Universidade Santa Cecília

Introduction: Introduction: The use of portable ventilators (PV) adapted to tracheostomy has been observed in critical patients in clinical practice. Objective: The study aimed to identify the characteristics associated with the indication for PV, patient outcomes, and survival. Methods: This was a prospective cohort study conducted with adult tracheostomized patients. Data collected included demographics, severity scores, reasons for ICU admission and intubation, days of mechanical ventilation (MV) until tracheostomy, cause of tracheostomy, and outcomes (ICU and hospital). Univariate analysis compared the groups with and without PV. Odds ratios (OR) assessed the likelihood of PV use, and age-adjusted logistic regression evaluated associated variables. Hospital survival was studied using the Kaplan-Meier method. Results: A total of 95 patients were included. The mean age was 71 years, with 58% being female. The median SAPS II was 55, and the Charlson Comorbidity Index was 4. Patients with an indication for PV (n=71) were older and had a longer continuous sedation time. Those intubated due to acute respiratory failure had a lower chance of using PV than those intubated for other causes. Hospital survival was higher in the PV group; however, the hospital mortality rate did not differ between the groups. Conclusion: PV use in tracheostomized patients was greater in the elderly and those intubated due to neurological causes or COPD. Despite higher survival, the similar hospital mortality rate suggests the need for further interventions. The literature reinforces that a multidisciplinary approach is essential to manage the complex dysfunctions in these patients with prolonged hospitalization.

Fish kills at Neotropical hydroelectric power plants, particularly those driven by total dissolved gas (TDG) supersaturation, are difficult to diagnose and quantify due to data scarcity and rapid carcass decomposition. This study proposes a novel framework to address these challenges by (1) inferring TDG saturation from more readily available Dissolved Oxygen (DO) data, using thermodynamic principles and (2) estimating true daily mortality through a Bayesian multistate model that accounts for decomposition stages and catchability. Applied to a fish kill event at an Amazonian dam, the models showed that TDG levels can be accurately inferred from DO data and that direct carcass counts severely underestimate the magnitude of mortality events due to low detection probabilities. Furthermore, these results revealed a significant temporal lag between the actual mortality peak and carcass recovery. This integrated methodology offers a robust framework for quantifying impacts, expanding monitoring capacity, and supporting more rigorous environmental licensing processes in the Neotropical region.

Context: This study examines the possibility of coverage and provision of Cannabis sativa-derived products for patients with chronic diseases within the Brazilian private health insurance. Problem: Despite scientific studies suggesting the efficacy of cannabinoids in the treatment of various chronic diseases, health plans refuse to cover the costs and provide these products. Hypothesis: The premise adopted is that coverage of medicinal cannabis-based products is necessary on the part of these private legal entities for the treatment of chronic pathologies. Objectives: The aim is to demonstrate the possibility of coverage and provision of Cannabis sativa-derived products by health plans for the treatment of chronic diseases and to identify the arguments used by them for the denial of coverage. Methods: Bibliographic analysis of the indirect documentation collected – medical literature and national legal norms – through narrative review. Results: Published clinical trials indicate that medicinal cannabis has therapeutic potential in many chronic diseases, representing a new treatment alternative. In Brazil, the exclusion of coverage for these products occurs because they are considered off-label, for home use, and, in some cases, imported but not nationalized. Conclusions: Considering that the arguments of the health insurance companies are unsustainable (the off-label argument cannot be used for what is not a medication; the exception for antineoplastic drugs is applicable to cannabis-based medications; import authorization is equivalent to registration) and that the right to the best therapy, the right to coverage of what is included in the SUS (Brazilian Public Health System), and the duty to establish the least costly treatment must be considered, there are arguments that reveal that the coverage and provision of cannabinoid-based products for chronically ill patients by health insurance plans are mandatory.

A qualidade de vida (QV) dos trabalhadores é influenciada por múltiplos fatores, entre eles a prática de atividade física/exercício físico (AF/EF) e o ambiente em que essa prática ocorre. Considerando o trabalho como um importante determinante social da saúde e a crescente urbanização, torna-se relevante investigar a relação entre AF/EF, contato com espaços verdes (EV) e QV. Assim, o presente estudo teve como objetivo analisar a relação da QV de trabalhadores, com a frequência e o tempo de realização de AF/EF, bem como considerando a prática de AF em EV. Trata-se de um estudo observacional, transversal, com abordagem quantitativa, realizado com 119 trabalhadores de uma instituição privada de ensino superior. Foram coletados dados gerais para caracterização, informações sobre a prática de AF/EF e o contato com EV, além da avaliação da QV por meio do questionário Short-Form Health Survey (SF-36). Os resultados demonstraram associações positivas e estatisticamente significativas entre maior frequência semanal e maior tempo diário de AF/EF com melhores escores nos domínios físicos e psicossociais da QV. Observou-se ainda que a prática de AF/EF em EV, o uso desses espaços próximos à residência e o contato visual com áreas verdes estiveram relacionados a melhores escores de QV. Conclui-se que não apenas a prática de AF/EF, mas sua frequência, duração e interação com EV desempenham papel relevante na promoção da QV de trabalhadores, reforçando a importância de políticas públicas integradas voltadas à saúde do trabalhador e ao planejamento urbano sustentável.

Contexto: A tripulação marítima está inserida em ambiente laboral propício ao desenvolvimento de agravos relacionados à saúde mental. Problema: Nesse contexto, importa identificar quem deve responder e de que forma pelos danos relacionados à saúde mental dos trabalhadores marítimos. Objetivo: Quer-se confirmar a hipótese de que a responsabilidade é do armador, enquanto empregador, e que ela deve ser pautada pela ótica da teoria do risco da atividade, caracterizando-se como objetiva. Resultados: A análise dos papéis dos agentes do ecossistema marítimo revela que a obrigação de garantir um meio ambiente de trabalho hígido recai sobre o armador. Os resultados indicam que a natureza intrínseca da atividade expõe ordinariamente a tripulação a um desgaste psicológico elevado, atraindo a aplicação da responsabilidade objetiva pelo risco da atividade. Conclusão: Confirma-se a hipótese de que o armador é quem tem o dever de reparar os danos à saúde mental de seus tripulantes, sob o regime de responsabilidade objetiva.

A pandemia de COVID-19 revelou fragilidades estruturais do regime internacional de saúde, especialmente a insuficiência do Regulamento Sanitário Internacional para assegurar respostas globais rápidas, coordenadas e equitativas. Ganhou relevo a adoção, em 2025, do Acordo sobre Pandemias, concebido para preencher lacunas de preparação, logística, transferência de tecnologia e acesso justo a contramedidas médicas. Objetivo: demonstrar que a relação entre esses dois documentos é de complementariedade funcional, e não de sobreposição ou superação, elucidando como cada instrumento ocupa papel distinto e sinérgico na arquitetura de governança sanitária. Método: empregou-se abordagem dedutiva e qualitativa, com revisão documental e análise comparativa de normas internacionais. Resultados: indicam que o Regulamento Sanitário Internacional funciona como sistema de alerta abrangente, porém com recomendações em regra não vinculantes e sem instrumentos para garantir acesso equitativo e gestão logística em crises, o que contribuiu para respostas fragmentadas e práticas de nacionalismo vacinal. O Acordo sobre Pandemias, por sua vez, institui obrigações jurídicas mais robustas, operacionaliza a cooperação por meio do compartilhamento de patógenos e benefícios, condiciona a produção e a alocação de insumos a critérios de risco e necessidade, e incentiva a diversificação geográfica e a transferência de know-how. Conclusão: o Regulamento Sanitário Internacional estabelece o “quê” da segurança sanitária global ao disparar o alarme e coordenar a notificação, enquanto o Acordo sobre Pandemias define o “como” ao estruturar uma resposta coletiva, vinculante e equitativa; juntos, inauguram um desenho institucional mais resiliente, capaz de mitigar desigualdades e fortalecer a preparação e a resposta a futuras pandemias

Valorization of municipal solid waste (MSW) for energy represents a strategic alternative for developing countries, as it mitigates emissions, reduces pressure on landfills, and diversifies the electricity matrix. This study quantified the potential for electricity generation from MSW in the Jequitinhonha Valley, Minas Gerais, Brazil, using primary gravimetric characterization data, a method rarely employed in tropical areas. The identified composition showed a predominance of the organic fraction (47.6–73.3%), confirming the relevance of biological routes. The results indicated a consolidated potential of 106,640 MWh·year−1, of which 94.7% was from biogas recovery and 5.3% from incineration. Almenara, one of the three locations analyzed, showed the highest potential (48,200 MWh·year−1), followed by Diamantina (34,540 MWh·year−1) and Capelinha (23,900 MWh·year−1). The specific yields ranged from 0.33 to 0.53 MWh·ton−1 MSW and the per capita indicators from 1.01 to 1.49 MWh·cap−1·year−1. The climate mitigation potential reached 1.0 Mt of CO2eq·year−1. It is concluded that valorization in the Jequitinhonha Valley should prioritize biogas recovery, complemented by the incineration of rejects. The materialization of this potential requires advancements in infrastructure, selective collection, and socio-productive inclusion. This study provides evidence for public policies and contributes to the literature by demonstrating that valorization can boost energy transition and socio-environmental equity in developing tropical regions.

The convergence of nanotechnology, plant hormones, andplant-associatedmicrobiomes offers a transformative approach for climate-resilientand sustainable agriculture. This perspective examines how nanocarrierscan improve the delivery and stability of natural hormones and microbiome-compatiblecompounds, addressing challenges such as low bioavailability, environmentaldegradation, and nontargeted effects. Plant hormones, such as auxins,gibberellins, and salicylic acid, play essential roles in stress responsesand growth regulation, while beneficial microorganisms contributeto nutrient cycling, pathogen resistance, and resilience against abioticstresses. However, their practical application remains limited dueto their instability and inconsistent performance under field conditions.Recent advancements have demonstrated that innovative nanomaterials,such as polymeric, lipid-based, or silica nanoparticles, can enablethe controlled release, targeted delivery, and environmental protectionof these compounds. For example, chitosan-based nanoparticles increaseroot colonization by beneficial microbes and enhance systemic resistancein tomatoes and maize. This review synthesizes the current knowledgeand emerging technologies at the nano–phyto–micro interface,highlighting synergistic mechanisms and gaps in regulation, formulation,and large-scale applications. We advocate integrated research strategiesthat combine omics approaches, advanced formulations, and real-worldvalidations to unlock the full potential of this triad. Aligning nanotechnologywith nature-based solutions may pave the way for low-input, high-efficiencyfarming systems tailored to changing climates.