Resiliência associada ao enfrentamento da dor musculoesquelética em profissionais da enfermagem / Resilience is associated with coping with musculoskeletal pain in nursing professionals

A dor musculoesquelética é um problema frequente nos profissionais da enfermagem e várias medidas vêm sendo pesquisadas a fim de diminui-la, entretanto, poucos estudos abordam a influência do aumento da resiliência desses profissionais no controle da sua dor. Desta maneira, o objetivo deste trabalho foi identificar associação entre resiliência e dor musculoesquelética, em diferentes regiões anatômicas, referida por profissionais de enfermagem. Trata-se de estudo observacional transversal com 321 profissionais de enfermagem. Foram utilizados questionário sociodemográfico e laboral, questionário nórdico de sintomas osteomusculares, escala analógica da dor e escala de resiliência. Para análise foi utilizado estatística descritiva e analítica, através dos testes Mann-Whitney U e Kruskal Wallis. Foi verificada relação da dor com características sociodemográficas, laborais e resiliência, analisadas. 261 (81,3%) afirmaram ter apresentado dor musculoesquelética no último ano e as regiões mais acometidas foram partes superior e inferior das costas s e ombros. Identificou-se associação entre intensidade da dor e dor musculoesquelética em todas as regiões corporais investigadas (p < 0,05), idade (p = 0,015), categoria profissional (p = 0,032), tempo de atuação na enfermagem (p = 0,003) e turno de trabalho (p = 0,012), e correlação entre resiliência e dor musculoesquelética no pescoço (p = 0,010) e quadril e coxas (p = 0,009). Sendo assim, a elevada resiliência está associada ao melhor controle da dor musculoesquelética, em especial, na região do pescoço, de enfermeiros.

Musculoskeletal pain is a frequent problem in nursing professionals, and several treatments have been researched to reduce it; however, few studies address the influence of increased resilience of these professionals in controlling their pain. Thus, this study aimed to identify an association between resilience and musculoskeletal pain reported by nursing professionals in different anatomical regions. This is a cross-sectional observational study with 321 nursing professionals. A sociodemographic and work questionnaire, a Nordic musculoskeletal symptoms questionnaire, an analog pain scale, and a resilience scale were used. Descriptive and analytical statistics were used for analysis, using the Mann-Whitney U and Kruskal Wallis tests. The relationships between pain and sociodemographic, work, and resilience characteristics were analyzed. 261 (81.3%) reported having had musculoskeletal pain in the last year, and the most affected regions were the upper and lower backs and shoulders. An association was identified between pain intensity and musculoskeletal pain in all investigated body regions (p < 0.05), age (p = 0.015), professional category (p = 0.032), length of experience in nursing (p = 0.003), and work shift (p = 0.012). A correlation was also observed between resilience and musculoskeletal pain in the neck (p = 0.010) and hip and thighs (p = 0.009). Thus, high resilience is associated with better control of musculoskeletal pain among nurses, especially in the neck region.

Fatores obstétricos e neonatais associados ao nascimento prematuro: uma coorte de cinco anos / Obstetric and neonatal factors associated with preterm birth: a five-year cohort

O nascimento prematuro constitui um momento de vulnerabilidade ao recém-nascido, sendo necessário maior cuidado e atenção. Com isso o objetivo do trabalho foi analisar fatores obstétricos e neonatais, relacionados ao desfecho a termo e prematuridade, de recém-nascidos internados em uma Unidade de Terapia Intensiva Neonatal. Trata-se de um estudo de coorte, documental e retrospectivo. As variáveis clínicas, epidemiológicas e assistenciais foram coletadas diretamente dos prontuários e sumários de alta dos neonatos, internados no período de janeiro de 2016 a dezembro de 2020, analisadas com estatística descritiva e inferencial. Foram analisadas 494 internações de recém-nascidos. Cerca de 70% dessas foram de neonatos prematuros. Foi verificada relação entre nascimento prematuro e as características obstétricas: baixo número de consultas pré-natal (p<0,001), parto vaginal (p=0,04), intercorrências (p<0,001) e uso de antibióticos na gestação (p=0,02), ocorrência de bolsa rota (p<0,001) e corticoterapia antenatal (p<0,001). E, diferença estatística significativa entre a prematuridade e: sexo (p=0,01), gemelaridade (p<0,001). E, entre prematuridade e a necessidade de intervenções assistenciais: uso de surfactante (p<0,001), acesso venoso central (p<0,001), suporte ventilatório (p=0,01), fototerapia (p<0,001), transfusão sanguínea (p<0,001) e nutrição parenteral (p<0,001). Observou-se os diversos fatores associados ao nascimento prematuro, os quais devem ser monitorados a fim de prevenir desfechos negativos.

Premature birth constitutes a moment of vulnerability for the newborn, requiring greater care and attention. Therefore, the objective of the study was to analyze obstetric and neonatal factors, related to the outcome, of newborns admitted to a Neonatal Intensive Care Unit born at term and prematurely. This is a cohort, documentary and retrospective study. Clinical, epidemiological and care variables were collected directly from the medical records and discharge summaries of newborns, hospitalized from January 2016 to December 2020, analyzed with descriptive and inferential statistics. 494 newborn hospitalizations were analyzed. Around 70% of these were premature newborns. A relationship was found between premature birth and obstetric characteristics: low number of prenatal consultations (p<0.001), vaginal birth (p=0.04), complications (p<0.001) and use of antibiotics during pregnancy (p=0 .02), occurrence of ruptured membranes (p<0.001) and antenatal corticosteroid therapy (p<0.001). And, statistically significant difference between prematurity and: sex (p=0.01), twin birth (p<0.001). And, between prematurity and the need for assistance interventions: use of surfactante (p<0.001), central venous access (p<0.001), ventilatory support (p=0.01), phototherapy (p<0.001), blood transfusion (p<0.001) and parenteral nutrition (p<0.001). The various factors associated with premature birth were observed, which must be monitored in order to prevent negative outcomes.

Eating Behaviors, Caregiver Feeding Interactions, and Dietary Patterns of Children Born Preterm: A Systematic Review and Meta-Analysis.

Infants born preterm (<37 weeks of gestation) often experience feeding problems during hospitalization. Whether difficulties persist or have long-term sequelae on childhood eating is unclear. We aimed to describe the oromotor eating skills (e.g., chewing/swallowing), eating behaviors (e.g., food neophobia), food parenting practices (e.g., pressure to eat), and dietary patterns of preterm children during late infancy (6-12 mo) and early childhood (>12 mo-7 y) and to determine whether these differed from those of term-born peers. We identified 67 articles (57 unique studies) for inclusion. We used random-effects meta-analysis of proportions to examine the prevalence of oromotor eating skill and eating behavior challenges among preterm children, standard meta-analysis for comparisons with term-born peers, and the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of evidence. Forty-three percent (95% CI: 24%, 62%) of infants and 25% (95% CI: 17%, 33%) of children born preterm experienced oromotor eating difficulties and 16% (95% CI: 4%, 27%) and 20% (95% CI: 11%, 28%), respectively, exhibited challenging eating behaviors. During late infancy and early childhood, oromotor eating difficulties (OR: 2.86; 95% CI: 1.71, 4.77; I2 = 67.8%) and challenging eating behaviors (OR: 1.52; 95% CI: 1.11, 2.10; I2 = 0.0%) were more common in those born preterm than in those born term: however, the certainty of evidence was very low. Owing to the low number and heterogeneity of studies, we narratively reviewed literature on food parenting and dietary patterns. Mothers of preterm infants appeared to have heightened anxiety while feeding and utilized coercive food parenting practices; their infants reportedly received less human milk, started solid foods earlier, and had poorer diet quality than term-born peers. In conclusion, meta-analyses show preterm children experience frequent oromotor eating difficulties and challenging eating behaviors throughout the early years. Given preterm birth increases risk of later obesity and diet-related chronic disease, research examining the effects of caregiver-child interactions on subsequent diet is warranted. This review was registered at www.crd.york.ac.uk/prospero/ as CRD42020176063.

Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial.

Background: Human milk-based fortifiers (HMBFs) are being adopted in neonatal care to enrich the nutrients in human milk for very low birth weight (VLBW) infants despite being costly and there being limited efficacy data. No randomized clinical trial has evaluated the use of HMBF compared with bovine milk-based fortifiers (BMBFs) in the absence of formula feeding. Objective: To determine if HMBF compared with BMBF for routine nutrient enrichment of human milk improves feeding tolerance, reduces morbidity, reduces fecal calprotectin (a measure of gut inflammation), and supports the growth of infants <1250 g. Design: In this blinded randomized clinical trial, infants born weighing <1250 g were recruited from neonatal units in Ontario, Canada between August 2014 and November 2015. The infants were fed mother's milk and donor milk as required. Fortification commenced at 100 mL/kg per day of HMBF (0.81 kcal/mL) or BMBF (0.72 kcal/mL) and advanced at 140 mL/kg per day to 0.88 and 0.78 kcal/mL, respectively. The primary outcome was percentage of infants with a feeding interruption for ≥12 h or a >50% reduction in feeding volume. Secondary outcomes included a dichotomous mortality and morbidity index (i.e., affirmative for any one of death, late-onset sepsis, necrotizing enterocolitis, chronic lung disease, or severe retinopathy of prematurity), fecal calprotectin, and growth. Results: Of 232 eligible infants, 127 (54.7%) were randomized (n = 64 HMBF, n = 63 BMBF). Mean ± SD birth weight and gestational age of infants were 888 ± 201 g and 27.7 ± 2.5 wk, respectively. No statistically significant differences were identified in feeding interruptions [17/64 HMBF, 20/61 BMBF; unadjusted risk difference: -6.2% (95% CI: -22.2%, 9.8%)]. There was no statistically significant difference in the mortality and morbidity index (48.4% HMBF, 49.2% BMBF, adjusted P = 0.76), changes in fecal calprotectin, or growth z scores. Conclusions: Among infants born weighing <1250 g and exclusively fed human milk, the use of HMBF did not improve feeding tolerance or reduce mortality and morbidity compared with BMBF. This trial was registered at clinicaltrials.gov as NCT02137473.

Plakophilin3 loss leads to an increase in lipocalin2 expression, which is required for tumour formation.

An increase in tumour formation and metastasis are observed upon plakophilin3 (PKP3) loss. To identify pathways downstream of PKP3 loss that are required for increased tumour formation, a gene expression analysis was performed, which demonstrated that the expression of lipocalin2 (LCN2) was elevated upon PKP3 loss and this is consistent with expression data from human tumour samples suggesting that PKP3 loss correlates with an increase in LCN2 expression. PKP3 loss leads to an increase in invasion, tumour formation and metastasis and these phenotypes were dependent on the increase in LCN2 expression. The increased LCN2 expression was due to an increase in the activation of p38 MAPK in the HCT116 derived PKP3 knockdown clones as LCN2 expression decreased upon inhibition of p38 MAPK. The phosphorylated active form of p38 MAPK is translocated to the nucleus upon PKP3 loss and is dependent on complex formation between p38 MAPK and PKP3. WT PKP3 inhibits LCN2 reporter activity in PKP3 knockdown cells but a PKP3 mutant that fails to form a complex with p38 MAPK cannot suppress LCN2 promoter activity. Further, LCN2 expression is decreased upon loss of p38ß, but not p38α, in the PKP3 knockdown cells. These results suggest that PKP3 loss leads to an increase in the nuclear translocation of p38 MAPK and p38ß MAPK is required for the increase in LCN2 expression.

Biomarcadores sanguíneos de caprinos Saanen com diferentes faixas etárias / Blood biomarkers of saanen goats with different ages

Objetivou-se estabelecer o perfil aminoacídico, bioquímico e hematológico de caprinos sadios da raça Saanen de diferentes faixas etárias criados em regime intensivo no Nordeste do Brasil. A partir de amostras de sangue de cada animal foi realizada a análise de aminoácidos, perfil hematológico e bioquímico. Os dados foram submetidos a ANOVA e ao Teste de Tukey (P<0,05). A concentração de glutamato [GLU] e a de glutamina e glutamato [GLN+GLU] apresentaram variações (P<0,05) enquanto que a [GLN] não variou (P>0,05). A [GLU] e de [GLN+GLU] foram 91% e 43% superiores nos animais do grupo cria quando comparados com os demais. Ocorreram também valores significativos nas concentrações de proteínas plasmáticas totais [PPT], ureia [URE], creatinina [CREAT], ácido úrico [AcU], alanina aminotransferase [ALT], creatina quinase [CK], glicose [GLIC], triglicérides [TRIG] e colesterol total [COLES-T] (P<0,05), diferentemente das albumina [ALB] e aspartato aminotransferase [AST]. Nos índices hematológicos houve diferenças para volume corpuscular médio (VCM), concentração de hemoglobina corpuscular média (CHCM), coeficiente de variação de amplitude de distribuição dos eritrócitos (RDW-CV) (P<0,05), mas não ocorreram variações significativas de resultados nas células brancas do sangue [CGB], hemácias [HEM], hemoglobina [Hb] e na percentagem do hematócrito (P>0,05). Destaca-se que este conhecimento possibilite melhor entendimento dos processos metabólicos nos animais hígidos e enfermos, levando em consideração as condições alimentar e do manejo da região. Contribuindo assim para aumentar a produtividade do rebanho na região tropical dada a grande importância da caprinocultura no Nordeste do Brasil.

The aim of this study was to establish biochemical, hematological and amino acid profiles from healthy Saanen goats, from different ages bred on intensive system, in Northeastern Brazil. It was used blood Samples to analyse these parameters. Data was submitted to ANOVA and Tukey test (P<0.05). The glutamate [GLU] and glutamine plus glutamate [GLN+GLU] showed differences (P<0.05), while [GLN] didn't (P>0.05). The [GLU] and [GLN+GLU] was 91% and 43% higher on post-weaning group. Also it was seen significance on total protein plasmatic [TPP], urea [URE], creatinine [CREAT], uric acid [UAC], alanine aminotransferase [ALT], creatine kinase [CK], glucose [GLU], total triglyceride [TG] and total cholesterol [CHOL]. Unlike albumin [ALB] and aspartate aminotransferase [AST]. Haematological indices were no differences of mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), coefficient of variation of amplitude red cell distribution (RDW-CV) (P <0.05), but no significant changes in results in white blood cell [WBC], [HEM] red blood cells, hemoglobin [Hb] and the percentage of hematocrit (P> 0.05). Metabolic processes on healthy and sick animals, should be better understood by this study, considering nutritional and environmental condition in this region. This contribution may increase herd productivity in this region by the great importance of goat breeding in northeastern Brazil

Effect of Supplemental Donor Human Milk Compared With Preterm Formula on Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: A Randomized Clinical Trial.

Importance: For many very low-birth-weight (VLBW) infants, there is insufficient mother's milk, and a supplement of pasteurized donor human milk or preterm formula is required. Awareness of the benefits of mother's milk has led to an increase in use of donor milk, despite limited data evaluating its efficacy. Objective: To determine if nutrient-enriched donor milk compared with formula, as a supplement to mother's milk, reduces neonatal morbidity, supports growth, and improves neurodevelopment in VLBW infants. Design, Setting, and Participants: In this pragmatic, double-blind, randomized trial, VLBW infants were recruited from 4 neonatal units in Ontario, Canada, within 96 hours of birth between October 2010 and December 2012. Follow-up was completed in July 2015. Interventions: Infants were fed either donor milk or formula for 90 days or to discharge when mother's milk was unavailable. Main Outcomes and Measures: The primary outcome was the cognitive composite score on the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 18 months' corrected age (standardized mean, 100 [SD, 15]; minimal clinically important difference, 5 points). Secondary outcomes included Bayley-III language and motor composite scores, growth, and a dichotomous mortality and morbidity index. Results: Of 840 eligible infants, 363 (43.2%) were randomized (181 to donor milk and 182 to preterm formula); of survivors, 299 (92%) had neurodevelopment assessed. Mean birth weight and gestational age of infants was 996 (SD, 272) g and 27.7 (2.6) weeks, respectively, and 195 (53.7%) were male. No statistically significant differences in mean Bayley-III cognitive composite score (adjusted scores, 92.9 in donor milk group vs 94.5 in formula group; fully adjusted mean difference, -2.0 [95% CI, -5.8 to 1.8]), language composite score (adjusted scores, 87.3 in donor milk group vs 90.3 in formula group; fully adjusted mean difference, -3.1 [95% CI, -7.5 to 1.3]), or motor composite score (adjusted scores, 91.8 in donor milk group vs 94.0 in formula group; fully adjusted mean difference, -3.7 [95% CI, -7.4 to 0.09]) were observed between groups. There was no statistically significant difference in infants positive for the mortality and morbidity index (43% in donor milk group, 40% in formula group) or changes in growth z scores. Conclusions and Relevance: Among VLBW infants, use of supplemental donor milk compared with formula did not improve neurodevelopment at 18 months' corrected age. If donor milk is used in settings with high provision of mother's milk, this outcome should not be considered a treatment goal. Trial Registration: isrctn.org Identifier: ISRCTN35317141.

Risk factors for nonsyndromic holoprosencephaly: a Manitoba case-control study.

Holoprosencephaly (HPE) is one of the most common developmental field defects, occurring in 1 in 250 conceptuses and in 1 in 10,000-20,000 live births. Nearly half of patients with HPE have a recognized syndrome or a single gene defect. However, little is known about the risk factors for the remainder with "nonsyndromic" HPE. In our case-control study, we examine factors associated with nonsyndromic HPE. We identified 47 patients with HPE from the genetics clinic database with an equal number of controls matched for gender and birthdate. Of the 47 patients, 23 were identified as nonsyndromic. No statistically significant differences were noted between the mean maternal and paternal ages of patients and controls. Factors associated with nonsyndromic HPE were: having an Aboriginal mother (unadjusted odds ratio [OR] 3.5, 95% confidence interval [CI] 1.1-11.1), an Aboriginal father (OR 12.8, 95% CI 3.0-55.1), at least one Aboriginal parent (OR 5.0, 95% CI 1.6-16.0), or two Aboriginal parents (OR 8.8, 95% CI 2.0-37.8), the presence of a family history of a midline facial defect (OR 8.2, 95% CI 1.5-45.2), and being of low socioeconomic status (OR 3.0, 95% CI 1.0-9.1). Having an Aboriginal background remained statistically significant after adjusting for low socioeconomic status. Other associations evaluated--history of prior spontaneous abortion, stillbirth, neonatal death, prepregnancy diabetes, infections during pregnancy, alcohol exposure, smoking, and substance abuse--were not significantly associated with nonsyndromic HPE. The use of periconceptional folic acid or vitamins was not associated with a lower risk of nonsyndromic HPE.

Aspectos sanitários de pescados comercializados em "pesque-pagues" de Toledo (PR) / Sanitary conditions of fish commercialized in 'pesque-pagues' de Toledo (PR)

O objetivo foi avaliar a qualidade microbiológica do pescado (filé de tilápia e carpa eviscerada) comercializado nos "pesque-pagues" de Toledo (PR). Os grupos de microrganismos investigados foram mesofílicos aeróbios, psicrotróficos, fungos e leveduras, coliformes totais e fecais, salmonela. Para os psicotróficos a contagem variou de 1,03x103 a 5,79x105 UFC/g para o filé de tilápia e de 1,35x102 a 1,84x105 UFC/g para carpa eviscerada. A presença de fungos e leveduras no filé de tilápia e na carpa eviscerada oscilaram de 2,9x10 a 1,0x104 UFC/g, 6,4x102 a 3,8x104 IFC/g, respectivamente. O teor máximo permitido por grama de pescado in natura de coliformes fecais é de 102 UFC, verificou-se que nas análises de filé de tilápia 66,6 por cento das amostras estão acima do permitido. Nas análises de carpa eviscera, 50 por cento das amostras estão acima. Todos os testes para determinação de Salmonella apresentaram-se negativos para 25g das amostras. Concluiu-se que 66,67 por cento dos filés de tilápia e 16,67 por cento das carpas evisceradas estão em condições higiênico-sanitárias insatisfatórias; 16,67 por cento das carpas evisceradas estão inaceitáveis para o consumo direto e 16,67 por cento estão impróprios para consumo. Dados de análise realizadas no período de frio indicam redução na carga microbiana.