Análise longitudinal do tempo de retorno e fatores associados para doação de sangue em primodoadores voluntários

Introduction: Different factors related to blood donation can generate situations that affect their return and, when not elucidated and solved, can compromise loyalty to blood centers. Objective: The purpose of this paper was to estimate first-time blood donors return time and associated factors. Method: Cohort studies were designed after consulting State Blood Center’s database in Apucarana, PR, Brazil. Donor medical records were analyzed from January 1, 2005 to June 30, 2009, and their returns were monitored until the year 2011. It was considered as the dependent variable the turnaround time for second donation and its prevalence after the first donation. Anthropometric, clinical and laboratory data were collected, followed by a structured interview. Data were submitted to Kaplan-Meier survival analysis comparing them with the log-rank test. The proportional hazards regression Cox model was used to identify risk factors associated with the return, calculating the proportional risk and interval 95% confidence interval (95%CI). Results: 41.5% returned: 26.1% temporarily were unfit and 50.0% fit. Donors who returned more quickly were Rh negative, under 19 years old and with hypotension. The proportional risk for the main impeditive were older age (RP = 0.190; 95%CI 0.071–0.510), farther distance (RP = 0.276; 95%CI 0.124–0.616), arterial hypotension (RP = 0.540; 95%CI 0.385–0.759), risky behavior (RP = 0.533; 95%CI 0.473–0.601), anemia (RP = 0.402; 95%CI 0.348–0.464) and arterial hypertension (RP = 0.377; 95%CI 0.277–0.513). Conclusions: This study showed a significant decrease in first-time donors who return to the service for other donations and identified that young people and those who were apt were the groups with the highest frequency of return. Knowledge of the causes of temporary inability to donate provides conditions to encourage those temporary unable to donate to return for future donations.Introdução: Diferentes fatores inerentes à doação de sangue podem gerar situações que intervêm no retorno dos doadores, as quais, quando não elucidadas e não solucionados os problemas delas derivados, comprometem a fidelização aos hemocentros. Objetivo: Estimar o tempo de retorno à doação de sangue em primodoadores e fatores associados. Método: Estudo de delineamento de coorte por meio da análise do Banco de Dados do Hemonúcleo da Regional de Saúde em Apucarana (PR). Foram analisados os prontuários de doadores no período de 1º de janeiro de 2005 a 30 de junho de 2009, cujos retornos foram acompanhados até o ano de 2011. Considerou-se como variáveis dependentes o tempo de retorno para segunda doação e sua frequência após a primeira doação. Foram coletados dados antropométricos, clínicos e laboratoriais e, em seguida, entrevista estruturada. Os dados foram submetidos à análise de sobrevida de Kaplan-Meier comparando-os pelo teste log-rank. O modelo de regressão de risco proporcional de Cox foi utilizado para identificar os fatores de risco associados ao retorno, calculando-se o risco proporcional com intervalo de 95% de confiança (IC95%). Resultados: Observou-se uma proporção de retorno de 41,5%, sendo 26,1% dos inaptos temporariamente e 50,0% dos aptos. Doadores que retornaram mais rapidamente foram os Rh negativos, idade menor de 19 anos e com hipotensão arterial. Os riscos proporcionais (RP) para fatores impeditivos do retorno estiveram associados a idade mais avançada (RP = 0,190; IC95% 0,071–0,510), procedência mais distante (RP = 0,276; IC95% 0,124–0,616), hipotensão arterial (RP = 0,540; IC95% 0,385–0,759), comportamento de risco (RP = 0,533; IC95% 0,473–0,601), anemia (RP = 0,402; IC95% 0,348–0,464) e hipertensão arterial (RP = 0,377; IC95% 0,277–0,513). Conclusões: Este estudo mostrou diminuição significativa de primodoadores que retornam ao serviço para outras doações e identificou que os jovens e aqueles aptos foram os grupos com maior frequência de retorno. O conhecimento das causas de inaptidão temporária propicia condições para incentivar os inaptos temporários a retornarem para doações futuras

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

Percepção da comunidade nipo-brasileira residente em Curitiba sobre o cadastro de medula óssea The perception of the bone marrow registry of Brazilian Japanese descendants living in the city of Curitiba, Brazil

O transplante de medula óssea é uma terapia de escolha utilizada para o tratamento de doenças hematológicas. Entrementes, a probabilidade de se encontrarem doadores compatíveis na população em geral é relativamente baixa. Felizmente, há uma maior probabilidade de se encontrar um doador compatível em doadores de grupos étnicos semelhantes aos do paciente. Especificamente quanto aos nipo-brasileiros, existem poucos virtuais doadores cadastrados no Hemepar de Curitiba. Frente a essa situação, este estudo teve por objetivo conhecer a percepção dos nipo-brasileiros residentes em Curitiba sobre o Cadastro Nacional de Doadores de Medula Óssea e as possíveis causas da pequena adesão a este cadastro. O estudo foi realizado com 400 nipo-brasileiros, entrevistados aleatoriamente por meio de um questionário semiestruturado, no período de abril a junho de 2008. Os resultados foram tabelados pelo Microsoft Office Excel 2003, e as análises estatísticas realizadas pelo Software Statgraphics, versão 5.1. Constatou-se que, mesmo possuindo um bom nível cultural (56%) e do bom entendimento sobre a medula óssea (77%), a baixa adesão apresentada para o cadastramento como potencial doador voluntário, principalmente pelas gerações nissei e sansei, deveu-se ao desconhecimento quanto aos locais onde se realizam os cadastros e sobre o processo de doação de medula óssea. Estratégias com vistas a melhorar ainda mais o repasse de informações e esclarecimentos sobre o tema podem ser elaboradas a fim de despertar o interesse e incentivar os potenciais doadores nipo-brasileiros residentes em Curitiba a participar do Cadastro Nacional de Doadores de Medula Óssea. Conhecer as características dos diferentes grupos étnicos que compõem a população brasileira é um indicador que poderá ser utilizado no processo de captação de doadores de medula óssea.Bone marrow transplantation is the therapy of choice for some hematological diseases. However, in the general population there are few compatible donors for patients. Fortunately, there is a better chance of finding compatible donors in the same ethnical group as the patient. In the city of Curitiba, the state of Paraná, few Japanese descendants are registered as bone marrow donors in the State Blood Center (Hemepar). The purpose of this study was to investigate the perception of the Japanese descendants of the Bone Marrow Registry and in particular the possible reasons that few of these individuals are registered. Data were collected from April to May of 2008, through an interview process applied at random to 400 Japanese descendants. Results were tabulated on a Microsoft Office Excel 2003 spreadsheet and statistical analyses were performed using the Statgraphics Software, version 5.1. In spite of the good cultural background (56%) and good knowledge about bone marrow (77%), Japanese descendents in particular second and third generation subjects did not join the registry not only because of the lack of information about where it is possible to be registered but also because of the lack of information about the donation process itself. It is necessary to develop strategies to provide correct information to the population in order to stimulate Japanese descendants to join the bone marrow registry. Knowledge of the characteristics of the different ethnical groups which compose the Brazilian population is an indicator that may help to increase the number of registered bone marrow donor

O papel do usuário na organização do setor de coleta de sangue do Hemonúcleo de Apucarana, Paraná, Brasil The role of the user in the organization of the blood collection of the blood center of Apucarana, Paraná, Brazil

O Hemonúcleo de Apucarana faz parte da rede pública de bancos de sangue do estado do Paraná e tem como finalidade fornecer hemocomponentes com qualidade aos hospitais a ele conveniados. Com a proposta de atingir as metas do Ministério da Saúde em aumentar a quantidade de doadores espontâneos, o serviço tem se preocupado em buscar subsídios para melhora do processo de trabalho a fim de que este possa favorecer os objetivos de seu plano diretor. Para avaliar este processo, tornou-se necessário elaborar um instrumento de avaliação que possibilitasse identificar a percepção do doador em relação às diferentes etapas do processo de doação, bem como as áreas de insatisfação que se refletem em impedimentos para o retorno espontâneo deste doador. Este trabalho tem, portanto, o objetivo de demonstrar a satisfação dos doadores de sangue em relação às atividades executadas pelo Hemepar-Apucarana. Foram avaliadas questões como: orientações recebidas, horário de atendimento, ambiente físico (limpeza, agradabilidade e cortesia) e equipe de trabalho. Todos os dados obtidos foram registrados num banco de dados e tabulados pela planilha Excel do Windows. Os dados determinados para avaliação foram classificados em ruim, regular, bom e ótimo, calculados em percentuais dispostos em tabelas elaboradas para sua visualização. Como resultado observou-se melhora da satisfação do doador em relação ao atendimento médico (p=0,038) e diminuição da satisfação em relação aos equipamentos e vestuário dos funcionários (p=0,012). Os demais ítens não apresentaram diferenças estatisticamente significantes entre os dois períodos avaliados.<br>The hemocenter of the city of Apucarana, PR, Brazil, is part of Paraná State's Network of Blood Banks. Its purpose is to provide member hospitals with high-quality hemo-components. Proposing to fulfill the Brazilian Health Ministry's goals to increase the amount of first-time donors, Hemepar-Apucarana has been concerned with acquiring subsidies to improve its procedures so that it can benefit from the application of its own main directive. To evaluate this process, it is necessary to elaborate an instrument that can assist with identifying the donor's perception in regards to the different stages associated with blood donation, especially areas of dissatisfaction, and reflecting also on the areas that hinder the return of first-time donors. This work has thus the purpose of demonstrating blood donors' degree of satisfaction toward the activities of Hemepar - Apucarana. Issues such as the following have been evaluated: Instructions, reception schedule, physical ambiance (cleanness, coziness), and staff. All data has been saved in a Microsoft Windows Excel chart. The points under evaluation have been rated by actual donors from a range of bad, average, good and excellent pertaining to service and procedure. Percentages have also been calculated and plotted in graphs for visual comparison. As a result it was observed an improvement of the donor related to the medical service (p=0,038) and decreasing of satisfaction related to the equipments and employees' vestry (p=0,012). The other items didn't present significant differences between both periods

Urticaria: recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology

Urticaria is a disorder affecting skin and mucosal tissues characterized by the occurrence of wheals, angioedema or both, the latter defining the urticaria-angioedema syndrome. It is estimated that 12-22% of the general population has suffered at least one subtype of urticaria during life, but only a small percentage (estimated at 7.6-16%) has acute urticaria, because it is usually self-limited and resolves spontaneously without requiring medical attention. This makes likely that its incidence is underestimated. The epidemiological data currently available on chronic urticaria in many cases are deeply discordant and not univocal, but a recent Italian study, based on the consultation of a national registry, reports a prevalence of chronic spontaneous urticaria of 0.02% to 0.4% and an incidence of 0.1-1.5 cases/1000 inhabitants/year

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research