Análise da efetividade do grupo de gestantes na modalidade online como ferramenta de aprendizagem gravídico puerperaleral / Analysis of the effectiveness of the online pregnancy group as a pregnancy and puerperal learning tool

Objetivo: Analisar a efetividade do grupo de gestantes na modalidade online como ferramenta de aprendizagem. Método: Estudo epidemiológico, transversal, observacional e descritivo. As participantes foram pacientes que participaram do grupo de gestantes, em um centro de parto normal, na modalidade presencial ou online. Os dados foram coletados através de um questionário estruturado, contendo 16 perguntas fechadas, acerca dos assuntos abordados no curso. Resultado: Verificamos a predominância de maiores acertos de questões no grupo presencial em comparação ao grupo online. Porém, observou-se que a média de acertos do grupo online gira em torno de 12,44 de um total de 16 questões, o que é muito efetivo. Conclusão: O grupo de gestante na modalidade online, se mostra como uma ferramenta efetiva no processo de ensino-aprendizagem, na medida que os ensinamentos e compartilhamentos de informações são absorvidos em sua maioria pelas gestantes.(AU)

Objective: to identify improvement through risk management applied to the acquisition and distribution processes of NPH human insulins. Method: The study was carried out in stages: in the 1st moment, meetings were held (Brainstorming) and in the 2nd moment, an electronic form was elaborated in the form of a questionnaire, showing the risk "events" with the weights inherent to the probability and impact they generated the risk inherent in the acquisition and distribution processes of NPH and Regular human insulins by the Ministry of Health. Results: Considering the processes, there was a higher incidence of medium risks. No very low risk was indicated, no extreme risk was identified and only 02 (two) high risks were presented. Conclusion: The risk management of the aforementioned study is an improvement tool for the processes of acquisition and distribution of NPH and Regular human insulins by the Ministry of Health.(AU)

Objetivo: identificar la mejora a través de la gestión de riesgos aplicada a los procesos de adquisición y distribución de insulinas humanas NPH. Método: El estudio se realizó por etapas: en el 1er momento se realizaron reuniones (Brainstorming) y en el 2do momento se elaboró un formulario electrónico en forma de cuestionario, mostrando los "eventos" de riesgo con los pesos inherentes a la probabilidad e impacto que generaron los riesgos inherentes a los procesos de adquisición y distribución de insulinas humanas NPH y Regular por parte del Ministerio de Salud. Resultados: Considerando los procesos, hubo una mayor incidencia de riesgos medios. No se indicó riesgo muy bajo, no se identificó riesgo extremo y solo se presentaron 02 (dos) riesgos altos. Conclusión: La gestión de riesgos del mencionado estudio es una herramienta de mejora para los procesos de adquisición y distribución de insulina humana NPH y Regular por parte del Ministerio de Salud.(AU)

Obstetric and neonatal adverse events and association with care models: a cohort study / Eventos adversos obstétricos y neonatales y asociación con modelos de atención: un estudio de cohorte / Eventos adversos obstétricos e neonatais e associação com os modelos de assistência: um estudo coorte

ABSTRACT Objective: to analyze the prevalence of practices in childbirth care, obstetric and neonatal adverse events and their association with care models in three public health services. Method: this is a prospective cohort study carried out with 548 dyads, postpartum women and their newborns, whose pregnancy was of usual risk and vaginal birth, admitted to hospital in three public services, one with an exclusive care model by nurse-midwives (service A), one with a collaborative model involving obstetric doctors and nurses (service B) and one with an exclusive medical care model (service C). Initially, an interview was carried out with participants, and a second contact was carried out 42 days after birth to complement the collection of the adverse event outcome. Results: in service A, no woman underwent the Kristeller maneuver, episiotomy, directed pushing or more than one vaginal examination per hour. Meanwhile, in service C, 19.3%, 39.9%, 77.1% and 26.3% of women underwent these interventions, respectively. Adverse events occurred in 19.2% of the dyads. Occurrence of adverse events was associated with not using partograph (p=0.001; OR: 11.03; CI: 2.64-45.99) and episiotomy (p=0.042; OR: 1.72; CI: 1. 02-2.91). The mean probability of experiencing an adverse event was 5% in service A, 21% in service B and 24% in service C. Conclusion: adverse events had a lower mean probability of occurrence in the service exclusively operated by nurse-midwives, in which greater application of recommendations for labor and birth care was identified.

RESUMEN Objetivo: analizar la prevalencia de prácticas en la atención del childbirth, eventos adversos obstétricos y neonatales y su asociación con los modelos de atención en tres servicios públicos de salud. Método: estudio de cohorte prospectivo realizado con 548 binomios, puérperas y sus recién nacidos, cuyo embarazo fue de riesgo habitual y childbirth vaginal, hospitalizados en tres servicios públicos, uno con modelo de atención exclusiva por enfermeras obstétricas (servicio A), otro con modelo colaborativo. modelo con la labor de médicos y enfermeras obstetras (servicio B) y otro con un modelo de asistencia médica exclusiva (servicio C). Inicialmente se realizó una entrevista a los participantes y se realizó un segundo contacto a los 42 días del nacimiento para complementar la recopilación del resultado del evento adverso. Resultados: en el servicio A ninguna mujer fue sometida a maniobra de Kristeller, episiotomía, pujo dirigido o más de un examen vaginal por hora. Mientras tanto, en el servicio C, el 19,3%, 39,9%, 77,1% y 26,3% de las mujeres se sometieron a estas intervenciones, respectivamente. Los eventos adversos ocurrieron en el 19,2% de los binomios. La aparición de eventos adversos se asoció con la no utilización del partographa (p=0,001; OR: 11,03; IC: 2,64-45,99) y episiotomía (p=0,042; OR: 1,72; IC: 1,02-2,91). La probabilidad promedio de experimentar un evento adverso fue del 5% en el servicio A, del 21% en el servicio B y del 24% en el servicio C. Conclusión: los eventos adversos tuvieron menor probabilidad promedio de ocurrencia en el servicio operado exclusivamente por enfermeras obstétricas, en el que se identificó mayor aplicación de las recomendaciones de asistencia al childbirth y nacimiento.

RESUMO Objetivo: analisar a prevalência de práticas na atenção ao parto, eventos adversos obstétricos e neonatais e sua associação com modelos assistenciais em três serviços de saúde públicos. Método: estudo coorte prospectivo realizado com 548 binômios, puérperas e seus recém-nascidos, cuja gestação foi de risco habitual e o parto vaginal, internados em três serviços públicos, sendo um com modelo de assistência exclusivo por enfermeiras obstetras (serviço A), um com modelo colaborativo com atuação de médicos e enfermeiras obstetras (serviço B) e um com modelo de assistência exclusiva médica (serviço C). Inicialmente, foi realizada uma entrevista com as participantes e um segundo contato foi realizado após 42 dias do parto para complementar a coleta do desfecho evento adverso. Resultados: no serviço A, nenhuma mulher foi submetida à manobra de Kristeller, episiotomia, incentivos a puxos dirigidos ou mais de um toque vaginal por hora. Enquanto, no serviço C, 19,3%, 39,9%, 77,1% e 26,3% das mulheres foram submetidas a essas intervenções, respectivamente. Os eventos adversos ocorreram em 19,2% dos binômios. A ocorrência dos eventos adversos foi associada ao não uso do partograma (p=0,001; OR: 11,03; IC: 2,64-45,99) e episiotomia (p=0,042; OR: 1,72; IC: 1,02-2,91). A probabilidade média de apresentar algum evento adverso foi de 5% no serviço A, 21% no serviço B e 24% no serviço C. Conclusão: os eventos adversos apresentaram menor probabilidade média de ocorrência no serviço com atuação exclusiva de enfermeiras obstetras, no qual se identificou maior aplicação das recomendações para assistência ao parto e nascimento.

Perfil clínico e epidemiológico de pacientes assistidas em uma unidade de terapia intensiva materna do distrito federal / Perfil clínico y epidemiológico de las pacientes atendidas en una unidad de cuidados intensivos maternos en el distrito federal / Clinical and epidemiological profile of patients assisted in a maternal intensive care unit in the federal district

Objetivo: Caracterizar perfil de pacientes encaminhadas para a UTI materna de um hospital público do Distrito Federal. Método: estudo quantitativo de caráter descritivo, transversal e analítico, pautado em dados secundários retroativos obtidos através do livro de admissões da UTI Materna do Hospital Materno Infantil de Brasília, realizando um comparativo entre o ano de criação junho de 2013-2014 e junho de 2019-2020. A Análise estatística descritiva foi realizada por meio de frequência absoluta e frequência relativa. Resultados: Os dados evidenciaram público atendido é exclusivamente feminino, com maior prevalência da faixa etária entre 20 e 29 anos de idade, com média de 30,27 anos de idade. O diagnóstico prevalente foi de Pré-eclâmpsia (17,12%). A transferência para outros setores do mesmo hospital foi o principal desfecho. Conclusão: As causas obstétricas diretas representam a maior parte das internações no setor. Em geral, são mulheres jovens e com diagnostico prioritário de Síndromes Hipertensivas.(AU)

Objective: To characterize the profile of patients referred to the Maternal ICU of a public hospital in the Federal District. Method: quantitative study of descriptive, cross-sectional and analytical nature, based on retrospective secondary data obtained through the Maternal ICU admissions book of the Materno Infantil Hospital of Brasilia, making a comparison between the year of creation June 2013-2014 and June 2019-2020. Descriptive statistical analysis was performed using absolute frequency and relative frequency. Results: The data evidenced public attended is exclusively female, with a higher prevalence of the age group between 20 and 29 years old, with an average of 30.27 years old. The prevalent diagnosis was preeclampsia (17.12%). Transfer to other sectors of the same hospital was the main outcome. Conclusion: Direct obstetric causes represent most of the hospitalizations in the sector. In general, they are young women and with priority diagnosis of hypertensive syndromes.(AU)

Objetivo: Caracterizar el perfil de las pacientes referidas a la UCI materna de un hospital público del Distrito Federal. Método: estudio cuantitativo de carácter descriptivo, transversal y analítico, basado en datos secundarios retrospectivos obtenidos a través del libro de ingresos de la UCI Materna del Hospital Materno Infantil de Brasilia, realizando una comparación entre el año de creación junio 2013-2014 y junio 2019-2020. El análisis estadístico descriptivo se realizó mediante la frecuencia absoluta y la frecuencia relativa. Resultados: Los datos evidencian que el público atendido es exclusivamente femenino, con una mayor prevalencia del grupo de edad entre 20 y 29 años, con una media de 30,27 años. El diagnóstico más frecuente fue la preeclampsia (17,12%). El traslado a otros sectores del mismo hospital fue el principal resultado. Conclusión: Las causas obstétricas directas representan la mayor parte de las hospitalizaciones del sector. En general, son mujeres jóvenes y con diagnóstico prioritario de Síndromes Hipertensivos.(AU)

Habitat filtering drives the local distribution of congeneric species in a Brazilian white-sand flooded tropical forest.

The investigation of ecological processes that maintain species coexistence is revealing in naturally disturbed environments such as the white-sand tropical forest, which is subject to periodic flooding that might pose strong habitat filtering to tree species. Congeneric species are a good model to investigate the relative importance of ecological processes that maintain high species diversity because they tend to exploit the same limiting resources and/or have similar tolerance limits to the same environmental conditions due to their close phylogenetic relationship. We aim to find evidence for the action and relative importance of different processes hypothesized to maintain species coexistence in a white-sand flooded forest in Brazil, taking advantage of data on the detailed spatial structure of populations of congeneric species. Individuals of three Myrcia species were tagged, mapped, and measured for diameter at soil height in a 1-ha plot. We also sampled seven environmental variables in the plot. We employed several spatial point process models to investigate the possible action of habitat filtering, interspecific competition, and dispersal limitation. Habitat filtering was the most important process driving the local distribution of the three Myrcia species, as they showed associations, albeit of different strength, to environmental variables related to flooding. We did not detect spatial patterns, such as spatial segregation and smaller size of nearby neighbors, that would be consistent with interspecific competition among the three congeneric species and other co-occurring species. Even though congeners were spatially independent, they responded to differences in the environment. Last, dispersal limitation only led to spatial associations of different size classes for one of the species. Given that white-sand flooded forests are highly threatened in Brazil, the preservation of their different habitats is of utmost importance to the maintenance of high species richness, as flooding drives the distribution of species in the community.

Tropical peatlands and their contribution to the global carbon cycle and climate change.

Peatlands are carbon-rich ecosystems that cover 185-423 million hectares (Mha) of the earth's surface. The majority of the world's peatlands are in temperate and boreal zones, whereas tropical ones cover only a total area of 90-170 Mha. However, there are still considerable uncertainties in C stock estimates as well as a lack of information about depth, bulk density and carbon accumulation rates. The incomplete data are notable especially in tropical peatlands located in South America, which are estimated to have the largest area of peatlands in the tropical zone. This paper displays the current state of knowledge surrounding tropical peatlands and their biophysical characteristics, distribution and carbon stock, role in the global climate, the impacts of direct human disturbances on carbon accumulation rates and greenhouse gas (GHG) emissions. Based on the new peat extension and depth data, we estimate that tropical peatlands store 152-288 Gt C, or about half of the global peatland emitted carbon. We discuss the knowledge gaps in research on distribution, depth, C stock and fluxes in these ecosystems which play an important role in the global carbon cycle and risk releasing large quantities of GHGs into the atmosphere (CO2 and CH4 ) when subjected to anthropogenic interferences (e.g., drainage and deforestation). Recent studies show that although climate change has an impact on the carbon fluxes of these ecosystems, the direct anthropogenic disturbance may play a greater role. The future of these systems as carbon sinks will depend on advancing current scientific knowledge and incorporating local understanding to support policies geared toward managing and conserving peatlands in vulnerable regions, such as the Amazon where recent records show increased forest fires and deforestation.

Ovarian ectopic pregnancy after in vitro fertilisation treated by laparoscopic excision with ovarian preservation.

A 42-year-old woman presented with lower abdominal pain and fainting episodes 36 days after in vitro fertilisation and embryo transfer. Transvaginal ultrasound revealed a large amount of free fluid in the pouch of Douglas and no evidence of an intrauterine gestational sac or adnexal mass suggestive of ectopic pregnancy. A presumed haemorrhagic corpus luteal cyst was seen in the left ovary. Laparoscopic exploration revealed a left ovarian haemorrhagic mass, which was excised with preservation of the ovary. Histopathological examination confirmed an ovarian ectopic pregnancy (OEP). OEP is rare but potentially life-threatening, as it can lead to internal haemorrhage. Its diagnosis is challenging as preoperative and intraoperative findings can be evocative of the far more frequent haemorrhagic corpus luteal cyst and histopathology is often necessary to confirm the diagnosis. Early recognition of OEP is crucial to reduce maternal morbidity and mortality, and allow treatment that preserves fertility as much as possible.

[The breech comeback : implementation of a vaginal delivery protocol in the CHUV]. / Le retour du siège : mise en place d'un protocole d'accouchement par voie basse au CHUV.

Choosing between vaginal delivery and caesarean section in cases of breech presentation is still a matter of controversy. In this article, we present the Lausanne University Hospital's protocol following the introduction of an institutional vaginal breech delivery policy. Vaginal breech delivery is a viable alternative to caesarean section in the presence of an experienced obstetrician and rigorous patient-selection criteria.

Le choix entre un accouchement par voie basse et une césarienne reste controversé lors de présentation en siège. Nous présentons dans cet article le protocole de la Maternité du Centre hospitalier universitaire vaudois suite à l'introduction d'une politique favorisant les accouchements en siège. L'accouchement par voie basse du siège est désormais une alternative possible à la césarienne en présence d'obstétriciens expérimentés et de critères de sélection rigoureux des patientes.

Diagnósticos de enfermagem entre usuários de anticoagulante oral acompanhados em ambulatório / Diagnósticos de enfermería entre usuarios de anticoagulante oral acompañados en ambulatorio / Nursing diagnoses among users of oral anticoagulants in outpatient follow-up

Objetivo identificar o perfil sociodemográfico e clínico, bem como principais diagnósticos de enfermagem entre usuários de anticoagulantes de uso oral acompanhados em ambulatório. Método pesquisa descritiva, transversal de abordagem quantitativa. Realizada com 128 usuários elegíveis acompanhados em ambulatório de hospital universitário público do Paraná, Brasil. Foram coletadas, em consulta de enfermagem e fonte documental, variáveis sociodemográficas e clínicas, bem como identificados diagnósticos de enfermagem segundo taxonomia da NANDA-International. Resultados a amostra foi predominantemente idosa; casada; de baixa escolaridade; com indicação de anticoagulação oral por fibrilação atrial e trombose venosa profunda; com adequado tempo médio de coagulação, expresso pela Razão Normalizada Internacional. Os cinco diagnósticos de enfermagem elencados pertenciam às classes de respostas cardiovasculares/pulmonares; infecção; ingestão; e controle da saúde. Conclusão os diagnósticos de enfermagem identificados coadunam-se ao perfil clínico dos usuários de anticoagulantes de uso oral acompanhados em ambulatório, o que reflete um cenário mais focado nas questões orgânico-funcionais, ainda que a necessidade de melhor controle da própria saúde e de domínio da promoção de saúde tenham emergido em menor proporção.

Objetivo identificar el perfil sociodemográfico y clínico, así como los principales diagnósticos de enfermería entre usuarios de anticoagulantes de uso oral acompañados en ambulatorio. Método investigación descriptiva, transversal con enfoque cuantitativo. Realizada con 128 usuarios elegibles acompañados en ambulatorio del hospital universitario público de Paraná, Brasil. Fueron recolectadas, en consulta de enfermería y base documental, variables sociodemográficas y clínicas, además de la identificación de diagnósticos de enfermería, de acuerdo con la taxonomía de la NANDA-International. Resultados la muestra se compuso predominantemente de personas mayores; casadas; de baja escolaridad; con indicación de anticoagulación oral por fibrilación atrial y trombosis venosa profunda; con una media de tempo adecuado de coagulación, expresado a través de la Razón Normalizada Internacional. Los cinco diagnósticos de enfermería enumerados pertenecían a las clases de respuestas cardiovasculares/pulmonares; infección; ingestión y; control de la salud. Conclusión los diagnósticos de enfermería identificados se coadunan al perfil clínico de los usuarios de anticoagulantes de uso oral acompañados en ambulatorio, lo que refleja un escenario más orientado para las cuestiones orgánico-funcionales, a pesar de que a necesidad de un mejor control de la propia salud y del dominio de la promoción de la salud hayan emergido en menor proporción.

Objective to identify the sociodemographic and clinical profile, as well as the main nursing diagnoses among users of oral anticoagulants in outpatient follow-up. Method it was a descriptive cross-sectional study with a quantitative approach, conducted with 128 eligible users in outpatient follow-up at a public university hospital in Paraná, Brazil. Sociodemographic and clinical variables were collected in nursing consultations and documentary sources, and the nursing diagnoses were identified according to NANDA International taxonomy. Results the sample was composed predominantly of elderly people; married; with low schooling; with indication of oral anticoagulation for atrial fibrillation and deep venous thrombosis; and adequate average clotting time expressed by the International Normalized Ratio. The five nursing diagnoses listed belonged to the classes of Cardiovascular/Pulmonary responses; Infection; Ingestion; and Health management. Conclusion the nursing diagnoses identified combine with the clinical profile of the users of oral anticoagulants in outpatient follow-up, thus reflecting a scenario more focused on organic-functional issues, although the need for better control of one's own health and domain of health promotion have emerged in a lesser extent.

Land cover changes and greenhouse gas emissions in two different soil covers in the Brazilian Caatinga.

The Caatinga biome covers an area of 844,453km(2) and has enormous endemic biodiversity, with unique characteristics that make it an exclusive Brazilian biome. It falls within the earth's tropical zone and is one of the several important ecoregions of Brazil. This biome undergoes natural lengthy periods of drought that cause losses in crop and livestock productivity, having a severe impact on the population. Due to the vulnerability of this ecosystem to climate change, livestock has emerged as the main livelihood of the rural population, being the precursor of the replacement of native vegetation by grazing areas. This study aimed to measure GHG emissions from two different soil covers: native forest (Caatinga) and pasture in the municipality of São João, Pernambuco State, in the years 2013 and 2014. GHG measurements were taken by using static chamber techniques in both soil covers. According to a previous search, so far, this is the first study measuring GHG emissions using the static chamber in the Caatinga biome. N2O emissions ranged from -1.0 to 4.2mgm(-2)d(-1) and -1.22 to 3.4mgm(-2)d(-1) in the pasture and Caatinga, respectively, and they did not significantly differ from each other. Emissions were significantly higher during dry seasons. Carbon dioxide ranged from -1.1 to 14.1 and 1.2 to 15.8gm(-2)d(-1) in the pasture and Caatinga, respectively. CO2 emissions were higher in the Caatinga in 2013, and they were significantly influenced by soil temperature, showing an inverse relation. Methane emission ranged from 6.6 to 6.8 and -6.0 to 4.8mgm(-2)d(-1) in the pasture and Caatinga, respectively, and was significantly higher only in the Caatinga in the rainy season of 2014. Soil gas fluxes seemed to be influenced by climatic and edaphic conditions as well as by soil cover in the Caatinga biome.