Dilemas da geração Z: até que ponto ir à procura de padrões?

The reflective critical descriptive article aims to highlight the dilemmas of the generation that is the generation that has a ton of information in the palm of their hand in fractions of seconds, through the Internet. The following categories were listed: invasive plastic surgery procedures; generation Z, self-acceptance and image and finally mental and aesthetic health. Concluding that the search for the standard and the perfect stereotype associated with the day-to-day access to social media that do not always show the real life of the “bloggers” triggers the desire and obsession for aesthetic changes, most of the time radical and unnecessary, whose ages are between 18 and 24 years. Obviously, in most cases, the lack of confidence, insecurity and the difficulty of self-acceptance, trigger psychic disorders that lead these people to never be satisfied, and in search of diverting frustrations in most invasive surgeries that end up generating the need constant change, according to the temporary standards of beauty established by the media, but in some cases it is extremely necessary, such as bariatric surgery patients.O artigo descritivo crítico reflexivo tem como objetivo destacar os dilemas da geração que se trata da geração que tem uma tonelada de informações na palma da mão em frações de segundos, através da Internet. Foram elencadas as seguintes categorias: procedimentos invasivos de cirurgia plástica; geração Z, autoaceitação e imagem e por fim saúde mental e estética. Concluindo que a busca pelo padrão e o estereótipo perfeito associados ao acesso dia a dia das mídias sociais que nem sempre mostram a vida real das “blogueirinhas” faz desencadear o desejo e a obsessão por mudanças estéticas, na maioria das vezes radicais e sem necessidade, cuja idades estão entre 18 e 24 anos. Obviamente que na maioria dos casos a falta de confiança, insegurança e a dificuldade de autoaceitação, desencadeiam transtornos psíquicos que levam essas pessoas a nunca estarem satisfeitas, e em busca de desviar as frustrações em cirurgias na maioria das vezes invasivas e que acabam gerando a necessidade constante de mudança, de acordo com os padrões temporários de beleza estabelecidos pela mídia, porém em alguns casos e extremamente necessário como os pacientes de cirurgia bariátrica

Sensor Surface Design with NanoMaterials: A New Platform in the Diagnosis of COVID-19

Mass testing for COVID-19 is essential to defining patient management strategies, choosing the best clinical management, and dimensioning strategies for controlling viral dissemination and immunization strategies. Thus, it is of utmost importance to search for devices that allow a quick and reliable diagnosis of low cost that can be transposed from the bench to the bedside, such as biosensors. These devices can help choose the correct clinical management to minimize factors that lead to infected patients developing more severe diseases. The use of nanomaterials to modify biosensors’ surfaces to increase these devices’ sensitivity and their biofunctionality enables high-quality nanotechnological platforms. In addition to the diagnostic benefits, nanotechnological platforms that facilitate the monitoring of anti-SARS-CoV-2 antibodies may be the key to determining loss of protective immune response after an episode of COVID-19, which leads to a possible chance of reinfection, as well as how they can be used to assess and monitor the success of immunization strategies, which are beginning to be administered on a large scale and that the extent and duration of their protection will need to be determined. Therefore, in this chapter, we will cover nanomaterials’ use and their functionalities in the surface design of sensors, thus generating nanotechnological platforms in the various facets of the diagnosis of COVID-19

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016.

BACKGROUND: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita

Retenção da Cofins nas Instituições Federais de Ensino Superior: reflexos na contabilidade das empresas tributadas pelo lucro real

Este artigo consiste em demonstrar os reflexos que a Retenção da Contribuição para o Financiamento da Seguridade Social nas Instituições Federais de Ensino Superior provoca na contabilidade das empresas tributadas pelo Lucro Real, tendo em vista a não cumulatividade do Tributo. Este é um estudo de caso de abordagem qualitativa quanto ao seu objeto de pesquisa. Para a coleta de dados, foram empregadas as técnicas da observação direta e participante com auxílio da análise empírica documental, corroborada com bibliografia específica e pertinente. Por fim, alguns resultados elencados demonstram que a obrigação da Retenção da Contribuição visando o Financiamento da Seguridade Social nas Instituições de Ensino Superior na fonte consiste na eficiência e efetividade do papel do Estado diante da sociedade para poder arrecadar de forma mais eficaz

Dilemas da geração Z: até que ponto ir à procura de padrões?

The reflective critical descriptive article aims to highlight the dilemmas of the generation that is the generation that has a ton of information in the palm of their hand in fractions of seconds, through the Internet. The following categories were listed: invasive plastic surgery procedures; generation Z, self-acceptance and image and finally mental and aesthetic health. Concluding that the search for the standard and the perfect stereotype associated with the day-to-day access to social media that do not always show the real life of the “bloggers” triggers the desire and obsession for aesthetic changes, most of the time radical and unnecessary, whose ages are between 18 and 24 years. Obviously, in most cases, the lack of confidence, insecurity and the difficulty of self-acceptance, trigger psychic disorders that lead these people to never be satisfied, and in search of diverting frustrations in most invasive surgeries that end up generating the need constant change, according to the temporary standards of beauty established by the media, but in some cases it is extremely necessary, such as bariatric surgery patients.O artigo descritivo crítico reflexivo tem como objetivo destacar os dilemas da geração que se trata da geração que tem uma tonelada de informações na palma da mão em frações de segundos, através da Internet. Foram elencadas as seguintes categorias: procedimentos invasivos de cirurgia plástica; geração Z, autoaceitação e imagem e por fim saúde mental e estética. Concluindo que a busca pelo padrão e o estereótipo perfeito associados ao acesso dia a dia das mídias sociais que nem sempre mostram a vida real das “blogueirinhas” faz desencadear o desejo e a obsessão por mudanças estéticas, na maioria das vezes radicais e sem necessidade, cuja idades estão entre 18 e 24 anos. Obviamente que na maioria dos casos a falta de confiança, insegurança e a dificuldade de autoaceitação, desencadeiam transtornos psíquicos que levam essas pessoas a nunca estarem satisfeitas, e em busca de desviar as frustrações em cirurgias na maioria das vezes invasivas e que acabam gerando a necessidade constante de mudança, de acordo com os padrões temporários de beleza estabelecidos pela mídia, porém em alguns casos e extremamente necessário como os pacientes de cirurgia bariátrica

Quality Of Life Of Women Living With HIV/AIDS

Objectives: to evaluate the quality of lifeof women withHIV/AIDSin the Stateof Paraíba anddefine them asthe socio-demographicprofile. Method: This was a descriptive, exploratory and quantitative study, conducted at the Hospital Clementino Fraga, had a population of 33 women with HIV / AIDS, using the form of interviews HATQoL, clinical and sociodemographic, data collection took place in July 2014 after approval of the CEP UFPB. Results and Discussion: There was concern domains with commitment of confidentiality, financial worry and sexual activity with a possible association with clinical and sociodemographic data obtained, most women: they are aged between 36-42 years acquired HIV through heterosexual sex, unmarried , have children (between 1-2), have low education (less than 9 years of schooling) and low income (up to two minimum wages). Conclusion: Therefore, it is necessary that the care of these women is conducted by interdisciplinary teams that promote integrated care, gazing beyond the individual needs, aspects related to their quality of life. In this perspective, the nurse plays a fundamental role in promoting quality of life. Keywords: Quality of life. Women. HIV. AIDS. Nursing