Efeitos do Manejo Dietético na Prevenção e Tratamento da Pré-Eclâmpsia em Gestantes de Alto Risco: Uma Revisão Integrativa

Introduction: Preeclampsia is a serious complication of pregnancy characterized by high blood pressure and protein in the urine after the 20th week of gestation. In severe cases, it can lead to serious complications for both the mother and the fetus, including seizures, organ damage, and even death.   Methodology: The descriptors used in the search were selected to broadly cover the topic, including terms such as "preeclampsia," "high-risk pregnant women," "dietary management," "nutrients," "DASH diet," "exercise during pregnancy," among others.   Result: Understanding the role of diet in the prevention and treatment of preeclampsia is complex and multifaceted. A variety of nutrients and specific diets have been investigated for their potential impact on risk factors and underlying mechanisms of preeclampsia. Among these nutrients, calcium has received special attention due to its role in regulating blood pressure and vascular health.   Conclusion: In conclusion, dietary management plays an important role in the prevention and treatment of preeclampsia in high-risk pregnant women. Adequate intake of specific nutrients such as calcium, vitamin D, magnesium, and folic acid, as well as the adoption of healthy diets like the DASH diet, can help reduce the risk of developing the condition.Introdução: A pré-eclâmpsia é uma complicação grave da gravidez caracterizada por pressão arterial elevada e proteína na urina após a 20ª semana de gestação. Em casos graves, pode levar a complicações sérias para a mãe e o feto, incluindo convulsões, danos aos órgãos e até mesmo morte. Metodologia: Os descritores utilizados na busca foram selecionados para abranger amplamente o tema, incluindo termos como "pré-eclâmpsia", "gestantes de alto risco", "manejo dietético", "nutrientes", "dieta DASH", "exercício na gravidez", entre outros. Resultado: A compreensão do papel da dieta na prevenção e tratamento da pré-eclâmpsia é complexa e multifacetada. Uma variedade de nutrientes e dietas específicas foram investigadas quanto ao seu potencial impacto sobre os fatores de risco e os mecanismos subjacentes à pré-eclâmpsia. Entre esses nutrientes, o cálcio tem recebido atenção especial devido à sua função na regulação da pressão arterial e na saúde vascular. Conclusão: Em conclusão, o manejo dietético desempenha um papel importante na prevenção e tratamento da pré-eclâmpsia em gestantes de alto risco. A ingestão adequada de nutrientes específicos, como cálcio, vitamina D, magnésio e ácido fólico, bem como a adoção de dietas saudáveis, como a dieta DASH, podem ajudar a reduzir o risco de desenvolver a condição. &nbsp

Infraestrutura e processo de trabalho na atenção primária à saúde: PMAQ no Ceará

OBJETIVO: Analisar a qualidade da infraestrutura e do processo de trabalho da Estratégia Saúde da Família nos municípios do Ceará entre 2012 e 2014. MÉTODOS: Estudo transversal, utilizando dados secundários da avaliação externa do 1º (2012) e 2º (2014) ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Ceará. Vinte indicadores compostos foram utilizados para averiguar a qualidade da infraestrutura e do processo de trabalho. RESULTADOS: Dados de 183 (99,4%) dos 184 municípios foram avaliados nos dois ciclos. Avaliaram-se 1.441 equipes para infraestrutura e 800 equipes para processo de trabalho. Dentre os 20 indicadores compostos avaliados, houve melhoria em 18, porém de forma não homogênea, variando de 0,0 a 413,5%. Observou-se que quanto menor o valor inicial do indicador, maior a variação na qualidade entre 2012 e 2014. Os indicadores da infraestrutura e do processo de trabalho foram influenciados pela região de saúde e porte populacional do município, sendo mais evidente a influência nas variáveis de processo de trabalho. CONCLUSÕES: Identificou-se que melhorias da qualidade referentes à infraestrutura e ao processo de trabalho ocorreram no período de implantação do programa no estado do Ceará de forma equitativa, sendo influenciadas pelo porte populacional e pela região, demonstrando a influência do contexto na implementação de políticas públicas dessa natureza.OBJECTIVE: To analyze the quality of the infrastructure and work process of the Family Health Strategy in the municipalities of Ceará between 2012 and 2014. METHODS: Cross-sectional study, using secondary data from the external evaluation of the 1st (2012) and 2nd (2014) cycle of the National Program for Improvement of Access and Quality of Primary Care in Ceará. A total of 20 composite indicators were used to verify the quality of infrastructure and work process. RESULTS: Data from 183 (99.4%) of the 184 municipalities of Ceará were collected in both cycles. A total of 1,441 teams were evaluated for the infrastructure and 800 for the work process. Among the 20 composite indicators evaluated, 18 presented an improvement, but in a non-homogeneous way, ranging between 0.0 and 413.5%. We observed that the lower the initial value of the indicator, the greater the variation in quality between 2012 and 2014. The indicators of infrastructure and work process were influenced by the regional health system and population size of the municipality, being more evident the influence on the variables of the work process. CONCLUSIONS: We identified that quality improvements related to infrastructure and work process occurred in the period of implementation of the program in the state of Ceará in an equitable manner, being influenced by population size and regional health system, showing the influence of the context in the implementation of public policies of this nature

A utilização do diagnóstico situacional para o planejamento das ações na ESF/ The use of situational diagnosis for action planning in the ESF

O Diagnóstico Situacional é um dispositivo que tem a finalidade de coletar e analisar os dados referentes as condições de saúde e risco de determinada população. Estes dados são importantes e servem como base para a decisão nas ações e serviços da Atenção Básica (AB). Essa pesquisa tem como objetivo analisar a produção cientifica que aborde a utilização do diagnóstico situacional para realização do planejamento das ações na Estratégia de Saúde da Família (ESF). Para o estudo foi adotado o método de revisão integrativa da literatura nas bases de dados: SciELO, LILACS e Biblioteca Virtual de Saúde (BVS), de outubro e novembro de 2020, utilizando quatro combinações de descritores que totalizaram sete produções. Foram selecionados os artigos completos, no idioma português, publicados nos últimos cinco anos, os quais abordassem o tema. Após isso, os dados foram catalogados e analisados a luz da literatura pertinente. Os estudos apontaram a importância do diagnóstico situacional para a compreensão das demandas de cuidados no território de atuação da ESF, servindo para desenvolver melhores estratégias de atenção integral, decisões assertivas no processo de trabalho em equipe, além de propiciar uma maior interligação entre a comunidade e os profissionais de saúde

Perspectivas epidemiológicas, clínicas e terapêuticas do transtorno bipolar em comorbidade com o uso de drogas: revisão de sistemática: Epidemiological, clinical and therapeutic perspectives of bipolar disorder in comorbidity with drug use: a systematic review

Conhecida como transtorno maníaco-depressivo, atualmente possui um novo nome: Transtorno Afetivo Bipolar, visto que com o passar do tempo foi se percebendo que esse transtorno não se tratava de uma alteração psicótica, e mais de um prejuízo afetivo. O transtorno bipolar possui alguns tipos, não se caracterizando em apenas uma forma, sua manifestação varia conforme o indivíduo e suas tendências, disforia e/ou euforia porém independente da forma expressa o paciente bipolar pode ter sua vida social comprometida, se não tratada, visto a irregularidade no estado de humor; bem como pode fazer uso de substâncias psicoativas, o que prejudica a sua condição clínica. Objetivo central da pesquisa é de apresentar a correlação do transtorno bipolar com o uso de drogas, mediante uma revisão de literatura integrativa realizada entre os meses de março de 2022 a julho de 2022, através da busca de artigos científicos nos bancos de dados online PubMed, Scielo e Google Acadêmico, utilizando como critério de refinamento de pesquisa artigos de todas as línguas publicados entre os anos 2000 e 2022

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

On the development of an ergonomic approach for the design of an industrial robotic coworker

As industries push for continuous technological innovation to boost their competitiveness, the need to balance techno-economical goals with emerging societal needs is now more pressing than ever. Inspired by the novel paradigm of Industry 5.0, we aim to place human physical and cognitive needs at the center of the production process, introducing proactive and human-aware robots capable of collaboration as co-workers. Although Human-Robot Collaboration (HRC) has successfully permeated different industrial sectors, they still have a relatively limited role as agents that share the human workspace mostly executing pre-programmed actions. Based on this gap a research project is ongoing, including researchers in Ergonomics and Robotics. The current article presents the first stage related to the design of a workstation prototype that emulates industrial tasks and will allow us to explore the different HRC scenarios. The selection of the assembly task was supported by ergonomic assessment (Rapid Upper Limb Assessment), and questionnaires focused on the workers’ psychophysical and cognitive overload perceived. Then, the CoppeliaSim simulation software was used to allow us to accurately reproduce both the visual and the physical aspects of the prototype, including the model of a humanoid abstract avatar. In addition, a set of ergonomic and safety requirements were defined to support the human-centered design of the prototype. The results of this research phase will be important for the next steps of our project and for other researchers/industrial practitioners focused on the human-centered design of HRC scenarios.This work has been supported by FCT within Project I-CATER: Intelligent 258 robotic Coworker Assistant for industrial Tasks with an Ergonomics Rati259 onale, reference PTDC/EEI-ROB/3488/2021. This work was also supported 260 under the base funding project of the DTx CoLAB - Collaborative Labora261 tory, under the Missão Interface of the Recovery and Resilience Plan (PRR), 262 integrated in the notice 01/C05-i02/2022, which aims to deepen the effort 263 to expand and consolidate the network of interface institutions between the 264 academic, scientific and technological system and the Portuguese business 265 fabric. In addition, this work was supported by R&D Unit Project Scope 266 UIDB/00319/2020 and by the Ph.D. Grants: SFRH/BD/151365/2021 (fina267 nced by the Portuguese FCT, and with funds from state budgets, under MIT 268 Portugal Program); and 2022.13737.BDANA (financed by the Portuguese 269 FCT)

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated