Reflexões sobre o crescente número de cesáreas no Brasil: um chamado à consciência

INTRODUÇÃO: A incidência de cesarianas tem aumentado ao longo das décadas em escala global, e no Brasil, esse índice atingiu uma marca significativa de 56% -  colocando-o substancialmente acima da média observada em nações em desenvolvimento. METODOLOGIA: Revisão narrativa da literatura realizada a partir da busca bibliográfica na base de dados PubMed, com os descritores “Cesarean”, “Prenatal care”, “Childbirth”. RESULTADOS: Os estudos pesquisados foram publicados em periódicos internacionais, sendo selecionados artigos de revisão, revisão sistemática e metanálise. DISCUSSÃO: No contexto obstétrico nacional, a tendência de aumento nas taxas de cesáreas começou a se manifestar em 2017 e foi exacerbada pela pandemia. Apesar dos esforços para reorganizar a rede de assistência pré-natal durante o período pandêmico, especialmente para pacientes com risco obstétrico, na prática, esses esforços foram limitados. Consequentemente, observou-se um influxo de gestantes em estágios avançados de complicações obstétricas nas unidades de maternidade, muitas das quais necessitando de cesariana para mitigar desfechos materno-perinatais desfavoráveis. CONCLUSÃO: Em conclusão, o aumento nas taxas de cesáreas no Brasil, que já vinha sendo observado há quase uma década e foi intensificado durante a pandemia, destaca a necessidade urgente de políticas e práticas que promovam uma abordagem mais equilibrada e baseada em evidências na assistência obstétrica

Adenomiose: etiofisiopatologia, diagnóstico e tratamento

A adenomiose é uma condição uterina benigna caracterizada pela invasão do tecido endometrial na camada muscular do útero, conhecida como miométrio. Essa invasão envolve glândulas e estroma endometrial, frequentemente acompanhadas por hiperplasia e hipertrofia das células musculares uterinas, sendo identificada pela presença desses elementos nas camadas miometriais. Revisão narrativa da literatura realizada a partir da busca bibliográfica na base de dados PubMed, com os descritores  “Adenomyosis”, “Etiophysiopathology”, “Diagnosis”, “Treatment”. Os estudos pesquisados foram publicados em periódicos internacionais, sendo selecionados artigos de revisão, revisão sistemática e metanálise. A etiofisiopatologia não é completamente compreendida, mas fatores hormonais e inflamatórios podem desempenhar um papel. O diagnóstico geralmente é feito por meio de exames de imagem, como ultrassonografia ou ressonância magnética. O tratamento pode incluir opções medicamentosas, como anti-inflamatórios e hormônios, para alívio dos sintomas. Em casos mais graves, a histerectomia pode ser considerada, especialmente se os sintomas não respondem aos tratamentos conservadores. A abordagem terapêutica é adaptada às necessidades individuais, considerando a gravidade dos sintomas e a preferência da paciente. A adenomiose é uma doença de etiofisiopatologia, diagnóstico e tratamento complexos, sendo necessários avanços na literatura científica em busca de sua melhor compreensão, além de diagnóstico precoce e tratamento mais assertivo e precoce

A EQUIPE MULTIPROFISSIONAL E O DEBATE ACERCA DO ATENDIMENTO HUMANIZADO

The provision of health services permeates the interaction between professionals from different areas, highlighting the importance of the multidisciplinary team. Humanized care emerges as a crucial element in this context, aiming to provide a patient-centered approach, respecting their individuality and promoting comprehensive care. This study seeks to analyze the relationship between the performance of the multidisciplinary team and the implementation of humanized care, exploring the available literature to understand the practices, challenges and benefits associated with this approach in the healthcare setting. The methodology adopted consists of an integrative literature review, allowing a comprehensive analysis of relevant studies on the intersection between the multidisciplinary team and humanized care. The search and selection of articles were carried out systematically in scientific databases. The results reveal that the integrated action of the multidisciplinary team is essential to promote humanization in health care. The exchange of knowledge and collaboration between different professionals contribute to a more holistic and effective approach, meeting the physical, emotional and social needs of patients. Discussions address challenges faced by the multidisciplinary team, such as interdisciplinary communication and overcoming hierarchical barriers. Furthermore, the benefits of humanized care stand out, including greater patient satisfaction, improved adherence to treatment and strengthening of the therapeutic bond. This study highlights the importance of the multidisciplinary team in the context of humanized care, highlighting the need for policies and practices that encourage interdisciplinary collaboration. Promoting an organizational culture that values ​​humanization in care contributes to the quality and effectiveness of health services.A prestação de serviços de saúde permeia a interação entre profissionais de diversas áreas, destacando a importância da equipe multiprofissional. O atendimento humanizado emerge como um elemento crucial nesse contexto, visando proporcionar uma abordagem centrada no paciente, respeitando sua individualidade e promovendo a integralidade do cuidado. Este estudo busca analisar a relação entre a atuação da equipe multiprofissional e a implementação do atendimento humanizado, explorando a literatura disponível para compreender as práticas, desafios e benefícios associados a essa abordagem no cenário da saúde. A metodologia adotada consiste em uma revisão integrativa da literatura, permitindo a análise abrangente de estudos relevantes sobre a interseção entre a equipe multiprofissional e o atendimento humanizado. A busca e seleção dos artigos foram realizadas de forma sistemática em bases de dados científicas. Os resultados revelam que a atuação integrada da equipe multiprofissional é fundamental para promover a humanização no atendimento em saúde. A troca de conhecimentos e a colaboração entre diferentes profissionais contribuem para uma abordagem mais holística e eficaz, atendendo às necessidades físicas, emocionais e sociais dos pacientes. Discussões abordam desafios enfrentados pela equipe multiprofissional, como a comunicação interdisciplinar e a superação de barreiras hierárquicas. Além disso, destacam-se os benefícios do atendimento humanizado, incluindo maior satisfação do paciente, melhoria na adesão ao tratamento e fortalecimento do vínculo terapêutico. Este estudo ressalta a importância da equipe multiprofissional no contexto do atendimento humanizado, evidenciando a necessidade de políticas e práticas que incentivem a colaboração interdisciplinar. A promoção de uma cultura organizacional que valorize a humanização no cuidado contribui para a qualidade e efetividade dos serviços de saúde

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

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings