Atenção: Para responder às questão, considere o texto abaixo.

Where are we letting our patients down?

By Rammya Mathew

October 20, 2020

    A recent consultation has stayed with me. In many respects it was a run of the mill general practice consultation, but it made me reflect on health inequalities and why the care we provide for people with low levels of health literacy can be woefully lacking.

    He was a patient with type 2 diabetes taking long term insulin, who had developed acute symptoms in the previous 24 hours. He had broken English, but he was able to communicate his history without too much difficulty, so I persevered without an interpreter. In response to some very direct questioning, it became apparent that he hadn’t had anything to eat or drink that morning, he hadn’t checked his blood sugar levels, and he hadn’t thought about adjusting his insulin dose. How was it feasible that a patient taking insulin for so many years had no idea about type 2 diabetes sick day rules? Could it really be that no one had ever taken the time to counsel him about this?

     I looked online for a patient information leaflet that might be of use, but I abandoned the idea quite quickly, as I was unsure whether he’d be able to read it − and even if he could, I was worried that the information might be too complex for him to follow. I decided that giving him the minimum information to avert a crisis was the best course of action. So, I encouraged him to drink more, to check his blood sugar every four hours, and to call a health professional if it was over a certain threshold. I was firefighting, and it didn’t feel good to be in that position.

    His lack of knowledge about type 2 diabetes sick day rules, however, probably reflected his overall understanding of the condition. It made me wonder where we’d let this man down. At diagnosis, was he enrolled onto a structured education programme? Even if he was, could he attend it around his shift work? And if so, was he able to take anything away from it, given his limited English?

    Patients with long term conditions such as type 2 diabetes are meant to have annual reviews with their GP or practice nurse. Was anything meaningful happening at these reviews, or was his medication just being continuously titrated up? A significant part of these reviews is meant to focus on helping patients to set goals and take control of the aspects of their health that matter most to them. But, if you don’t understand your condition and your role in managing it, you can very quickly become a passive spectator in managing your health, and well intentioned tasks such as goal setting just become yet another meaningless, tick box exercise.

    That single consultation and the patient journey behind it capture many of the gaps in our system, and they explain at least partly the stark health inequalities that have become so painfully visible in recent times. There’s a tendency to think that some patients can’t be helped, but the reality is that the system has let them down.

(Adapted from https://www.bmj.com)

O texto a seguir é referência para a questão.

Is Brazil safe to visit?

Offering pristine nature and access to the Amazon rainforest, historic cities and colonial architecture, and lots of affordable food and activities, Brazil will have some something for every traveler. A popular destination for revelers looking to party hard at Carnival as well as a hot spot for adventure junkies and beachgoers, Brazil is a country known for its amazing weather and pristine landscapes. But is it safe? Brazil has a reputation for being a rough and tumble destination, one where travelers need to be extra cautious and on their guard at all times. Here is everything you need to know to stay safe and make the most out of your next trip to Brazil.

To help you stay safe in Brazil, here are 11 tips that will keep both you and your possessions out of harm’s way:

1. Walk with purpose – When out exploring, always walk with purpose. Look like you’re heading somewhere in specific, even if you’re not. Pickpockets and muggers look for travelers who are unsure of themselves. Don’t look like a target.
2. Don’t carry cash – Carry only the minimum cash needed for the day. Keep the rest locked up back in your accommodation.
3. Separate your cards – If you have more than one credit or debit card, keep them separate. Bring one with you for the day (if you think you’ll need it) and leave the other one locked up in your room. That way, should something happen, you always have at least one card.
4. Don’t bring valuables to the beach – When you go to the beach, don’t take anything unnecessary. Towel, bathing suit, and a small amount of cash. That’s it! Anything else you bring is likely to disappear!
5. Dress to fit in – When out and about, dress down and try to fit in. Leave any valuables or jewelry at home. Don’t walk around flashing your camera or phone. If you need to use them, be discreet.
6. Carry a spare wallet – Bring a spare wallet with a small amount of cash in it. That way, if you get robbed or pickpocketed they won’t get your real wallet (where you’ll keep the rest of your cash and cards).
7. Avoid outdoor ATMs – If you need to withdraw cash, only use ATMs inside buildings. Always be aware of your surroundings before you take out your wallet.
8. Double check your accommodation – No matter where you are staying, be sure to check the doors and windows before leaving for the day and before settling in at night. Don’t leave anything valuable lying around your room; lock everything up.
9. Don’t accept free food/drinks – Never accept drinks or food from strangers. Drugging victims before they are robbed is common, so decline free food or drinks from strangers.
10. Watch out for distractions – Thieves will often try to distract you before they rob you. Be mindful of this common scam to help you stay vigilant.
11. Take precautions when driving – If traveling by car, always keep your doors locked. By on guard at stop signs or red lights, especially at night. Many Brazilians won’t even stop for them to avoid the risk of a carjacking. Buy travel insurance before you go just in case you run into trouble. It’s always better to be safe than sorry!

(Disponível em: https://www.nomadicmatt.com/travel-blogs/is-brazil-safe-to-visit/. Acessado em 11 de setembro de 2019. Adaptado.)

Leia o texto para responder à questão.

    The problem of rising ocean plastic pollution such as plastic bags, discarded fishing nets and microplastics has received increased attention in recent years. But other pollutants such as oil and gas, pesticides, antibiotics, heavy metals and industrial chemicals are also severely impacting the world’s oceans, says a new report from the High Level Panel for a Sustainable Ocean Economy (Ocean Panel).

    “Even though plastic is a hot topic, it is unfortunately just the latest major pollutant to enter the ocean,” says Ellie Moss, an ocean plastic expert and co-author of the report. “I think one of the things that differentiates it from most of the other pollutants is that you can see it. In the other cases, it’s sort of these invisible pollutants that we don’t even recognise as being there. That’s a huge problem.”

    The new report, commissioned by the Ocean Panel which is convened by 14 heads of state, outlines a range of ways to reduce these different ocean pollutants. Part of the solution is exploring how materials can be recaptured and recycled, the report says, preventing them from seeping into the ocean as pollutants and instead keeping them circulating in the economy. Developing more eco-friendly materials and chemicals is another important part of the picture. In many cases, strategies can tackle more than one type of ocean pollutant at once, the report says. “You really do have to look for opportunities to address as many of these pollutants at once as you can,” says Moss.

    But there is also a need to simply use resources more efficiently in the first place, the report adds, such as through zero-packaging supermarkets, eliminating single-use plastics and exploring new business models which incentivise more efficient use of pesticides.

    “A lot of people think about ‘how do we clean up the ocean’ and that’s the wrong question,” says Moss. “The question is not how do we clean it up, it’s how do we stop befouling it in the first place.”

(Jocelyn Timperley. www.sciencefocus.com, 30.05.2020. Adaptado.)