Reference values for spirometry in preschool children

OBJECTIVES: Reference values for lung function tests differ in samples from different countries, including values for preschoolers. The main objective of this study was to derive reference values in this population. METHODS: A prospective study was conducted through a questionnaire applied to 425 preschool children aged 3 to 6 years, from schools and day-care centers in a metropolitan city in Brazil. Children were selected by simple random sampling from the aforementioned schools. Peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volumes (FEV1, FEV0.50), forced expiratory flow (FEF25-75) and FEV1/FVC, FEV0.5/FVC and FEF25-75/FVC ratios were evaluated. RESULTS: Of the 425 children enrolled, 321 (75.6%) underwent the tests. Of these, 135 (42.0%) showed acceptable results with full expiratory curves and thus were included in the regression analysis to define the reference values. Height and gender significantly influenced FVC values through linear and logarithmic regression analysis. In males, R2 increased with the logarithmic model for FVC and FEV1, but the linear model was retained for its simplicity. The lower limits were calculated by measuring the fifth percentile residues. CONCLUSION: Full expiratory curves are more difficult to obtain in preschoolers. In addition to height, gender also influences the measures of FVC and FEV1. Reference values were defined for spirometry in preschool children in this population, which are applicable to similar populations.OBJETIVOS: Valores de referência para testes de função pulmonar diferem em amostras de diferentes países, incluindo valores para pré-escolares. O objetivo principal do presente estudo foi derivar valores de referência em nossa população. MÉTODOS: Foi realizado estudo prospectivo, com aplicação de questionário a 425 crianças pré-escolares com idade variando entre três e seis anos, provenientes de escolas e creches públicas e privadas de uma cidade metropolitana do Brasil. As crianças foram selecionadas por amostragem aleatória simples dos referidos educandários. Foram avaliados: PFE, CVF, VEF1 VEF0,50, FEF25-75 e as relações: VEF1/CVF, VEF0,5/CVF e FEF25-75/CVF. RESULTADOS: Das 425 crianças recrutadas, 321 (75,6%) realizaram os testes. Destas, 135 (42,0%) apresentaram manobras aceitáveis, com curvas expiratórias completas e fizeram parte da análise de regressão para definir os valores de referência. Por análise de regressão linear e logarítmica, a estatura e o sexo influenciaram significativamente nas medidas de CVF. No sexo masculino, o r² se elevou com o modelo logarítmico, para a CVF e VEF1, porém o modelo linear foi mantido, por sua simplicidade. Os limites inferiores foram calculados através das medidas do 5º percentil dos resíduos. CONCLUSÃO: Curvas expiratórias completas são de mais difícil obtenção em pré-escolares. Além da estatura, o sexo também influencia nas medidas de CVF e VEF1. Foram definidos valores de referência para espirometria em crianças pré-escolares, nessa população, aplicáveis a populações semelhantes.Universidade Federal de PernambucoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUFPE Departamento de Medicina ClínicaFundação Oswaldo Cruz Centro de Pesquisas Ageu MagalhãesUNIFESP, EPM, Depto. de MedicinaSciEL

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

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

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Asma em escolares do Recife - comparação de prevalências: 1994-95 e 2002

OBJETIVOS: Descrever a prevalência atual (2002) de asma e suas variantes em escolares da cidade do Recife, comparando os dados com o período de 1994-95; analisar a relação entre instrução materna e o surgimento ou o agravamento da asma; e avaliar a acurácia diagnóstica da prevalência anual de sibilância como indicador de asma. MÉTODO: Em um corte transversal, estudou-se, por questionário escrito, uma amostra probabilística de escolares de 13 e 14 anos em Recife, em 1994-95 (n = 3.086) e 2002 (n = 2.774), como parte do projeto ISAAC (International Study of Asthma and Allergies in Childhood). RESULTADOS: Em 1994-95 e 2002, as prevalências foram, respectivamente: cumulativa de asma referida, 21 e 18,2%; cumulativa de sibilância, 39 e 38%; anual de sibilância, 19,7 e 19,4%; anual de tosse equivalente de asma, 31 e 38%; anual de sibilância desencadeada por exercício, 20,6 e 23,8%. A prevalência anual de crises, estratificada em 1 a 3, 4 a 12 e mais de 12 foi: 16,3, 2,7 e 1% em 1994-95 e 15,2, 1,2 e 0,4% em 2002. A prevalência anual de crises que comprometeram o sono foi, respectivamente, de 13 e 10,3%; a prevalência de crises com prejuízo da fala foi de 4,8 e 4,1%. Nível mais elevado de instrução materna associou-se a maior prevalência cumulativa de asma referida, prevalência cumulativa e anual de sibilância. CONCLUSÕES: A prevalência de asma e suas formas graves é elevada em escolares adolescentes do Recife e está associada a maior instrução materna.OBJECTIVES: To describe the prevalence of asthma and asthma variants in schoolchildren from Recife in 2002, and to compare these data with data from 1994-95; to analyze the relationship between maternal schooling and the presence of asthma or worsening asthma; and to evaluate the diagnostic accuracy of the yearly prevalence of wheezing as an asthma indicator. METHODS: Cross-sectional study. A probabilistic sample of 3,086 and 2,774 13- and 14-year-old students answered a written questionnaire in 1994-95 and 2002, as part of the International Study of Asthma and Allergies in Childhood. RESULTS: The following prevalence rates were observed in 1994-95 and 2002, respectively: cumulative prevalence of referred asthma: 21 vs. 18.2%; cumulative prevalence of wheezing: 39 vs. 38%; yearly prevalence of wheezing: 19.7 vs. 19.4%; yearly prevalence of night cough: 31 vs. 38%; yearly prevalence of exercise-induced wheezing: 20.6 vs. 23.8%. The yearly prevalence of asthma attacks was 16.3% vs. 15.2% for 1 to 3 attacks; 2.7% vs. 1.2% for 4 to 12 attacks; and 1% vs. 0.4% for more than 12 attacks. The yearly prevalence of attacks that disturbed sleep was 13 and 10.3%. The yearly prevalence of attacks with compromised speech was 4.8 and 4.1%. Higher levels of maternal schooling were related to higher cumulative prevalence of referred asthma and to cumulative and yearly prevalence of wheezing. CONCLUSIONS: The prevalence of asthma and its severe forms is high in teenager students in Recife. It is also related to higher levels of maternal schooling