Frailty and risk of complications in head and neck oncologic surgery. Systematic review and dose-response meta-analysis

There is emerging evidence that frail individuals present a decreased physiological reserve, decreased ability to maintain homeostasis, and increased vulnerability to stressors. The concept of frailty has become increasingly recognized as a valuable measure in oncological surgical patients, including those with head and neck cancer. Preoperative screening for frailty may provide an individualized risk assessment that can be used by an interdisciplinary team for preoperative counseling and to improve outcomes. The aim of this meta-analysis was to evaluate the relationship between frailty and the risk of major postoperative complications in frail individuals submitted to head and neck oncologic surgery. PubMed, SCOPUS, Web of Science, Google Scholar and OpenThesis were systematically searched to identify studies that evaluated the risk of major postoperative complications in frail individuals undergoing head and neck oncologic surgery. The search was performed on August 31, 2020, without language or date restrictions. Two independent investigators screened the searched studies based on each paper?s title and abstract. Relevant studies were read in full and selected according to the eligibility criteria. Frailty was assessed by modified Frailty Index (mFI-11) and major postoperative complications were measured by the Clavien-Dindo classification. We performed a categorical and dose-response meta-analysis using a random-effects model to evaluate the association between frailty and the risk of major postoperative complications in patients submitted to head and neck oncologic surgery. The results of the meta-analysis were expressed as relative risk (RR) and 95% confidence interval (95% CI). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Four studies (9,947 patients) were included in this systematic review and meta-analysis. Frail patients presented an increased risk of life-threatening complications requiring intensive care unit (ICU) admission (RR = 4.67; 95% CI 1.54?14.10) and 30-day mortality (RR = 8.10; 95% CI 2.30?28.57) compared to non-frail patients. We found evidence of dose-response trend between mFI-11 and major postoperative complications. Higher frailty scores are associated with a significant increase in ICU-level complications and 30-day mortality after head and neck oncologic surgery

Tempo de sobrevida e distância para acesso a tratamento especializado por pessoas vivendo com HIV/Aids no estado de Alagoas, Brasil

Objective: to evaluate the effect of the distance between the place of residence and specialized treatment on the survival time of people living with HIV/Aids in Alagoas, Northeast Brazil. Methods: data from the notification and mortality systems related to individuals aged 13 years or older diagnosed with the infection between 2007 and 2013 were used. The cases were observed for a period of follow-up until December 2017. The test was adopted Pearson's chi-square, Kaplan Meier method and Cox regression for analyzes according to the outcome of the case, place of residence, distance to the health unit, population size of the municipality of residence, sex, color/ethnicity and age. Results: Of the 2732 cases analyzed, 760 died of Aids-related causes. The average estimate of survival time for individuals residing in the capital was 98.6 months (CI 95%: 96.1–101). Among residents in the interior cities, the estimate was 92.7 months (CI 95%: 89.3–96.1). There was a significant difference in curves throughout the period. The group residing in the interior and those traveling at a distance> 70 km had a higher average risk of death (RR 1.21, CI 95%: 1.05–1.4 and RR 1.18, 95% CI 95%: 1, 01-1.39, respectively). Conclusion: living in or near the capital decreases the average relative risk of death. In order to increase the survival time of HIV / AIDS patients in Alagoas, it is suggested to decentralize specialized assistance, that is, to create regional centers to care for these people.Objetivo: avaliar o efeito da distância entre o local de residência e de tratamento especializado sobre o tempo de sobrevida de pessoas vivendo com HIV/Aids em Alagoas, Nordeste do Brasil. Métodos: utilizou-se dados dos sistemas de notificação e mortalidade relacionados a indivíduos com idade ≥ a 13 anos diagnosticados com a infecção entre 2007 a 2013. Os casos foram observados por um tempo de seguimento até dezembro de 2017. Foi adotado o teste qui-quadrado de Pearson, método Kaplan Meier e regressão de Cox para as análises de acordo com o desfecho do caso, local da moradia, distância até a unidade de saúde, tamanho populacional do município de residência, sexo, cor/etnia e idade. Resultados: Dos 2732 casos analisados, 760 evoluíram para óbito por causas relacionadas à Aids. A estimativa média do tempo de sobrevida dos indivíduos residentes na capital foi de 98,6 meses (IC 95%: 96,1–101). Entre os residentes nos municípios do interior, a estimativa foi de 92,7 meses (IC 95%: 89,3–96,1). Houve diferença significativa nas curvas em todo o período. O grupo residente no interior e daqueles que viajavam a uma distância > 70 Km apresentaram razão de risco médio de óbito maior (RR 1,21, IC 95%: 1,05–1,4 e RR 1,18, IC 95%: 1,01-1,39, respectivamente). Conclusão: residir na capital ou próximo dela diminui o risco relativo médio de óbito. A fim de aumentar o tempo de sobrevida dos pacientes com HIV/Aids em Alagoas, sugere-se descentralizar a assistência especializada, ou seja, criar centros regionais para atendimento dessas pessoas

Sífilis congênita no Pará: O panorama de uma década na região metropolitana de Belém / Congenital Syphilis in Pará: The panorama of a decade in the metropolitan region of Belém

A sífilis congênita, causada pelo Treponema pallidum, é uma moléstia infecciosa de abrangência mundial. Considerada um evento sentinela para avaliar a Atenção Primária em Saúde, a persistência de falhas no controle desse agravo está associada aos obstáculos na assistência pré-natal do Brasil. Sobretudo na última década, a região Metropolitana de Belém/Pará vivencia tal realidade, justificando essa investigação. Trata-se de um estudo quantitativo, descritivo, retrospectivo, executado mediante levantamento de dados do Departamento de Informática do Sistema Único de Saúde (DATASUS). A amostra foi composta por 2.078 casos entre 2008 a 2018. Observou-se a tendência de crescimento da notificação de casos confirmados até 2016; contudo, entre 2017-2018 visualizou-se declínio. A faixa etária mais acometida foi de conceptos de até 6 dias. Houve predomínio da raça parda e do sexo masculino, bem como prevalência entre mães que realizaram pré-natal. O percentual dos parceiros sexuais não tratados fora significativo. Existiu maior quantitativo de casos com evolução benigna. É fundamental reforçar que os fatores que implicam em maior índice da doença podem ser amenizados por medidas preventivas e de acompanhamento. Palavras-Chave:

Hepatites virais na infância: perfil epidemiológico dos pacientes pediátricos do estado do Pará/ Viral hepatitis in childhood: epidemiological profile of pediatric patients in the state of Pará

O artigo examina as Hepatites Virais na infância, com um enfoque epidemiológico no Norte do Brasil, no Pará. As hepatites virais causam distintas apresentações clínicas, variando também com as respostas dos pacientes e das medidas de saúde e preventivas adotadas pelas regiões. Desse modo, a prevalência dos casos de infecção pelos vírus nas regiões brasileiras é heterogênea, assim como a situação de enfrentamento das regiões contra as hepatites também o são. Porém, esse difícil cenário ainda é pouco revelado nas literaturas, principalmente em relação ao estado do Pará. Assim, o artigo acentua essa discussão sobre a necessidade do estudo epidemiológico das hepatites na infância, visto os números acentuados de infecção das hepatites entre o 2009 e 2018, sobretudo na população pediátrica.  Em conclusão, salienta-se a importância do reforço da atuação da Atenção Primária à Saúde, pois há relação entre a diminuição dos índices e adoção de medidas preventivas e profilática

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Educomunicação e suas áreas de intervenção: Novos paradigmas para o diálogo intercultural

oai:omp.abpeducom.org.br:publicationFormat/1O material aqui divulgado representa, em essência, a contribuição do VII Encontro Brasileiro de Educomunicação ao V Global MIL Week, da UNESCO, ocorrido na ECA/USP, entre 3 e 5 de novembro de 2016. Estamos diante de um conjunto de 104 papers executivos, com uma média de entre 7 e 10 páginas, cada um. Com este rico e abundante material, chegamos ao sétimo e-book publicado pela ABPEducom, em seus seis primeiros anos de existência. A especificidade desta obra é a de trazer as “Áreas de Intervenção” do campo da Educomunicação, colocando-as a serviço de uma meta essencial ao agir educomunicativo: o diálogo intercultural, trabalhado na linha do tema geral do evento internacional: Media and Information Literacy: New Paradigms for Intercultural Dialogue

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others