Arterial pressure control for nursing military professionals

Objective: Determine which risks factors for hypertension that military nursing professionals identify in their lifestyle; classifying blood pressure levels of professionals. Method: Quantitative, based on descriptive research. Results: This study included 40 military professionals in nursing. The following risks factors were identified for hypertension in the study population: using of hormonal contraceptives (8.0%), smoking (7.0%), alcoholic beverages (2.0%), physical inactivity (21.0%), stress (25.0%), excessive salt intake (11.0%), obesity (8.0%) and high calorie and high protein diet (18.0%). The classification of blood pressure of the subjects revealed that 70.0% showed pressure values considered normal or optimal, values between 12.5% and 17.5 % were considered borderline hypertensions prove. Conclusion: This study indicates the needs for changes in professionals’ lifestyle, because the risks factors associated with blood pressure levels may contribute to the onset of hypertension into analyzed population

Estressores na atividade gerencial do enfermeiro: implicações para saúde

As atividades exercidas pelo enfermeiro combinam a assistência com funções gerenciais, o que pode conduzir à sobrecarga profissional.Objetivo: descrever fatores geradores de estresse na atividade gerencial do enfermeiro e refletir sobre suas implicações para a saúde desse profissional.Método: trata-se de estudo descritivo e exploratório que utilizou a revisão bibliográfica, com obras publicadas do período de 2001 a 2011, como fontes de informações para construção de discussão temática.Discussão: alicerçou-se na descrição de fatores causais na atividade gerencial do enfermeiro e as consequências do estresse para a saúde.Conclusão: as atividades gerenciais, ligadas ao planejamento e gestão de pessoal de enfermagem aumentam a carga de estresse que se somam às tarefas assistenciais. Tal situação traz prejuízos à saúde e ao bem-estar que se manifestam através de esgotamento físico, mental e transtornos psicossomáticos. Devem ser propostas ações que busquem melhores condições de trabalho e amenização do estresse do enfermeiro no ambiente laboral. Percebem-se deficiências que podem prejudicar a qualidade de vida deste trabalhador, fato alarmante, em uma realidade social em que a saúde do trabalhador tem sido preconizada e valorizada como direito inalienável.Resumen (Español)Las actividades realizadas por los enfermeros incluyen las funciones de asistencia y administración que pueden generar sobrecarga de trabajo.Objetivo: describir los factores que causan estrés en las tareas administrativas de los enfermeros y reflexionar sobre sus implicaciones para la salud de este profesional.Método: se realizó un estudio descriptivo que utilizócomo fuente de información la revisión de la literatura, contrabajos publicados entre 2001 a 2011, para la construcción dela discusión del texto reflexivo. Discusión: se fundamentó en ladescripción de los factores causales de estrés en las tareas administrativas del personal de enfermería y sus consecuencias para los profesionales de la salud.Conclusión: las actividades de administrativas relacionadas a la planificación y gestión del personal de enfermería aumentan la carga de estrés que se suman a las tareas de cuidado. Esta situación perjudica a la salud y el bienestar en que se manifiesta a través del agotamiento físico, mental y trastornos psicosomáticos. Por lo expuesto, deben ser propuestas acciones que busquen mejores condiciones de trabajo y mitigar el estrés de los enfermeros en el ambiente del trabajo. Se perciben deficiencias que pueden ser perjudiciales para la calidad de vida de los trabajadores, hecho alarmante, en una realidad social en que la salud del trabajador ha sido considerada y valorada como derecho inalienable

Atuação do enfermeiro no atendimento pré-hospitalar de emergência

The aim was to describe the role of nurses in pre-hospital care. This is an integrative literature review, carried out through a survey of works on the subject, including: articles, books, manuals, laws and ordinances, theses, and dissertations from the last 13 years. The works were read in full, and after textual analysis, four categories emerged, according to their characteristics and contents: history of pre-hospital care, legal aspects, nurses' role in PHC, PHC teaching in nursing. It was possible to notice that, even though PHC is an area still under development in Brazil, nurses are present and active. It is important to emphasize that emergency nursing, in the country and in the world, needs to be permanently discussed, as the performance of some procedures by nurses faces legal obstacles.Objetivou-se descrever a atuação do enfermeiro no atendimento pré-hospitalar. Trata-se de revisão integrativa da literatura, realizada por meio de levantamento de obras sobre a temática sendo: artigos, livros, manuais, leis e portarias, teses e dissertações dos últimos 13 anos. As obras foram lidas na íntegra, e após a análise textual, emergiram quatro categorias, de acordo com as características e conteúdos: história do atendimento pré-hospitalar, aspectos legais, atuação do enfermeiro no APH, ensino de APH na enfermagem. Foi possível notar que, mesmo o APH sendo uma área ainda em desenvolvimento no Brasil, o enfermeiro se faz presente e atuante. É importante ressaltar que a enfermagem de urgência, no país e no mundo, precisa ser permanentemente discutida, pois a realização de alguns procedimentos pelos enfermeiros encontra entraves legais

RELATIONSHIP BETWEEN HEALTH-DISEASE PROCESS AND CROSS-CULTURAL CARE:CONTRIBUTIONS TO NURSING CARE

A visão sobre o que o indivíduo percebe como saúde é de suma importância para a lógica assistencial. Leininger percebeu que a cultura estava intimamente interligada ao processo de adoecer do indivíduo. Objetivo: este estudo teve como objetivo refletir sobre a relação entre a teoria do cuidado transcultural de Madeleine Leininger com o processo saúde-doença, como possível benefício à assistência de enfermagem. Métodos: trata-se de um estudo descritivo, exploratório, que utilizou a revisão de bibliografia como fonte de informações. Resultados: a discussão da temática priorizou a divisão em categorias que relacionassem o cuidar transcultural ao processo de saúde-doença, buscando subsídios à assistência de saúde. Conclusão: a teoria transcultural aliada ao conhecimento das esferas subjetivas do cliente e suas vertentes culturais, pode tornar o cuidado de enfermagem mais efetivo. Descritores: ”Enfermagem transcultural”,”processo saúde-doença”, “cuidado”

Relationship between health-disease process and cross-cultural care: contributions to nursing care

Objective: This study aimed to reflect on the relationship between the theory of transcultural care of Madeleine Leininger with the health-disease as a possible benefit to nursing care. Method: This is a descriptive, exploratory study, which used the review of literature as a source of information. Results: The discussion of the prioritized thematic division into categories that related to transcultural caring health disease process of seeking grants to health care. Conclusion: The Transcultural Nursing theory coupled with the knowledge of the client's subjective spheres and its cultural aspects can make nursing care more effective

RELATIONSHIP BETWEEN HEALTH-DISEASE PROCESS AND CROSS-CULTURAL CARE:CONTRIBUTIONS TO NURSING CARE

A visão sobre o que o indivíduo percebe como saúde é de suma importância para a lógica assistencial. Leininger percebeu que a cultura estava intimamente interligada ao processo de adoecer do indivíduo. Objetivo: este estudo teve como objetivo refletir sobre a relação entre a teoria do cuidado transcultural de Madeleine Leininger com o processo saúde-doença, como possível benefício à assistência de enfermagem. Métodos: trata-se de um estudo descritivo, exploratório, que utilizou a revisão de bibliografia como fonte de informações. Resultados: a discussão da temática priorizou a divisão em categorias que relacionassem o cuidar transcultural ao processo de saúde-doença, buscando subsídios à assistência de saúde. Conclusão: a teoria transcultural aliada ao conhecimento das esferas subjetivas do cliente e suas vertentes culturais, pode tornar o cuidado de enfermagem mais efetivo. Descritores: ”Enfermagem transcultural”,”processo saúde-doença”, “cuidado”

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation