583 research outputs found


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    Em Setembro de 1978, a Confer√™ncia Internacional sobre Cuidados de Sa√ļde Prim√°rios, organizada pela Organiza√ß√£o Mundial de Sa√ļde (OMS) em Alma-Ata, Rep√ļblica do Cazaquist√£o, expressou ‚Äúa necessidade de ac√ß√£o urgente por parte de todos os governos, de todos aqueles que trabalham na sa√ļde e do desenvolvimento e do comunidade global para promover a sa√ļde de todas as pessoas do mundo‚ÄĚ, a Organiza√ß√£o Mundial da Sa√ļde conseguiu formular uma defesa dos direitos √† sa√ļde que teve o alcance de um documento de 1978 que tinha essa caracter√≠stica exemplar para os pa√≠ses, com √™nfase na aten√ß√£o prim√°ria , onde os enfermeiros tiveram grande visibilidade. OBJETIVO: descrever a atua√ß√£o do enfermeiro da aten√ß√£o b√°sica que atua ativa e extensamente nos protocolos da aten√ß√£o b√°sica e nas estrat√©gias de Sa√ļde da Fam√≠lia. METODOLOGIA: Trata-se de uma revis√£o de literatura, que √© um m√©todo que visa sintetizar de forma sistem√°tica, ordenada e abrangente os resultados alcan√ßados em pesquisas sobre um determinado tema. CONSIDERA√á√ēES FINAIS: Reconhecemos que os enfermeiros desempenham diversas fun√ß√Ķes nos cuidados de sa√ļde prim√°rios, desde o aconselhamento pr√©-natal at√© √† preven√ß√£o e tratamento da tuberculose e de doen√ßas sexualmente transmiss√≠veis, onde os protocolos s√£o muito mais complexos e extensos. √Č por isso que a enfermeira √© fundamental para manter uma boa sa√ļde p√ļblica, o que contribui para a manuten√ß√£o dos princ√≠pios do SUS: equidade, universalidade e integralidade

    Pervasive gaps in Amazonian ecological research

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    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‚Äď7 vast areas of the tropics remain understudied.8‚Äď11 In the American tropics, Amazonia stands out as the world‚Äôs 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‚Äď15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon‚Äôs 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‚Äôs vulnerability to environmental change. 15%‚Äď18% 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


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    Safe ecosystems have a significant influence on the composition of sustainable aquaculture products, which serve as the foundation of every food web and are the responsibility of marine life, a critical requirement for sustained global quantitative and qualitative development. Currently, the distribution, speciation, environmental bioaccumulation, and toxicity assessment of heavy metals (HMs) in aquatic environments are constantly growing. Due to their high toxicity and non-biodegradability, PMs are harmful environmental pollutants that can be transferred and biomagnified through food chains that seriously threaten human health and have a negative influence on marine biota. With this, this bibliographic review aims to present the main recent research about the contamination of PMs in the aquatic ecosystem and its effects on the environment and human health, presenting the main environmental remediation strategies used for the benefit of the planet.Os ecossistemas seguros t√™m uma influ√™ncia significativa na composi√ß√£o dos produtos da aquicultura sustent√°vel, que servem de base a todas as cadeias alimentares e s√£o da responsabilidade da vida marinha, um requisito cr√≠tico para o desenvolvimento quantitativo e qualitativo global sustentado. Atualmente, a distribui√ß√£o, especia√ß√£o, bioacumula√ß√£o ambiental e avalia√ß√£o da toxicidade de metais pesados (MHs) em ambientes aqu√°ticos est√£o em constante crescimento. Devido √† sua elevada toxicidade e n√£o biodegradabilidade, as PM s√£o poluentes ambientais nocivos que podem ser transferidos e bioamplificados atrav√©s das cadeias alimentares que amea√ßam seriamente a sa√ļde humana e t√™m uma influ√™ncia negativa na biota marinha. Com isso, esta revis√£o bibliogr√°fica tem como objetivo apresentar as principais pesquisas recentes sobre a contamina√ß√£o de MPs no ecossistema aqu√°tico e seus efeitos no meio ambiente e na sa√ļde humana, apresentando as principais estrat√©gias de remedia√ß√£o ambiental utilizadas em benef√≠cio do planeta

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

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    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 < 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)

    S100A9 Drives the Chronification of Psoriasiform Inflammation by Inducing IL-23/Type 3 Immunity

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    Psoriasis is a chronic inflammatory skin disorder driven by the IL-23/type 3 immune response. However, molecular mechanisms sustaining the chronicity of inflammation and psoriatic lesions remain elusive. Combining systematic analyses of several transcriptomic datasets, we delineated gene signatures across human psoriatic skin, identifying S100A9 as one of the most up-regulated genes, which was confirmed in lesioned skin from patients with psoriasis and preclinical psoriasiform skin inflammation models. Genetic ablation or pharmacologic inhibition of S100A9 alleviated Aldara-induced skin inflammation. By single-cell mapping of human psoriatic skin and bone marrow chimeric mice experiments, we identified keratinocytes as the major source of S100A9. Mechanistically, S100A9 induced IL-23 production by dendritic cells, driving the IL-23/type 3 immunity in psoriasiform skin inflammation. In addition, the cutaneous IL-23/IL-17 axis induced epidermal S100A9 expression in human and experimental psoriasis. Thus, we showed an autoregulatory circuit between keratinocyte-derived S100A9 and IL-23/type 3 immunity during psoriasiform inflammation, identifying a crucial function of S100A9 in the chronification of psoriasis

    Performance of artificial intelligence in the characterization of colorectal lesions

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    Background: Image-enhanced endoscopy (IEE) has been used in the differentiation between neoplastic and non-neoplastic colorectal lesions through microvasculature analysis. This study aimed to evaluate the computer-aided diagnosis (CADx) mode of the CAD EYE system for the optical diagnosis of colorectal lesions and compare it with the performance of an expert, in addition to evaluating the computer-aided detection (CADe) mode in terms of polyp detection rate (PDR) and adenoma detection rate (ADR). Methods: A prospective study was conducted to evaluate the performance of CAD EYE using blue light imaging (BLI), dichotomizing lesions into hyperplastic and neoplastic, and of an expert based on the Japan Narrow-Band Imaging Expert Team (JNET) classification for the characterization of lesions. After white light imaging (WLI) diagnosis, magnification was used on all lesions, which were removed and examined histologically. Diagnostic criteria were evaluated, and PDR and ADR were calculated. Results: A total of 110 lesions (80 (72.7%) dysplastic lesions and 30 (27.3%) nondysplastic lesions) were evaluated in 52 patients, with a mean lesion size of 4.3 mm. Artificial intelligence (AI) analysis showed 81.8% accuracy, 76.3% sensitivity, 96.7% specificity, 98.5% positive predictive value (PPV), and 60.4% negative predictive value (NPV). The kappa value was 0.61, and the area under the receiver operating characteristic curve (AUC) was 0.87. Expert analysis showed 93.6% accuracy, 92.5% sensitivity, 96.7% specificity, 98.7% PPV, and 82.9% NPV. The kappa value was 0.85, and the AUC was 0.95. Overall, PDR was 67.6% and ADR was 45.9%. Conclusions: The CADx mode showed good accuracy in characterizing colorectal lesions, but the expert assessment was superior in almost all diagnostic criteria. PDR and ADR were high

    Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

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    Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe


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    Mercury (Hg) is a highly teratogenic and carcinogenic non-essential metal, classified as a priority pollutant. Hg is present in the environment both naturally and by anthropogenic origin. The objective of this work was to determine Hg in a shrimp sample using thermal composition amalgamation atomic absorption spectrometry (TDA-AAS) by the direct analysis method. In this work, wild (Farfantepenaeus brasiliensis) and farmed (Litopenaeus vannamei) shrimp purchased on the market in northeastern Brazil were considered. The analysis method applied was the U.S. EPA Method 7473 and is described elsewhere in the literature as a proven alternative to these techniques that provided environmentally friendly sample preparation. The wild shrimp tissue presented 75.47 őľg kg‚ąí1 Hg and was the highest concentration of Hg presented in the work while the lowest concentration of Hg in the work was from the shrimp exoskeleton which presented a concentration of 3.71 őľg kg ‚ąí1 Hg.O merc√ļrio (Hg) √© um metal n√£o essencial altamente teratog√™nico e cancer√≠geno, classificado como poluente priorit√°rio. O Hg est√° presente no meio ambiente tanto naturalmente quanto por origem antropog√™nica. O objetivo deste trabalho foi determinar o Hg em uma amostra de camar√£o utilizando espectrometria de absor√ß√£o at√īmica por am√°lgama de composi√ß√£o t√©rmica (TDA-AAS) pelo m√©todo de an√°lise direta. Neste trabalho foram considerados camar√Ķes silvestres (Farfantepenaeus brasiliensis) e de viveiro (Litopenaeus vannamei) adquiridos no mercado do Nordeste do Brasil. O m√©todo de an√°lise aplicado foi o M√©todo 7473 da EPA dos EUA e √© descrito em outras partes da literatura como uma alternativa comprovada a essas t√©cnicas que forneceram prepara√ß√£o de amostras ecologicamente corretas. O tecido do camar√£o selvagem apresentou 75,47 őľg kg‚ąí1 Hg e foi a maior concentra√ß√£o de Hg apresentada no trabalho enquanto a menor concentra√ß√£o de Hg no trabalho foi do exoesqueleto do camar√£o que apresentou concentra√ß√£o de 3,71 őľg kg ‚ąí1 Hg
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