ABSTRACT OBJETIVE To map the international literature on Permanent Health Education initiatives to care for people with obesity. METHODS In total, six databases were searched without any language or publication period restriction according to the Joana Briggs Institute manual for evidence synthesis and the Prisma extension for scoping reviews (Prisma-ScR). Articles were independently analyzed by four reviewers and data, by two authors, which were then analyzed and discussed with our research team. RESULTS After screening 8,780 titles/abstracts and 26 full texts, 10studies met our eligibility criteria. We extracted data on methodologies, themes, definitions of obesity, outcomes, and gaps. Most initiatives came from North American countries without free or universal health systems and lasted a short period of time (70%), had multidisciplinary teams (70%), and addressed sub-themes on obesity approaches (90%). Results included changes in participants’ understanding, attitude, and procedures (80%) and gaps which pointed to the sustainability of these changes (80%). CONCLUSION This review shows the scarce research in the area and a general design of poorly effective initiatives, with traditional teaching methodologies based on information transmission techniques, the understanding of obesity as a disease and a public health problem, punctual actions, disciplinary fragmentation alien to the daily work centrality, and failure to recognize problems and territory as knowledge triggers and to focus on health care networks, line of care, the integrality of care, and food and body cultures. total PrismaScR. PrismaScR ScR . (Prisma-ScR) authors team 8780 8 780 8,78 titlesabstracts titles abstracts 2 texts studies criteria themes outcomes 70%, 70 70% , (70%) subthemes sub 90%. 90 90% (90%) participants attitude 80% 80 (80% 80%. techniques problem actions centrality networks cultures (Prisma-ScR 878 78 8,7 7 (70% 9 (90% (80 87 8, (70 (90 (8 (7 (9 (

ABSTRACT OBJETIVE To map the international literature on Permanent Health Education initiatives to care for people with obesity. METHODS In total, six databases were searched without any language or publication period restriction according to the Joana Briggs Institute manual for evidence synthesis and the Prisma extension for scoping reviews (Prisma-ScR). Articles were independently analyzed by four reviewers and data, by two authors, which were then analyzed and discussed with our research team. RESULTS After screening 8,780 titles/abstracts and 26 full texts, 10studies met our eligibility criteria. We extracted data on methodologies, themes, definitions of obesity, outcomes, and gaps. Most initiatives came from North American countries without free or universal health systems and lasted a short period of time (70%), had multidisciplinary teams (70%), and addressed sub-themes on obesity approaches (90%). Results included changes in participants’ understanding, attitude, and procedures (80%) and gaps which pointed to the sustainability of these changes (80%). CONCLUSION This review shows the scarce research in the area and a general design of poorly effective initiatives, with traditional teaching methodologies based on information transmission techniques, the understanding of obesity as a disease and a public health problem, punctual actions, disciplinary fragmentation alien to the daily work centrality, and failure to recognize problems and territory as knowledge triggers and to focus on health care networks, line of care, the integrality of care, and food and body cultures.

RESUMO Objetivo: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. Métodos: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. Resultados: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01). O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). Conclusão: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.

ABSTRACT Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01). The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

Resumo Introdução: amiotrofia espinhal do tipo 1 (AME 1) é uma doença genética autossômica recessiva que promove morte celular de neurônios motores localizados no corno anterior da medula e núcleos motores do tronco cerebral. A precoce morbimortalidade está associada à disfunção bulbar e insuficiência respiratória, necessitando de internamento hospitalar e de suporte ventilatório artificial. O objetivo do estudo foi divulgar a relevância da manutenção de paciente com AME 1 sem prótese ventilatória invasiva e com protocolo de fisioterapia individualizado, proporcionando melhor qualidade de vida e integração com seus familiares. Descrição: relato de caso de menor diagnosticado com AME 1 que aos 11 meses foi submetido à ventilação mecânica invasiva (VMI) por 76 dias, obtendo sucesso no desmame após aplicação de um protocolo de fisioterapia respiratória, incluindo a utilização de tosse mecanicamente assistida e ventilação não invasiva (VNI). Discussão: apesar das dificuldades e intercorrências observadas, a assistência proposta alcançou o objetivo de retirada da VMI e transferência para internação domiciliar com dispositivos ventilatórios não invasivos. A VMI por traqueostomia é considerada tratamento de eleição no Brasil, no entanto, as famílias precisam ser esclarecidas da irreversibilidade da doença e das possibilidades estratégicas das terapêuticas atuais (VMI, VNI e paliação) para o manuseio de criança grave com AME 1.

Abstract Introduction: the spinal muscular atrophy type 1 (AME1) is an autosomal recessive genetic disorder that promotes cell death of motor neurons located in the anterior horn of the spinal cord and motor nuclei of the brainstem. Early mortality is linked to the bulbar dysfunction and respiratory failure, requiring hospitalization and invasive mechanical ventilation (IMV). The purpose of this study is to promote the maintenance patients with SMA type 1 without invasive ventilation support and individualized physical therapy protocol, improving child's quality of life and integration with their families. Description: this report relates a child diagnosed with AME1, who at 11 months was admitted and underwent IMV for 76 days, succeeding extubation after respiratory therapy protocol application using cough machine and noninvasive ventilation (NIV). Discussion: despite the difficulties and complications observed, there was persistence of the proposed assistance, reaching goal of withdrawal of IMV and transfer to home care with noninvasive ventilation devices. The IMV for tracheostomy is considered treatment of choice in Brazil. Notwithstanding, families need to be clarified of the irreversibility of the disease and strategic possibilities of therapeutic strategies (IMV, NIV and palliation) for the management of the child with severe SMA 1.