Relações de gênero no trabalho em saúde em um estabelecimento prisional feminino

O objetivo do artigo é discutir sobre as relações de gênero na perspectiva de profissionais de uma Equipe de Atenção Básica Prisional (EABp) de uma penitenciária feminina. Os dados foram produzidos a partir da fala de profissionais da saúde em cinco encontros de apoio matricial e o gênero foi utilizado como categoria de análise. Como resultados, foi possível organizar três subtemas como desdobramentos do tema principal: gestação e permanência dos bebês na prisão; normas corporais e saúde; e, nome social de pessoas trans. A discussão segue referenciais dos estudos de diversidade sexual e de gênero e saúde coletiva e aborda a necessidade do direito à saúde integral da população encarcerada e, especificamente, de mulheres e população LGBTI. A centralidade do cuidado relativo à gestação e o papel da educação permanente para a redução do preconceito e qualificação no atendimento, também aparecem como campos de trabalho a ser explorados

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Eficiência e sustentabilidade: uma análise econômica, social, ambiental e sustentável das usinas paulistas de cana-de-açúcar

Concerns regarding environmental footprint have been the key in sustaining the relationship between competitiveness and sustainability in a changing capitalist context. Brazil has a solid level of heterogeneity in the efficiency of its production chains due to its legal and political characteristics. The Brazilian sugar-energy sector poses a strong influence on the economy, it is the pioneer in replacing the use of fossil fuels for renewable sources, and it is a sector marked by chain efficiency differences. In this context, this study aims to analyze the efficiency of the sugar cane mills in the state of Sao Paulo, from 2007 to 2016, from an economic, social, environmental, and sustainable point of view. Data Envelopment Analysis (DEA) is used to generate robust and complete efficiency models. Large-classified plants were ranked with economic efficiency, due to economies of scale, and small-classified plants ranked benchmarks in the social and environmental analysis, showing that the operational size bias is not necessarily a prerequisite to rank benchmark units. Finally, it was seen a preponderance of small and large-classified mill plants, along with ethanol-classified plants, in the sustainable benchmark ranking

Eficiência e sustentabilidade: uma análise econômica, social, ambiental e sustentável das usinas paulistas de cana-de-açúcar

Concerns regarding environmental footprint have been the key in sustaining the relationship between competitiveness and sustainability in a changing capitalist context. Brazil has a solid level of heterogeneity in the efficiency of its production chains due to its legal and political characteristics. The Brazilian sugar-energy sector poses a strong influence on the economy, it is the pioneer in replacing the use of fossil fuels for renewable sources, and it is a sector marked by chain efficiency differences. In this context, this study aims to analyze the efficiency of the sugar cane mills in the state of Sao Paulo, from 2007 to 2016, from an economic, social, environmental, and sustainable point of view. Data Envelopment Analysis (DEA) is used to generate robust and complete efficiency models. Large-classified plants were ranked with economic efficiency, due to economies of scale, and small-classified plants ranked benchmarks in the social and environmental analysis, showing that the operational size bias is not necessarily a prerequisite to rank benchmark units. Finally, it was seen a preponderance of small and large-classified mill plants, along with ethanol-classified plants, in the sustainable benchmark ranking

Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy

Abstract Background: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. Objective: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. Methods: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p 50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. Conclusion: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis