I Diretriz brasileira de cardio-oncologia pediátrica da Sociedade Brasileira de Cardiologia

Sociedade Brasileira de Oncologia PediátricaUniversidade Federal de São Paulo (UNIFESP) Instituto de Oncologia Pediátrica GRAACCUniversidade Federal de São Paulo (UNIFESP)Universidade de São Paulo Faculdade de Medicina Instituto do Coração do Hospital das ClínicasUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto AlegreInstituto Materno-Infantil de PernambucoHospital de Base de BrasíliaUniversidade de Pernambuco Hospital Universitário Oswaldo CruzHospital A.C. CamargoHospital do CoraçãoSociedade Brasileira de Cardiologia Departamento de Cardiopatias Congênitas e Cardiologia PediátricaInstituto Nacional de CâncerHospital Pequeno PríncipeSanta Casa de Misericórdia de São PauloInstituto do Câncer do Estado de São PauloUniversidade Federal de São Paulo (UNIFESP) Departamento de PatologiaHospital Infantil Joana de GusmãoUNIFESP, Instituto de Oncologia Pediátrica GRAACCUNIFESP, Depto. de PatologiaSciEL

Skin color and severe maternal outcomes: evidence from the brazilian network for surveillance of severe maternal morbidity

Taking into account the probable role that race/skin color may have for determining outcomes in maternal health, the objective of this study was to assess whether maternal race/skin color is a predictor of severe maternal morbidity. This is a secondary analysis of the Brazilian Network for Surveillance of Severe Maternal Morbidity, a national multicenter cross-sectional study of 27 Brazilian referral maternity hospitals. A prospective surveillance was performed to identify cases of maternal death (MD), maternal near miss (MNM) events, and potentially life-threatening conditions (PLTC), according to standard WHO definition and criteria. Among 9,555 women with severe maternal morbidity, data on race/skin color was available for 7,139 women, who were further divided into two groups: 4,108 nonwhite women (2,253 black and 1,855 from other races/skin color) and 3,031 white women. Indicators of severe maternal morbidity according to WHO definition are shown by skin color group. Adjusted Prevalence Ratios (PRadj - 95%CI) for Severe Maternal Outcome (SMO=MNM+MD) were estimated according to sociodemographic/obstetric characteristics, pregnancy outcomes, and perinatal results considering race. Results. Among 7,139 women with severe maternal morbidity evaluated, 90.5% were classified as PLTC, 8.5% as MNM, and 1.6% as MD. There was a significantly higher prevalence of MNM and MD among white women. MNMR (maternal near miss ratio) was 9.37 per thousand live births (LB). SMOR (severe maternal outcome ratio) was 11.08 per 1000 LB, and MMR (maternal mortality ratio) was 170.4 per 100,000 LB. Maternal mortality to maternal near miss ratio was 1 to 5.2, irrespective of maternal skin color. Hypertension, the main cause of maternal complications, affected mostly nonwhite women. Hemorrhage, the second more common cause of maternal complication, predominated among white women. Nonwhite skin color was associated with a reduced risk of SMO in multivariate analysis. Nonwhite skin color was associated with a lower risk for severe maternal outcomes. This result could be due to confounding factors linked to a high rate of Brazilian miscegenation.2019CNPQ - Conselho Nacional de Desenvolvimento Científico e Tecnológico402702/2008-

Bolsa Família: um survey sobre os efeitos do programa de transferência de renda condicionada do Brasil

Revisam-se pesquisas sobre efeitos do Programa Bolsa Família. Há quatro evidências frequentes. A primeira é que o programa tem focalização relativamente boa, mas que pode ainda ser melhorada. A segunda é o efeito positivo sobre a aquisição (consumo) de alimentos – sem conclusões sobre a qualidade da dieta. A terceira diz respeito ao estimulo às crianças a participarem da escola (matrícula, frequência e progressão), embora pouco se saiba sobre os efeitos na aprendizagem. A ausência de efeitos sobre a fecundidade das mulheres caracteriza a quarta conclusão robusta que se pode tirar da literatura, ainda que mais estudos devam ser realizados. Em outras dimensões, as evidências não formam consenso sobre direção dos efeitos.This paper surveys the literature about the effects of Bolsa Familia Program. We found four main results. The first is that the program is relatively well targeted, but it can still be improved.The second is the positive effect on the acquisition (consumption) of food, but there is no conclusions about the quality of the diet. The third is that the program encourages children to attend school (enrollment, attendance and progression). However, little is known about the effects on learning. The absence of effects on the fecundity of the women characterizes the fourth conclusion that can be drawn from the literature, although more studies must be carried out on this topic. In other dimensions, the evidence does not form consensus on the direction of effects

Climate seasonality limits leaf carbon assimilation and wood productivity in tropical forests

The seasonal climate drivers of the carbon cycle in tropical forests remain poorly known, although these forests account for more carbon assimilation and storage than any other terrestrial ecosystem. Based on a unique combination of seasonal pan-tropical data sets from 89 experimental sites (68 include aboveground wood productivity measurements and 35 litter productivity measurements), their associated canopy photosynthetic capacity (enhanced vegetation index, EVI) and climate, we ask how carbon assimilation and aboveground allocation are related to climate seasonality in tropical forests and how they interact in the seasonal carbon cycle. We found that canopy photosynthetic capacity seasonality responds positively to precipitation when rainfall is  < 2000 mm yr⁻¹ (water-limited forests) and to radiation otherwise (light-limited forests). On the other hand, independent of climate limitations, wood productivity and litterfall are driven by seasonal variation in precipitation and evapotranspiration, respectively. Consequently, light-limited forests present an asynchronism between canopy photosynthetic capacity and wood productivity. First-order control by precipitation likely indicates a decrease in tropical forest productivity in a drier climate in water-limited forest, and in current light-limited forest with future rainfall  < 2000 mm yr⁻¹

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Growth and sporulation of Verticillium lecanii isolates under different nutritional conditions

O objetivo deste trabalho foi determinar as melhores condições de crescimento e esporulação de dois isolados de Verticillium lecanii (Zimm.) Viégas, cultivados em vários meios de cultura, fontes de C, fontes orgânicas e inorgânicas de N e relações C:N. Após 20 dias de cultivo, BDA e Meio Completo mostraram ser os melhores meios de cultura, e a lactose e o amido foram as fontes de C que mais favoreceram o crescimento dos isolados JAB 02 e JAB 45, respectivamente; baixa esporulação foi apresentada por JAB 02, enquanto JAB 45 obteve boa esporulação em glicose e maltose. JAB 02 desenvolveu melhor quando a fonte orgânica de N era casitona; JAB 45 obteve bom desenvolvimento em presença de casitona e peptona, mas houve pouca esporulação em presença de triptona e caseína hidrolisada. As fontes inorgânicas de N que favoreceram o melhor desenvolvimento dos isolados foram (NH4)2HPO4 e NaNO3, porém, JAB 02 apresentou baixa esporulação. Entre as relações C:N analisadas, JAB 02 obteve melhor crescimento na relação 60:1 e JAB 45 nas relações 5:1, 10:1 e 20:1; baixa esporulação foi obtida por JAB 02 nas relações testadas, mas não se verificou efeito da relação C:N do meio sobre a esporulação dos isolados.The objective of this work was to determine the best growth and sporulation conditions of two Verticillium lecanii (Zimm.) Viégas, isolates cultivated in different culture medium, C sources, organic and inorganic N sources and C:N ratio. Twenty days after inoculation, PDA and Complete Medium provided the best development, and lactose and starch were the best C sources to promote the growth of JAB 02 and JAB 45 isolates, respectively; JAB 02 showed low sporulation while JAB 45 sporulated well on glucose and maltose. JAB 02 isolate developed well when the organic N source was casitone; JAB 45 obtained good development when the tested sources were casitone and peptone, although a low sporulation occurred in presence of tryptone and hydrolysed casein. The inorganic N sources that favoured the best development of isolates were (NH4)2HPO4 and NaNO3, although JAB 02 isolate showed low sporulation. In the C:N ratio analysed, JAB 02 isolate developed better on the 60:1 ratio, and the JAB 45 isolate on the 5:1, 10:1 and 20:1 ratio. The sporulation of JAB 02 isolate was low on all the ratios tested, but there was no effect of the C:N ratio on the sporulation of both isolates

Crescimento e esporulação de isolados de Verticillium lecanii sob diferentes fatores ambientais

O objetivo deste trabalho foi avaliar o crescimento e a esporulação de dois isolados (JAB 02 e JAB 45) de Verticillium lecanii (Zimm.) Viégas, submetidos a diferentes valores de pH (4, 5, 6, 7, 8, 9) inicial do meio de cultivo sólido, de temperatura (19, 22, 25, 28 e 31ºC) e fotoperíodo (0, 12 e 24 horas). Após 20 dias de cultivo, não se observou efeito do pH inicial do meio no crescimento e esporulação dos isolados, exceto no pH 4,0 que reduziu o crescimento. A ausência de iluminação proporcionou a melhor condição para o crescimento de JAB 02 (32,70 mm) e JAB 45 (32,67 mm). Não houve efeito do fotoperíodo na produção de esporos. As melhores temperaturas para o crescimento de JAB 02 foram 19, 22 e 25ºC e para JAB 45 foram 19 e 25ºC. Este último isolado apresentou melhor esporulação a 19 e 22ºC, mas a temperatura não influenciou a esporulação de JAB 02. Não houve desenvolvimento dos isolados a 31ºC.This research aimed to evaluate the growth and sporulation of two Verticillium lecanii (Zimm.) Viégas isolates cultivated on solid medium with different initial pH values (4, 5, 6, 7, 8 and 9), exposed to different temperatures (19, 22, 25, 28 and 31ºC) and photoperiods (0, 12 and 24 hours). There was no substantial effect of the initial pH values on growth and sporulation of both isolates twenty days after inoculation, except at pH 4.0 in which the growth was significantly reduced. Absence of light promoted the best growth of JAB 02 (32.70 mm) and JAB 45 (32.67 mm) isolates but there was no effect of photoperiod on sporulation. The best temperatures for growth of JAB 02 were 19, 22 and 25ºC and for JAB 45, 19 and 25ºC. The latter isolate sporulated most at 19 and 22ºC and there was no effect of temperature on sporulation of JAB 02. None of the isolates developed at 31ºC.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES