Menores extranjeros no acompañados en Ceuta: posibilidades y desafíos de intervención

La existencia de menores extranjeros en la calle, en situación de desprotección y exposición a situaciones de riesgo victimológico y delictivo es una realidad en algunas ciudades españolas. La ciudad de Ceuta, así como Melilla, vive este fenómeno de manera más intensa. Las exigencias de protección de estos niños, niñas y adolescentes, alejadas de cualquier otra consideración por su condición de extranjeros, ha puesto en jaque a los sistemas de protección españoles, garantes del bienestar de todo menor en situación de desamparo. En este contexto, la Ciudad autónoma de Ceuta ha suscrito con la Universidad de Málaga (UMA) un convenio ejecutado por el Observatorio criminológico del sistema penal ante la inmigración (OCSPI) – UMA. Se trata de un proyecto piloto de investigación e intervención para prevenir la delincuencia infanto-juvenil de estos menores. Los objetivos específicos del programa son: realizar un diagnóstico de la situación de los menores en situación de calle; asistirles en algunas necesidades básicas; desarrollar estrategias de prevención de comportamientos delictivos e intervenir con estos menores de manera individualizada para ofrecer respuestas, a través del sistema de protección, adecuadas a sus necesidades e intereses para que abandonen la calle. Además, el programa tiene como objetivo trasversal coordinar los agentes clave de la ciudad para la protección de los menores y aumento de la paz social. En esta comunicación presentaremos posibilidades y desafíos de intervención con menores extranjeros no acompañados en situación de calle en Ceuta.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Peso materno em gestantes de baixo risco na atenção pré-natal

Objectives: To evaluate the nutritional status of low-risk pregnant women during prenatal, characterize the sociodemographic profile and quantify the patients with inadequate weight. Methods: Observational, prospective in low-risk pregnant women in Aracaju health centers, Sergipe, from March to June 2014. The evaluation followed the nutritional standards recommended by the Ministry of Health (MOH) and was conducted in three consultations consecutive, where the body mass index (BMI) was calculated by the researcher. Socioeconomic and gestational data of the patients were placed on a special form. Statistical analysis was performed using the EPI-INFO software, made distribution tables of frequencies and performed association testing variables. Results: 188 pregnant women were selected, of these 150 were eligible. The average age was 26 years, with standard deviation of 6.53. The average pre-pregnancy weight was 56.3 kg (± 20.8), average weights in the first, second and third reviews were 65.17 kg (± 12.8), 67.56 kg (± 12.9 ) and 69.97 kg (± 12.6), respectively. The pregnant woman’s card filling was incomplete in 63% of cases. In the pre-pregnancy period, 14% were malnourished and 14% obese. A significant association between BMI identified in the consultations and the inadequacy of pre-pregnancy BMI (p <0.01). Conclusions: Most of the women had BMI changed during the evaluations. Prenatal card filling proved inadequate, but there was no association with BMI during pregnancy. The factor related to pregnancy BMI change was the pre-pregnancy BMI inappropriate

A stop along the way: Secondary prevention strategy of trafficking in Andalucía

La frontera sur de España es una de las principales puertas de entrada a Europa para la inmigración irregular por mar. Entre las personas que llegan por vía marítima, las mujeres subsaharianas embarazadas y / o acompañadas de niños, niñas o adolescentes plantean un desafío especial a las autoridades encargadas de la lucha contra la trata de personas con fines de explotación sexual, así como para la protección de los menores en movimiento. La Fiscalía General del Estado o la Defensoría del Pueblo en España han denunciado el riesgo que corren estas mujeres de ser explotadas en su tránsito por Europa. El programa ÖDOS es un programa pionero y especializado de primera acogida y acompañamiento de estas familias migrantes para dar respuesta a una necesidad imperiosa e invisible de protección y prevención de la victimización con enfoque de género e infancia. Este artículo presenta los resultados de la evaluación externa de los dos primeros años del programa ÖDOS (2018 y 2019). Se enfoca en la valoración de su eficacia. Los resultados muestran que el programa ÖDOS es una iniciativa necesaria para la prevención secundaria de la trata y para la protección de la infancia en movimiento, aunque la continuidad del trayecto migratorio hacia Francia de la mayoría de las mujeres atendidas apunta a un gran desafío: la necesidad de estrategias internacionales de seguimiento para una efectiva protección de estas mujeres y menores.Spanish southern border is one of the main gateways to Europe for irregular immigration bysea. Among those who arrive, sub-Saharan women who are pregnant and / or accompanied by children or adolescents pose a special challenge to the authorities in charge of the fight against trafficking in persons for the purpose of sexual exploitation, as well as for the protection of minors on the move. The Office of the Attorney General of the State or the Ombudsman's Office in Spain have denounced the risk that these women run of being exploited in their transit through Europe. The ÖDOS program is a pioneer and specialized program for the first reception and accompaniment of these migrant families to respond to an urgent and invisible need for protection and prevention of victimization with a gender and childhood approach. This article presents the results of the external evaluation of the first two years of the ÖDOS program (2018 and 2019). It focuses on evaluating its effectiveness. The results show that the ÖDOS program is a necessary initiative for the secondary prevention of trafficking and for the protection of children on the move, although the continuity of the migratory path towards France of most of the women attended points to a great challenge: the need for international follow-up strategies for effective protection of these women and minor

Análise bibliométrica sobre terapia infusional e cuidados intensivos / Bibliometric analysis on infusion therapy and intensive care

Objective: to map the behavior of scientific production on infusion therapy in intensive care in Scopus. Method: bibliometric study, with descriptive statistical analysis of articles indexed in Scopus from 2010 to 2021. Results: 857 documents were retrieved, published in 393 journals, 738 original articles and 119 review articles. There were 32 articles of single authorship and 5814 with multiple authorship. The average number of articles per author was 0.147 and the collaboration index was 7.06. Conclusion: Although based on empirical facts, the laws of Bradford and Lotka confirmed possible theoretical hypotheses that the nucleus of journals is formed by the most devoted and, therefore, the most productive, nevertheless, it revealed that the more specific the subject/theme, the more limited the possibility of identifying elite groups of authors will be.Objetivo: mapear o comportamento da produção científica sobre terapia infusional em terapia intensiva na Scopus. Método: estudo tipo bibliométrico, com análise estatística descritiva de artigos indexados na Scopus de 2010 a 2021. Resultados: foram recuperados 857 documentos, publicados em 393 periódicos, 738 artigos originais e 119 de revisão. Contabilizou-se 32 artigos de autoria única e 5814 com autoria múltipla. A média de artigos por autor foi de 0,147 e o índice de colaboração de 7,06. Conclusão: Muito embora baseada em fatos empíricos, as leis de Bradford e Lotka confirmaram possíveis hipóteses teóricas de que o núcleo de periódicos é formado pelos mais devotados e, portanto, mais produtivos, não obstante, revelou que quanto mais específico for o assunto/tema, mais limitada será a possibilidade de identificação de grupos de Elite de autores.

Aplicação da radiografia e ressonância magnética em cardiomiopatia e megaesôfago na doença de chagas crônica: uma revisão voltada ao Brasil / Application of radiography and magnetic resonance in cardiomyopathy and megaesophagus in chronic chagas disease: a review on Brazil

A Doença de Chagas (DC) é endêmica nas Américas Central e do Sul atingindo 12 milhões de pessoas em todo o mundo. No Brasil são estimados entre 1,9 a 4,6 milhões de casos com cerca de 12 mil óbitos por ano. O objetivo deste estudo foi definir as principais alterações morfológicas do megaesôfago e cardiomiopatia chagásica em radiografia e ressonância magnética. Foi realizada uma revisão narrativa a partir de livros, anais, congressos e artigos científicos de livre acesso, publicados em língua portuguesa entre 2010 e 2020 no SciELO, LILACS e BIREME/OPAS/OMS. A busca se deu a partir dos descritores: doença de Chagas AND cardiomiopatia OR megaesôfago AND radiografia OR ressonância magnética. Foram avaliados 39 artigos. Sobre o megaesôfago, o esofagograma baritado permitiu classificar em quatro graus o acometimento desse órgão, permitindo delimitar o estadiamento da DC. A ressonância magnética permitiu diferenciar com excelente resolução a fibrose miocárdica focal, multifocal e difusa por Trypanosoma cruzi, e favoreceu o rastreamento precoce de lesão cardíaca na forma indeterminada. Concluiu-se que os exames de imagem constituem importantes ferramentas não invasivas e indolores no prognóstico da DC crônica sintomática e indeterminada

Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors

Abstract The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions