Associação da adesão das regiões do brasil à rede cegonha com a mortalidade materna e outros indicadores de saúde / Association of adhesion to the cegonha network in brazil with maternal mortality and other health indicators / Asociación de adhesión a la redcegonha en brasil con mortalidad materna y otros indicadores de salud

Introdução:As taxas de morbimortalidade materna, no Brasil, são evidenciadas pelo processo de trabalho intervencionista e por desigualdades socioculturais entre as regiões do país.Objetivo:Avaliar a adesão das regiões do Brasil à Rede Cegonha associada à mortalidade materna e aos indicadores de aleitamento materno exclusivo e cobertura da Atenção Básica.Metodologia:Trata-se de um estudo ecológico, do tipo transversal, onde foram analisados o comportamento da adesão à Rede cegonha, entre os anos de 2012 e 2017, associado a indicadores de saúde materna. Resultados:Percebeu-se que a adesão à Rede Cegonha coincidiu com o aumento da cobertura da atenção básica nas regiões do Brasil. Houve associação da adesão ao programa com a diminuição da mortalidade materna com o passar dos anos, com destaque para as regiões Sul e Sudeste do país. Ainda, a distribuição de coeficiente de aleitamento materno exclusivo revelou-se em crescimento em todas as regiões, com dados discrepantes na região sul. Conclusões:Observam-se os impactos da Rede Cegonha no Brasil dentro do recorte temporal estabelecido, expressos pela diminuição dos índices de mortalidade e melhoria dos indicadores de saúde, apesar das limitações institucionais e culturais encontradas (AU).

Introduction: Maternal morbidity and mortality rates in Brazil are evidenced by the interventionist work process and by sociocultural inequalities between the regions of the country. Objective:To evaluate the adhesion of regions of Brazil to rede cegonha associated with maternal mortality and indicators of exclusive breastfeeding and coverage of Primary Care. Methodology: This is an ecological, cross-sectional study, which analyzed the behavior of adhesion to the Stork Network between 2012 and 2017, associated with maternal health indicators. Results: It was noticed that the adhesion to Stork Network coincided with the increase in the coverage of Primary Care in the regions of Brazil. There was an association between adherence to the program and a decrease in maternal mortality over the years, especially in the South and Southeast regions of the country. Furthermore, the distribution of the coefficient of exclusive breastfeeding was growing in all regions, with discrepant data in the southern region. Conclusions: The impacts of Rede Cegonha in Brazil are observed within the established time frame, expressed by the decrease in mortality rates and improvement in health indicators, despite the institutional and cultural limitations found (AU).

Introducción: Las tasas de morbilidad y mortalidad materna en Brasil se evidencian por el proceso de trabajo intervencionista y por las desigualdades socioculturales entre las regiones del país. Objetivo: Evaluar la adhesión de las regiones de Brasil a la Rede Cegonha asociada a la mortalidad materna e indicadores de lactancia materna exclusiva y cobertura de Atención Primaria.Metodología: Se trata de un estudio ecológico, transversal, que analizó el comportamiento de incorporación a la Red Cigüeña entre 2012 y 2017, asociado a indicadores de salud materna.Resultados: Se notó que la adhesión a Rede Cegonha coincidió con el aumento de la cobertura de atención primaria en las regiones de Brasil. Hubo una asociación entre la adherencia al programa y una disminución de la mortalidad materna a lo largo de los años, especialmente en las regiones Sur y Sudeste del país. Además, la distribución del coeficiente de lactancia materna exclusiva estaba creciendo en todas las regiones, con datos discrepantes en la región sur.Conclusiones: Los impactos de la Rede Cegonha en Brasil se observan dentro del marco temporal establecido, expresados por la disminución de las tasas de mortalidad y la mejora de los indicadores de salud, a pesar de las limitaciones institucionales y culturales encontradas (AU).

Atenção hospitalar ao recém-nascido saudável no Brasil: estamos avançando na garantia das boas práticas? / Care for healthy newborns in Brazil: are we making progress in achieving best practices?

Resumo O artigo tem como objetivo comparar práticas do cuidado ao recém-nascido saudável no momento do nascimento em hospitais públicos e mistos conveniados ao SUS, segundo o tipo de parto, verificadas na pesquisa "Nascer no Brasil/2011" (NB) e no último ciclo avaliativo da RC, aqui denominada "Avaliação da Rede Cegonha/2017" (ARC). O NB incluiu uma amostra com representatividade nacional de 266 hospitais e a ARC foi conduzida em 606 maternidades inseridas na estratégia Rede Cegonha, totalizando 15.994 e 8.047 pares de puérperas e recém-nascidos saudáveis, respectivamente. Entre os dois estudos, NB-2011 e ARC-2017, embora a proporção de cesariana tenha se mantido em torno de 44%, a prevalência do contato pele a pele com o RN, da amamentação na sala de parto e nas primeiras 24h de vida aumentaram, 140%, 82% e 6%, respectivamente. Já a proporção de aspiração de vias aéreas superiores do RN, caiu 65%. Os resultados indicam que o uso de diretrizes baseadas em evidências para o cuidado de recém-nascidos saudáveis aumentou na prática clínica, considerando o período de seis anos entre os estudos comparados. Apesar desse progresso, permanecem importantes desafios para garantir as melhores práticas para a totalidade de mulheres e recém-nascidos, principalmente em relação aos partos cesáreos.

Abstract This paper aims to compare best practices for healthy newborns in public and mixed hospitals affiliated with SUS, according to type of birth, between "Nascer no Brasil/2011" (NB - Birth in Brazil) and in the last assessment cycle of Rede Cegonha, here called "Avaliação da Rede Cegonha/2017" (ARC - Stork Network Assessment). NB included a sample with national representativeness of 266 hospitals, and ARC was conducted in 606 maternity hospitals included in the Rede Cegonha strategy, totaling 15,994 and 8,047 pairs of healthy mothers and newborns, respectively.Between the two studies, NB-2011 and ARC-2017, although the proportion of cesarean sections remained around 44%, the prevalence of skin-to-skin contact with newborns, breastfeeding in the delivery room and breastfeeding in the first 24h of life increased by 140%, 82% and 6%, respectively. The proportion of upper airway aspiration of newborns dropped 65%. The results indicate that the use of evidence-based guidelines for the care of healthy newborns has increased in clinical practice, considering the six-year period between the compared studies. Despite the progress, important challenges remain to ensure best practices for all women and newborns, especially in relation to cesarean births.

Atenção ao parto e nascimento em Maternidades da Rede Cegonha/Brasil: avaliação do grau de implantação das ações / Labor and childbirth care in maternities participating in the "Rede Cegonha/Brazil": an evaluation of the degree of implementation of the activities

Resumo O artigo analisa o grau de implantação das Boas Práticas de Atenção ao Parto e Nascimento conforme preconizado pela Rede Cegonha (RC) a partir da configuração de uma matriz de julgamento para o Brasil e grandes regiões. Foram elegíveis para a avaliação todos os 606 hospitais públicos e mistos das regiões de saúde que dispunham de plano de ação da RC em 2015. Foram utilizados três diferentes métodos de coleta de dados: entrevista pessoal com gestores, profissionais de saúde e puérperas; análise documental; e observação in loco. A matriz foi composta com as cinco diretrizes da RC. Para julgamento da adequação da implantação, foi utilizado como parâmetro: adequado; parcialmente adequado e não adequado. Todas as diretrizes foram avaliadas como parcialmente adequada, exceto a ambiência que foi não adequado. A atenção ao parto e nascimento encontra-se em estágios diferenciados de implantação com variações entre as grandes regiões. As regiões Sul e Sudeste, apresentaram situação privilegiada quanto ao grau de implantação da maioria dos itens analisados. Os resultados evidenciam que a avaliação das ações da RC deve fazer parte do alicerce de informações empregadas no direcionamento de políticas e regulamentação na atenção hospitalar ao parto e nascimento.

Abstract Using a judgment framework, this article analyzes the degree of implementation of the best practices in labor and childbirth care contained in the guidelines of the Rede Cegonha (RC) across Brazil. The study eligibility criteria were public and mixed hospitals located in a health region with a RC action plan in place in 2015, resulting in a total of 606 facilities distributed across the country. Three different data collection methods were used: face-to-face interviews with managers, health professionals and puerperal women; document analysis; and on-site observation. The framework was built around the five guidelines of the Labor and Childbirth component of the RC. Degree of implantation was rated as follows: adequate; partially adequate and inadequate. The performance of maternity facilities was rated as partially adequate for all guidelines except for hospital environment, which was rated as inadequate. A huge variation in degree of implementation was observed across regions, with the South and Southeast being the best-performing regions in most items. The results reinforce the need for an ongoing evaluation of the actions developed by the RC to inform policy-making and the regulation of labor and childbirth care.

Occurrence of Chlamydia spp. In wild birds in Thailand

Objective: To determine the occurrence of Chlamydia spp. in wild birds in Thailand. Methods: Cloacal and tracheal swabs of 313 wild birds from 11 orders, 27 families, and 51 species were tested to determine the occurrence of Chlamydia infection. The outer membrane protein A (ompA) gene was amplified from positive samples to construct a phylogenetic tree. Results: At the time of sample collection, none of the birds showed clinical signs of any disease. Of 313 wild birds, two Asian openbill stork (Anastomus oscitans) were positive for Chlamydia spp., representing 0.64% (2/313) and 4.9% (2/41) occurrence for birds overall and for the Asian openbill stork, respectively. Phylogram analysis based on deduced amino acid of the ompA gene showed that Chlamydia spp. in Asian openbill storks was closely related to that in wildfowl (Pica pica and Cygnus olor) from Poland in a different branch with a 95% bootstrap value and had a shorter evolutionary distance to Chlamydia abortus. Conclusions: Asymptomatic Asian openbill storks could be a potential source of Chlamydia infection in domestic animals, poultry, and humans who share their habitat.

Práticas assistenciais no pré-parto, parto e pós-parto imediato: experiência de uma enfermeira residente em obstetrícia / Assistant practices in immediate pre-birth, birth and post-birth: experience of an obstetric resident nurse

Objetivo: descrever as atividades aplicadas na prática assistencial do enfermeiro residente na assistência ao pré-parto, parto e pós-parto imediato. Métodos: trata-se de um estudo descritivo do tipo relato de experiência, realizado durante as atividades práticas do Programa de Residência Multiprofissional em Saúde e Área Profissional em Saúde - Enfermagem Obstétrica do Hospital Universitário Getúlio Vargas, da Universidade Federal do Amazonas, em uma maternidade da cidade de Manaus-AM. Resultados: as atividades assistenciais ao parto de risco habitual foram pautadas em evidências científicas e no que a Rede Cegonha preconiza, bem como o Ministério da Saúde no que se refere às boas práticas obstétricas. Conclusão: o enfermeiro residente em enfermagem obstétrica torna-se cada vez mais importante no cenário da assistência ao parto, haja vista que sua formação e sua conduta são baseadas em evidencias científicas, desconstruindo o aprendizado mecanizado e engessado, tornando-a mais humanizada e voltada à devolução do protagonismo do parto à mulher.

Objective: To describe the activities applied in the nursing practice of resident nurses in pre-delivery, delivery and immediate postpartum care. Methods: This is a descriptive study of the experience report type, carried out during the practical activities of the Multiprofessional Residency Program in Health and Professional Health Area - Obstetric Nursing at Getúlio Vargas University Hospital, Federal University of Amazonas, in a maternity ward from Manaus-AM Results: the care activities for the usual risk delivery were based on scientific evidence and what the Stork Network recommends, as well as the Ministry of Health regarding good obstetric practices. Conclusion: the resident nurse in obstetric nursing becomes increasingly important in the delivery care scenario, given that their training and conduct are based on scientific evidence, deconstructing mechanized and plastered learning, making it more humanized and focused the return of the protagonism of childbirth to women.

Occurrence of Chlamydia spp. In wild birds in Thailand

Objective: To determine the occurrence of Chlamydia spp. in wild birds in Thailand. Methods: Cloacal and tracheal swabs of 313 wild birds from 11 orders, 27 families, and 51 species were tested to determine the occurrence of Chlamydia infection. The outer membrane protein A (ompA) gene was amplified from positive samples to construct a phylogenetic tree. Results: At the time of sample collection, none of the birds showed clinical signs of any disease. Of 313 wild birds, two Asian openbill stork (Anastomus oscitans) were positive for Chlamydia spp., representing 0.64% (2/313) and 4.9% (2/41) occurrence for birds overall and for the Asian openbill stork, respectively. Phylogram analysis based on deduced amino acid of the ompA gene showed that Chlamydia spp. in Asian openbill storks was closely related to that in wildfowl (Pica pica and Cygnus olor) from Poland in a different branch with a 95% bootstrap value and had a shorter evolutionary distance to Chlamydia abortus. Conclusions: Asymptomatic Asian openbill storks could be a potential source of Chlamydia infection in domestic animals, poultry, and humans who share their habitat.

Educação interprofissional e o programa de educação pelo trabalho para a saúde/Rede Cegonha: potencializando mudanças na formação acadêmica / Interprofessional education and the Education through Work for Health Program "Stork Network": leveraging changes in education / Educación interprofesional y Programa de Educación para el trabajo en Salud/Red Cigüeña: potencializando cambios en la formación académica

A educação interprofissional é uma possibilidade de capacitação de estudantes de diferentes cursos da área da saúde, na perspectiva do aprendizado colaborativo, bem como do trabalho em equipe e em rede, visando à integralidade do cuidado em saúde. Este trabalho tem por objetivo relatar as vivências e experiências no Programa de Educação pelo Trabalho para a Saúde/Rede Cegonha, com ênfase na educação interprofissional e nas práticas colaborativas em saúde para a promoção do cuidado integral materno-infantil, bem como na contribuição dessas vivências durante o processo de formação em saúde.

The interprofessional education is the opportunity to train students from different courses in the health area under the perspective of collaborative learning, as well as in teamwork and networking, aiming at the comprehensiveness of health care. This paper aims to report experiences in Education through Work for Health Program “Stork Network”, focusing on interprofessional education and collaborative practice in health to promote maternal and child comprehensive care, as well as the contribution of these experiences during the health education process.

La educación interprofesional es una posibilidad para la formación de estudiantes de diferentes cursos en el área de la salud, a partir de la perspectiva del aprendizaje colaborativo, trabajo en equipo y en red, dirigidos a la integridad del cuidado en salud. Este trabajo tiene como objetivo informar sobre las experiencias y vivencias en el programa PET Salud/Red Cigüeña, centrándose en la educación interprofesional y la práctica de colaboración en materia de salud para promover la atención integral materno-infantil, así como aportar material relativo a la contribución de estas experiencias durante el proceso de formación en salud.

Compreensão e reconhecimento da Rede Cegonha pela estratégia saúde da família / Understanding and recognition of the Stork Network for Family Health Strategy

Estudo qualitativo de perspectiva Hermenêutica Dialética que investigou o conhecimento da Estratégia Saúde da Família sobre a Rede Cegonha, e analisou a efetividade do Programa na Atenção Primária à Saúde. Foram entrevistados 06 agentes comunitários de saúde, 06 enfermeiros e 06 médicos. O Programa é reconhecido como rede temática de atenção à saúde, e está presente na atenção primária, mas é frágil na articulação entre níveis de atenção e gera falha no acolhimento da gestante anteparto e na contrarreferência pós-parto. Conclui-se que a Rede Cegonha não está efetivamente implementada.

Qualitative study of Dialectical Hermeneutics perspective that investigated the knowledge of the Family Health Strategy on the Stork Network, and analyzed the effectiveness of the Program in Primary Health Care. We interviewed 06 community health workers, 06 nurses and 06 doctors. The program is recognized as a thematic network of health care, and is present in primary care, but it is fragile on the relationship between levels of care and generates failure host of antepartum pregnant and postpartum counter. We conclude that the Stork Network is not effectively implemented. Descriptors: Primary Health Care; Maternal and Child Care Services; Stork Network.

Estudio cualitativo de dialécticas Hermenéutica perspectiva que investigó el conocimiento de la Estrategia Salud de la Familia en la Red Ciqüena, y analizó la efectividad dei Programa de Atención Primaria de Salud. Entrevistamos a 06 trabajadores de la salud de la comunidad, 06 enfermeras y 06 médicos. El programa es reconocido como una red temática de la asistencia sanitaria, y está presente en la atención primaria, pero es frágil en la relación entre los niveles de atención y genera anfitrión fracaso de preparto y postparto embarazada contrario. Llegamos a la conclusión de que la Red Cigüena no se aplique con eficacia.

Hematologic and serum biochemical reference intervals of the Oriental white stork (Ciconia boyciana) and the application of an automatic hematologic analyzer

This study was conducted to establish accurate baseline values of clinical laboratory data with regard to age-related changes in the Oriental white stork (Ciconia boyciana). In addition, the availability of an automated hematological cell counter was evaluated. A total of 94 clinically normal storks, including 64 young storks ( 1 year old; 17 male and 13 female) were included. Hematological assays were performed using manual and automated cell counters and serum biochemistry profiles were examined using an automated analyzer. There were no significant differences in any parameters between male and female storks, while 16 parameters were significantly different between young and adult storks. Of these 16 parameters, total protein, albumin, aspartate aminotransferase, alanine aminotransferase, creatinine, triglyceride, total bilirubin, potassium, white blood cell count, packed cell volume, mean cell volume and hemoglobin levels were higher in adult storks than in young storks, while the latter showed higher glucose, uric acid and alkaline phosphatase levels, as well as a higher sodium/potassium ratio. The results presented herein will aid researchers who work for the conservation and rehabilitation of this endangered species.

Cross-species amplification of microsatellite markers in Mycteria leucocephala Pennant 1769: Molted feathers as successful DNA source.

DNA from molted feathers is being increasingly used for genetic studies on birds. However, the DNA obtained from such non-invasive sources is often not of enough quantity and quality for isolation of new microsatellite markers. The present study examined the potential of shed feathers of near threatened Painted Stork as a source of its DNA for cross-species amplification of microsatellites. Thirty-one shed feathers of varying conditions (‘good’ and ‘deteriorated’) and sizes (‘large’, ‘intermediate’ and ‘small’) collected in a north Indian population were used to isolate DNA by a standard isopropanol method and 11 microsatellite markers already developed in the Wood Stork were screened for amplification. Nine plucked feathers from two dead Painted Storks were also used to compare the DNA yield and amplification success. The DNA yield of feathers varied significantly in relation to the calamus size and condition. Among molted feathers, ‘good’ and ‘large’ samples provided more DNA than ‘deteriorated’ and ‘small’ ones, respectively. ‘Large’ plucked feathers yielded more DNA than ‘large’ molted feathers. DNA was almost degraded in all the samples and ratio of absorbance at 260/280 nm varied from 1.0 to 1.8, indicating impurity in many samples. Independent of DNA yields, all microsatellites were cross-amplified in all kinds of feathers, with >80% success in different feather categories. It is concluded that the shed feathers can be successfully used to isolate DNA in the Painted Stork and for cross-species amplification of microsatellites.

A macroanatomical and histological study of the uropygial gland in the white stork (Ciconia cicionia) / Un estudio macroanatómico e histológicos de la glándula uropigial de la cigüeña blanca (Ciconia cicionia)

The present study was aimed at the macroanatomical and histological investigation and the demonstration of the structural characteristics of the uropygial gland in the white stork. The uropygial gland of two adult male white storks constituted the material of the study. It was determined that the gland was situated subcutaneously in between the caudal aspect of the lumbosacral bone and the first coccygeal vertebrae. The gland was composed of two lobes, which displayed an oval appearance when viewed from above and resembled a water drop when observed medially. Tuft of feathers were present on the caudal margin of each lobe. The present study revealed that the uropygial gland of the white stork is a simple tubular gland, which discharges its secretion into the lumen by a holocrine mode. Each lobe, possessed centrally located large cavities and a main excretory duct and displayed the presence of externally situated "peripheral tubules" and interiorly situated "central tubules". These secretory tubules, which composed the parenchyma, were separated by connective tissue septa referred to as "trabeculae", and released their secretion into a centrally located lumen. The wall of the secretory tubules was comprised of four layers, referred to as the germinative, intermediary, secretory and degenerative layers. The silver-staining procedure demonstrated that the stroma of the uropygial gland did not contain reticulum fibres. The anatomy and histology of the gland has been examined in few avian species. Up to date, this study is the first to describe the histological and anatomical peculiarities of the uropygial gland in white stork. The results acquired hereby will surely contribute to further studies to be conducted on the related area.

El estudio tuvo como objetivo la investigación anatómica e histológica de la glándula uropigial de la cigüeña blanca, junto con demostrar las características estructurales de ella. El material del estudio estuvo constituido por glándula uropigial de dos cigüeñas blancas adultas macho. Se determinó que la glándula se encuentra vía subcutánea entre la parte caudal del hueso lumbosacro y las primeras vértebras coccígeas. La glándula se compone de dos lóbulos que muestran un aspecto ovalado, vista desde arriba y se asemejan a una gota de agua cuando se observa en sentido medial. Un penacho de plumas estaba presente en el margen caudal de cada lóbulo. El presente estudio reveló que la glándula uropigial de la cigüeña blanca es una glándula tubular simple, que descarga su secreción al lumen de un modo holocrino. Cada lóbulo posee una gran cavidad de ubicación céntrica y un conducto excretor principal, además muestra la presencia de "túbulos periféricos" situados exteriormente y "túbulos centrales "situados interiormente. Estos túbulos secretores que componen el parénquima, estaban separados por tabiques de tejido conectivo denominado "trabéculas", y liberan su secreción en una luz central. La pared de los túbulos secretores se componen de cuatro capas: germinativa, intermedia, secretora y degenerativa. La tinción de plata demostró que el estroma de la glándula uropigial no contienen fibras reticulares. La anatomía e histología de esta glándula se ha examinado en algunas especies de aves. Hasta la fecha, este es el primer estudio en describir las particularidades histológicas y anatómicas de la glándula uropigial de la cigüeña blanca. Los resultados obtenidos contribuirán a llevar a cabo nuevos estudios relacionados en el área.

Avifaunal diversity of Anekere wetland, Karkala, Udupi district, Karnataka, India.

The avifaunal diversity and density in Anekere wetland, Karkala, Udupi district, Karnataka, India, was studied for a period of three years. Anekere pond inhabits several local and migratory bird species. Reduction in water retention in this pond in summer, weed infestation, variations in food availability in different seasons and threat of predation on the breeding activity of birds affected the avifauna diversity in the study area. This habitat attracted 44 bird species, which are local and migratory including aquatic birds, waders and others. Highest population of tree ducks (lesser whistling teal) was recorded in all the three years of study. Other prominent residents were Moorhens, Jacanas, Herons and Cormorants. The visitors include ringed plovers, wagtails and storks. It was evident that purple moorhen and tree ducks have developed high tolerance to this highly fluctuating habitat and human activity.