A intervenção precoce: uma aliada dos cuidados de saúde prestados nas Unidades de Cuidados Intensivos Neonatais?

Dissertação de mestrado em Educação Especial (área de especialização em Intervenção Precoce)As Unidades de Cuidados Intensivos Neonatais representam uma realidade muitas vezes desconhecida e ignorada pela nossa sociedade, no entanto significam um início de vida diferente para um número considerável de recém-nascidos. Nos últimos anos, tem havido uma preocupação crescente em tornar estas unidades num serviço hospitalar complexo que valoriza, ao mesmo tempo, a sofisticação científica e tecnológica que permite salvar um número cada vez maior de bebés, prematuros ou doentes, e os cuidados holistas e humanistas que visam salvaguardar o bem-estar e promover o desenvolvimento dos bebés, dos pais e dos profissionais. O presente estudo tem como finalidade conhecer um serviço de Neonatologia de referência do nosso país, e perceber a sua articulação com o Sistema Nacional de Intervenção Precoce. De natureza qualitativa, esta investigação tomou como metodologia o Estudo de Caso. Participaram no estudo oito pais de bebés prematuros internados na Unidade de Cuidados Intensivos Neonatais e dez profissionais de saúde da equipa de profissionais desta mesma unidade. Para a coleta de dados, recorremos à entrevista semiestruturada. Dos resultados obtidos verificou-se uma parceria de cuidados entre profissionais de saúde e pais, na qual os pais são incentivados a participar nos cuidados a prestar ao recémnascido. Uma relação de empatia, ajuda, conforto e confiança entre profissionais de saúde e pais parece existir. As preocupações e necessidades dos pais são tidas em consideração, no entanto, a falta de tempo dos profissionais de saúde aparece como uma limitação à sua atuação. A articulação entre os serviços de Neonatologia e os serviços de Intervenção Precoce não é a que seria desejada, no entanto esta confirma-se no que concerne à referenciação de algumas crianças para o Sistema Nacional de Intervenção Precoce.The Neonatal Intensive Care Unit (NICU) can be a reality sometimes unnoticed and ignored by the society, however for some new born children it might mean a significantly different beginning of their lives. In the latest years, there is a growing concern in developing those type of wards, providing a complex hospital service, looking for scientific and technological innovation, which has enabled the lifesaving of more and more new born babies either sick or premature as well as an holistic and humanitarian care to prevent welfare and to promote the development of babies, parents and healthcare professionals. This study aims at knowing one of the most renown NICU in Portugal and understanding its coordination with the Sistema Nacional de Intervenção Precoce na Infância (SNIPI). From a quality point of view, this research used the study case method, 8 parents from babies hospitalized in the ward and 10 healthcare professionals from the Neonatal Intensive Care Unit participated in this study. To collect the data, semi-structured interview was used. From the results analysis, it could be concluded that there is a partnership between healthcare professionals and parents in terms of involvement in treatment. Parents are encouraged to be involved in the medical care provided to newborn children. It is also indicated that sympathetic, trustful and mutual help and comfort relationship exists between healthcare professionals and parents. The concerns and needs of the parents are taken into account, however the lack of availability from the healthcare professionals may limit it. The coordination between Neonatal services and Early Intervention services is not the ideal one, yet it was confirmed that some children are referred to the Sistema Nacional de Intervenção Precoce na Infância

Dieta Mediterrânica e Diabetes Gestacional

Introdução: A Diabetes Gestacional é um problema de saúde pública com prevalência crescente e consequências adversas para a mãe e o recém-nascido a curto e longo prazo. A International Diabetes Federation estimou que, em 2017, 14% das grávidas a nível mundial, ou seja, cerca de 18 milhões de mulheres eram afetadas pela Diabetes Gestacional. É essencial atuar na prevenção desta patologia, sendo que uma das formas é a promoção de estilos de vida saudáveis, onde a Dieta Mediterrânica se destaca. Esta dieta é caracterizada pelo consumo abundante de produtos vegetais e utilização preferencial de azeite como fonte de gordura, tendo propriedades antiinflamatórias e antioxidantes potencialmente benéficas na prevenção da Diabetes Gestacional. Neste trabalho pretende-se descrever a fisiopatologia da Diabetes Gestacional, o conceito de Dieta Mediterrânica e o modo como os componentes desta dieta têm influência neste quadro clínico, respondendo à seguinte questão: a adoção da Dieta Mediterrânica pode prevenir o desenvolvimento da Diabetes Gestacional? Metodologia: Foi feita uma pesquisa na Publisher Medline com as palavraschave “mediterranean diet” AND “gestational diabetes”, com especificação de artigos publicados entre janeiro de 2016 e setembro de 2021 e, após a leitura dos resumos, foram escolhidos aqueles que abordavam a influência da adoção da Dieta Mediterrânica no desenvolvimento de Diabetes Gestacional. Foram também lidas e analisadas publicações em revistas científicas, normas e websites. Resultados: A análise dos artigos indica que a Dieta Mediterrânica tem capacidade de reduzir o estado pró-inflamatório, o stress oxidativo e a hiperglicemia associados à Diabetes Gestacional e, portanto, reduzir o risco do seu desenvolvimento. O azeite extra-virgem, os frutos secos e os alimentos com polifenóis na sua constituição são essenciais nestes resultados, no entanto, é o efeito sinérgico de todos os elementos constituintes desta dieta que mostra melhores resultados. Conclusão: A adoção de uma Dieta Mediterrânica, no início da gravidez, diminui o risco de desenvolvimento de Diabetes Gestacional, reduz a necessidade de farmacoterapia nas grávidas que desenvolveram este quadro e tem capacidade de redução de algumas das complicações associadas a esta. Assim, deverá ser feita a sua implementação como estratégia preventiva na abordagem às grávidas no início da gestação e, se possível, mesmo antes da conceção.Introduction: Gestational Diabetes is a public health problem with rising prevalence and adverse outcomes to the mother and the baby both in short and long term. The International Diabetes Federation, in 2017, has estimated that 14% of world pregnant women had gestational diabetes, which means 18 million pregnancies were affected by this. It’s crucial to act on behalf of preventing this disease, bringing up the promotion of healthy lifestyles, where the Mediterranean Diet fits. This diet is characterized by the abundant consumption of vegetable products and the use of olive oil as the main source of fat, having anti-inflammatory and antioxidant properties which can be beneficial in the prevention of Gestational Diabetes. This thesis intends to describe the pathophysiology of Gestational Diabetes, the concept of Mediterranean Diet and the way in which the components of this diet exert influence in Gestational Diabetes, answering the following question: can the adoption of Mediterranean Diet prevent the development of Gestational Diabetes? Methodology: A research was made in Publisher Medline with the key words “Mediterranean diet” and “gestational diabetes”, with specification to articles published since January of 2016 until September of 2021, and after reading all the abstracts, the ones that adressed the influence of the adoption of the Mediterranean Diet and the development of Gestational Diabetes were chosen. Publications in scientific journals, guidelines and websites were read and analyzed. Results: After careful analysis of the articles, they indicate that the Mediterranean Diet has the capacity of reducing the pro-inflammatory state, the oxidative stress and the hyperglycemia related to Gestational Diabetes and, so, reducing the risk of its development. Extra virgin olive oil, nuts and polyphenols enriched foods are essential to these results, however, the synergic effect of all elements has the highest value. Conclusion: Following a Mediterranean diet since early in pregnancy lowers the risk of developing gestational diabetes, lowers the need for pharmacotherapy in pregnant women that had already developed gestational diabetes during that pregnancy and has the ability of reducing some of the complications associated to the disease. Thereby, it should be implemented as a preventive strategy in the approach of pregnant women since early pregnancy and, if possible, even before conception

VA Centers of Excellence in Primary Care Education

VETERANS HEALTH ADMINISTRATION CoEPCE Purpose •Develop and test innovative approaches for curricula related to core competencies of patient-centered care. •Study the impact of new educational approaches and models on health professions education to include collaboration, cultural shifts in educational priorities, and educational and workforce outcomes within and beyond VA. •Improve primary care instructional strategies with emphasis on workplace learning Stuart C. Gilman, MD, MPH Director, Advanced Fellowships and Professional Development Centers of Excellence in Primary Care Education Office of Academic Affiliations Veterans Health Administration In his role as Director, Advanced Fellowships and Professional Development, Office of Academic Affiliations, Veterans Health Administration, Stuart is a leader in national education policy with the nation’s largest health profession education system. He has oversight of VA’s most in-depth and advanced training programs for physicians and others, including the VA Quality Scholars Program and Advanced Fellowships in Patient Safety, Mental Illness Treatment, and Health System Engineering. Stuart also oversees VA’s engagement with the Robert Wood Johnson Foundation Clinical Scholars Program. In addition, he directs the Centers of Excellence in Primary Care Education, a national demonstration project at five VA sites advancing interprofessional education in patient-centered primary care settings. Stuart’s undergraduate education was at Grinnell College, then he received his medical degree from Rush University. Stuart completed Internal Medicine residency at VA/ UC Irvine and obtained his MPH from UCLA. After his residency, he was a VA/Robert Wood Johnson Clinical Scholar at UC San Francisco. Based in Southern California, Stuart is a practicing primary care general internist and has rank of Professor, Clinical Health Sciences at University of California, Irvine. Kathryn Rugen, PhD, FNP-BC Nurse Practitioner Consultant Centers for Excellence in Primary Care Education Office of Academic Affiliations Veterans Health Administration Kathryn Rugen, PhD, FNP-BC is the nurse practitioner consultant to the VA Centers of Excellence in Primary Care Education. These Centers are funded by the VA Office of Academic Affiliations. Dr. Rugen is a member of the coordinating center which oversees the facilitation of the Centers and manages the operations, evaluation and sustainability efforts. She is responsible for assisting the sites in transforming primary care delivery models and developing and testing new models of education. Dr. Rugen is an assistant professor at the University of Illinois at Chicago, College of Nursing

Ethics and the Public Administrator

This article provides an overview and analysis of the practical problems of developing and implementing a code of ethics for public administrators. The article addresses three key issues: (1) What are public ethics and where do they come from? (2) What are the central ethical issues facing public administrators? and (3) Are there practical tools and guidelines to assist public servants to be both ethical and effective public managers? The article concludes with a plea for consideration of ethical issues, and it presents five general ethical principles for public administrators

Glycosylation of Trypanosoma cruzi TcI antigen reveals recognition by chagasic sera

Chagas disease is considered the most important parasitic disease in Latin America. The protozoan agent, Trypanosoma cruzi, comprises six genetic lineages, TcI-TcVI. Genotyping to link lineage(s) to severity of cardiomyopathy and gastrointestinal pathology is impeded by the sequestration and replication of T. cruzi in host tissues. We describe serology specific for TcI, the predominant lineage north of the Amazon, based on expression of recombinant trypomastigote small surface antigen (gTSSA-I) in the eukaryote Leishmania tarentolae, to allow realistic glycosylation and structure of the antigen. Sera from TcI-endemic regions recognised gTSSA-I (74/146; 50.7%), with no cross reaction with common components of gTSSA-II/V/VI recombinant antigen. Antigenicity was abolished by chemical (periodate) oxidation of gTSSA-I glycosylation but retained after heat-denaturation of conformation. Conversely, non-specific recognition of gTSSA-I by non-endemic malaria sera was abolished by heat-denaturation. TcI-specific serology facilitates investigation between lineage and diverse clinical presentations. Glycosylation cannot be ignored in the search for immunogenic antigens

Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010

Typhoid and paratyphoid fever remain important causes of morbidity worldwide. Accurate disease burden estimates are needed to guide policy decisions and prevention and control strategies

Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9-10 year old children from deprived neighbourhoods: a cross-sectional study.

BACKGROUND: Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods. METHODS: Cross-sectional data was collected from 9-10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level. RESULTS: Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is 'definitely' bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to 'definitely' believe that the smoke from other people's cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to 'definitely' believe that smoking is bad for health. CONCLUSION: This study indicates that sibling and friend smoking may represent important influences on 9-10 year old children's cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed