INCIDÊNCIA DE INFECÇÕES DE SÍTIO CIRÚRGICO EM CIRURGIAS LIMPAS EM CLÍNICAS CIRÚRGICAS DE UM HOSPITAL ONCOLÓGICO DA REGIÃO NORTE

ABSTRACT Surgical Site Infection (SSI) is characterized as a post-surgical complication that occurs at the incision site, resulting from clinical aspects of the patient and/or incorrect handling of techniques that ensure the safety of procedures, increasing the probability of complications in surgeries classified as clean. This study aimed to determine the incidence of surgical site infection in breast, cardiac and thoracic surgeries in an oncology hospital in the North Region, highlighting the predisposing conditions and the etiological agents involved in the emergence of infections. This is an exploratory research with a quantitative, retrospective approach, carried out with 2,811 patients, in the period 2013-2020. The study found that 17 (0.6%) patients had infections, 13 (76.47%) were female and 4 (23.52%) were male. Escherichia coli and Staphylococcus Coagulase Negative (17.65%) were the most reported etiologic agents in SSI. The surgical wound was the main risk factor for SSI (33.33%).  Therefore, the article seeks to provide up-to-date knowledge about SSI-related risk factors to help with control interventions in hospitals. KEYWORDS: Cross Infection. Epidemiology. Surgery.RESUMEN La Infección del Sitio Quirúrgico (ISQ) se caracteriza como una complicación posquirúrgica que se presenta en el sitio de la incisión, resultante de aspectos clínicos del paciente y / o manejo incorrecto de técnicas que garantizan la seguridad de los procedimientos, aumentando la probabilidad de complicaciones en cirugías clasificadas tan limpio. Este estudio tuvo como objetivo determinar la incidencia de infección del sitio quirúrgico en cirugías de mama, cardíaca y torácica en un hospital de oncología de la Región Norte, destacando las condiciones predisponentes y los agentes etiológicos involucrados en la aparición de infecciones. Se trata de una investigación exploratoria con abordaje cuantitativo, retrospectivo, realizada con 2.811 pacientes, en el período 2013-2020. El estudio encontró que 17 (0,6%) pacientes tenían infecciones, 13 (76,47%) eran mujeres y 4 (23,52%) eran hombres. Escherichia coli y Staphylococcus Coagulase Negative (17,65%) fueron los agentes etiológicos más notificados en la ISQ. La herida quirúrgica fue el principal factor de riesgo de ISQ (33,33%). Por lo tanto, el artículo busca proporcionar conocimientos actualizados sobre los factores de riesgo relacionados con la ISQ para ayudar con las intervenciones de control en los hospitales. Palabras-clave: Infección nosocomial. Epidemiología. Cirugías.A Infecção de Sítio Cirúrgico (ISC) é caracterizada como uma complicação pós-cirúrgica que ocorre no local da incisão, decorrente de aspectos clínicos do paciente e/ou do manejo incorreto das técnicas que garantem a segurança dos procedimentos, elevando a probabilidade de intercorrências em cirurgias classificadas como limpas. Este trabalho teve como objetivo determinar a incidência de infecção de sítio cirúrgico em cirurgias de mastologia, cardíaca e torácica de um hospital oncológico da Região Norte, destacando as condições predisponentes e os agentes etiológicos envolvidos no surgimento das infecções. Trata-se de uma pesquisa exploratória com abordagem quantitativa, retrospectiva, realizada com 2.811 pacientes, no período de 2013-2020. O estudo constatou que 17 (0,6%) pacientes apresentaram infecções, sendo 13 (76,47%) do sexo feminino e 4 (23,52%) do sexo masculino. Escherichia coli e Staphylococcus Coagulase Negativo (17,65%) foram os agentes etiológicos mais notificados nas ISC. A ferida operatória foi o principal fator de risco para a ISC (33,33%). Portanto, o artigo procura prover conhecimento atualizado sobre os fatores de risco relacionados à ISC para ajudar nas intervenções de controle nos hospitais. Palavras-chave: Infecção Hospitalar. Epidemiologia. Cirurgias

ASSISTÊNCIA A MULHER NEGRA DENTRO DA ATENÇÃO BÁSICA: REVISÃO DE LITERATURA

To analyze the paradigms faced by the black female population in the Primary Care health system, identifying the main factors that prevent better access and assistance. Method: This is an integrative literature review, searching the Medline, BDENF, LILACS databases, using as descriptors: “Women's Health”, “Primary Health Care”, “Public Health” and “Health Policy”. Health” combined between Boolean operators AND and OR, with a time frame of the last 5 years. Results: Of the 4,541 articles found, 8 were selected to compose the study. Factors related to the unpreparedness of professionals through vulnerabilities and lack of continuing education were identified as challenges to comprehensive health care for black women within the scope of Primary Care, which become borderline and challenging issues faced by women on a daily basis. The existence of racial prejudice, although it is fiercely fought, still exists in society and there must be intervention by health institutions to serve the individual as a whole. The study also highlighted socioeconomic factors related to girls' housing. This signals a slow process of surveying and monitoring by experts. conclusions: As primary care is the gateway to the health system, it is still necessary to expand the framework of scientific research to understand the topic in a specific and adequate way, as there is no doubt that stunted girls face several gaps in the provision of care without inequalities.Objetivo: Analisar os paradigmas enfrentados pela população negra feminina no sistema de saúde na Atenção Primária, identificando os principais fatores que impedem uma melhor acesso e assistência. Método: Trata-se de uma revisão integrativa de literatura, com busca nas bases de dados da Medline, BDENF, LILACS, utilizando como descritores: “Saúde da Mulher”, “Atenção Primária a Saúde”, “Saúde Pública” e “Política de Saúde” combinados entre operadores boleanos AND e OR, com recorte temporal dos últimos 5 anos. Resultados: Dos 4.541 artigos encontrados, 8 foram selecionados para compor o estudo. Identificaram-se, como desafios à assistência à saúde integral da mulher negra no âmbito da Atenção Básica fatores relacionados ao despreparo dos profissionais mediante as vulnerabilidades e a falta de educação continuada, que se tornam questões limítrofes e desafiadoras enfrentadas pelas mulheres diariamente. A existência de preconceito racial, embora seja ferozmente combatido Mas ainda existe na sociedade E deve haver intervenção das instituições de saúde para atender o indivíduo como um todo. O estudo também destacou os factores socioeconómicos relacionados com a habitação das meninas Isto sinaliza um processo lento de enquête e monitoramento por parte de especialistas. conclusões: Sendo a atenção básica a porta de entrada do sistema de saúde, ainda é necessário ampliar o arcabouço da investigação científica para compreender o tema de forma específica e adequada, pois não há dúvidas de que as meninas atros enfrentam diversas lacunas na prestação de cuidados sem desigualdades

EFETUAÇÃO SOBRE O ACOLHIMENTO AVANÇADO EM UNIDADE BÁSICA DE SAÚDE LIDANDO COM ARCO DE MAGUEREZ

ABSTRACT: Introduction: Access to healthcare is essential for good quality of service, with clinical management being one of the pillars to guarantee this objective. In this context, reception appears as a tool to screen, listen, manage situations and facilitate the user's introduction to the service in an organized way. Among the various methods in structuring the agenda, the Advanced Access program, based in the United States of America, stands out as a strategy based on principles. "Work today!"Objective: To report the impact of access to counseling following the implementation of the New Agenda strategy in primary health care. methods: This is an experience report from a doctor who works in the area of ​​family and community medicine using the Maguerez arch for reception and improving access in the basic health unit in the city of PB Conceição. Results: After implementing a welcoming and agreed access strategy, the number of scheduled appointments increased, ensuring better access and quality of services provided. This helped to build bonds between the team and users and strengthen continuity of care. Conclusion: It can be said that the recruitment and dissemination strategy aligns the agency's agenda and the team's work processes. It is expected to contribute and stimulate controversies about the use of these strategies to improve access to primary care.RESUMO: Introdução: O acesso aos cuidados de saúde é essencial para uma boa qualidade de serviço, sendo a gestão clínica um dos pilares para garantir esse objetivo. Neste contexto, o acolhimento surge como uma ferramenta para triar, ouvir, gerir situações e facilitar a introdução do utilizador ao serviço de forma organizada. Entre os vários métodos Na estruturação da agenda o programa Advanced Access, com sede nos estadosunidosdaamérica destaca-se como uma estratégia baseada em princípios. "Trabalhar hoje!"!Objectivo: Relatar o impacto do acesso ao aconselhamento após a implementação da estratégia da Nova Agenda nos cuidados de saúde primários. métodos: Trata-se de um relato de experiência de um médico que atua na área de medicina de família e comunidade utilizando o arco de Maguerez para acolhimento e melhoria de acesso na unidade básica de saúde do município de PB Conceição. Resultados: Após a implementação de uma estratégia de acesso acolhedor e pactuado, o número de consultas agendadas aumentou, garantindo melhor acesso e qualidade dos serviços prestados. Isso ajudou a construir vínculos entre a equipe e os usuários e a fortalecer a continuidade do cuidado. Conclusão: Pode-se afirmar que a estratégia de recrutamento e divulgação alinha a agenda da agência e os processos de trabalho da equipe. Espera-se contribuir e estimular controvérsias sobre o uso dessas estratégias para melhorar o acesso à atenção primária

Soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares no município de São Paulo, 2020

OBJECTIVE: To estimate seroprevalence of SARS-CoV-2 antibodies in schoolchildren aged 4 to 14 years living in the city of São Paulo, according to clinical, demographic, epidemiological, and social variables, during the school closure period as a measure against covid-19 spread. METHODS: A serological survey was made in September 2020 with a random sample stratified by school system (municipal public, state public and private) type. A venous blood sample was collected using the Wondfo SARS-CoV-2 Antibody Test (lateral flow method) for detection of total SARS-CoV-2 virus antibodies. Semi-structured questionnaires were applied to collect clinical, demographic, social, and epidemiological data. RESULTS: Seroprevalence of SARS-CoV-2 antibodies in schoolchildren was of 16.6% (95%CI 15.4–17.8). The study found higher seroprevalence in the municipal (18.5%; 95%CI 16.6–20.6) and state (16.2%; 95%CI 14.4–18.2) public school systems compared to the private school system (11.7; 95%CI 10.0–13.7), among black and brown students (18.4%; 95%CI 16.8–20.2) and in the most vulnerable social stratum (18.5 %;95%CI 16.9–20.2). Lower seroprevalence was identified in schoolchildren who reported following the recommended protective measures against covid-19. CONCLUSION: Seroprevalence of SARS-CoV-2 antibodies is found mainly in the most socially vulnerable schoolchildren. This study can contribute to support public policies that reinforce the importance of suspending face-to-face classes and developing strategies aimed at protective measures and monitoring of the serological status of those who have not yet been included in the vaccination schedule.OBJETIVO: Estimar a soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares de quatro a 14 anos de idade residentes no município de São Paulo, segundo variáveis clínicas, demográficas, epidemiológicas e sociais, durante o período de fechamento das escolas como medida de controle da covid-19. MÉTODOS: Realizou-se um inquérito sorológico em setembro de 2020 com amostra aleatória estratificada por tipo de rede de ensino (pública municipal, pública estadual e privada). Foi coletada amostra de sangue venoso utilizando-se o teste de imunoensaio de fluxo lateral da fabricante Wondfo para detecção de anticorpos totais contra o vírus SARS-CoV-2. Aplicaram-se questionários semiestruturados para o levantamento de dados clínicos, demográficos, sociais e epidemiológicos. RESULTADOS: A soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares foi de 16,6% (IC95% 15,4–17,8). O estudo encontrou soroprevalências mais elevadas na rede pública municipal (18,5%; IC95% 16,6–20,6) e estadual (16,2%; IC95% 14,4–18,2) em relação à rede privada (11,7; IC95% 10,0–13,7) e entre escolares da raça/cor preta e parda (18,4%; IC95% 16,8–20,2) e no estrato social mais vulnerável (18,5%; IC95% 16,9–20,2). A pesquisa identificou menores soroprevalências nos escolares que relataram seguir as medidas recomendadas de proteção contra a covid-19. CONCLUSÃO: A soroprevalência de anticorpos contra o vírus SARS-CoV-2 atinge principalmente os escolares socialmente mais vulneráveis. Este estudo pode contribuir para embasar políticas públicas que reforcem a importância da suspensão das aulas presenciais e da necessidade de estratégias de medidas de proteção e acompanhamento do status sorológico daqueles que ainda não foram contemplados no calendário vacinal

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

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

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning