los criterios de exclusión, fueron excluidos: editoriales, libros, resúmenes, descriptores que no correspondían al tema y artículos repetidos en las bases de datos utilizadas para la recolección de datos. Los resultados mostraron que en los últimos tiempos, ha habido un aumento significativo en el número de personas con trastornos psiquiátricos, por lo que demandan servicios extrahospitalarios que buscan acomodar a estos pacientes. La mayoría de las veces, los profesionales brindan una atención inhumana, priorizando solo la sedación y la derivación inmediata al hospital, utilizando solo estos métodos para contener al paciente. Se concluyó que la asistencia que brinda el SAMU ante las urgencias y emergencias psiquiátricas aún es deficiente, y se realiza una atención mecanizada, utilizando medios coercitivos. Mostrando, a través de esto, que el servicio prehospitalario ha actuado mayoritariamente en contra de los principios establecidos por la Reforma Psiquiátrica, provocando la descalificación de la atención.  O presente estudo buscou evidências científicas sobre a assistência prestada pelo Serviço de Atendimento Móvel de Urgência (SAMU) frente às urgências e emergências psiquiátricas. O trabalho realizado trata-se de uma revisão bibliográfica, onde os dados para a construção do artigo foram coletados no Google Scholar, Scielo, BVS e LILACS. Para a busca dos artigos nas bases de dados foram usadas as seguintes palavras-chaves: “saúde mental”, “emergência psiquiátrica” e “pronto atendimento”. Como critérios de inclusão, utilizou-se: artigos completos e disponíveis na íntegra, publicados entre os anos de 2017 e 2021, nos idiomas português e inglês. Quanto aos critérios de exclusão, foram excluídos: editoriais, livros, resumos, descritores que não correspondia a temática e artigos repetidos nas bases de dados utilizadas para a coleta de dados. Os resultados mostraram que nos últimos tempos, houve um aumento significativo no número de pessoas que apresentam transtornos psiquiátricos, dessa forma, exigindo serviços extra-hospitalares que busquem acolher estes pacientes. Ainda existe uma enorme falha no atendimento aos pacientes com transtornos mentais, pois na grande maioria das vezes, os profissionais prestam uma assistência desumana, priorizando apenas a sedação e o encaminhamento imediato para a internação hospitalar, utilizando apenas destes métodos para conter o paciente. Concluiu-se que a assistência prestada pelo SAMU frente às urgências e emergências psiquiátricas ainda é falha, sendo realizado um cuidado mecanizado, utilizando de meios coercitivos. Mostrando, através disso, que o serviço pré-hospitalar em sua maioria tem atuado contra os princípios estabelecidos pela Reforma Psiquiátrica, fazendo com que a assistência se torne desqualificada

The germline mutational landscape of BRCA1 and BRCA2 in Brazil

The detection of germline mutations in BRCA1 and BRCA2 is essential to the formulation of clinical management strategies, and in Brazil, there is limited access to these services, mainly due to the costs/availability of genetic testing. Aiming at the identification of recurrent mutations that could be included in a low-cost mutation panel, used as a first screening approach, we compiled the testing reports of 649 probands with pathogenic/likely pathogenic variants referred to 28 public and private health care centers distributed across 11 Brazilian States. Overall, 126 and 103 distinct mutations were identified in BRCA1 and BRCA2, respectively. Twenty-six novel variants were reported from both genes, and BRCA2 showed higher mutational heterogeneity. Some recurrent mutations were reported exclusively in certain geographic regions, suggesting a founder effect. Our findings confirm that there is significant molecular heterogeneity in these genes among Brazilian carriers, while also suggesting that this heterogeneity precludes the use of screening protocols that include recurrent mutation testing only. This is the first study to show that profiles of recurrent mutations may be unique to different Brazilian regions. These data should be explored in larger regional cohorts to determine if screening with a panel of recurrent mutations would be effective.This work was supported in part by grants from Barretos Cancer Hospital (FINEP - CT-INFRA, 02/2010), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, 2013/24633-2 and 2103/23277-8), Fundação de Apoio à Pesquisa do Rio Grande do Norte (FAPERN), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Ministério da Saúde, the Breast Cancer Research Foundation (Avon grant #02-2013-044) and National Institute of Health/National Cancer Institute (grant #RC4 CA153828-01) for the Clinical Cancer Genomics Community Research Network. Support in part was provided by grants from Fundo de Incentivo a Pesquisa e Eventos (FIPE) from Hospital de Clínicas de Porto Alegre, by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, BioComputacional 3381/2013, Rede de Pesquisa em Genômica Populacional Humana), Secretaria da Saúde do Estado da Bahia (SESAB), Laboratório de Imunologia e Biologia Molecular (UFBA), INCT pra Controle do Câncer and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). RMR and PAP are recipients of CNPq Productivity Grants, and Bárbara Alemar received a grant from the same agencyinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Measurement of associated W plus charm production in pp collisions at √s=7 TeV

Peer reviewe

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation