As perspectivas da pedagogia freireana e a sua influência sobre a educação alimentar e nutricional: Uma revisão de literatura / The perspectives of freirean pedagogy and its influence on food and nutrition education: A literature review

A Educação Alimentar e Nutricional (EAN) é um campo de conhecimento e de ação contínua e multiprofissional que objetiva promover a prática autônoma de hábitos alimentares saudáveis (BEZERRA, 2018). Neste sentido, reafirma-se a necessidade de situar a EAN no campo das ciências sociais e humanas, o que resulta no entendimento da alimentação como prática social, ou seja, constituída por elementos objetivos e simbólicos capazes de converter o ato alimentar em um fato social (ALVES, 2013). Esta dimensão da alimentação é um alicerce teórico importante, especialmente se embasado nas perspectivas da Pedagogia Freireana, impulsionando reflexões e elaborando estratégias de superação de um “pseudocientificismo” do campo, o qual tende a ignorar a importância do sujeito e de sua relação com o mundo por meio das práticas alimentares (BESERRA, 2011). Na educação em saúde, é muito comum que seja observada a prevalência do modelo tradicional e antigo de educação, que segundo as concepções de Paulo Freire, é denominado de “educação bancária”, ou seja, um modelo de ensino no qual o educador tem como dever “encher” os educandos de conteúdos de sua narração, realizando apenas depósitos de informações (FREIRE, 2005). Conforme o apresentado por Becker (2012), as práticas educativas nos âmbitos da alimentação e nutrição, atualmente, ainda se apresentam com base nesta transmissão de informações, valendo-se de estratégias como palestras e materiais informativos, que evidenciam uma concepção empirista do processo de ensino e aprendizagem, na qual a crença de que os educandos somente aprenderão se o professor ensinar, como nos modelos tradicionais e conhecidos de ensino. Quanto a Nutrição, a intenção é convencer os sujeitos a aderirem ao projeto dietoterápico preconizado, incentivando uma boa relação com os alimentos de forma a também estimular a mudança de hábitos com seu inteiro protagonismo, ressignificando o processo e permitindo um aprimoramento do cuidado por meio de uma escuta acolhedora e humana, formação de vínculo profissional/usuário e integração da pessoa ao meio ambiente e sociedade (SANTOS, 2012). Segundo Pereira (2003), a educação e a saúde são espaços de agregação e aplicação de saberes e conhecimentos destinados ao desenvolvimento humano. Tal desenvolvimento pode ser conquistado através da pedagogia proposta por Freire, a qual tende a possibilitar e incentivar que o  indivíduo, através de atos que indagam determinados contextos, possa refletir e encontrar novas soluções e estratégias para lidar com as situações

Morbidade materna pela doença hipertensiva especifica da gestação: estudo descritivo com abordagem quantitativa Maternal morbidity by hypertensive disease specific of the pregnancy: a descriptive study of a quantitative approach

Objetivos: identificar o perfil das mulheres com Doença Hipertensiva Especifica da Gestação atendidas no Hospital Universitário Antônio Pedro (HUAP). Método: estudo descritivo e retrospectivo, com abordagem quantitativa. Realizado no HUAP. Resultados: no ano de 2011, 8% das internações na maternidade do HUAP foram decorrentes da DHEG. A idade média das pacientes foi de 29 anos. Referente à raça/cor houve predominância da cor parda, 57%. Quanto à paridade, 30% eram primigestas. Os diagnósticos médicos predominantes foram Hipertensão Arterial Não Classificada 30% e Pré-eclâmpsia, 28%. Considerações finais: a DHEG é uma das principais causas de mortalidade materna, e o conhecimento a respeito do perfil da população permite a enfermagem obstétrica possa exercer um papel fundamental no auxilio a redução da mortalidade materna

Morbidade materna pela doença hipertensiva especifica da gestação: estudo descritivo com abordagem quantitativa Maternal morbidity by hypertensive disease specific of the pregnancy: a descriptive study of a quantitative approach

Objetivos: identificar o perfil das mulheres com Doença Hipertensiva Especifica da Gestação atendidas no Hospital Universitário Antônio Pedro (HUAP). Método: estudo descritivo e retrospectivo, com abordagem quantitativa. Realizado no HUAP. Resultados: no ano de 2011, 8% das internações na maternidade do HUAP foram decorrentes da DHEG. A idade média das pacientes foi de 29 anos. Referente à raça/cor houve predominância da cor parda, 57%. Quanto à paridade, 30% eram primigestas. Os diagnósticos médicos predominantes foram Hipertensão Arterial Não Classificada 30% e Pré-eclâmpsia, 28%. Considerações finais: a DHEG é uma das principais causas de mortalidade materna, e o conhecimento a respeito do perfil da população permite a enfermagem obstétrica possa exercer um papel fundamental no auxilio a redução da mortalidade materna

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

Avanços da cirurgia robótica no tratamento de doenças cardiovasculares

Várias cirurgias médicas já utilizaram a tecnologia robótica, tais como: cirurgias no estômago, bexiga, rins, próstata, cérebro e inclusive no coração, o qual proporciona-se a reparação de válvulas cardíacas e até mesmo cirurgias nas artérias. O principal objetivo do presente estudo é discutir por meio da literatura científica acerca dos avanços da cirurgia robótica no tratamento de doenças cardiovasculares. Trata-se de uma revisão sistemática da literatura, dos quais, utilizou-se as bases e biblioteca eletrônica Scielo e Periódico Capes, totalizando 5 artigos elegíveis. A cirurgia robótica tem sido um dos principais métodos utilizados em tratamentos cardiovasculares quando comparados com técnicas convencionais, sobretudo, no que diz respeito, a cirurgia de revascularização do miocárdio

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

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Com o diabo no corpo: os terríveis papagaios do Brasil colônia

Desde a Antiguidade, papagaios, periquitos e afins (Psittacidae) fascinaram os europeus por seu vivo colorido e uma notável capacidade de interação com seres humanos. A descoberta do Novo Mundo nada faria além de acrescentar novos elementos ao tráfico de animais exóticos há muito estabelecido pelos europeus com a África e o Oriente. Sem possuir grandes mamíferos, a América tropical participaria desse comércio com o que tinha de mais atrativo, essencialmente felinos, primatas e aves - em particular os papagaios, os quais eram embarcados em bom número. Contudo, a julgar pelos documentos do Brasil colônia, esses voláteis podiam inspirar muito pouca simpatia, pois nenhum outro animal - exceto as formigas - foi tantas vezes mencionado como praga para a agricultura. Além disso, alguns psitácidas mostravam-se tão loquazes que inspiravam a séria desconfiança de serem animais demoníacos ou possessos, pois só três classes de entidades - anjos, homens e demônios - possuíam o dom da palavra. Nos dias de hoje, vários representantes dos Psittacidae ainda constituem uma ameaça para a agricultura, enquanto os indivíduos muito faladores continuam despertando a suspeita de estarem possuídos pelo demônio. Transcendendo a mera curiosidade, essa crença exemplifica o quão intrincadas podem ser as relações do homem com o chamado “mundo natural”, revelando um universo mais amplo e multifacetado do que se poderia supor a princípio. Nesse sentido, a existência de aves capazes de falar torna essa relação ainda mais complexa e evidencia que as dificuldades de estabelecer o limite entre o animal e o humano se estendem além dos primatas e envolvem as mais inusitadas espécies zoológicas.Since ancient times, parrots and their allies (Psittacidae) have fascinated Europeans by their striking colors and notable ability to interact with human beings. The discovery of the New World added new species to the international exotic animal trade, which for many centuries had brought beasts to Europe from Africa and the Orient. Lacking large mammals, tropical America participated in this trade with its most appealing species, essentially felines, primates and birds - especially parrots - which were shipped in large numbers. It should be noted, however, that at times these birds were not well liked. In fact, according to documents from colonial Brazil, only the ants rank higher than parrots as the animals most often mentioned as agricultural pests. On the other hand, some of these birds were so chatty that people suspected them to be demonic or possessed animals, since only three classes of beings - angels, men and demons - have the ability to speak. Nowadays, several Psittacidae still constitute a threat to agriculture, and the suspicion that extremely talkative birds were demon possessed has also survived. More than a joke or a mere curiosity, this belief exemplifies how intricate man’s relationships with the “natural world” may be. In this sense, the existence of birds that are able to speak adds a further twist to these relationships, demonstrating that the problem of establishing a boundary between the animal and the human does not only involve primates, but also includes some unusual zoological species

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