O enfermeiro especialista na articulação e continuidade dos cuidados

Os cuidados de saúde, no âmbito da saúde materno-infantil, são considerados complexos, uma vez que implicam áreas de saber multidisciplinares, envolvendo uma estrutura de profissionais e serviços de proximidade e hospitalares. Uma articulação e continuidade de cuidados bem-sucedidos refletem-se em melhor acesso aos serviços de saúde, elevados padrões de qualidade na prestação de cuidados, aumento da satisfação dos clientes, obtendo-se, assim, ganhos em eficiência e em saúde. Os enfermeiros são profissionais fundamentais para uma articulação eficaz entre os dois níveis de prestação de cuidados. O presente relatório tem a intenção de dar a conhecer todo o trabalho desenvolvido na aquisição e desenvolvimento de conhecimentos e competências, que fundamentem as intervenções de enfermagem realizadas durante os ensinos clínicos, de acordo com o Plano de Estudo do Curso de Mestrado em Enfermagem de Saúde Materna e Obstetrícia. A metodologia utilizada para a realização deste relatório, tendo por base uma prática baseada na evidência científica, foi o recurso à revisão sistemática da literatura, à reflexão sobre a prática clínica, bem como, análise de conteúdo de entrevistas semiestruturadas, de forma a clarificar o cuidado de enfermagem especializado na articulação e continuidade dos cuidados à mulher / família /recém-nascido, durante a gravidez, trabalho de parto e puerpério, entre os diversos contextos de saúde. Foram identificadas lacunas na continuidade dos cuidados, entre os vários contextos de saúde, no âmbito da articulação entre as instituições. Atualmente, a articulação dos cuidados ainda está muito a cargo da equipa médica e os diversos meios de comunicação, através dos quais é transmitida a informação entre profissionais de saúde, revela-se insuficiente e com falta de informação

A procura de equipamentos e serviços de proximidade no Bairro das Colinas do Cruzeiro, Odivelas: contributos para a construção de uma cidade saudável

O presente trabalho intitula-se “A procura de equipamentos e serviços de proximidade no Bairro das Colinas do Cruzeiro, Odivelas – contributos para a construção de uma cidade saudável” e tem como objetivo compreender se os equipamentos e serviços de proximidade existentes conseguem responder às necessidades da população residente atualmente e num futuro próximo. Para isso, foi necessário identificar e analisar as dinâmicas quotidianas da população no que respeita à estrutura familiar, características socioprofissionais, as suas dinâmicas de consumo e lazer e, ainda, as perspetivas futuras da população no que diz respeito à dinâmica familiar, de modo a determinar quais as necessidades da população residente. Neste contexto, para a realização do presente trabalho foi necessário estabelecer tarefas de investigação, como a recolha e revisão de bibliografia para a realização do enquadramento teórico. A recolha e tratamento da informação estatística mostrou-se igualmente importante para a caracterização tanto do município de Odivelas como do bairro, assim como a análise do Alvará da Urbanização das Colinas do Cruzeiro. Por fim, realizou-se um inquérito com o propósito de caracterizar o perfil da população residente e perceber quais as suas principais necessidades e dinâmicas quotidianas. Através desta investigação foi possível compreender e identificar quais as fragilidades do bairro em estudo no que respeita aos equipamentos e serviços de proximidade existentes, especialmente aqueles ligados ao ambiente (destacando-se aqui a necessidade de uma maior limpeza ao nível das ruas e mais espaços verdes); mais segurança; mobilidade, onde se deve salientar o reforço do estacionamento e os transportes públicos; mais comércio de proximidade, onde é referida essencialmente a necessidade de mais mercearias, talhos, peixarias e similares. Finalmente, refira-se a necessidade de um maior número de instituições de Ensino (principalmente do 1.º ciclo do ensino básico) e creches/infantários.The present work is entitled “The search for equipment and proximity services in Bairro das Colinas do Cruzeiro, Odivelas - contributions to the construction of a healthy city” and aims to understand whether existing equipment and proximity services meet the needs of the resident population nowadays and in the near future. It was then necessary to identify and analyse the daily dynamics of the population regarding family structure, socio-professional characteristics, its consumption and leisure dynamics and the future perspectives of the population with regard to family dynamics, to determine the resident population's needs. In this context, in order to take this study, it was necessary to carry out research tasks, such as the collection and review of bibliography for the realization of the theoretical framework. It was also of utmost importance collecting and processing statistical information for the characterization of both the municipality of Odivelas and the neighborhood, as well as the analysis of the Urbanization Permit for Colinas do Cruzeiro. Finally, it urged to take a survey that allowed to characterize the profile of the resident population and understand their main needs and daily dynamics. Through this investigation it was possible to understand and identify the weaknesses of the neighborhood under study with regard to existing equipment and proximity services, especially those related to the environment (highlighting the need for greater cleaning at the street level and more green spaces)); more security; mobility, where emphasis should be placed on strengthening parking and public transport; more local commerce, where the need for more grocery stores, butchers, fish shops and the like is mentioned. Finally, mention should be made of the need for a greater number of educational institutions (mainly in the 1st cycle of basic education) and kindergartens

Infecção relacionada a cateter venoso central: comparação entre duas técnicas de fixação

Estudo realizado com objetivo de avaliar diferença na taxa de infecção relacionada a cateter venoso central (IRCVC) entre os dois métodos de fixação com sutura mais comuns. Foram avaliados 40 indivíduos (20 do grupo ALETA e 20 do grupo BAILARINA) internados em enfermarias ou unidades de terapia intensiva do Hospital Universitários Walter Cantídio, unidade terciária localizada em Fortaleza/Ce. Não foram considerados na pesquisa pacientes em uso de antibióticos, portadores de traqueostomia, com sítio de punção em veia femoral ou cuja indicação seja troca por suspeita de IRCVC prévia. Os dados foram analisados por meio do programa Jamovi®.  Foi considerada como infecção associada ao cateter, hiperemia regional, saída de secreção purulenta pelo óstio de punção ou infecção de corrente sanguínea sem fonte determinada. O tempo médio de permanência foi de 13,7 dias para o grupo ALETA e 12,8 dias para o grupo BAILARINA. A taxa de IRCVC foi de 27,5%, não havendo diferença estatisticamente significativa entre os grupos estudados

Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups

Background: Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovascular disease (primary prevention). Methods: In CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), 4401 participants with type 2 diabetes mellitus and chronic kidney disease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care. Results: Primary prevention participants (n=2181, 49.6%) were younger (61 versus 65 years), were more often female (37% versus 31%), and had shorter duration of diabetes mellitus (15 years versus 16 years) compared with secondary prevention participants (n=2220, 50.4%). Canagliflozin reduced the risk of major cardiovascular events overall (hazard ratio [HR], 0.80 [95% CI, 0.67-0.95]; P=0.01), with consistent reductions in both the primary (HR, 0.68 [95% CI, 0.49-0.94]) and secondary (HR, 0.85 [95% CI, 0.69-1.06]) prevention groups (P for interaction=0.25). Effects were also similar for the components of the composite including cardiovascular death (HR, 0.78 [95% CI, 0.61-1.00]), nonfatal myocardial infarction (HR, 0.81 [95% CI, 0.59-1.10]), and nonfatal stroke (HR, 0.80 [95% CI, 0.56-1.15]). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P for interaction >0.5 for each outcome). Conclusions: Canagliflozin significantly reduced major cardiovascular events and kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, including in participants who did not have previous cardiovascular disease

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Occurrence of pesticides from coffee crops in surface water

The excessive amount of pesticides applied in agricultural areas may reach surface water, thereby contaminating it. Thus, the main purpose of this study was to investigate the presence of pesticides used in a sub-basin headwater with coffee crops, situated in the Dom Corrêa district, Manhuaçu, Minas Gerais. The region of study is a great producer of coffee. Crops occupy steep areas and are situated close to surface water bodies. In this study, four sample collection points were selected in streams as well as a point in the distribution network and two points in the water treatment station (raw and treated water) a total of seven points. The samples were collected in rainy and dry seasons. Organochlorines, organophosphates, pyrethroids, carbamates and triazoles pesticides were identified by liquid and gas chromatography analysis with tandem mass spectrometry. The occurrence of pesticides was more evident in the rainy season. A total of 24 distinct pesticides were detected. At least one pesticide was identified in 67% of the samples collected during the rainy season and in 21% of the samples collected during drought. Many pesticides detected in water are not regulated in Brazilian legislation regarding potability

Physicochemical properties of endodontic sealers of different bases

OBJECTIVE: To assess the setting time (ST), flow (FL), radiopacity (RD), solubility (SB) and dimensional change following setting (DC) of different sealers (AH Plus®, Polifil, Apexit Plus®, Sealapex®, Endométhasone® and Endofill®) according to American National Standards Institute/American Dental Association (ANSI/ADA) Specification 57. MATERIAL AND METHODS: Five samples of each material were used for each test. For ST, cast rings were filled with sealers and tested with a Gilmore needle. For FL, the sealer was placed on a glass plate. After 180 s, another plate with 20 g and a load of 100 g were applied on the material, and the diameters of the discs formed were measured. In RD, circular molds were filled with the sealers, radiographed and analyzed using Digora software. For SB, circular molds were filled with the sealers, a nylon thread was placed inside the material and another glass plate was positioned on the set, pressed and stored at 37°C. Samples were weighed, placed in water, dried and reweighed. The water used for SB was analyzed by atomic absorption spectrometry. For DC, circular molds were filled with the sealers, covered by glass plates and stored at 37°C. Samples were measured and stored in water for 30 days. After this period, they were dryed and measured again. RESULTS: Regarding ST, AH Plus®, Apexit® and Endofil® sealers are in accordance with ANSI/ADA standards. Endométhasone's manufacturer did not mention the ST; Polifil is an experimental sealer and Sealapex® did not set. Considering RD, SB and DC, all sealers were in accordance with ANSI/ADA. The spectrometric analysis showed that a significant amount of K+ and Zn2+ ions was released from Apexit Plus® and Endofill®, respectively. CONCLUSION: Except for DC, all other physicochemical properties of the tested sealers conformed to ANSI/ADA requirements