Entre consumos suntuários e comuns: a posse de objetos exóticos entre alguns habitantes do Porto (séculos XVI – XVII)

O estudo da documentação referente aos doadores da Misericórdia do Porto entre os séculos XVI e XVII, através dos objetos exóticos patentes nos respectivos testamentos e inven- tários – estes últimos provenientes de uma área que se estende de Macau ao Brasil –, permite discernir uma panóplia de objetos que mudaram a cultura material dos portuenses em contato com os territórios da expansão portuguesa. Um levantamento sistemático permitiu já rastrear, até o ano de 1699, 257 doadores, dos quais se apresentarão aqui apenas alguns, referentes a benfeitores que, não obstante possuírem bens móveis nesse âmbito, não são dados como tendo estado nos territórios de expansão transoceânica. Argumentar-se-á que essa circulação de objetos não foi exclusiva das elites nobiliárquicas, nem dos grandes centros urbanos, pelo que a sua difusão atingiu maiores proporções do que aquelas que a historiografia tem admitido até agora. A cidade em observação neste estudo – o Porto dos séculos XVI e XVII – estava longe de ser das maiores da Europa nesse período, quer em dimensão territorial, quer em efetivos populacionais, embora se situasse numa região de demografia pujante, que canalizou os seus excedentes desde cedo para a emigração interna e externa – o Entre Douro e Minho. Como teremos ocasião de verificar, fidalgos e nobres possuíam bens exóticos, mas estes encontravam-se também entre mercadores e até artesãos mais desafogados. Por outro lado, nem todos os objetos provenientes dos espaços da expansão transoceânica devem ser conotados com bens de luxo.The study of the sources referring to the donors of the Misericórdia of the city of Porto during the sixteenth and seventeenth centuries has revealed the presence of numerous exotic objects in their last wills and inventories. A survey has traced 257 donors until 1699, some of them having died in an area that extends from Macao to Brazil. Only a small number of cases shall be presented here, pertaining to benefactors who, in spite of owning objects of transoceanic origin, seem to have remained in mainland Portugal. It shall be argued that the circulation of objects has not been exclusive either to the elites of the nobility or to the large urban centres, their diffusion having been on a larger scale than what has been admitted until now. The city under scrutiny in this study – Porto during the sixteenth and seventeenth centuries – was not one of the bigger cities in this period, either in what respects to size or population, although it was located in an area of flourishing demography, that channelled its surplus population early on to internal and external emigration. Fidalgos and noblemen owned exotic goods, but these were to be found among merchants and even well-to-do artisans. On the other hand, not all objects originating from the areas of transoceanic expansion should be considered as luxury goods.info:eu-repo/semantics/publishedVersio

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