A prática da enfermeira em auditoria em saúde

O objetivo da investigação foi conhecer a prática da enfermeira em auditoria em saúde. A concepção de análise adotada foi a da hermenêutica-dialética, e foi desenvolvida em três lócus: a auditoria interna de uma organização hospitalar; a auditoria externa de um comprador privado de serviços de saúde, e o sistema de auditoria do âmbito estadual do Sistema Único de Saúde (SUS), na Bahia. Foram entrevistadas nove enfermeiras auditoras. Na auditoria do SUS, as enfermeiras expressaram satisfação no exercício desta prática e valorização de seu papel profissional. Na auditoria privada - interna e externa às organizações de saúde - as ações das enfermeiras se direcionam para atender aos interesses de seus contratantes, e pouco se relacionam com a assistência prestada pela equipe de enfermagem e com as necessidades dos usuários dos serviços.El objetivo de la investigación es conocer la práctica de la enfermera en la auditoría de salud. La concepción de análisis adoptada fue la de la hermenéutica-dialéctica, y se desarrolló en tres locales: la auditoría interna de una organización hospitalaria, la auditoría externa de un comprador privado de servicios de salud y el sistema de auditoría del ámbito estatal del Sistema Único de Salud (SUS) en Bahía, Brasil. Fueron entrevistadas nueve enfermeras auditoras. En la auditoría del SUS, las enfermeras expresaron satisfacción en el ejercicio de esta práctica y en la valorización de su papel profesional. En la auditoría privada - interna y externa a las organizaciones de salud - las acciones de las enfermeras están dirigidas a atender los intereses de sus contratantes, y poco se relacionan con la asistencia prestada por el equipo de enfermería y con las necesidades de los usuarios de los servicios.The objective of this investigation was to identify nurses' practice in heath audit. The hermeneutic-dialectic method was used for the analysis. The study was performed in three loci: the internal audit service of a hospital; the external audit service of a private health service buyer, and the state audit service of the public health system (SUS, acronym in Portuguese for Sistema Único de Saúde - Unique Health System), in Bahia. Nine audit nurses were interviewed. In the SUS audit, the nurses report being fulfilled with their practice and with the valorization of their professional role. In the private audit - both inside and outside of health organizations - the nurses' activities are focused on meeting the interests of their contractors, and do not get much involved with the care delivered by the nursing team and with the needs of service users

Profound and Sustained Reduction in Chlamydia trachomatis in The Gambia: A Five-Year Longitudinal Study of Trachoma Endemic Communities

Trachoma is the most common infectious cause of blindness worldwide. Mass antibiotic treatment with azithromycin is used to control ocular Chlamydia trachomatis infection. There is uncertainty over how frequently and for how long treatment is needed, particularly in low prevalence settings. This study examines the effect of a single round of treatment on clinical disease and infection in a cluster of trachoma endemic Gambian villages over a five-year period. These villages had good water supplies and sanitation improved part way through the study. We found treatment was followed by a marked decline in infection prevalence (by PCR) to less than 1%. The decline in prevalence of active disease in children was less marked. Several villages had a prevalence of active trachoma in 1 to 9 year old children of greater than 10% during the follow-up period, mostly in the absence of detectable infection. The implication of this study is that a single, high coverage mass treatment may be sufficient to control C. trachomatis infection in a low prevalence setting, particularly when combined with environmental measures to limit transmission. However, relying on clinical signs to guide treatment decisions is likely to lead to significant amounts of over treatment where current guidelines are implemented

Higher Expression of CCL2, CCL4, CCL5, CCL21, and CXCL8 Chemokines in the Skin Associated with Parasite Density in Canine Visceral Leishmaniasis

Several previous studies correlated immunopathological aspects of canine visceral leishmaniasis (CVL) with tissue parasite load and/or the clinical status of the disease. Recently, different aspects of the immune response in Leishmania-infected dogs have been studied, particularly the profile of cytokines in distinct compartments. However, the role of chemokines in disease progression or parasite burdens of the visceralising species represents an important approach for understanding immunopathology in CVL. We found an increase in inflammatory infiltrate, which was mainly composed of mononuclear cells, in the skin of animals presenting severe forms of CVL and high parasite density. Our data also demonstrated that enhanced parasite density is positively correlated with the expression of CCL2, CCL4, CCL5, CCL21, and CXCL8. In contrast, there was a negative correlation between parasite density and CCL24 expression. These findings represent an advance in the knowledge of the involvement of skin inflammatory infiltrates in CVL and the systemic consequences and may contribute to developing a rational strategy for the design of new and more efficient prophylactic tools and immunological therapies against CVL

Understanding How Microplastics Affect Marine Biota on the Cellular Level Is Important for Assessing Ecosystem Function: A Review

Plastic has become indispensable for human life. When plastic debris is discarded into waterways, these items can interact with organisms. Of particular concern are microscopic plastic particles (microplastics) which are subject to ingestion by several taxa. This review summarizes the results of cutting-edge research about the interactions between a range of aquatic species and microplastics, including effects on biota physiology and secondary ingestion. Uptake pathways via digestive or ventilatory systems are discussed, including (1) the physical penetration of microplastic particles into cellular structures, (2) leaching of chemical additives or adsorbed persistent organic pollutants (POPs), and (3) consequences of bacterial or viral microbiota contamination associated with microplastic ingestion. Following uptake, a number of individual-level effects have been observed, including reduction of feeding activities, reduced growth and reproduction through cellular modifications, and oxidative stress. Microplastic-associated effects on marine biota have become increasingly investigated with growing concerns regarding human health through trophic transfer. We argue that research on the cellular interactions with microplastics provide an understanding of their impact to the organisms’ fitness and, therefore, its ability to sustain their functional role in the ecosystem. The review summarizes information from 236 scientific publications. Of those, only 4.6% extrapolate their research of microplastic intake on individual species to the impact on ecosystem functioning. We emphasize the need for risk evaluation from organismal effects to an ecosystem level to effectively evaluate the effect of microplastic pollution on marine environments. Further studies are encouraged to investigate sublethal effects in the context of environmentally relevant microplastic pollution conditions

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

This is the final version. Available on open access from Wiley via the DOI in this recordData availability statement: The percentages of dispersal modes per plot are included as Supporting Information (Table S7, based on 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests in Amazonia). The dispersal modes assigned to these 5433 species and morphospecies are also included as Supporting Information (Table S8).Aim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types.Colombian institution Departamento Administrativo de Ciencia, Tecnología e Innovación COLCIENCIASFaculty of Sciences, Universidad de los Ande