ESTRESSE OCUPACIONAL RELACIONADO À ASSISTÊNCIA DE ENFERMAGEM EM TERAPIA INTENSIVA

Objetivo: estimar a prevalência de estresse ocupacional entre profissionais de enfermagem que atuam em Unidade de Terapia Intensiva e identificar sua associação com variáveis sociodemográficas, profissionais e relacionadas à assistência de enfermagem. Método: estudo transversal, realizado em um hospital de ensino de Salvador, Bahia, Brasil, com 54 profissionais. Os dados foram coletados entre fevereiro e março de 2020 por meio da Escala Bianchi de Stress e analisados pelo Programa Stata. Resultados: a prevalência de estresse ocupacional em nível médio ou alto foi de 57,4%. Maiores níveis de estresse foram associados significativamente ao menor tempo de formação (p-valor=0,05), ser enfermeiro (p-valor=0,00), enfrentar a morte do paciente (p-valor=0,01), atender aos familiares dos pacientes críticos (p-valor=0,00) e atender às necessidades dos familiares (p-valor=0,00). Conclusão: a elevada prevalência de estresse ocupacional, bem como os fatores associados identificados, foram informações essenciais para implementação de estratégias preventivas. Descritores: Estresse Ocupacional. Cuidados de Enfermagem. Unidade de Terapia Intensiva. Equipe de Enfermagem. Enfermagem

INCIDÊNCIA E CARACTERIZAÇÃO DAS FLEBITES NOTIFICADAS ELETRONICAMENTE EM UM HOSPITAL DE ENSINO

Objetivo: analisar a incidência e as notificações de flebite em um hospital de ensino. Método: estudo observacional retrospectivo, realizado em Salvador, Bahia, Brasil. Os dados foram coletados com base nas notificações de incidentes relacionados à assistência à saúde, ocorridas no período de janeiro/2016 a dezembro/2017. Realizou-se análise descritiva. Resultados: foram notificados 277 casos de flebite, com incidência variando entre 1,45% e 26,09% no período do estudo. A maioria das flebites ocorreu em indivíduos adultos (63,27%); raça negra (66,06%); e com baixo nível de escolaridade (53,43%). O uso prolongado de medicamentos e/ou uso de medicamento irritante (52%) foram citados como principais causas do evento; 95,31% foram classificados como não graves. Conclusão: a incidência de flebite variou no período de estudo, e as notificações em um hospital de ensino apontaram para danos à saúde da maioria dos pacientes com flebites notificadas.Descritores: Eventos Adversos. Flebite. Segurança do Paciente

MAPEAMENTO DA OFERTA DE CURSOS E VAGAS DOS PROGRAMAS DE RESIDÊNCIA EM ENFERMAGEM NA BAHIA

Objetivo: mapear a oferta de cursos e vagas dos programas de residência multiprofissional e em área profissional da saúde em enfermagem na Bahia. Método: estudo documental, quantitativo, cujas fontes de dados foram 15 editais de processo seletivo para programas de residência em enfermagem que descreveram as variáveis ano, número de programa, áreas de concentração, vagas, instituições de ensino superior vinculada e modalidade dos programas. A coleta deu-se de 15 a 19 de janeiro de 2018. Resultados: foram identificadas 566 vagas distribuídas entre 19 áreas de concentração e ofertadas por oito instituições de ensino. No ano de 2014 houve a maior oferta de vagas 107 (18,9%), em 2015 houve queda considerável de 57,9% no número dessas vagas. Conclusão: os programas de residência multiprofissional expandiram-se em decorrência de reformulações das políticas de saúde e dos incentivos à formação de recursos humanos especializados, no entanto vem ocorrendo redução na oferta de vagas.Descritores: Especialização. Internato não Médico. Educação. Ensino. Enfermagem

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Competências socioemocionais mobilizadas por enfermeiros-líderes no enfrentamento da pandemia pelo covid-19 em um hospital universitário

Objetivo: Conhecer as competências socioemocionais mobilizadas por enfermeiros-líderes durante e após o enfrentamento da pandemia pelo covid-19 em um hospital universitário.Método: Estudo de caso, realizado com 16 enfermeiras(os) atuantes na liderança de unidades e serviços de um hospital universitário do nordeste do Brasil. Dados coletados em dois momentos mediante entrevista semiestruturada. As entrevistas ocorreram entre o mês de agosto a dezembro de 2022 e janeiro a agosto de 2023. Procedeu-se à análise temática indutiva e codificada, segundo a técnica bucket theme, auxiliado pelo software NVivo12 e sustentada pelo agrupamento de 25 itens constantes na Escala de Competências Socioemocionais. Resultados: Durante o enfrentamento da pandemia pelo covid-19, os enfermeiros esboçaram um misto de emoções em face ao desconhecimento da doença. Diante do clima de medo e da sensação de desamparo, elaboraram estratégias que minimizassem os riscos de adoecimento e morte. Emergindo duas categorias: Clima emocional vivenciado pelos enfermeiros e Estratégias de enfrentamento desenvolvidas pelos enfermeiros no contexto da pandemia pelo covid-19.Considerações finais: Identificou-se nos relatos dos enfermeiros as competências da consciência social, regulação, autocontrole, criatividade e consciência emocional. Estas competências contribuíram para o enfrentamento do período pandêmico, a partir da participação, envolvimento e integração dos profissionais.Descritores: Enfermagem. Liderança. Hospitais Universitários. Habilidades Sociais. Covid-19

O Claustro e o Século

O segundo ebook resultante das Residências Cistercienses realizadas no mosteiro de S. Bento de Cástris (Évora) e que agora se apresenta sob o título O Claustro e o Século. Espaços, Fronteiras e Identidades, pretende continuar o propósito traçado no primeiro: reinventar na contemporaneidade a densidade histórica do discurso cisterciense, integrando e debatendo realidades distintas no tempo e no espaço. Essa reinvenção vem permitindo uma aproximação de várias abordagens, significados e linguagens que, no presente trabalho, se desenrola em três partes distintas. Nelas se desenha o perfil das Residências Cistercienses em que ocorreram as intervenções, originando um espaço-tempo que permite novos e diferentes olhares, capazes de analisar, apreciar e contextualizar a realidade multisecular do mosteiro e referenciá-la com outras realidades. História, História da Arte, Música, Organologia, Arquitectura, Química, Engenharia, Informática e Humanidades Digitais dialogam entre si e criam, também neste e-book, mais uma edição com a garantia Openedition do CIDEHUS, um renovado e responsável olhar sobre o Património

General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants

International audienceSummaryBackground Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension.MethodsWe used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson’s correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI).FindingsThe correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m² (95% CI 2·31–3·28) lower for women and 1·28 kg/m² (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone.InterpretationBMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)