Higienização de unidade móvel de saúde

Introduction: Considering the spread of microorganisms in the transport and mobility of people in mobile health units, the cleaning and disinfec tion of all areas for accommodation of users and equipment is crucial. Objective: To identify scientific literature related to the hygiene of mobile health units. Method: This is an integrative literature review in the databases LILACS, SciELO, MEDLINE, PubMed, CINAHL, Embase, WoS, and Scopus. The data collection was carried out in March 2015, including articles from 2005 to 2015. Results:  769 articles were selected. From these, only six articles met the inclusion criteria: three from CINAHL, two from PubMed, and one from LILACS. All described international studies. Conclusion: It is necessary to carry out further investigations to aid in the cleaning of mobile health units by choosing the right disinfectant for the microbial load of these vehicles to provide strategies for preventing infection related to health assistance. Therefore, increasing good practices and even drafting care protocols or Standard Operating Procedures (POP) in the control of cross infection in mobile health units is vital.Introdução: Considerando a disseminação de micro-organismos no transporte e locomoção de pessoas por unidades móveis de saúde, não podemos deixar de prover a limpeza e desinfecção de todas as áreas destinadas à acomodação dos usuários e equipamentos. Objetivo: Identificar na literatura científica sobre higienização de Unidade Móvel de Saúde. Método: Trata-se de uma revisão integrativa da literatura nas bases de dados LILACS, SciELO, MEDLINE, PubMED, CINAHL, Embase, WoS, Scopus. A coleta de dados deu-se em março de 2015, incluindo artigos do período compreendido entre 2005 a 2015. Resultados: Foram selecionados 769 artigos. Destes, apenas seis artigos preencheram os critérios de inclusão.  Ao caracterizar estes estudos percebe-se que todos descrevem estudos internacionais, dos quais três são da base de dados CINAHL, dois da Pubmed e um da LILACS. Conclusão: É necessária a realização de maiores investigações que subsidiem a higienização de unidades móveis de saúde, a partir da escolha do desinfetante adequado, frente à carga microbiana desses veículos, com o intuito de proporcionarem estratégias para prevenção da infecção relacionada à assistência à saúde, aumentando a adesão das boas práticas e inclusive elaboração de Protocolos Assistenciais ou Procedimentos Operacional Padrão (POP), no controle de infecção cruzada em unidades móveis de saúde

Correction to: The child and adolescent psychiatry: study of training in Europe (CAP‑STATE)

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Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children

IntroductionZika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes.Methods and analysisWe will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty.Ethics and disseminationThe IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals.Trial registration numberPROSPERO International prospective register of systematic reviews (CRD42017068915).</jats:sec

Educomunicação e suas áreas de intervenção: Novos paradigmas para o diálogo intercultural

oai:omp.abpeducom.org.br:publicationFormat/1O material aqui divulgado representa, em essência, a contribuição do VII Encontro Brasileiro de Educomunicação ao V Global MIL Week, da UNESCO, ocorrido na ECA/USP, entre 3&nbsp;e 5 de novembro de 2016. Estamos diante de um conjunto de 104 papers executivos, com uma média de entre 7 e 10 páginas, cada um. Com este rico e abundante material, chegamos ao sétimo e-book publicado pela ABPEducom, em seus seis primeiros anos de existência. A especificidade desta obra é a de trazer as “Áreas de Intervenção” do campo da Educomunicação, colocando-as a serviço de uma meta essencial ao agir educomunicativo: o diálogo intercultural, trabalhado na linha do tema geral do evento internacional: Media and Information Literacy: New Paradigms for Intercultural Dialogue

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

Proteinas de soro de sangue bovino : propriedades nutritivas e funcionais

Orientador: Valdemiro Carlos SgarbieriDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia de AlimentosResumo: Há um interesse constante pela utilização do sangue gerado por abates em frigoríficos tanto pela solução do problema ambiental causado pelo descarte deste sem prévio tratamento, quanto recuperação e aproveitamento das proteínas constituintes deste tecido, que possuem altíssimo valor biológico e funcional. Este trabalho propôs-se a testar o método de saturação com sulfato de amônio na recuperação das duas principais frações protéicas do sangue, a partir do soro sangüíneo. As albuminas (BSA) e globulinas (GB) isoladas foram desidratadas por dois métodos de secagem e caracterizadas quanto sua composição química, solubilidade, propriedades espumantes e emulsificantes. Sua qualidade nutricional foi avaliada através da digestibilidade in vitro e da composição de aminoácidos e minerais. O método utilizado, apesar de seletivo, separa frações com características físicoquímicas semelhantes e, portanto a utilização das frações para fins farmacêuticos exige um posterior passo de purificação. As duas frações obtidas são compostas de aproximadamente 85% de proteínas, limitadas em 30% de triptofano (BSA) e 12% em isoleucina (GB), e com digestibilidades idênticas (91 e 98%) (p<O,05) à da caseína (90%). As frações apresentaram excelentes propriedades funcionais, sendo que a BSA mostrou-se bem mais solúvel que a GB, não tendo sofrido influência da variação do pH. Sua capacidade de formação de espuma (CFE) comparou-se à da proteína da clara de ovo, sendo superior em pequenas concentrações de proteína. A BSA, apesar de mesma CFE, forma uma espuma menos estável que a GB. As diferenças encontradas nos métodos de secagem são relevantes, tendo a secagem em spray melhorado as propriedades funcionais estudadas das duas frações protéicas, exceto a CFE da GB, e não interferido na composição química (centesimal e de aminoácidos). Portanto num escalonamento de produção de proteínas a partir do sangue bovino, seguramente poder-se-ia fazer uso da secagem em spray dryer, por ser mais rápida e mais barata. No entanto, através de um planejamento experimental, comparou-se o resíduo de secagem da BSA para saber se a fração do produto mantido nas condições do spray por um tempo prolongado teria suas características funcionais modificadas. Esse indicador de desnaturação foi observado, revelando que as condições de secagem em spray devem ser controladas. Mesmo assim, a BSA na forma de resíduo apresentou boa solubilidade e propriedade emulsificante, mas certamente isto se deve à sua estrutura compacta e com muitas pontes dissulfeto.Abstract: It has been a constant interest in the utilization of animal blood from slaughter houses not only because of the intrinsical value of their constituents, mainly the proteins, but also to solve environmental problems. In this research the two main bovine protein fractions, the albumin (BSA) and globulin (GB) were isolated by using respectively 50% and 80% saturation with ammonium sulphate. The isolated fractions were dehydrated by two methods of drying (freeze drying and spray drying) Chemical composition and technological properties (solubility, foaming, emulsifying capacity and stability) were studied in the dehydrated powders. Protein content of two fractions was respectively, BSA 83%, GB 84-85%. BSA was 30% limited in tryptophan and GB 12% in isoleucine and protein digestibility was above 95% for both fractions. Both fractions presented excellent protein solubility. BSA was less sensitive to changes in pH than GB. Foaming capacity was very high in both fractions (equal or better than egg white). The influence ofthe drying methods was relevant. The drying method did not influence significantly the composition and the functional properties studied, except for the emulsifying capacity of GB that was decreased in the spray dried sample. The data suggested that for industrial operation the spray drying could perfectly replace the freeze-drying method. A factorial planned experiment was performed to compare the fractions that come out naturally from the spray drying with the portion that remains inside the equipment during the entire drying period. It was demonstrated that the retained sample (called BSA residue) was significantly affected by prolonged heat treatment. Even dough the solubility and emulsifying properties of this sample remained high but significantly inferior BSAthat was collected naturally out of the spray drying. The nutritional index estimated (PDCAAS) ranged from 80% for Iyophilized BSA to 91% for the spray dried GB, compared to 86% for casein.MestradoMestre em Alimentos e Nutriçã

Study of the physical-chemical parameters in the microcapsules formation produced for complex coacervation

Orientadores: Carlos Raimundo Ferreira Grosso, Maria Ines ReTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia de AlimentosResumo: Microencapsulação é uma tecnologia usada como ferramenta potencial para proteção de um composto e modulação de sua liberação. Atualmente, estudos na área de micropartículas e liberação controlada estão bastante avançados e uma variedade de técnicas estão disponíveis entre as quais destacam-se processos por atomização (spray drying, spray cooling e spray chilling), coacervação e recobrimento por leito fluidizado e por complexação. A coacervação complexa envolve a associação reversível de dois polímeros e apresenta algumas vantagens frente a outras técnicas como a possibilidade de se trabalhar com biopolímeros, a ausência de solvente orgânico e condições brandas de temperatura no processamento. Porém a complexidade do processo dificulta a aplicação da técnica a biopolímeros com diferentes características físico-químicas. Assim, neste trabalho foram estudadas as principais condições que podem interferir na formação das partículas por coacervação complexa do sistema clássico goma-arábica:gelatina e pectina:gelatina, na tentativa de elucidar os mecanismos envolvidos. Além disso, as propriedades de barreira das partículas encapsuladas com óleo essencial de vetiver foram alteradas sob duas condições de reticulação (glutaraldeído e transglutaminase) como forma de prever o comportamento da membrana polimérica em diferentes meios. O ensaio de liberação foi mensurado a partir de um composto apolar fluorescente (dansilato de kusimila - KD) em meios aquosos com polaridade modificada pela adição de tensoativos de natureza iônica (dodecilsulfato de sódio) e não-iônica (Tween 80). Os resultados obtidos confirmaram que existe uma faixa ótima de formação de partículas dependente do pH. Acredita-se que as partículas são formadas pela coacervação dos polímeros no sistema líquido-líquido sobre a superfície hidrofóbica do agente de núcleo. O planejamento experimental possibilitou a otimização do processo clássico de formação de partículas gelatina-goma arábica resultando em uma proporção ótima de 2:1. As condições estudadas para a pectina não possibilitaram otimizar o processo nem produzir cápsulas esféricas, sendo que uma massa coacervada foi formada arrastando a porção hidrofóbica e conseqüentemente encapsulando-a. Nas melhores condições experimentais encontradas foram testados agentes reticulantes (glutaraldeído e transglutaminase) que apresentaram diferenças quanto à retenção do composto fluorescente encapsulado e diferenças morfológicas nos meios estudados. Para as partículas não reticuladas úmidas, KD foi completamente liberado após 5 horas enquanto para partículas secas esta quantidade foi de 80%. Nestes sistemas liberação do óleo de vetiver foi avaliada por quantificação cromatográfica através da medida de liberação de alguns compostos presentes no óleo. Em geral, maior porcentagem de liberação foi observada para álcoois e cetonas e menor porcentagem de liberação observada para os hidrocarbonetos. Partículas reticuladas com glutaraldeído apresentaram menor liberação de KD em relação às reticuladas com transglutaminase, que por sua vez apresentaram liberação ligeiramente inferior às partículas não-reticuladas, independentemente dos meios de liberação estudados. Considerando os meios, a ordem de liberação de KD observada foi : etanol anidro>SDS>tween80Abstract: Microencapsulation is a technology used as a potential tool in the protection of a product and the modulation of its core release. Currently, studies in the area of microparticles and controlled release are considerably advanced and a variety of techniques and products are available, among them differents processes for atomization (spray drying, spray cooling and spray chilling), coacervation and fluidized bed and complexation. The complex coacervation involves the reversible association (ionic) of two polymers and presents some advantages in comparison to other techniques such as the possibility to work with biopolymers, the absence of organic solvent and mild temperatures. However the complexity of the process turns the application of the technique difficult to biopolymers due to different physical and chemical characteristics. Thus, this work considered a study of the main conditions that can influence the formation of particles by complex coacervation in an attempt to elucidate the mechanisms involved. Moreover, the barrier properties of these particles were modified under two conditions of crosslinking. The release assay was measured with a hydrophobic fluorescent (khusimyl dansylate - KD), substance in solvents with their polarity modified by the addition of ionic and non-ionic surfactants (SDS and Tween 80). The results confirmed that an optimum band of particle formation exists and depends on the pH. The particles are formed by the coacervation of polymers in the liquid-liquid system over the hydrophobic surface of the core agent. The experimental design made possible the optimization of the classic process of particle formation when the arabic gum-gelatin ratio was 1:2. For the pectin, the range of conditions studied did not allow to optimize the process or to produce spherical capsules, but a coacervated mass was formed dragging the hydrophobic portion and consequently encapsulating it. In the best conditions found, the crosslinking agents (glutaraldehyde and transglutaminase) presented different retention capacities for the encapsulated fluorescent probe and morphological differences in the solvents studied. The KD in the moist capsules without reticulation was completely released after 5 hours, whilst for the freeze-dried particles, this amount was 80%. Release of vetiver oil was evaluated indirectly by chromatographic quantification following the release of some of the compounds present in the oil. In general, a greater percent of release occurred for the alcohols and ketones and smaller percent release was observed for the hydrocarbon compounds. Crosslinking using glutaraldehyde showed smaller release of the KD than particles crosslinked with transglutaminase. The release KD profile of the particles crosslinked with transglutaminase was almost the same compared with particles without crosslinking, in all release medium used. The release order observed for KD was: anhydrous ethanol>SDS>tween80DoutoradoNutrição Experimental e Aplicada à Tecnologia de AlimentosDoutor em Alimentos e Nutriçã