1,252 research outputs found
Primum non nocere e a prevenção quaternária: Revisão sistemática com metanálise / Primum non nocere and quaternary prevention: Systematic review with metanalysis
No decorrer da história da humanidade as concepções do processo saúde-doença foram mudando até desembocar na atualidade no entendimento biopsicossocial. Atravessando compreensões que iam desde conceitos mágicos a compreensão multifatorial do adoecer. Destarte, as ações dos profissionais de saúde devem ser pautadas por procedimentos, protocolos e sistematizações para que se tragam melhorias para as pessoas e a sociedade no geral. Assim em 1995 foi desenvolvido o conceito de prevenção quaternária que pode ser entendido como a prevenção desenvolvida no que tange aos tratamentos e intervenções desnecessárias e/ou excessivas nos sujeitos causando diversos tipos de iatrogenias. Para chegar ao objetivo do trabalho foi realizado uma revisão sistemática com metanálise sobre a prevenção quaternária, seguindo com rigor todo o protocolo prisma de revisão sistemática, coletando as divulgações cientificas que abordaram o tema. Como resultados encontrou-se poucas publicações sobre o tema que se mostra de grande relevância diante do cenário econômico atual no qual aponta-se como uma alternativa para reduzir gastos. Pois diante da pesquisa mostrou-se de grande valia para diminuir despesas e melhorar a qualidade da saúde
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Rarity of monodominance in hyperdiverse Amazonian forests.
Tropical forests are known for their high diversity. Yet, forest patches do occur in the tropics where a single tree species is dominant. Such "monodominant" forests are known from all of the main tropical regions. For Amazonia, we sampled the occurrence of monodominance in a massive, basin-wide database of forest-inventory plots from the Amazon Tree Diversity Network (ATDN). Utilizing a simple defining metric of at least half of the trees ≥ 10 cm diameter belonging to one species, we found only a few occurrences of monodominance in Amazonia, and the phenomenon was not significantly linked to previously hypothesized life history traits such wood density, seed mass, ectomycorrhizal associations, or Rhizobium nodulation. In our analysis, coppicing (the formation of sprouts at the base of the tree or on roots) was the only trait significantly linked to monodominance. While at specific locales coppicing or ectomycorrhizal associations may confer a considerable advantage to a tree species and lead to its monodominance, very few species have these traits. Mining of the ATDN dataset suggests that monodominance is quite rare in Amazonia, and may be linked primarily to edaphic factors
Effects of isokinetic eccentric training on knee extensor and flexor torque and on gait of individuals with long term ACL reconstruction: A controlled clinical trial
Abstract-This study investigated the effects of the isokinetic eccentric training (IET) on the knee extensor and flexor torque and kinematic gait parameters in individuals with ACL reconstruction. Sixteen men with ACL reconstructed (ACLr) whose torque and the gait were evaluated, before and after 12 weeks of IET, was compared to a control group (14 individuals). Student t, MANOVA and ANOVA tests were performed with 5% of significance. The training increased the isometric, concentric at 30 and 120º/s (p < .05) and eccentric at 30º/s (p < .01) extensor torque on the affected limb (AL), and eccentric at 30 and 120º/s (p < .01), on the non-affected limb (NAL). In the flexors, there was an increase on the torque: isometric, concentric at 30º/s and eccentric at 30 and 120º/s (p < .01) in AL and in eccentric at 30 (p < .05) and 120º/s (p < .01) in NAL. With respect to the angular and spatio-temporal variables gait, there was no difference between pre-and post-training in LCAr group. Compared to control group, the cycle time, in two members, was lower in LCAr group, and stride length and cadence were higher in the AL of the LCAr (p < .05). Moreover, the knee flexion-extension angles (minimum and maximum) remained lower in LCAr, pre-and post-training (p < .01). The torque gain associated with eccentric isokinetic training did not affect the kinematic parameters of gait in patients undergoing ACL reconstruction. Keywords: gait, exercise, muscle strength, movement, anterior cruciate ligament reconstruction Resumo-"Efeitos do treinamento isocinético excêntrico de extensores de joelho e torque flexor na marcha de indivíduos com reconstrução do LCA: Um ensaio clínico controlado." Este estudo investigou os efeitos do treinamento isocinético excêntrico (TIE) sobre o torque extensor e flexor do joelho e parâmetros cinemáticos da marcha de indivíduos com reconstrução do LCA. Dezesseis homens com LCA reconstruído (LCAr), foram avaliados quanto ao torque e marcha, antes e após 12 semanas de TIE e comparados com um grupo controle (14 indivíduos). Testes t Student, MANOVA e ANOVA foram realizados com 5% de significância. O treinamento aumentou o torque extensor isométrico, concêntrico a 30 e 120º/s (p < 0,05) e excêntrico a 30º/s (p < 0,01) no membro afetado (MA), e excêntrico a 30 e 120º/s (p < 0,01), no membro não afetado (MNA). Nos flexores, houve um aumento no torque: isométrico, concêntrico a 30º/s e excêntrico a 30 e 120º/s (p < 0,01) no MA, e excêntrico a 30 (p < 0,05) e 120º/s (p < 0,01) no MNA. Com relação às variáveis espaço-temporais e angulares da marcha, não houve diferença entre as avaliações pré e pós-treino no grupo LCAr. Comparado ao controle, a duração do ciclo, nos dois membros, foi menor no LCAr, e comprimento da passada e cadência foram maiores no MA do grupo LCAr (p < 0,05). Além disso, os ângulos (mínimo e máximo) de flexão-extensão do joelho permaneceram menores no LCAr, pré e pós-treino (p < 0,01). O ganho de torque associado ao treinamento isocinético excêntrico não modificou os parâmetros cinemáticos da marcha nos indivíduos submetidos à reconstrução do LCA. Palavras-chave: marcha, exercício, força muscular, movimento, reconstrução do ligamento cruzado anterior H.H. Santos, C.O. Sousa, J.A. Barela, A.M.F. Barela & T.F. Salvini Motriz, Rio Claro, v.20 n.4, p. 431-441, Oct./Dec. 2014 432 Resumen-"Efectos del entrenamiento excéntrico isocinético en extensor de la rodilla y el par flexor y sobre la marcha de las personas con reconstrucción ACL: Un ensayo clínico controlado." Este estudio investigó los efectos del entrenamiento isocinético excéntrico (EIE) en el torque del extensor y del flexor de la rodilla y parámetros cinemáticos de la marcha de personas con la reconstrucción del LCA. Dieciséis hombres con LCA reconstruido (LCAr), fueron evaluados para el par y la marcha antes y después de 12 semanas de EIE y se compararon con un grupo control (14 personas). Prueba t Student, ANOVA y MANOVA se realizaron con 5 % de significación. La formación aumentó extensor torque isométrico, concéntrico 30 y 120°/s (p < 0,05) y la excéntrica 30°/s (p < 0,01) en el miembro afectado (MA), y la excéntrica 30 y 120°/s (p < 0,01) en el miembro no afectado (MNA). Flexor, hubo un aumento en el par motor: isométrica , concéntrica 30°/s excéntrica 30 y 120°/s (p < 0,01) en MA, excéntrico y 30 (p < 0,05 ) y 120°/ s (p < 0,01) en el MNA. Con respecto a las variables angulares y espacio-temporal de andar, no hubo diferencia entre pre y post-entrenamiento en grupo LCAr. En comparación con el grupo control, el tiempo de ciclo, em los dos miembros, fue menor en LCAr, y la longitud del paso y cadencia fueron mayores en el LCAr del MA (p < 0,05). Por otra parte, los ángulos de flexión-extensión de la rodilla (mínimo y máximo) se mantuvieron bajos en LCAr, pre y post-entrenamiento (p < 0,01). El aumento del torque asociado con el entrenamiento isocinético excéntrico no afectó los parámetros cinemáticos de la marcha en las personas sometidas a la reconstrucción del LCA
Validation Of The Ebmt Risk Score In Chronic Myeloid Leukemia In Brazil And Allogeneic Transplant Outcome.
The management of chronic myeloid leukemia (CML) has changed radically since the introduction of imatinib therapy. The decision of whether to offer a patient a hematopoietic stem cell transplant (HSCT) must be based on the probability of success of the procedure. The aim of this retrospective analysis of 1,084 CML patients who received an allogeneic HSCT in 10 Brazilian Centers between February 1983 and March 2003 was to validate the EBMT risk score. The study population comprised 647 (60%) males and 437 (40%) females, with a median age of 32 years old (range 1 - 59); 898 (83%) were in chronic phase, 146 (13%) were in accelerated phase and 40 (4%) were in blast crisis; 151 (14%) were younger than 20 years old, 620 (57%) were between 20 and 40 and 313 (29%) were older than 40; 1,025 (94%) received an HLA fully matched sibling transplant and only 59 (6%) received an unrelated transplant. In 283 cases (26%) a male recipient received a graft from a female donor. The interval from diagnosis to transplantation was less than 12 months in 223 (21%) cases and greater in 861 (79%). The overall survival, disease-free survival, transplant-related mortality and relapse incidence were 49%, 50%, 45% and 25%, respectively. Of the 1084 patients, 179 (17%) had a risk score of 0 or 1, 397 (37%) had a score of 2, 345 (32%) had a score of 3, 135 (12%) had a score of 4 and 28 (2%) a score of 5 or 6. The overall survival (OS) rate in patients with risk scores 0-1 and 2 was similar (58% and 55%, respectively) but significantly better than that in patients with scores 3 or more (score 3 - 44%, 4 - 36 % and 5-6 - 27%, respectively) pp<0.001). Disease-free survival (DFS) and transplant related mortality (TRM) in a patients with a score of 3 or more were 46% and 49%, respectively and the relapse rate beyond score 5-6 was 77%. Disease status had a negative impact on all outcomes (OS, DFS, TRM, and relapse). The OS rate for male recipients of a graft from a female donor was 40% compared to 52% among the other donor-recipient pairs (p=0.004). DFS and TRM were significant for disease phase and female donor-male recipient (p<0.001 and p<0.003, respectively). In our experience, age and interval between diagnosis and transplant did influence OS, DFS, TRM, and relapse rate. Our results validate the EBMT risk score in the context of a developing country and confirm its usefulness for making point decisions in the imatinib era.90232-
Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates
Unidad de excelencia María de Maeztu CEX2019-000940-MAim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types
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
Geography and ecology shape the phylogenetic composition of Amazonian tree communities
Aim: Amazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types.
Location: Amazonia.
Taxon: Angiosperms (Magnoliids; Monocots; Eudicots).
Methods: Data for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran\u27s eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny.
Results: In the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R = 28%). A greater number of lineages were significant indicators of geographic regions than forest types.
Main Conclusion: Numerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions
Geography and ecology shape the phylogenetic composition of Amazonian tree communities
AimAmazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types.LocationAmazonia.TaxonAngiosperms (Magnoliids; Monocots; Eudicots).MethodsData for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran's eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny.ResultsIn the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R2 = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R2 = 28%). A greater number of lineages were significant indicators of geographic regions than forest types.Main ConclusionNumerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions
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