Inovação para o aprimoramento do bem-estar subjetivo de pacientes oncológicos pediátricos

A presente tese apresenta diretrizes projetuais para inovação de serviços oncológicos pediátricos hospitalares, voltadas para o aprimoramento do bem-estar dos pacientes internados. A tese possui os seguintes objetivos: a) investigar a experiência vivenciada pelos pacientes pediátricos internados para tratamento de câncer quando submetidos a exames laboratoriais e de imagem, buscando delinear intervenções lúdicas para aprimorar o seu bem-estar subjetivo; b) levantar dados e criar diretrizes para o uso da ludicidade como estratégia de inovação hospitalar para aprimorar o bem-estar subjetivo das crianças internadas para tratamento de câncer; c) desenvolver diretrizes com auxílio dos profissionais a respeito do serviço em que estão inseridos, buscando novas diretrizes projetuais para hospitais, as quais depois devem ser analisadas por especialistas em arquitetura e saúde mental, para entender o potencial das diretrizes para aprimorar o bem-estar das crianças internadas. A tese apresentada é empírica, com caráter qualitativo através de observação participante, workshops de design thinking e entrevistas em profundidade. Como resultados, os três artigos apresentados propõem diretrizes de projeto que poderiam ser aplicadas no contexto oncológico hospitalar pediátrico. O primeiro artigo apresenta diretrizes lúdicas divididas em quatro categorias: o uso de tecnologia, design para personalização, gamificar experiências e design para redirecionamento de foco. No segundo, são apresentadas estratégias para aplicação no SUS, desde o diagnóstico até receberem a alta para ir para casa, como o desenvolvimento de artefatos, projetos customizados de acordo com a avaliação de necessidades do paciente e o auxílio de profissionais não contratados pelo hospital como prestadores de serviço. Já no terceiro, são propostas 36 ideias lúdicas de projeto, de acordo com o ambiente hospitalar ao qual se propõem e suas categorias de projeto.The present thesis presents design guidelines for the innovation of pediatric oncology services in hospitals, aimed at improving the subjective wellbeing of hospitalized patients. The thesis has the following objectives: (a) investigate the experience lived by pediatric inpatients for cancer treatment when subjected to laboratory and imaging exams, with the goal of designing playful interventions to improve their subjective well-being; (b) collect data and create guidelines on how playfulness can be used as a hospital innovation strategy to improve the subjective well-being of children hospitalized for cancer treatment; (c) develop guidelines with help from the professionals about the service in which they are inserted, seeking new design strategies for hospitals, which later must be analyzed by specialists in architecture and mental health, to understand the potential of the guidelines to improve the well-being of hospitalized children. The thesis presented is empirical, qualitative in nature, through participant observation, design thinking workshops and in-depth interviews. For results, the three articles presented propose design guidelines that could be applied in the pediatric hospital oncology context. The first article presents playful guidelines divided into four categories: use of technology to allow immersive experiences in learning about treatment and medical condition, design for personalization, gamifying experiences to allow positive reinforcement, and design for focus redirection. In the second, strategies for application in the SUS are presented, from the diagnosis to when they are discharged to go home, such as the development of artifacts, customized projects according to the assessment of the patients' needs and the assistance of professionals not hired by the hospital as service providers. In the third, 36 playful design ideas are proposed, according to the hospital environment to which they are proposed and their project categories

A Systematic Review of Design and Wellbeing

An increasing number of researches has been focusing on how design can contribute to happiness by trying to increase wellbeing. The focus is providing solutions through design to improve people's lives, thus increasing the appreciation of their lives.  The Ebscohost database was systematically searched for relevant publications about design and wellbeing until 2019. A total of 17 journal articles, published between 2010 and 2018, were included in the research. Data was extracted on macro-theme and category of research, by application area, design, methods, instruments, and focus. Studies on design and wellbeing were explored in the last decade mostly by European researchers. Physical environment, product design, sustainability, and technology are the most common application areas, and most of them have references related to the psychological literature. The main method adopted is experimental and qualitative in nature. The association between design and wellbeing is one that most often targets variables and projects to increase wellbeing instead of discussing how the results will improve positive affect and decrease negative affect to improve people’s lives. The area of research has been growing at a slow steady pace since 2010

RATIONAL AND EXPERIENTIAL DECISION-MAKING IN PRODUCT DESIGN

Several studies on decision-making allow us to observe that professionals use one of two systems to define their projects: rational (i.e., inferential or analytical system that operates by rules of reasoning, relatively affect-free) or experiential/ intuitive (i.e., learning or automatic system that is intimately associated with affect). Professionals from creativity related areas may often need to make decisions without much concrete data, which requires the use of their intuition. This paper presents a study that aims to evaluate the reasoning process of making decisions by product designers in comparison to other professionals that work in the same field (i.e., engineers and architects). For this purpose, we used the Rational-Experiential Inventory (REI). Overall, our results show a significant difference between engineers and the other professionals: they make decisions based on a more rational and less experiential system than architects and designers, although we didn’t find huge differences between designers and architects.Diversos estudos referentes à tomada de decisão permitem observar que profissionais utilizam um dos dois sistemas para definir seus projetos: o racional (sistema inferencial ou analítico que opera através de regras de raciocínio, relativamente livres de emoção) ou experiencial/intuitivo (aprendizagem ou sistema automático que está intimamente associado a elementos emocionais). Profissionais de áreas relacionadas à criatividade podem muitas vezes precisar tomar decisões sem muitos dados concretos, necessitando utilizar sua intuição. Com isso em mente, este artigo apresenta um estudo cujo objetivo é avaliar o processo de tomada de decisão de designers de produto em comparação a outros profissionais que atuam na mesma área (engenheiros e arquitetos). Com esse propósito, foi utilizado o Inventário Racional-Experimental (Rational-Experiential Inventory). De forma geral, os resultados mostraram uma diferença significativa entre engenheiros e outros profissionais: eles tomam decisões baseando-se em um sistema mais racional e menos experiencial do que arquitetos e designers, mas diferenças consistentes entre designers e arquitetos não foram identificadas

Design para o bem-estar: desafios enfrentados ao projetar para o estímulo a forças de caráter

Forças de caráter são traços pessoais que indicam como as pessoas lidam com adversidades. Quando aplicam essas forças no cotidiano, seu bem-estar tende a ser desenvolvido, o que pode ser estimulado através do Design, segundo uma área emergente denominada Positive Design. Este artigo tem como objetivo investigar os desafios encontrados ao projetar para estimular forças de caráter. Sete profissionais graduados, todos estudantes de mestrado, foram preparados para desenvolver projetos na área. A pesquisa foi baseada na observação da prática desses designers durante suas atuações em workshops projetuais, que tiveram uma temática social como estímulo. Nessas ocasiões, uma mulher transgênera atuou como usuária do projeto e apontou oportunidades para o desenvolvimento de seu bem-estar. As atividades foram registradas em vídeo e acompanhadas por dois observadores. Os resultados indicam que os projetos desenvolvidos foram adequados para estimular o bem-estar da usuária e discutem os desafios encontrados durante o projeto.Las fuerzas de carácter son rasgos personales que indican cómo las personas tratan con adversidades. Cuando aplican esas fuerzas en el cotidiano, su bienestar tiende a ser desarrollado, lo que puede ser estimulado a través del Diseño, según un área emergente denominada Positive Design. Este artículo tiene como objetivo investigar los desafíos encontrados al proyectar para estimular fuerzas de carácter. Siete profesionales graduados, todos los estudiantes de maestría en Diseño fueron preparados para desarrollar proyectos en el área. La investigación se basó en la observación de la práctica de estos diseñadores durante sus actuaciones en talleres de diseño, que tuvieron una temática social como estímulo. En esas ocasiones, una mujer transgénera actuó como usuaria del proyecto y apuntó oportunidades para el desarrollo de su bienestar. Las actividades fueron registradas en video y acompañadas por dos observadores. Los resultados indican que los proyectos desarrollados fueron adecuados para estimular el bienestar de la usuaria y discuten los desafíos encontrados durante el proyecto.Character strengths are personal traits that indicate how individuals handle adversities. When users apply their strengths in everyday life, their wellbeing tends to increase, which can be stimulated by Design, according to an emerging field defined as Positive Design. This paper aims to investigate challenges faced when designing to stimulate character strengths. Seven graduated professionals, who were also master students, were prepared to design in this field. The research was based on the observation of the designers during the workshops, which had a social issue as stimulus. In these situations, a transgender woman played the role of a user and reported opportunities to increase her wellbeing. The activities were registered in video and observed by three researchers. Results indicate that the projects developed during the workshop were adequate to stimulate the user’s wellbeing and discuss the challenges encountered during the project development

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Sexual function evaluation in Brazilian women accessing a public health service: an observational cross-sectional study

The aim of this study was to evaluate the prevalence of sexual dysfunction (SD) and its impact on quality of life in a sample of women attending a public health service in the city of Porto Alegre. We conducted an observational, cross-sectional study in which 278 women who had sexual intercourse within four weeks before the study were interviewed. All of the women answered three self-administered questionnaires: a questionnaire for sample characterization, the Female Sexual Function Index (FSFI), and the 36-Item Short Form Survey (SF-36). Most of the women were white, Catholic, married, and had a high school diploma. In addition, a large percentage of women had at least one child, had sex with only one partner, and used oral or injectable contraceptive methods. Of the women interviewed, 103 (37.1%) experienced SD. Women without SD had higher scores in all domains of the FSFI and SF-36 questionnaires, including the pain domain. According to the results of this study, SD decreases women’s quality of life, and the high prevalence of SD emphasizes the importance of preventive approaches and treatment that allow women to fully enjoy their sexuality and sexual healt

Sexual dysfunctions in female university students and the correlation with body image: a cross-sectional study

Purpose This study aims to correlate female sexual dysfunctions and dissatisfaction with female university students' body image. Methods 276 female university students completed an online questionnaire, including sociodemographic data, the Female Sexual Function Index, and the Body Shape Questionnaire. Results 31.1% reported some degree of dissatisfaction with body image, and 39.5% had a risk of female sexual dysfunction. The majority of women with a risk of female sexual dysfunctions (69.4%) had no concerns with shape, and the majority of women without sexual problems (67.7%) had no concerns with shape. Pearson’s coefficient underlined no correlation between Body Shape Questionnaire and Female Sexual Function Index domains. Conclusion The body image perception did not seem to affect the sexual function of female university students in our sample. However, it is important to further investigate these variables to improve women’s quality of life