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AIM: To investigate the relationship between nurses' climate of perceived organizational support, and their well-being and healthcare-unit performance. DESIGN: A two-wave cohort questionnaire study among nurses within six hospitals in Sweden. METHODS: Hypotheses were tested using cross-lagged path models on the individual (organizational support, job satisfaction, burnout, intention to stay) and aggregate levels (care-unit organizational support, team effectiveness, patient safety climate and patient safety). Analyses were based on 1.817 nurses in 228 care-units (T1), 1.362 nurses in 213 care-units (T2) and longitudinal samples of 711 nurses and 140 care-units. RESULTS: Organizational support (T1) positively influenced job satisfaction (T2) and tended to decrease burnout (T2) but did not affect turnover intent. Reversed relationships were also found. No statistically significant prospective effects were found on the aggregate level. CONCLUSION: The results indicated a prospective reciprocally reinforcing relationship between organizational support and job satisfaction. Burnout and intention to stay were predictors rather than outcomes of the organizational support climate. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: A climate where nurses perceive that their organization values their contributions and cares about their well-being is beneficial for their job satisfaction and health, which, according to previous research, may influence nurse retention. IMPACT: The study addressed perceived organizational support as a potential predictor of nurses' well-being and healthcare-unit performance. A mutually reinforcing relation was indicated between organizational support and nurses' job satisfaction and health. Job dissatisfaction, burnout symptoms and turnover intentions were prospectively negatively related to the organizational support. Identifying and implementing a variety of practical measures to support perceptions of organizational support may be an effective way for healthcare management to start and sustain the development of a healthier work environment for healthcare professionals. REPORTING METHOD: STROBE statement for cohort studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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Advances in deep learning and computer vision have overcome many challenges inherent in the field of autonomous intelligent vehicles. To improve the detection accuracy and efficiency of EdgeBoard intelligent vehicles, we proposed an optimized design of EdgeBoard based on our PP-YOLOE+ model. This model innovatively introduces a composite backbone network, incorporating deep residual networks, feature pyramid networks, and RepResBlock structures to enrich environmental perception capabilities through the advanced analysis of sensor data. The incorporation of an efficient task-aligned head (ET-head) in the PP-YOLOE+ framework marks a pivotal innovation for precise interpretation of sensor information, addressing the interplay between classification and localization tasks with high effectiveness. Subsequent refinement of target regions by detection head units significantly sharpens the system's ability to navigate and adapt to diverse driving scenarios. Our innovative hardware design, featuring a custom-designed mainboard and drive board, is specifically tailored to enhance the computational speed and data processing capabilities of intelligent vehicles. Furthermore, the optimization of our Pos-PID control algorithm allows the system to dynamically adjust to complex driving scenarios, significantly enhancing vehicle safety and reliability. Besides, our methodology leverages the latest technologies in edge computing and dynamic label assignment, enhancing intelligent vehicles' operations through seamless sensor integration. Our custom dataset, specifically designed for this study, includes 4777 images captured by intelligent vehicles under a variety of environmental and lighting conditions. The dataset features diverse scenarios and objects pertinent to autonomous driving, such as pedestrian crossings and traffic signs, ensuring a comprehensive evaluation of the model's performance. We conducted extensive testing of our model on this dataset to thoroughly assess sensor performance. Evaluated against metrics including accuracy, error rate, precision, recall, mean average precision (mAP), and F1-score, our findings reveal that the model achieves a remarkable accuracy rate of 99.113%, an mAP of 54.9%, and a real-time detection frame rate of 192 FPS, all within a compact parameter footprint of just 81 MB. These results demonstrate the superior capability of our PP-YOLOE+ model to integrate sensor data, achieving an optimal balance between detection accuracy and computational speed compared with existing algorithms.
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COVID-19 may have residual consequences in multiple organs, including the cardiovascular system. The purpose of the present investigation is to quantify myocardial function in symptomatic individuals with long COVID and investigate the association between illness severity and myocardial function. A retrospective cross-sectional study was conducted in which symptomatic individuals with previous COVID-19 underwent echocardiographic analysis of left ventricle global longitudinal strain (LVGLS) and myocardial work (MW). Individuals also performed cardiopulmonary testing (CPX) to assess peak oxygen uptake (VO2peak). Differences between illness severity subgroups were analyzed by the Mann-Whitney test. Correlations were calculated using the Spearman correlation test. Multilinear regressions were performed to evaluate the influences of COVID-19 severity, body mass index, age, and sex on MW. Fifty-six individuals were included (critical subgroup: 17; moderate/severe subgroup: 39), 59% females; median age: 56 years (IQR: 43-63). CPX revealed a substantial reduction in VO2peak (median of 53% of predicted values). LVGLS were not statistically different between subgroups. Global wasted work (GWW) was higher in the critical subgroup [146 (104-212) versus 121 (74-163) mmHg%, p = 0.01], and global work efficiency (GWE) was lower in this subgroup [93 (91-95) versus 94 (93-96), p = 0.03]. Illness severity was the only independent predictor of GWW and GWE (GWW: r2 = 0.167; p = 0.009; GWE: r2 = 0.172; p = 0.005) in multilinear regressions. In our study with long COVID-19 individuals, despite having a similar LVGLS, patients had subclinical LV dysfunction, demonstrated only by an increase in GWW and a decrease in GWE.
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COVID-19 , Índice de Severidad de la Enfermedad , Humanos , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estudios Transversales , Adulto , Ecocardiografía , Función Ventricular Izquierda , SARS-CoV-2 , Consumo de Oxígeno , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Prueba de EsfuerzoRESUMEN
BACKGROUND: COVID-19 poses great challenges for preschool teachers in China, which will increase the level of job stress and job burnout, and have an impact on the relationship between job stress, job burnout, and perceived organizational support (POS). However, few studies have examined trilateral relationships, especially the role of POS concerning job stress and job burnout of preschool teachers. OBJECTIVE: This study aimed to investigate the relationship among the three variables of job burnout, job stress, and POS, as well as explore the moderating effects of POS between job stress and job burnout. METHODS: A cross-sectional study was conducted among preschool teachers in six provinces of China. A total of 408 preschool teachers completed a self-report questionnaire, including three scales that measured job burnout, job stress, and POS respectively. The Pearson correlation coefficient and regression analysis were used to examine the relationship among variables. RESULTS: The results showed that job burnout among Chinese preschool teachers was at a medium level during the COVID-19 pandemic. Job stress was positively related to job burnout, and the POS was negatively related to job burnout. Additionally, POS moderated the relationship between job stress and job burnout and alleviated the adverse effects of job stress on the job burnout of preschool teachers. CONCLUSION: POS can play a moderating role between job stress and job burnout of Chinese preschool teachers during the COVID-19 pandemic.
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Platypnea-orthodoxia syndrome (POS) is a clinical condition that causes dyspnea and hypoxia in the sitting and standing positions. In this case, a 67-year-old man showed hypoxemia after undergoing the Bentall procedure that worsened in the standing position during rehabilitation. Contrast-enhanced computed tomography of the thorax and abdomen revealed no cause of respiratory failure. POS was suspected as the cause of the positional exacerbation of oxygen saturation. A bubble study showed a positive grade IV within three heartbeats on transthoracic echocardiography, which also confirmed an intracardiac shunt caused by a patent foramen ovale (PFO). Percutaneous PFO closure was performed, and hypoxemia was immediately resolved. Various factors were considered to cause the POS, including right heart failure, constrictive pericarditis, and postoperative adhesions, and each of these factors was discussed. POS after open-heart surgery is very rare. This is the first reported case of POS treated with a closure device following the Bentall procedure.
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High dimensional studies that include proliferation dyes face two inherent challenges in panel design. First, the more rounds of cell division to be monitored based on dye dilution, the greater the starting intensity of the labeled parent cells must be in order to distinguish highly divided daughter cells from background autofluorescence. Second, the greater their starting intensity, the more difficult it becomes to avoid spillover of proliferation dye signal into adjacent spectral channels, with resulting limitations on the use of other fluorochromes and ability to resolve dim signals of interest. In the third and fourth editions of this series, we described the similarities and differences between protein-reactive and membrane-intercalating dyes used for general cell tracking, provided detailed protocols for optimized labeling with each dye type, and summarized characteristics to be tested by the supplier and/or user when validating either dye type for use as a proliferation dye. In this fifth edition, we review: (a) Fundamental assumptions and critical controls for dye dilution proliferation assays; (b) Methods to evaluate the effect of labeling on cell growth rate and test the fidelity with which dye dilution reports cell division; and. (c) Factors that determine how many daughter generations can be accurately included in proliferation modeling. We also provide an expanded section on spectral characterization, using data collected for three protein-reactive dyes (CellTrace™ Violet, CellTrace™ CFSE, and CellTrace™ Far Red) and three membrane-intercalating dyes (PKH67, PKH26, and CellVue® Claret) on three different cytometers to illustrate typical decisions and trade-offs required during multicolor panel design. Lastly, we include methods and controls for assessing regulatory T cell potency, a functional assay that incorporates the "know your dye" and "know your cytometer" principles described herein.
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Rastreo Celular , Colorantes Fluorescentes , Citometría de Flujo/métodos , Proliferación Celular/fisiología , División Celular , Rastreo Celular/métodosRESUMEN
After the SARS-CoV-2 pandemic we face a new global epidemic: the Post-COVID Syndrome. This novel condition has fluctuating progression and a wide range of symptoms, such as fatigue, headaches, muscle pain or breathlessness. Although its pathophysiology is not clear, a multiorganic affection is suspected, altering the immune, cardiorespitatory and nervous systems. Whereas there is no consensus over its treatment, most of the researches conclude the effectiveness of therapeutic exercise and a multicomponent rehabilitation, coordinating and cooperating between different health professionals. A functional, respiratory and strength evaluation prior to treatment prescription is highly recommended, since it will help professionals to precisely prescribe and objectively measure the evolution of our patients. In this article we suggest a few tests, adequate to primary health requirements, to evaluate our patients' initial condition, as well as the most secure way to initiate a therapeutic exercise programme, together with other healthcare providers.
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COVID-19 , Terapia por Ejercicio , Síndrome Post Agudo de COVID-19 , Atención Primaria de Salud , Humanos , COVID-19/complicaciones , Terapia por Ejercicio/métodosRESUMEN
This paper introduces the 'Australian Park Life Project' and describes a protocol to standardise the capture and collation of public open greenspace spatial data across Australian cities. This method will progress greenspace research allowing for unique coherent national analyses and comparative research across Australia. We also outline the development of the Park Life public participatory geographic information system (PPGIS) to spatially explore what, and how, public open greenspaces are being used by Australian communities. The combination of community crowdsourced spatial data providing location-specific information on the green public open spaces used, in combination with the national spatial layer of greenspace allows for unique analyses exploring the role of greenspace provision and design on use and represents a transformative strategy in shaping public open space policy and strategy.â¢A spatial layer of public open greenspace was created for the eight Australian State and Territory capital cities using a standardised data capture and collection method from local government planning schemes and land use data, and listings of managed and demarcated parks and reserves.â¢The Park Life public participatory geographic information system (PPGIS) was built to capture spatially referenced information on the use of greenspaces - specifically what spaces are used, and how they are used.
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Symptoms of COVID-19 are similar to the influenza virus, but because treatments and prognoses are different, it is important to accurately and rapidly differentiate these diseases. The aim of this study was to evaluate whether the analysis of complete blood count (CBC), including cellular population (CPD) data of leukocytes and automated flow cytometry analysis, could discriminate these pathologies. In total, 350 patients with COVID-19 and 102 patients with influenza were included between September 2021 and April 2022 in the tertiary hospital of Suresnes (France). Platelets were lower in patients with influenza than in patients with COVID-19, whereas the CD16pos monocyte count and the ratio of the CD16pos monocytes/total monocyte count were higher. Significant differences were observed for 9/56 CPD of COVID-19 and flu patients. A logistic regression model with 17 parameters, including among them 11 CPD, the haemoglobin level, the haematocrit, the red cell distribution width, and B-lymphocyte and CD16pos monocyte levels, discriminates COVID-19 patients from flu patients. The sensitivity and efficiency of the model were 96.2 and 86.6%, respectively, with an area under the curve of 0.862. Classical parameters of CBC are very similar among the three infections, but CPD, CD16pos monocytes, and B-lymphocyte levels can discriminate patients with COVID-19.
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Introducción: en los pacientes que cursaron COVID-19 grave o crítico se ha descripto el uso de prednisona y rehabilitación musculoesquelética y respiratoria. No está claramente establecido el rol de estas intervenciones, ni el momento óptimo para su inicio. En este trabajo se muestran los resultados de la Unidad de Rehabilitación del Hospital del Banco de Seguros del Estado (URHBSE) que implementó un programa de rehabilitación integral y uso de corticoides en la etapa subaguda de pacientes pos-COVID-19 grave o crítico, con un enfoque sistematizado, trabajando desde la interdisciplina y centrado en la persona atendida. Se reportan hallazgos al ingreso, requerimiento de oxígeno, escala de Barthel, patrones tomográficos, uso de corticoides, su respuesta y complicaciones. Se describen los resultados de este enfoque sobre variables clínicas, respiratorias y funcionales. Material y método: estudio descriptivo, retrospectivo, de pacientes pos-COVID-19 que completaron la rehabilitación en la URHBSE, en el período comprendido entre abril y agosto de 2021. Datos obtenidos de revisión de historias clínicas. Análisis estadístico con PRISM (v8.2.1). Resultados: completaron el programa de rehabilitación 84 pacientes. Al ingreso a la URHBSE, 55% tenía dependencia total o grave en la escala de Barthel. No lograba marcha el 48%. Requería oxígeno el 89,2% de los pacientes con una media de saturación de 90,3 ± 4,8. El 25% ingresó requiriendo máscara con reservorio. Todos los pacientes que comenzaron el programa se encontraban en fase subaguda de la enfermedad (4 a 12 semanas), y recibieron un plan de rehabilitación integral e individualizado. El objetivo era alcanzar una situación funcional similar a la que presentaban previo al COVID-19. La duración de la internación en la URHBSE fue de 23,5 ± 13,8 días. A 76 pacientes (90,5%) se les realizó tomografía de alta resolución de tórax (TACAR), resultando patológica en 96,1%. Predominaba el vidrio deslustrado (49,3%), la consolidación en 8,23% y un patrón de tipo fibrosis like en 30,13%. Se detectaron alteraciones tomográficas "no típicas" de daño pos-COVID (derrame pleural, nódulos cavitados, cavidades apicales, etc.) en 11,8% de las tomografías. En dos pacientes (2,6%) se halló una aspergilosis pulmonar y en 6,6% tromboembolismo pulmonar. Recibieron prednisona 44 pacientes (52,3%). En 63,4% se suspendió el aporte de oxígeno en los primeros 15 días desde el inicio de prednisona. Encontramos asociación entre el patrón tomográfico con vidrio deslustrado y la suspensión precoz del aporte de oxígeno desde el inicio de prednisona (p = 0,047). A pesar del alto grado de colonización, incluso en aquellos casos en que utilizamos prednisona, no observamos infecciones por microorganismos colonizantes. Comparando ingreso y egreso se hallaron diferencias estadísticamente significativas en los siguientes parámetros: el grado de disnea, el requerimiento de oxígeno (un solo paciente fue dado de alta con oxígeno), la saturación, el grado de instrumentación (traqueostomía, sonda nasogástrica, etc.), y la escala de dependencia de Barthel. En cuanto a las variables respiratorias solo contamos con el dato de la presencia de disnea de los primeros 35 pacientes, de éstos, 83% presentaba disnea al ingreso, mientras que solo 17% la presentaba al egreso (p < 0,0001). Hubo, asimismo, diferencias significativas en el requerimiento de oxígeno entre el ingreso y el egreso (p < 0,0001) y en el grado de dependencia medido en la escala de Barthel, teniendo dependencia total o grave al ingreso 55% de los pacientes y solo 3,4% al alta. Conclusiones: las intervenciones realizadas en la etapa subaguda de la enfermedad se asociaron con mejoras significativas en variables de interés clínico. Faltan más estudios para definir el rol y el momento exacto del inicio de los corticoides y la rehabilitación en este grupo de pacientes. (AU)
Introduction: In patients with severe or critical COVID-19, the use of prednisone and musculoskeletal and respiratory rehabilitation has been described. The role of these interventions and the optimal time for their initiation are not clearly established. This study presents the results of the Rehabilitation Unit of the Banco de Seguro del Estado Hospital, which implemented a comprehensive rehabilitation program and the use of corticosteroids in the subacute stage of patients with severe or critical post-COVID-19, with a systematic approach, working interdisciplinary and centered on the person being treated. Findings at admission, oxygen requirement, Barthel scale, tomographic patterns, use of corticosteroids, their response, and complications are reported. The results of this approach on clinical, respiratory, and functional variables are described. Method: Descriptive, retrospective study of post-COVID-19 patients who completed rehabilitation at the Rehabilitation Unit of the Banco de Seguros del Estado Hospital (URHBSE) in the period April-August 2021. Data obtained from review of medical records, statistical analysis with PRISM (v8.2.1). Results: Eighty-four patients completed the rehabilitation program. Upon admission to the URHBSE, 55% had total or severe dependence on the Barthel scale. Forty-eight percent were unable to walk. Eighty-nine-point two percent required oxygen, with a mean saturation of 90.3 ± 4.8. Twenty-five percent of patients were admitted requiring a reservoir mask. All patients who entered the program were in the subacute phase of the disease (4 to 12 weeks) and received a comprehensive and individualized rehabilitation plan. The objective was to achieve a functional situation similar to what they had before COVID-19. The length of stay at the URHBSE was 23.5 ± 13.8 days. A total of 76 patients (90.5%) underwent high-resolution chest tomography (HRCT), which was pathological in 96.1% of cases. The predominant findings were ground-glass opacity in 49.3% of cases, consolidation in 8.23%, and a fibrosis-like pattern in 30.13%. "Non-typical" post-COVID damage tomographic alterations were detected (pleural effusion, cavitary nodules, apical cavities, etc.) in 11.8% of the tomographies. In 2 patients (2.6%), pulmonary aspergillosis was found, and in 6.6%, pulmonary thromboembolism. Forty-four patients (52.3%) received prednisone. In 63.4% of cases, oxygen supplementation was discontinued within the first 15 days from the start of prednisone. We found an association between the ground-glass opacity tomographic pattern and early discontinuation of oxygen supplementation from the start of prednisone (p = 0.047). Despite the high degree of colonization, we did not observe infections by colonizing microorganisms, even in those who used prednisone. Comparing admission and discharge, statistically significant differences were found in the following parameters: degree of dyspnea, oxygen requirement (only one patient was discharged with oxygen), saturation, degree of instrumentation (tracheostomy, nasogastric tube, etc.), and the Barthel dependency scale. Regarding respiratory variables, we only have data on the presence of dyspnea in the first 35 patients. Of these, 83% had dyspnea at admission, while only 17% had it at discharge (p < 0.0001). There were also significant differences in the oxygen requirement between admission and discharge (p < 0.0001) and in the degree of dependency measured on the Barthel scale. Fifty-five percent of patients had total or severe dependence at admission, compared to only 3.4% at discharge. Conclusions: The interventions carried out in the subacute stage of the disease were associated with significant improvements in clinical variables of interest. More studies are needed to define the role and the exact timing of the initiation of corticosteroids and rehabilitation in this group of patients.
Introdução: O uso de prednisona e reabilitação musculoesquelética e respiratória foi descrito no tratamento de pacientes com COVID-19 grave ou crítico. O papel destas intervenções e o momento ideal para o seu início não estão claramente estabelecidos. Este trabalho mostra os resultados da Unidade de Reabilitação Hospitalar do Banco de Seguro del Estado que implementou um programa abrangente de reabilitação e uso de corticosteroides na fase subaguda de pacientes graves ou críticos pós-COVID-19, com uma abordagem sistematizada, trabalhando de forma interdisciplinar e centrada no paciente. São relatados os achados na admissão, a necessidade de oxigênio, a escala de Barthel, os padrões tomográficos, o uso de corticosteroides, a resposta ao tratamento e as complicações. Os resultados desta abordagem sobre variáveis clínicas, respiratórias e funcionais são descritos. Material e métodos: Estudo descritivo e retrospectivo de pacientes pós-COVID-19 que completaram reabilitação na Unidade de Reabilitação do Hospital Banco de Seguros del Estado (URHBSE) no período de abril a agosto de 2021. Os dados foram obtidos dos prontuários de pacientes com posterior análise estatísticas usando PRISM (v8.2.1). Resultados: 84 pacientes completaram o programa de reabilitação. No momento da admissão na URHBSE, 55% apresentavam dependência total ou grave da escala de Barthel. 48% não conseguiam se mover. 89,2% necessitaram oxigênio com saturação média de 90,3 ± 4,8. 25% dos pacientes foram internados necessitando máscara com reservatório. Todos os pacientes que ingressaram no programa estavam na fase subaguda da doença (4 a 12 semanas) e receberam um plano de reabilitação abrangente e individualizado. O objetivo era alcançar uma situação funcional semelhante à que apresentavam antes da COVID-19. O tempo de permanência na URHBSE foi de 23,5±13,8 dias. A tomografia de tórax de alta resolução (TCAR) foi realizada em 76 pacientes (90,5%); os resultados foram patológicos em 96,1%. O vidro fosco predominou em 49,3% deles, a consolidação em 8,23% e o padrão fibroso em 30,13%. Alterações tomográficas "atípicas" de danos pós-COVID (derrame pleural, nódulos cavitados, cavidades apicais, etc.) foram detectadas em 11,8% dos exames tomográficos. Aspergilose pulmonar foi encontrada em 2,6% dos pacientes e tromboembolismo pulmonar em 6,6%. 44 pacientes (52,3%) receberam prednisona. Em 63,4% a oferta de oxigênio foi suspensa nos primeiros 15 dias após o início da mesma. Encontramos associação entre o padrão tomográfico em vidro fosco e a suspensão precoce da oferta de oxigênio desde o início da administração da prednisona (p = 0,047). Apesar do alto grau de colonização, mesmo naqueles que usaram prednisona, não observamos infecções. Em relação às variáveis respiratórias, só temos dados sobre a presença de dispneia nos primeiros 35 pacientes; destes, 83% apresentavam dispneia na admissão, enquanto apenas 17% a apresentavam na alta (p< 0,0001). Observou-se também diferenças significativas na necessidade de O2 entre a admissão e a alta (p< 0,0001) e no grau de dependência medido pela escala de Barthel, com 55% dos pacientes apresentando dependência total ou grave na admissão e apenas 3,4% na alta. Conclusões: As intervenções realizadas na fase subaguda da doença foram associadas a melhorias significativas nas variáveis de interesse clínico. São necessários mais estudos para definir o papel e o momento exato do início dos corticosteroides e da reabilitação neste grupo de pacientes.
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Corticoesteroides/uso terapéutico , Síndrome Post Agudo de COVID-19/rehabilitación , Síndrome Post Agudo de COVID-19/terapia , Estudios RetrospectivosRESUMEN
Resumo: A gravidez, o parto e o nascimento são momentos de grandes mudanças na vida das mães e dos pais. Este artigo tem como objetivo apresentar o protocolo da pesquisa para estimar a prevalência dos desfechos em saúde mental nas mães e pais no pós-parto, dos maus tratos e satisfação na atenção ao parto/abortamento, e as inter-relações entre eles e fatores socioeconômicos, obstétricos e da saúde da criança. A pesquisa tem dois componentes: estudo de coorte prospectiva com todas as puérperas entrevistadas nas 465 maternidades incluídas na linha de base da pesquisa Nascer no Brasil II realizada entre 2021 e 2023, e estudo seccional com os companheiros/pais dos bebês. As entrevistas são realizadas por ligação telefônica ou link de autopreenchimento enviado por WhatsApp com as puérperas aos 2 e 4 meses após o parto/aborto. Os companheiros são abordados três meses após o nascimento (excluídos os abortos, natimortos e neomortos), a partir do telefone informado pela puérpera na maternidade. As entrevistas abordam, entre as puérperas, sintomas de depressão, ansiedade e transtorno de estresse pós-traumático, maus-tratos na atenção na maternidade e qualidade do vínculo mãe-bebê. São investigados também a presença de morbidade materna e neonatal, utilização de serviços pós-natais, e satisfação com o atendimento na maternidade. Entre os pais, é abordada a ocorrência de sintomas de depressão e ansiedade, e a qualidade do relacionamento com a esposa/companheira e o bebê. As informações coletadas nessa etapa da pesquisa poderão subsidiar o planejamento e melhoria do cuidado voltado para a saúde da tríade mãe-pai-filho após o nascimento.
Resumen: El embarazo, el parto y el nacimiento son momentos de grandes cambios en la vida de madres y padres. Este artículo tiene como objetivo presentar el protocolo de investigación para estimar la prevalencia de los resultados de la salud mental en madres y padres en el posparto, maltratos y la satisfacción durante la atención del parto/aborto, y las interrelaciones entre ellos y los factores socioeconómicos, obstétricos y de salud infantil. La investigación tiene dos componentes: un estudio de cohorte prospectivo con todas las puérperas entrevistadas en las 465 maternidades incluidas en la línea de base de la encuesta Nacer en Brasil II realizada entre 2021 y 2023, y un estudio seccional con las parejas/padres de los bebés. Las entrevistas se efectúan mediante llamada telefónica o enlace de autocumplimentación enviado vía WhatsApp a las puérperas a los 2 y 4 meses después del parto/aborto. El contacto con la pareja se hace a los tres meses del nacimiento (excluyendo abortos, mortinatos y muertes de recién nacidos), a través del teléfono facilitado por la puérpera en la sala de maternidad. Las entrevistas abordan, entre las puérperas, los síntomas de depresión, ansiedad y trastorno de estrés postraumático, maltrato durante la atención en la maternidad y la calidad del vínculo madre-bebé. También se investiga la presencia de morbilidad materna y neonatal, uso de servicios posnatales y satisfacción con la atención en la maternidad. Entre los padres, se aborda la ocurrencia de síntomas de depresión y ansiedad, y la calidad de la relación con la esposa/pareja y el bebé. La información recopilada en esta etapa de la investigación puede apoyar la planificación y mejora de la atención dirigida a la salud de la tríada madre-padre-hijo después del nacimiento.
Abstract: Pregnancy, parturition and birth bring major changes to the lives of mothers and fathers. This article presents a research protocol for estimating the prevalence of postpartum mental health outcomes in mothers and fathers, abuse and satisfaction in delivery/abortion care, and the correlations between them and socioeconomic, obstetric, and child health factors. As a 2-component research, it consists of a prospective cohort study with all postpartum women interviewed in the 465 maternity hospitals included at the Birth in Brazil II baseline survey conducted from 2021 to 2023, and a cross-sectional study with the newborns' fathers/partners. Interviews will be conducted via telephone or self-completion link sent by WhatsApp with the mother at 2 and 4 months after delivery/abortion. Partners will be approached three months after birth (excluding abortions, stillbirths and newborn death) using the telephone number informed by the mother at the maternity ward. Postpartum women will be inquired about symptoms of depression, anxiety and post-traumatic stress disorder, abuse during maternity care and quality of the mother-newborn bond. Maternal and neonatal morbidity, use of postnatal services, and satisfaction with maternity care are also investigated. Fathers will be asked to report on symptoms of depression and anxiety, and the quality of the relationship with the partner and the newborn. The information collected in this research stage may help to plan and improve care aimed at the postpartum health of the mother-father-child triad.
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Resumo Fundamento: Pouco explorada na decisão de extubação no pós-operatório de cirurgia cardíaca, a complacência pulmonar estática seriamente afetada no procedimento cirúrgico pode levar à insuficiência respiratória e à falha na extubação. Objetivo: Avaliar a complacência pulmonar estática no pós-operatório de cirurgia cardíaca e relacionar sua possível redução aos casos de falha na extubação dos pacientes submetidos ao método fast-track de extubação. Métodos: Foram incluídos pacientes que realizaram cirurgia cardíaca com uso de circulação extracorpórea (CEC) em um hospital universitário estadual admitidos na UTI sob sedação e bloqueio residual. Tiveram sua complacência pulmonar estática avaliada no ventilador mecânico por meio do software que utiliza o least squares fitting (LSF) para a medição. No período de 48 horas após a extubação os pacientes foram observados respeito à necessidade de reintubação por insuficiência respiratória. O nível de significância adotado para os testes estatísticos foi de 5%, ou seja, p<0,05. Resultados: Obtiveram sucesso na extubação 77 pacientes (75,49%) e falharam 25 (24,51%). Os pacientes que falharam na extubação tiveram a complacência pulmonar estática mais baixa quando comparados aos que tiveram sucesso (p<0,001). Identificamos o ponto de corte para complacência por meio da análise da curva Receiver Operating Characteristic Curve (ROC) sendo o ponto de corte o valor da complacência <41ml/cmH2O associado com maior probabilidade de falha na extubação (p<0,001). Na análise de regressão múltipla, verificou-se a influência da complacência pulmonar (dividida pelo ponto de corte da curva ROC) com risco de falha 9,1 vezes maior para pacientes com complacência <41ml/cmH2O (p< 0,003). Conclusões: A complacência pulmonar estática <41ml/cmH2O é um fator que compromete o sucesso da extubação no pós-operatório de cirurgia cardíaca.
Abstract Background: Static lung compliance, which is seriously affected during surgery, can lead to respiratory failure and extubation failure, which is little explored in the decision to extubate after cardiac surgery. Objective: To evaluate static lung compliance in the postoperative period of cardiac surgery and relate its possible reduction to cases of extubation failure in patients submitted to the fast-track method of extubation. Methods: Patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) at a state university hospital admitted to the ICU under sedation and residual block were included. Their static lung compliance was assessed on the mechanical ventilator using software that uses least squares fitting (LSF) for measurement. Within 48 hours of extubation, the patients were observed for the need for reintubation due to respiratory failure. The level of significance adopted for the statistical tests was 5%, i.e., p<0.05. Results: 77 patients (75.49%) achieved successful extubation and 25 (24.51%) failed extubation. Patients who failed extubation had lower static lung compliance compared to those who succeeded (p<0.001). We identified the cut-off point for compliance through analysis of the Receiver Operating Characteristic Curve (ROC), with the cut-off point being compliance <41ml/cmH2O associated with a higher probability of extubation failure (p<0.001). In the multiple regression analysis, the influence of lung compliance (divided by the ROC curve cut-off point) was found to be 9.1 times greater for patients with compliance <41ml/cmH2O (p< 0.003). Conclusions: Static lung compliance <41ml/cmH2O is a factor that compromises the success of extubation in the postoperative period of cardiac surgery.
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Este artículo explora los desafíos que presenta a la bioética la emergencia del transhumanismo en Occidente. La exploración es abordada desde una perspectiva de investigación genealógica, que tiene por objetivo preguntarse por las condiciones de inteligibilidad del transhumanismo y a partir de allí analizar sus impactos en la actualización de un debate central en bioética, a saber, los límites a la manipulación de la vida humana. El transhumanismo, habitando la crisis del humanismo que le antecede y compele, reactualiza la cuestión de la condición humana presentando una línea argumental que al menos autoriza a formular de nuevo la pregunta límite: ¿podemos, o acaso debemos, ir más allá de lo humano?.
This article explores the challenges presented to bioethics by the emergence of transhumanism in the West. The exploration is approached from a genealogical research perspective. A genealogical investigation aims to question the conditions of intelligibility of transhumanism and from there analyze its impacts on the updating of a central debate in bioethics, namely: the limits to the manipulation of human life. Transhumanism, inhabiting the crisis of humanism that precedes and compels it, updates the issue of the human condition by presenting a line of argument that at least authorizes to formulate again the limit question: can we/should we go beyond the human?.
Este artigo explora os desafios apresentados à bioética pela emergência do transumanismo no Ocidente. A exploração é abordada a partir de uma perspectiva de pesquisa genealógica. Uma investigação genealógica visa indagar sobre as condições de inteligibilidade do transumanismo e a partir daí analisar seus impactos na atualização de um debate central na bioética, a saber: os limites à manipulação da vida humana. O transumanismo, habitando a crise do humanismo que o precede e o compele, atualiza a questão da condição humana ao apresentar uma linha de argumentação que ao menos nos autoriza a formular novamente a questão límite: podemos ou devemos ir além do que é humano?.
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OBJETIVO: Mapear as evidências científicas sobre as ações dos enfermeiros obstétricos no gerenciamento clínico da hemorragia pós-parto. MÉTODO: Trata-se de uma revisão de escopo elaborada segundo as recomendações do JBI Institute Manual do Revisor para Scoping Review. As buscas serão realizadas nas bases de dados eletrônicas CINAHL, Cochrane Library, EMBASE, Literatura Latino-americana e do Caribe em Ciências da Saúde, MEDLINE/PubMed, SciELO, ScienceDirect, SCOPUS, Web of Science e na literatura cinzenta. Os estudos que serão incluídos precisarão responder ao objetivo desta pesquisa e estar nos idiomas Português, Espanhol ou Inglês. Além disso, é necessário ter disponibilidade dos estudos na íntegra através de acesso remoto pelo acesso da CAFe. Os estudos que não serão incluídos serão os em formato de editorial e carta ao editor. Haverá a seleção por meio da leitura do título e resumo dos materiais encontrados nas buscas, sendo assim avaliados de maneira independente por dois revisores e nos casos de divergências por um terceiro avaliador. Os dados coletados estarão organizados e relacionados segundo a análise descritiva. Os resultados poderão estar dispostos em tabelas ou quadros, e serão discutidos com suporte de literatura acerca da temática, retratando a quinta etapa do método escolhido.
OBJECTIVE: To map the scientific evidence regarding the actions of obstetric nurses in the clinical management of postpartum hemorrhage. METHOD: This scoping review was developed according to the JBI Institute Reviewer's Manual for Scoping Reviews. The electronic databases CINAHL, Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature, MEDLINE/PubMed, SciELO, ScienceDirect, SCOPUS, Web of Science, and gray literature were searched. Included studies must address the research objective in Portuguese, Spanish, or English. In addition, full remote access to the studies via CAFe is required. Studies in editorial or letter format will be excluded. Selection will be based on the title and abstract of the materials found in the searches, independently assessed by two reviewers, with disagreements resolved by a third reviewer. Collected data will be organized and related through descriptive analysis. Results may be presented in tables or figures and discussed with support from literature, reflecting the fifth step of the selected methodology.
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Objetivo: Evidenciar através de uma revisão integrativa os resultados clínicos atuais do impacto do consumo de ômega 3 frente a depressão pós-parto. Método: Revisão integrativa da literatura realizada no período de Fevereiro a Julho de 2023 nas bases de dados Pubmed, LILACS, Medline e Scielo. Resultados:Foi realizada uma busca pelos descritores em saúde determinados e foram selecionadas 5 produções científicas que atenderam os critérios de inclusão. De modo geral, os trabalhos mostraram relações com a saúde do bebê e da mãe. No bebê, observou-se aumento do crescimento intrauterino, maior resposta do sistema nervoso central, melhor desenvolvimento neural, de retina, imunológico, cognitivo e físico. Já na saúde materna, observou-se aumento no processo antiinflamatório, melhor resposta imune, melhora no efeito neurotrófico do cérebro, aumento do metabolismo, melhora hormonal, menor risco cardiovascular, menores distúrbios neurológicos (incluindo a depressão) e distúrbios visuais. Conclusão:Mais estudos são necessários para elucidar os benefícios da suplementação de ômega-3 em gestantes no pós-parto
Objective: To show, through an integrative review, the current clinical results of the impact of omega 3 consumption on postpartum depression. Method:Integrative literature review carried out from February to July 2023 in the Pubmed, LILACS, Medline and Scielo databases. Results:A search was performed for specific health descriptors and 5 scientific productions that met the inclusion criteria were selected. In general, the studies showed relationships with the health of the baby and the mother. In the baby, there was an increase in intrauterine growth, greater response of the central nervous system, better neural, retinal, immunological, cognitive and physical development. In maternal health, there was an increase in the anti-inflammatory process, better immune response, improvement in the neurotrophic effect of the brain, increased metabolism, hormonal improvement, lower cardiovascular risk, lesser neurological disorders (including depression) and visual disturbances. Conclusion:More studies are needed to elucidate the benefits of omega-3 supplementation in postpartum pregnant women.
Objetivo: Mostrar, a través de una revisión integradora, los resultados clínicos actuales del impacto del consumo de omega 3 en la depresión posparto. Método:Revisión integrativa de la literatura realizada de febrero a julio de 2023 en las bases de datos Pubmed, LILACS, Medline y Scielo. Resultados:Se realizó una búsqueda de determinados descriptores de salud y se seleccionaron 5producciones científicas que cumplían con los criterios de inclusión. En general, los estudios mostraron relaciones con la salud del bebé y de la madre. En el bebé hubo un aumento del crecimiento intrauterino, mayor respuesta del sistema nervioso central,mejor desarrollo neural, retiniano, inmunológico, cognitivo y físico. En salud materna, hubo aumento del proceso antiinflamatorio, mejor respuesta inmunológica, mejora del efecto neurotrófico del cerebro, aumento del metabolismo, mejora hormonal, menor riesgo cardiovascular, menos trastornos neurológicos (incluyendo depresión) y alteraciones visuales. Conclusión:Se necesitan más estudios para dilucidar los beneficios de la suplementación con omega-3 en mujeres embarazadas posparto
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Depresión Posparto , Ácidos Grasos Omega-3RESUMEN
ABSTRACT In its 20th anniversary, laparoscopic pancreatoduodenectomy, while feasible and safe in the hands of experienced surgeons, has not seen the anticipated popularity observed in other digestive surgery procedures. The primary hurdle remains the absence of a clear advantage over traditional open surgery, paired with the procedures complexity and a consequent steep learning curve. In regions with limited pancreatic surgery services, conducting this procedure without adequate training can have serious repercussions. Given the advent of robotic platforms and the anticipation of prospective and randomized studies on this new technology, it is imperative to engage in comprehensive discussions, endorsed by surgical societies, on the value, application, and implementation strategies for various minimally invasive pancreatoduodenectomy techniques. Such dialogue is crucial for advancing the field and ensuring optimal patient outcomes.
RESUMO No ano em que completa 20 anos, a Pancreatoduodenectomia Laparoscópica, embora factível e segura em mãos experientes, não obteve uma esperada popularização como aquela observada em vários outros procedimentos no campo da cirurgia digestiva. A ausência de uma clara vantagem sobre a cirurgia aberta associada a complexidade do procedimento com consequente difícil e demorada curvas de aprendizado são os principais obstáculos. Em nosso país onde se dispõe de poucos serviços de cirurgia pancreática as consequências da prática desse procedimento sem um adequado treinamento pode trazer sérios prejuizos. Torna-se imperativo, agora com difusão das plataformas robóticas e enquanto se aguarda os estudos prospectivos e randomizados com essa nova tecnologia, que uma ampla discussão seja feita com chancela das sociedades de cirurgia sobre o valor, a aplicação e a forma de implantação das diversas técnicas de pancreatoduodenectomia minimamente invasivas.
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ABSTRACT Introduction: Vitamin D plays a crucial role in various biological processes, including the well-known regulation of the immune system and calcium metabolism. While its involvement in the surgical outcomes of various medical specialties is recognized, there is a lack of consistent data regarding plastic surgery. This study aimed to assess preoperative serum levels of 25-hydroxyvitamin D and its relationship with complications in patients undergoing reconstructive and aesthetic plastic surgeries. Methods: prospective and observational cohort study, conducted from October 2021 to August 2023 at the Hospital das Clínicas, Universidade Federal de Pernambuco, involving 83 patients. Results: vitamin D levels were deemed deficient in 7 (8,4%) patients, insufficient in 36 (43,4%), and sufficient in 40 (48,2%). No direct association was demonstrated between deficient or insufficient serum levels of 25-hydroxyvitamin D and the incidence of complications in plastic surgery, even when considering comorbidities. Conclusion: preoperative hypovitaminosis D was not associated with complications in plastic surgery.
RESUMO Introdução: a vitamina D é parte constituinte de diversos processos biológicos. Além da conhecida regulação do sistema imunológico e do metabolismo do cálcio, está envolvida no desfecho cirúrgico de diversas especialidades, porém não há dados consistentes sobre cirurgia plástica. Este estudo teve como objetivo avaliar os níveis séricos pré-operatórios de 25-hidroxivitamina D e sua relação com complicações em pacientes submetidos a cirurgias plásticas reparadoras e estéticas. Métodos: coorte prospectiva e observacional, conduzida de outubro de 2021 a agosto de 2023 no Hospital das Clínicas da Universidade Federal de Pernambuco, em 83 pacientes. Resultados: os níveis de vitamina D foram considerados deficientes em 7 (8,4%) dos pacientes, insuficientes em 36 (43,4%) e suficientes em 40 (48,2%). Não se demonstrou associação direta entre níveis séricos deficientes ou insuficientes de 25-hidroxivitamina D e a incidência de complicações em cirurgia plástica, nem mesmo quando associado a comorbidades Conclusão: a hipovitaminose D pré-operatória não foi associada a complicações em cirurgia plástica.
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Resumo: O objetivo do estudo é analisar o perfil de egressos e identificar fatores associados ao desempenho positivo relativo à trajetória de formação e de inserção profissional entre aqueles que concluíram cursos presenciais de mestrado e doutorado acadêmico da Fundação Oswaldo Cruz (Brasil). Participaram do estudo 2.462 egressos (1.402 de mestrado e 1.060 de doutorado) que responderam um questionário digital, contendo questões sobre perfil do egresso e inserção profissional antes do ingresso no curso e após a conclusão. Foi criada uma medida sobre "desempenho positivo pós-curso". Os resultados revelam que egressos de mestrado com impacto positivo do curso tendem a ser homens; ter especialização antes de ingressar no curso; ter emprego remunerado após o término do curso nas áreas de pesquisa, educação, assistência e gestão; e ser servidor público. No doutorado o seguinte perfil é evidenciado: egressos com emprego remunerado após o término do curso nas áreas de pesquisa ou educação; contratados por Regime Jurídico Único ou contrato temporário de pessoa jurídica; e com publicação científica ou patente. A avaliação/acompanhamento de egressos deve se instaurar como uma importante política pública educacional, incorporada no processo de autoavaliação institucional, o que possibilita rever rumos e prioridades na agenda educacional e pedagógica da instituição.
Abstract: This study aims to analyze the profile of graduates and identify factors associated with positive performance regarding training and professional insertion among those who have completed face-to-face master's and doctoral courses at the Oswaldo Cruz Foundation (Brazil). A total of 2,462 graduates participated in the study (1,402 master's and 1,060 doctoral graduates), who answered a digital questionnaire containing questions about individual characteristics and professional insertion before entering the course and after completion. A measure on "positive post-course performance" was created. The results show that Master's graduates with a positive impact from the course tend to be men; to have a specialization degree before entering the course; to have paid employment after finishing the course in the areas of research, education, assistance, and management; and to be civil servants. In the Doctorate, the following profile is evident: graduates with paid employment after finishing the course in the areas of research or education; hired under a single legal regime or temporary contract as a legal entity; and with a scientific publication or patent. Evaluating/monitoring graduates must be established as an important public educational policy, incorporated into the institutional self-evaluation process, which makes it possible to review directions and priorities in the institution's educational and pedagogical agenda.
Resumen: El objetivo del estudio es analizar el perfil de egresados e identificar factores asociados al desempeño positivo relacionado a la trayectoria de formación e inserción profesional entre aquellos que concluyeron cursos presenciales de maestría y doctorado académico de la Fundación Oswaldo Cruz (Brasil). Participaron del estudio 2.462 egresados (1.402 de maestría y 1.060 de doctorado) que contestaron el cuestionario de manera digital, con preguntas sobre el perfil del egresado y la inserción profesional antes del ingreso al curso y tras su conclusión. Se creó una medida sobre "desempeño positivo tras el curso". Los resultados muestran que los egresados de la maestría con un impacto positivo del curso tienden a ser hombres; tener especialización antes de ingresar al curso; tener trabajo remunerado tras concluir el curso en las áreas de investigación, educación, asistencia y gestión; y ser funcionario público. Se evidencia el siguiente perfil en el doctorado: egresados con trabajo remunerado tras el término del curso en las áreas de investigación o educación; contratados bajo un régimen jurídico único o un contrato temporal de persona jurídica; y con publicación científica o patente. La evaluación/seguimiento de egresados se debe establecer como una importante política pública educativa, incorporada en el proceso de autoevaluación institucional, lo que permite revisar direcciones y prioridades en la agenda educativa y pedagógica de la institución.
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RESUMEN El hematoma subcapsular hepático es una complicación infrecuente pero potencialmente grave de la colangiografía retrógrada endoscópica. Por otra parte, las complicaciones derivadas del hematoma pueden ser su rotura, con el consiguiente sangrado masivo, y/o la trombosis portal por compresión que evolucione hacia la necrosis, la cual es susceptible de infecciones generalmente graves que requieren un manejo más enérgico. Presentamos el caso de una paciente a quien se le realizó una colangiografía endoscópica retrógrada por una colangitis aguda, y presentó en la evolución un hematoma subcapsular, que progresó a la necrosis hepática por compresión del pedículo portal, y una infección de esa necrosis, por lo que requirió una hepatectomía derecha de urgencia.
ABSTRACT Hepatic subcapsular hematoma is a rare but potentially lethal complication of endoscopic retrograde cholangiography. On the other hand, complications derived from the hematoma can be its rupture with the consequent massive bleeding, and/or portal thrombosis due to compression that evolves towards necrosis, which is susceptible to generally serious infections that require more aggressive management. We present the case of a patient treated in our department who underwent retrograde endoscopic cholangiography as treatment for her acute cholangitis, presenting in the evolution a subcapsular hematoma that progressed to hepatic necrosis due to compression of the portal pedicle and later an infection of that necrosis. requiring an emergency right hepatectomy as surgical treatment.
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Objetivo: identificar na literatura científica as incidências dos sintomas depressivos pós-parto e os fatores associados. Método: revisão narrativa da literatura descrita conforme a declaração Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A busca bibliográfica foi realizada na BVS, nas bases de dados LILACS e MEDLINE. Foram elegíveis estudos observacionais com delineamento longitudinal, que utilizaram a Escala de depressão pós-parto de Edimburgo, disponíveis em texto completo, publicados nos anos de 2019 e 2020. Resultados: foram incluídos 17 artigos. A incidência de sintomatologia depressiva pós-parto variou de 0,18% a 27,87%. Os principais fatores de risco associados foram histórico de depressão, estresse e relação estressante familiar, baixo suporte social, transtornos psiquiátricos como comorbidade e experiência negativa ou complicações durante parto. Conclusão: a sintomatologia depressiva pós-parto atinge parcela expressiva das puérperas e se mantém como problema de saúde pública. Sugere-se a continuidade dos estudos que se relacionam com a temática no cenário nacional
Objective: to identify in the scientific literature the incidence of postpartum depressive symptoms and associated factors. Method: narrative review of the literature described according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The bibliographic search was carried out in the BVS, in the LILACS and MEDLINE databases. Observational studies with a longitudinal design were eligible, using the Edinburgh Postnatal Depression Scale, available in full text, published in 2019 and 2020. Results: 17 articles were included. The incidence of postpartum depressive symptoms ranged from 0.18% to 27.87%. The main associated risk factors were a history of depression, stress and stressful family relationships, low social support, comorbid psychiatric disorders and negative experiences or complications during childbirth. Conclusion: postpartum depressive symptoms affect a significant proportion of postpartum women and remain a public health problem. It is suggested that studies related to the theme be continued on a national level
Objetivos: identificar en la literatura científica la incidencia de síntomas depresivos posparto y factores asociados. Método: revisión narrativa de la literatura descrita según la declaración Preferred Reporting Items for Systematic Reviews and Meta- Analyses. La búsqueda bibliográfica se realizó en la BVS, en las bases de datos LILACS y MEDLINE. Fueron elegibles estudios observacionales con diseño longitudinal, utilizando la Escala de Depresión Postnatal de Edimburgo, disponible en texto completo, publicada en 2019 y 2020. Resultados: se incluyeron 17 artículos. La incidencia de síntomas depresivos posparto varía del 0,18% al 27,87%. Los principales factores de riesgo asociados fueron antecedentes de depresión, estrés y relaciones familiares estresantes, bajo apoyo social, trastornos psiquiátricos comórbidos y experiencias negativas o complicaciones durante el parto. Conclusion: los síntomas depresivos posparto afectan a una proporción significativa de mujeres posparto y siguen siendo un problema de salud pública. Se sugiere continuar con los estudios relacionados con el tema a nivel nacional