“Escuta no pátio”: cuidado e vínculo como práticas de redução de danos

O artigo trata de uma proposta de prática de estágio supervisionado na área da Psicologia realizada em um CAPS ad, denominada “Escuta no pátio”. Para fundamentá-la, apresenta o paradigma proibicionista e sua influência na constituição das intervenções direcionadas às pessoas que usam drogas, fundamentadas prioritariamente no discurso jurídico-moral e nos dispositivos de criminalização e medicalização, e discute o paradigma da redução de danos e as possibilidades de construção de intervenções singulares e cidadãs, que inspiram a proposta de estágio em questão. A metodologia de “Escuta no pátio”, orientada pelos pressupostos da atenção integral à saúde e da clínica ampliada, é apresentada como dispositivo de cuidado, que oferece uma escuta qualificada por meio de conversas individuais e coletivas não agendadas, demandadas espontaneamente pelos usuários. Conclui-se que o uso de tecnologias relacionais no cuidado em saúde tende a potencializar o exercício do acolhimento e do vínculo, o que amplia a eficácia das ações, ao favorecer a participação do usuário e seu engajamento na elaboração de estratégias de cuidado e preservação.Palavras-chave: Uso de drogas; redução de danos; cuidado em saúde; tecnologias relacionais

ANÁLISE SALIVAR E O DIAGNÓSTICO DE DOENÇAS BUCAIS

Abstract: Saliva has an active action in the digestion of food, being also a tool for the detection of possible pathologies, as it has biological markers, which makes it a non-invasive and practical form. Objective: accomplish an integrative literature review on the analysis of salivary fluid for the diagnosis of diseases in the oral cavity and to answer the research question, in addition to presenting the main metabolic changes found in published articles. Methodology: A literature search was carried out through the electronic databases PubMed, LILACS, SciELO and Cochrane Library, in these two keywords were used for research, “MeSHterm”: “Saliva”; "Diagnosis"; and the free term “Oral Diseases”. The articles were obtained regarding the pre-incorporated inclusion and exclusion criteria and the Boolean connector "AND '' was used. Results and Discussion: Therefore, from this search strategy, 1,717 scientific papers were found in full, of which 5 articles were duplicated in the search strategies, thus totaling 7 selected scientific articles.It became evident that saliva analysis is an important diagnostic method for diseases such as periodontitis, oral lichen planus, COVID-19 and oral cancer. Final considerations: In this way, the scientific article answered the guiding question and had satisfactory results for the pre-established objective. However, there is still a need for further clinical and laboratory research to better clarify its applicability and scope.Resumen: La saliva tiene una acción activa en la digestión de los alimentos, siendo también una herramienta para la detección de posibles patologías, ya que cuenta con marcadores biológicos, lo que la convierte en una forma no invasiva y práctica. Objetivo: realizar una revisión bibliográfica integradora sobre el análisis del líquido salival para el diagnóstico de enfermedades de la cavidad oral y dar respuesta a la pregunta de investigación, además de presentar los principales cambios metabólicos encontrados en los artículos publicados. Metodología: Se realizó una búsqueda bibliográfica a través de las bases de datos electrónicas PubMed, LILACS, SciELO y Cochrane Library, en estas dos palabras clave se utilizaron para la investigación, “MeSHterm”: “Saliva”; "Diagnóstico"; y el término libre "Enfermedades Bucales". Los artículos se obtuvieron con respecto a los criterios de inclusión y exclusión preincorporados y se utilizó el conector booleano "Y". Resultados y Discusión: Por lo tanto, de esta estrategia de búsqueda se encontraron 1.717 artículos científicos completos, de los cuales 5 artículos fueron duplicados en las estrategias de búsqueda, totalizando así 7 artículos científicos seleccionados. Se evidenció que la saliva es un método diagnóstico importante para enfermedades como periodontitis, liquen plano oral, COVID-19 y cáncer oral. Consideraciones finales: De esta manera, el artículo científico respondió la pregunta orientadora y resultados satisfactorios para el objetivo preestablecido. Sin embargo, todavía es necesario realizar más investigaciones clínicas y de laboratorio para aclarar mejor su aplicabilidad y alcance.Resumo: A saliva tem ação ativa na digestão de alimentos, sendo também uma ferramenta para a detecção de possíveis patologias, pois a mesma possui marcadores biológicos, o que a torna uma forma não invasiva e prática. Objetivo: realizar uma revisão integrativa da literatura sobre a análise do fluido salivar para os diagnósticos de doenças na cavidade bucal e responder à pergunta de pesquisa, além de apresentar as principais alterações metabólicas encontradas nos artigos analisados. Metodologia: Foi realizada uma busca da literatura através das bases de dados eletrônicas PubMed, LILACS, SciELO e Cochrane Library, nessas foram utilizadas duas palavras-chave para pesquisa, “MeSHterm”: “Saliva”; “Diagnosis”; e o termo livre “Oral diseases”. Os artigos foram avaliados quanto aos critérios de inclusão e exclusão pré-estabelecidos e utilizou-se do conector booleano “AND’’. Resultados e Discussão: Portanto, a partir dessa estratégia de busca, foram encontrados 1.717 trabalhos na íntegra, destes, 5 artigos encontravam-se duplicados nas estratégias de busca, totalizando, assim, 7 artigos científicos selecionados. Tornou-se evidente que a saliva é um importante método diagnóstico de doenças como a periodontite, líquen plano oral, a COVID-19 e o câncer bucal. Considerações Finais: Dessa forma, o artigo científico respondeu à pergunta norteadora e estabeleceu resultados satisfatórios para o objetivo pré-estabelecido. Evidenciou-se que a análise salivar é fundamental para o diagnóstico de doenças na cavidade bucal, como também das variações decorrentes de síndromes e alterações metabólicas no indivíduo. Porém, ainda há necessidade de novas pesquisas clínico-laboratoriais para um melhor esclarecimento de sua aplicabilidade e abrangência

DIAGNÓSTICO E TRATAMENTO DE EMERGÊNCIAS HIPERTENSIVAS REVISÃO DE LITERATURA

The sudden and acute increase in blood pressure, especially diastolic, greater than 120 mmHg, combined with signs of target organ damage is known as hypertensive emergency (HE). Pulmonary edema, cardiac ischemia, neurological deficits, acute renal failure, aortic dissection and eclampsia are some examples. This article aims to discuss the pathophysiological mechanisms of the disease in view of the epidemiological importance of HE. The objective of this research is to discuss and describe HE and its pathophysiology, as well as show how the disease affects patients' personal lives. The database used was SciElo (Scientific Electronic Library Online) and PubMed (US National Library of Medicine), which contains scientific information as of March 9, 2024. The pathophysiology of HE is demonstrated in several studies, including conditions related to increased intravascular volume, peripheral vascular resistance and the likelihood of decreased production of endogenous vasodilators, which could result in greater vasoreactivity, which could result in an emergency situation. In summary, healthcare systems around the world still face a significant burden of sepsis.Keywords: Emergency, Treatment, Semiology.A elevação brusca e aguda da pressão arterial, principalmente a diastólica, maior que 120 mmHg, combinada com sinais de lesão de órgão-alvo é conhecida como emergência hipertensiva (EH). Edema pulmonar, isquemia cardíaca, déficits neurológicos, insuficiência renal aguda, dissecção aórtica e eclâmpsia são alguns exemplos. Este artigo visa discutir os mecanismos fisiopatológicos da doença diante da importância epidemiológica da EH. O objetivo desta pesquisa é discutir e descrever a EH e sua fisiopatologia, bem como mostrar como a doença afeta as vidas pessoais dos pacientes. O banco de dados utilizado foi o SciElo (Scientific Eletronic Library Online) e o PubMed (US National Library of Medicine), que contém informações científicas de 09 de março de 2024.A fisiopatologia da EH é demonstrada em vários estudos, incluindo condições relacionadas ao aumento do volume intravascular, à resistência vascular periférica e à probabilidade de diminuição da produção de vasodilatadores endógenos, o que pode resultar em vasorreatividade maior, o que pode resultar em situação de emergência . Em resumo, os sistemas de saúde em todo o mundo ainda enfrentam uma carga significativa de sepse

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

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

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

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

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)