O cuidado de enfermagem aos homens com hipertensão arterial participantes de um grupo da estratégia saúde da família no município de Ouvidor/GO

TCC(especialização) - Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Programa de Pós-graduação em Enfermagem. Linhas de Cuidado em Doenças Crônicas Não TransmissíveisAtualmente a maioria das causas de morte no mundo se dão por doenças crônicas não transmissíveis e no Brasil trazem onerosos gastos ao Sistema Único de Saúde. A atenção primária tem como desafio assistir com qualidade à saúde do homem. A Política Nacional De Atenção Integral à Saúde do Homem vem para fortalecer a garantia da promoção da saúde e a prevenção de agravos evitáveis contribuindo para que se comprometam com sua própria saúde. A Estratégia Saúde da Família torna-se privilegiada para cuidados de atenção primária, respaldada na capacidade de gerar vínculos e no seu potencial de integração à rede de vigilância em saúde. Este estudo trata da dificuldade no acesso a saúde dos homens participantes do grupo HIPERDIA no município de Ouvidor, os privando de ouvir orientações de uma equipe multidisciplinar e ainda de trocar experiências sobre hábitos de vida saudável, mudanças no estilo de vida e adesão ao tratamento da hipertensão arterial. O estudo teve como objetivo elaborar um plano de ações para saúde de homens inseridos no Programa HIPERDIA no município de Ouvidor com o intuito de interferir em fatores de risco modificáveis fortalecendo o enfrentamento das doenças crônicas não transmissíveis e direcionar profissionais e gestão a desenvolver ações facilitadoras que garantam o acesso dos homens hipertensos em atividade de promoção à saúde

Variações temporais na estrutura em fitofisionomias de Cerrado e Floresta Estacional Semidecidual em Curvelo, MG

This study aimed to analyze the structural dynamics of tree species and to relate changes with edaphic conditions in the phytophysiognomies of cerrado stricto sensu (from 2010 to 2015), cerradão (from 2010 to 2015) and seasonal semideciduous forest (from 2011 to 2015) in Curvelo, state of Minas Gerais, Brazil. Forest inventories involved systematic sampling in 15 sample units (20 × 50m) in cerrado strict sensu (CSS), 10 sample units (20 × 50m) in cerradão (CD; CAS ≥ 15.7 cm) and 25 sample units (10 × 40m) in semideciduous seasonal forest (SSF; CAP ≥ 15.7 cm). Soil samples were collected in all sample units for the chemical and granulometric characterization. The number of individuals entering was lower than the total recruitment in all phytophysiognomies. Basal area in the final inventory of CSS was higher than initial basal area (23.675 - 25.845m2/ha), due to a significant increase in the surviving individuals. There were reductions in the basal area for DC (19.322 - 17.008 m2/ha) and SSF (28.183 - 28.148 m2/ha), due to high mortality rates. The mortality was higher for the first diametric classes in all three phytophysiognomies. Individual recruitment and diametric growth of survivors during post fire disturbance recovery was slow for CSS and CD. The number of individuals recovering during a 5-year interval could not be determined, however, without fire disturbance, the loss of individuals due to mortality and the recruitment of new individuals in FES were more balanced.Este estudo teve como objetivo analisar a dinâmica da estrutura de espécies arbóreas e relacionar as mudanças com as condições edáficas em fitofisionomias de cerrado stricto sensu (de 2010 a 2015), cerradão (de 2010 a 2015) e floresta estacional semidecidual (de 2011 a 2015) em Curvelo, Minas Gerais. O inventário florestal considerou amostragens do tipo sistemática em 15 unidades amostrais de 20 × 50 metros no cerrado stricto sensu (CSS), 10 unidades amostrais 20 × 50m no cerradão (CD), CAS ≥ 15,7cm) e 25 unidades amostrais de 10 × 40m na floresta estacional semidecidual (FES - CAP ≥ 15,7 cm). Amostras de solo foram coletadas em todas as unidades amostrais para caracterização química e granulométrica. Nas três fitofisionomias, o número de indivíduos ingressantes foi inferior ao de egressos. No CSS, a área basal no inventário final foi superior à área basal inicial (23,675 – 25,845m2/ha), devido ao incremento expressivo dos sobreviventes. Ocorreram reduções na área basal no CD (19,322 – 17,008 m2/ha) e na FES (28,183 – 28,148 m2/ha), decorrente da alta taxa de mortalidade. Nas três fitofisionomias, a mortalidade foi maior nas primeiras classes diamétricas. De forma lenta, o CSS e CD estão se recuperando pós-distúrbio (fogo), estão surgindo novos indivíduos (recrutas) e crescimento diamétrico dos sobreviventes. Durante o intervalo de 5 anos, não foi possível identificar a recuperação do número de indivíduos, enquanto que a FES sem distúrbio do fogo, a perda de indivíduos pela mortalidade e a inclusão de novos indivíduos pelo recrutamento foram mais equilibradas

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

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

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

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

Trabalhos completos - Administração

Trabalhos completos - Administraçã

Resumos em andamento - Administração

Resumo em andamento - Administraçã

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author