EDUCAÇÃO PERMANENTE NA PRÁTICA DA ENFERMAGEM: INTEGRAÇÃO ENTRE ENSINO E SERVIÇO

Objective: to report the experience of continuing education in health in the training of nursing undergraduate students focused on integrating nursing education and nursing service.Development: experience report on the educational practice carried out at a hospital in the capital of the state of Rondônia, Brazil, between April and June 2019. It had four stages: exchange of experiences between the involved people; problematization of the practices; intervention plan; and evaluation. Implementing continuing education in health was fundamental to qualification of the services. However, there were difficulties during the execution of the practice, especially because of the way the hospital work was organized.Conclusion: continuing education in health in supervised internships allowed the creation of reflection spaces with the team, which contributed to intensifying dialogue, increasing the understanding of the reality, and including strategies that facilitate the nursing work.Objetivo: relatar la experiencia de la educación continua en salud en la educación de estudiantes de enfermería integrando la enseñanza con el servicio de enfermería.Desenvolvimiento: informe de experiencia sobre la práctica de educación desarrollada en el hospital de la capital de Rondônia, realizada entre abril y junio de 2019. Sucedió en cuatro momentos: intercambio de experiencias entre los involucrados; problematización de las prácticas; plan de intervención; y evaluación. La implementación de la educación continua en salud fue fundamental para la calificación de los servicios, sin embargo, hay dificultades en la ejecución, especialmente debido a la forma en que el trabajo hospitalario es organizado.Conclusión: la formación continua en salud en las prácticas supervisadas permitió la creación de espacios de reflexión con el equipo, contribuyendo a la expansión del diálogo, la comprensión de la realidad y la inclusión de estrategias que faciliten el trabajo de enfermería.Objetivo: relatar a experiência da Educação Permanente em Saúde na formação de acadêmicos de enfermagem integrando o ensino com o serviço de enfermagem.Desenvolvimento: relato de experiência sobre a prática de educação desenvolvida no hospital na capital de Rondônia, realizada no período entre abril e junho de 2019. Ela aconteceu em quatro momentos: troca de experiência entre os envolvidos; problematização das práticas; plano de intervenções; e avaliação. A implantação da educação permanente em saúde foi fundamental para a qualificação dos serviços, porém, registram-se dificuldades na execução, especialmente devido à forma da organização do trabalho hospitalar.Conclusão: a educação permanente em saúde no estágio supervisionado permitiu a criação de espaços de reflexão com a equipe, contribuindo para a ampliação do diálogo, compreensão da realidade e inclusão de estratégias facilitadoras ao trabalho da enfermagem

Implicações da radiação na saúde dos profissionais que utilizam a fluoroscopia na prática diária: Implications of radiation on the health of professionals who use the fluoroscopy in daily practice

O presente estudo tem como objetivo analisar as implicações da radiação na saúde dos profissionais que utilizam o arco cirúrgico na prática diária. Neste estudo foi realizada uma revisão sistemática da literatura. Para seleção das publicações foram considerados como critérios de inclusão estar disponível em formato completo, publicado nos últimos cinco anos (2018-2022), escritas em língua portuguesa e inglesa. E como critérios de exclusão foram considerados estar foram do tema de pesquisa, ser revisão de literatura e repetido na base de dados. Os critérios de inclusão e exclusão foram considerados como meio de validade metodológica. Concluiu-se a partir desse estudo que apesar de baixos níveis de radiação emitidos por arco cirúrgico, os riscos ainda são significativos, verificando-se a necessidade de conscientização dos profissionais de saúde sobre a proteção necessária para mitigação das implicações, principalmente, entre os menos experientes.&nbsp

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Abordaje desafiador de la educación permanente en salud en la formación en enfermería: una experiencia en la atención hospitalaria

Objetivo: Relatar a experiência de uma prática educativa de sensibilização dos trabalhadores de saúde às ações de Educação Permanente em Saúde. Método: Trata-se de um relato de experiência, de cunho qualitativo e natureza descritiva, conduzido por meio do Arco de Maguerez, no ano de 2019, em um hospital de referência para o tratamento de doenças infectocontagiosas do estado de Rondônia. Resultados: O Arco de Maguerez foi ponto importante para a intervenção na realidade do contexto, por meio de duas dinâmicas intituladas “mitos e verdades” e “roleta lúdica”, que facilitaram a reflexão e a compreensão sobre o papel da educação permanente nos serviços estudados. Conclusão: As ações de educação permanente têm papel fundamental na construção de saberes, ampliando o conhecimento, por facilitar o compartilhamento de novas experiências com a equipe e o público externo.Objective: To report the experience of an educational practice of sensitization of health workers to the actions of Permanent Health Education. Method: This is an experience report, of a qualitative and descriptive nature, conducted through the Arc of Maguerez, in 2019, in a reference hospital for the treatment of infectious diseases in the state of Rondônia. Results: The Arc of Maguerez was an important point for intervention in the context reality, through two dynamics entitled “myths and truths” and “ludic wheel”, which facilitated reflection and understanding of the role of continuing education in the services studied. Conclusion: Continuing education actions play a fundamental role in the construction of expertise, expanding knowledge, as they facilitate the sharing of new experiences with the team and the external public.Objetivo: Relatar la experiencia de una práctica educativa de sensibilización de los trabajadores de salud a las acciones de Educación Permanente en Salud. Método: Se trata de un relato de experiencia, del tipo cualitativo y naturaleza descriptiva, conducido por medio del Arco de Maguerez, en 2019, en un hospital de referencia para tratamiento de enfermedades infectocontagiosas del estado de Rondonia, Brasil. Resultados: El Arco de Maguerez fue punto importante para la intervención en la realidad del contexto, por medio de dos dinámicas llamadas “mitos y verdades” y “ruleta lúdica”, que facilitaron la reflexión y la comprensión sobre el rol de la educación permanente en los servicios estudiados. Conclusión: Las acciones de educación permanente tienen un rol fundamental en la construcción de saberes, ampliando el conocimiento, pues facilitan el compartir de nuevas experiencias con el equipo y el público externo

Agentes Comunitários de Saúde no cuidado com a saúde da criança: implicações para a educação permanente

Objetivo: compreender as principais situações enfrentadas pelos agentes comunitários de saúde em relação à saúde da criança sob a ótica das ações de educação permanente. Método: trata-se de uma pesquisa com abordagem qualitativa, que utilizou o Arco de Maguerez. Participaram do estudo 10 agentes comunitários de saúde de uma Unidade de Atenção Primária à Saúde. Foram abordadas as etapas: observação da realidade; identificação dos pontos-chave e teorização. Os discursos foram gravados, transcritos e seu conteúdo textual foi processado no software IRAMUTEQ, utilizando-se a Classificação Hierárquica Descendente. Resultados: Formaram-se cinco classes, que compuseram três blocos temáticos nomeados da seguinte forma: vulnerabilidade social da criança no território; o manuseio da caderneta de saúde da criança e o calendário vacinal. Conclusão: O desvelar das situações que impactam no trabalho dos agentes comunitários de saúde são imprescindíveis para a educação permanente, por favorecer pressupostos aplicáveis no cotidiano do trabalho com resolutividade na saúde da criança.Objetivo: Comprender las principales situaciones vividas por los agentes de salud comunitaria en lo que se refiere a la salud del niño bajo la óptica de las acciones de educación permanente. Método: Es una investigación con abordaje cualitativo que utilizó el Arco de Maguerez. Participaron del estudio 10 agentes de salud comunitaria de un Centro de Atención Primaria a la Salud. Se abordaron las etapas: observación de la realidad, identificación de las cuestiones principales y teorización. Los discursos fueron grabados, transcritos y su contenido textual fue procesado en el software IRAMUTEQ utilizando la Clasificación Descendente Jerárquica. Resultados: Resultaron cinco clases que compusieron tres grupos temáticos nombrados de la siguiente manera: vulnerabilidad social del niño en el territorio, el manejo del carné de vacunación del niño y el calendario de vacunas. Conclusión: La revelación de las situaciones que impactan el trabajo de los agentes de salud es imprescindible para la educación permanente, una vez que puede favorecer premisas aplicables en el cotidiano del trabajo con resoluciones en la salud del niño.Objective: To understand the main situations faced by community health agents in relation to children’s health in the light of permanent education actions. Method: This is a research of qualitative approach, which used the Arc of Maguerez. Ten community health agents from a Primary Health Care Unit participated in the study. The following steps were addressed: observation of reality; identification of key points, and theorization. The speeches were recorded, transcribed, and their textual content was processed in the IRAMUTEQ software, using the Descending Hierarchical Classification. Results: Five classes were formed, which composed three thematic blocks named as follows: child’s social vulnerability in the territory; handling the child’s health record, and vaccination schedule. Conclusion: Unveiling situations that influence the work of community health agents is essential for continuing education, as this favors assumptions applicable to daily work with resoluteness in child health

Ba/Ca ratios in teeth reveal habitat use patterns of dolphins

Teeth and otoliths are metabolically inert structures that preserve a chronology of chemical variations that may be related to the environmental histories experienced by each organism. Because of the natural decrease of barium (Ba) and increase of strontium (Sr) bioavailability in water with increasing salinity, these elements may be especially useful to track habitat use in aquatic organisms. Therefore, we tested whether the Ba/Ca and Sr/Ca ratios in the teeth of dolphins represent a salinity gradient. The main aim was to determine whether these elements can be used as a natural tag for different aquatic environments. Teeth from 2 freshwater dolphins (Inia geoffrensis and Sotalia fluviatilis) and 2 marine species (S. guianensis and Pontoporia blainvillei) from Brazil and Uruguay were analyzed using a Laser Ablation Inductively Coupled Plasma-Mass Spectrometer. Intensity ratios of 138Ba/43Ca and 86Sr/43Ca were measured along a line that covered all growth increments in the dentin from the second year of life onwards. Teeth from the freshwater species had mean Ba/Ca values tenfold higher than marine dolphins, confirming the inverse relationship between salinity (and thus ambient Ba/Ca) and elemental ratios in teeth. Furthermore, Ba/Ca ratios could also differentiate dolphins from lower-salinity estuarine areas from those in areas with minimal freshwater discharge. No significant differences were found for Sr/Ca values. Results presented encouraging indications for the application of this technique as a potential new tool for studying habitat use in aquatic mammals