Impact of storage temperature abuse on the microbial quality and safety of fresh-cut vegetables and fruits

info:eu-repo/semantics/publishedVersio

Monitorização e avaliação da dor na pessoa em situação crítica: uma revisão integrativa de literatura

Introdução: A dor é um fenómeno frequente na Pessoa em situação crítica (PSC), tem impacto no estado geral da pessoa e torna-se consciente segundo um processo denominado nociceção. Assim, a sua gestão torna-se essencial, envolvendo a sua monitorização, avaliação e tratamento, o que requer o uso de escalas e instrumentos apropriados. Objetivos: Analisar a evidência existente sobre os instrumentos e intervenções de avaliação e monitorização da dor na PSC. Metodologia: Foi efetuada uma Revisão integrativa da literatura (RIL), através da pesquisa nas bases de dados MEDLINE e CINAHL e em outras fontes. Foram estabelecidos critérios de inclusão e exclusão para seleção dos documentos finais. Resultados e Discussão: Obtiveram-se 165 documentos, quatro dos quais obtidos através de outras fontes. Após leitura do resumo e texto integral para verificação de elegibilidade, resultaram 19 documentos finais, para extração e análise de dados. Os documentos obtidos reforçam a necessidade de avaliação e monitorização sistemática da dor e a utilização de protocolos de gestão da dor. No que diz respeito à sua monitorização, esta deve ter por base a utilização de instrumentos/escalas devidamente validadas para a PSC, dando prioridade ao uso de escalas de autorrelato quando possível. Surge ainda a monitorização da nociceção como forma de detetar a presença de dor na PSC de modo objetivo, não invasivo e contínuo. Simultaneamente deve ser efetuada a avaliação da dor tendo em consideração os fatores individuais que possam afetar a forma como a dor é avaliada, tratada e vivenciada pela pessoa. Conclusão: A gestão da dor requer uma monitorização e avaliação da mesma, por profissionais com conhecimento específico na área, tendo o enfermeiro uma intervenção fulcral nessa gestão. A evidência aponta para a necessidade de desenvolvimento de estudos mais profundos e com população de maiores dimensões, sobre a eficácia da monitorização da nociceção, em comparação com a monitorização-padrão, para que o seu uso sistemático seja sustentado na prática clínica

Economia brasileira: transição para uma Economia Verde?

Este artigo visa considerar duas questões. Primeiro, discute-se se o que a Economia Verde tenta propor é um conteúdo “mais do mesmo” acerca das discussões ambientais desde a década de 70 do último século, em que as proposições sobre o desenvolvimento sustentável foram sua maior expressão, mas agora com um novo apelo: a crise ambiental é inevitável e, ao invés de ela ser necessariamente um problema econômico, pode vir a ser uma oportunidade de mercado. Nessa perspectiva, a segunda questão é analisada a partir de dados e informações relacionados ao comportamento do setor produtivo brasileiro, indagando-se se a economia brasileira segue o caminho de uma Economia Verde. Os dados e perspectivas dos investimentos que eram planejados até 2015 não permitem afirmar que a economia brasileira caminha na direção de uma Economia Verde, ou se segue a marcha de uma trajetória para isso. Palavras-chave: Economia Verde; economia brasileira; oportunidades econômicasTÍTULO EM INGLÊSBrazilian economy: transition to a Green Economy?AbstractThis article aims at considering two questions. First, we discuss whether the Green Economy is not attempting to propose a content that is "more of the same" about the environmental discussions that have been taking place since the 1970s, of which the propositions of sustainable development were the greatest expression, but now with a new appeal: the environmental crisis is inevitable and instead of necessarily being an economic problem, could end up being a market opportunity. In this perspective, the second question is examined based on data and information concerning the behavior of the Brazilian productive sector, in which we question if the Brazilian economy follows the path of a Green Economy. The data and prospects of the investments that were planned until  2015 do not allow us to claim that the Brazilian economy is moving towards a Green Economy or that it is following the trend of a transition to it. Keywords: Green Economy; Brazilian economy; economic opportunitiesClassificação JEL: O44, Q56Artigo recebido em dez. 2013 e aceito para publicação em set. 2015

Delirium management in critically ill patients: an integrative review

Introduction: The critically ill patient is at high risk of developing delirium, which is an independent predictor of mortality, morbidity, increased length of stay, health costs and safety incidents. The incidence of this disturbance can reach 80% in this population, with severe impact on short and long-term outcomes of patients and family. Objectives: To analyse and summarise evidence regarding nursing interventions that are effective on delirium management in critically ill patients. Methodology: For this integrative review, literature research was conducted in electronic databases MEDLINE, CINAHL and Cochrane Database of Systematic, as well as other sources, from January 2013 to September 2021. Results and Discussion: The search retrieved 140 documents, 135 obtained from electronic databases and five from other sources. After assessing eligibility, 22 final documents were obtained for data extraction and analysis. The results show that the implementation of multicomponent interventions have greater benefits in reducing delirium incidence and duration. Non-pharmacological interventions, like early mobilization and family participation, also stand out. Nurses play a significant role in delirium management, and this review can help nurses to choose interventions based on clinical evidence, improving the outcomes of the critically ill patient. Conclusion: The implementation of multicomponent interventions demonstrates greater benefits in reducing delirium incidence and duration, with impact on other person-centred outcomes. Further multicentric studies are needed to prove unequivocal benefits of engaging the family of critically ill adults with delirium, and its benefits in their outcomes

Intrapartum care policies in high-income countries with a universal health system: A scoping review

Evidence-based and sustainable intrapartum care policies are essential for safer, effective, and positive birth experiences. This scoping review aimed to map intrapartum care policies for pregnant women at low-risk of complications, in high-income countries with a universal health system. The study followed Joanna Briggs Institute methodology for scoping reviews and PRISMA-ScR. Search was conducted on CINAHL-EBSCO, Scopus, MEDLINE-Pubmed, Cochrane Central Register of Controlled Trials-EBSCO, and, Academic Search CompleteEBSCO. Grey literature was searched, references screened and experts contacted for additional studies/policies. Data were extracted/analysed by two independent reviewers and results were presented in tabular and narrative format. The concept was governmental intrapartum care policies, the context were OECD high-income countries with a health-financing system founded on the Beveridge Model and the participants were low-risk pregnant women From the 561 records screened, 22 were selected, concerning intrapartum care policies from Australia, Denmark, Spain, Finland, Portugal, and the United Kingdom. All the included records were retrieved in the grey literature. No intrapartum care governmental policies were found for Greece, Iceland, Italy, New Zealand, Norway, and Sweden. Some countries do not refer to all the analysed care aspects and there are differences in detail, depth, range, and scientific. The policies show general similarities but differ in the timing and the content of the recommended intrapartum care. Not all of the analysed countries have intrapartum care policies and those who have shown differences between recommendations. These results can be used to create/ revise intrapartum care policies.info:eu-repo/semantics/publishedVersio

Educação Nutricional Continuada no Controle do Diabetes em Idosos

O diabetes mellitus tipo 2 é um distúrbio do metabolismo dos carboidratos associados à produção defi ciente de insulina pelas células beta-pancreáticas e/ou diminuição da sensibilidade celular a esse hormônio. O controle glicêmico favorece o retardo de complicações crônicas. Tal controle é atingido com tratamento adequado da doença em resposta à ingestão de dieta adequada, atividade física regular e uso de medicamentos. Assim, o objetivo do presente trabalho foi conscientizar diabéticos da terceira idade sobre a importância da adesão ao tratamento prescrito. Para tal, voluntários do projeto participaram de reuniões quinzenais e atendimentos ambulatoriais individualizados. Esse último, por meio da avaliação nutricional e de orientações sobre a doença, que proporcionou treinamento e desenvolvimento de habilidades úteis ao bom exercício da profi ssão, no que tange à atividade de ensino e também atendimento diferenciado e de qualidade à comunidade assistida pelo projeto. Foi possível perceber que o controle metabólico do diabetes seja por tratamento medicamentoso ou não, depende não só do atendimento nutricional ou das reuniões das quais o grupo participa. É necessário total envolvimento do paciente, da família e da sociedade para que o diabético consiga conduzir o tratamento de maneira satisfatória, minimizando o risco de desenvolver complicações induzidas pelo descontrole glicêmico. &nbsp

Caracterización de los síntomas físicos de estrés en el equipo de Emergencias

O profissional de enfermagem que atua no Pronto Atendimento sofre sintomas físicos de estresse em sua atividade diária. O objetivo desta pesquisa foi caracterizar esses sintomas com utilização do instrumento semiestruturado Occupational Stress Indicator. Para tanto, os autores elaboraram perguntas abertas, aplicadas em entrevistas gravadas e analisadas. Os sintomas físicos listados pelos pesquisadores foram: cefaléia, sensação de fadiga, dores nas pernas e taquicardia. Segundo relatos dos colaboradores, as dores sempre resultavam de estresse emocional ou surgiam após atendimentos emergenciais, o que leva a crer que existe uma grande dificuldade desses colaboradores em separar o estresse físico do psíquico. A investigação determinou a necessidade de medidas para acompanhamento dos funcionários na sua atividade laboral. Elaborou-se uma cartilha com sugestões básicas para a melhoria da qualidade de vida da equipe de saúde.Nursing professionals working in Emergency Care suffer from the physical symptoms of stress in their everyday activity. The objective of this study was to characterize these symptoms using the Occupational Stress Indicator, a semi-structured instrument. To do this, the authors created open questions that were applied in interviews that were recorded and analyzed. The researchers listed the following physical symptoms: headache, a sensation of fatigue, leg pain, and tachycardia. According to reports form the workers, pain always resulted from emotional stress or appeared after providing emergency care, which suggests the workers find it very difficult to differentiate physical from mental stress. The investigation found that there is a need for measures to follow workers in their working activity. A manual was created, containing basic suggestions to improve the quality of life of the health team.El profesional de enfermería que actúa en Emergencias sufre síntomas físicos de estrés en su actividad diaria. Esta investigación objetivó caracterizar tales síntomas con utilización del instrumento semiestructurado Occupational Stress Indicator. Para ello, los autores elaboraron preguntas abiertas, aplicadas en entrevistas grabadas y analizadas. Los síntomas físicos determinados por los investigadores fueron: cefalea, sensación de fatiga, dolor de piernas y taquicardia. Según testimonios de los colaboradores, los dolores siempre derivaban de estrés emocional o surgían luego de atenciones de emergencias, lo que lleva a pensar que existe una gran dificultad en tales colaboradores para separar el estrés físico del psíquico. La investigación determinó la necesidad de medidas para seguimiento de los trabajadores en su actividad laboral. Se elaboró un listado de sugerencias básicas para mejorar la calidad de vida del equipo de salud

Salivary Changes, Systemic Conditions, and Medication Use in Independently-Living Aged: A Cross-Sectional Study

Objective: To determine the unstimulated salivary flow, pH, and buffering capacity and their associations with systemic conditions and medication use in independently living aged. Material and Methods: This cross-sectional study included 72 participants with a minimum of 60 years recruited in Belo Horizonte, Brazil. A questionnaire was used to collect age, sex, presence of systemic diseases, and medications in continuous use. Salivary data collection was performed to determine unstimulated salivary flow, pH, and buffering capacity. Descriptive, bivariate, and multivariate analyses were performed (p<0.05). Results: Most of the sample had at least one systemic disease (81.9%) and used at least one medication (79.2%). Female participants (p=0.01), those with five or more systemic diseases (p<0.01), and hypertension (p=0.04) had reduced salivary flow. Participants with systemic diseases (p=0.02), taking any medication (p=0.04), in a polypharmacy regimen, and presenting hypertension (p=0.02) had more acidic salivary pH. Participants with diabetes had average salivary buffering capacity (p=0.02). In the adjusted multiple regression models, no explanatory variable was significantly associated with the salivary outcomes. Conclusion: Systemic alterations and medication use appear to be related to salivary changes in older adults. Integrative assessment of older adults is fundamental to identifying and controlling the factors that may modify their salivary characteristics

Clinical and Laboratory Profile of Dogs Seroreactive to Ehrlichiosis Treated at the Veterinary Medical Teaching Hospital in Niterói, State of Rio de Janeiro, Brazil

Background: Ehrlichiosis is a tick-borne disease highly prevalent in Brazil, and is relevant in canine clinical practice due to its high morbidity and mortality. Its clinical signs are nonspecific and its phases are acute, lasting 2 to 4 weeks; subclinical, i.e., asymptomatic; and chronic, resembling an autoimmune disease. The purpose of this study was to identify the occurrence of reactivity to Ehrlichia canis of bitches treated at the Veterinary Medical Teaching Hospital of the Universidade Federal Fluminense (UFF) - Niterói, RJ, Brazil, based on serological examination by iELISA, and to compare the hematological, biochemical, urinary protein-creatinine and urinary density profiles of reactive and non-reactive animals. Materials, Methods & Results: This study involved solely bitches, regardless of breed, starting at 1 year of age. One hundred and thirty bitches, 1 to 16 year-old (mean age 7.02 ± 4.00), weighing 1.5 to 50 kg (mean weight 12.12 ± 10.65) were subjected to clinical examination and abdominal ultrasound. Complete blood count, biochemical measurements, urinalysis and serology for E. canis were also performed. The serum was used in the iELISA to identify immunoglobulin G (IgG), using a canine Ehrlichia Imunotest® diagnostic kit (Imunodot®, Jaboticabal, SP, Brazil) according to the manufacturer’s instructions. Sixty animals (46.20%) were reactive to E. canis. According to their owners, only 5 (8.3%) of the 60 seroreactive animals had a history of tick-borne disease. The most common profile was that of mixed breed animals living with their owners, older than 7 years, who had not been treated preventatively with specific drugs against ectoparasites. Laboratory tests showed significant differences between groups in terms of total protein (TP), and calcium and urinary protein-creatinine ratio (UPC). TP and UPC were elevated in the non-reactive group, while the only significant change in the reactive group was mild hypocalcemia. In this study, 30% (18/60) of the bitches were seroreactive to E. canis and had hypocalcemia. Of these, 50% (9/18) had a UPC above 0.5. Furthermore, 66.7% (12/18) of this group with hypocalcemia also showed urine density (UD) of less than 1024. Among these 18 bitches, 5 had both alterations, i.e., UPC > 0.5 and UD < 1024.Discussion: In this study, a high prevalence of bitches seroreactive to Ehrlichia canis was observed, despite the absence of clinical and/or laboratory signs indicative of the disease. In the investigation of IgG class antibodies, it is not possible to determine the exact time of infection, and titers may remain high for a period of more than 11 months, even after treatment and elimination of the bacterium. The fact that most seroreactive bitches showed no symptoms compatible with the disease either before or during the study suggests that they were in the subclinical phase of ehrlichiosis. The main reason for calcium metabolism disorders is a phosphorus imbalance, a condition that occurs in kidney diseases. Isosthenuria reflects the kidney’s inability to concentrate urine. This finding may be one of the first clinical manifestations of chronic kidney disease (CKD), especially in dogs. On the other hand, the UPC ratio may increase with the progression of CKD. The presence of hypocalcemia, isosthenuria and increased UPC associated with seroreactivity suggests that infection by E. canis may be associated with the onset of CKD. Veterinarians should keep in mind the complexity of the pathophysiology of ehrlichiosis to ensure the disease is not underdiagnosed in any of its phases, thereby ensuring the correct treatment is provided. Such awareness is expected to reduce the chronicity of the disease and underlying sequelae among dogs.Keywords: Ehrlichia canis, serology, tick, clinic, renal.Descritores: Ehrlichia canis, sorologia, carrapato, clínica, renal.Título: Perfil clínico e laboratorial de cadelas sororeativas para erliquiose tratadas em um Hospital Veterinário Universitário em Niterói, Estado do Rio de Janeiro, Brasil

Diffuse Axonal Injury: Epidemiology, Outcome and Associated Risk Factors

Abstract Diffuse axonal injury (DAI), a type of traumatic injury, is known for its severe consequences. However, there are few studies describing the outcomes of DAI and the risk factors associated with it. This study aimed to describe the outcome for patients with a primary diagnosis of DAI six months after trauma and to identify sociodemographic and clinical factors associated with mortality and dependence at this time point. Seventy-eight patients with DAI were recruited from July 2013 to February 2014 in a prospective cohort study. Patient outcome was analyzed using the Extended Glasgow Outcome Scale (GOS-E) within six months of the traumatic injury. The mean Injury Severity Score was 35.0 (SD = 11.9), and the mean New Injury Severity Score (NISS) was 46.2 (SD = 15.9). Mild DAI was observed in 44.9% of the patients and severe DAI in 35.9%. Six months after trauma, 30.8% of the patients had died, and 45.1% had shown full recovery according to the GOS-E. In the logistic regression model, the severity variables—DAI with hypoxia, as measured by peripheral oxygen saturation, and hypotension with NISS value—had a statistically significant association with patient mortality; on the other hand, severity of DAI and length of hospital stay were the only significant predictors for dependence. Therefore, severity of DAI emerged as a risk factor for both mortality and dependence