Acurácia dos indicadores de mortalidade devido a sepse dos óbitos ocorridos no Distrito Federal

Background: Sepsis currently represents a challenge for health systems, this fact may be related to the spread of bacterial resistance, the increase in the population of elderly, immunosuppressed individuals, and the improvement of emergency care, favoring the survival of critically ill patients. This article aimed to evaluate the accuracy of mortality indicators due to sepsis in 2018. Method: Validation study of death certificates that occurred in the Federal District in 2018. Declarations whose basic causes of death identified were classified as garbage codes were identified, which were investigated by a multidisciplinary team, capable of reclassifying them with codes that allow for the improvement of health data. In order to assess accuracy, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios of death certificates from sepsis were calculated, with 95% confidence intervals. Results: A total of  6.244 statements were evaluated, of which 233 (3.74%) presented sepsis as the underlying cause before being investigated and only 35 (0.56%) maintained it after the investigation. The filling of statements with sepsis as the underlying cause by physicians showed a sensitivity of 0.9% (95%CI: 0.6 to 1.3) and a specificity of 92.0% (95%CI: 90.9 to 93.1). Conclusion: The low accuracy of the declarations demonstrates the non-reliability of the underlying cause of death from sepsis, especially the completion of death certificates that occurred in the Federal District in 2018.  Justificación: Sepsis representa en la actualidad un desafío para los sistemas de salud, este hecho puede estar relacionado con propagación de resistencias bacterianas, aumento de la población de ancianos, inmunodeprimidos, y mejora de la atención de urgencias, favoreciendo la supervivencia de los pacientes críticos. Este artículo tuvo como objetivo evaluar la precisión de los indicadores de mortalidad por sepsis en 2018. Método: Estudio de validación de causa básica de muertes ocurridas en Distrito Federal en 2018. Se identificaron actas de defunción cuyas causas básicas de muerte fueron clasificadas como sepsis código basura y fueron investigadas por un equipo multidisciplinario capacitado para reclasificarlas con códigos que permitan la mejora de datos de salud. Para evaluar la precisión, se calcularon sensibilidad, especificidad, valores predictivos positivo y negativo y razones de verosimilitud positiva y negativa de certificados de defunción por sepsis, con intervalos de confianza del 95%. Resultados: se evaluaron 6.244 declaraciones, de las cuales 233 (3,74%) tenían como causa básica la sepsis antes de ser investigadas y solo 35 (0,56%) mantuvieron después de investigación. Realización de declaraciones con sepsis como causa subyacente por parte de los médicos mostró sensibilidad del 0,9% (95%IC: 0,6 a 1,3) y especificidad del 92,0% (95%IC: 90,9 a 93,1). Conclusión: Baja precisión de las declaraciones demuestra la poca confiabilidad de la causa subyacente de muerte por sepsis, especialmente la finalización de los certificados de defunción ocurridos en Distrito Federal en 2018.Justificativa: A sepse, atualmente, representa um desafio para os sistemas de saúde, tal fato pode estar relacionado com a disseminação da resistência bacteriana, o aumento da população de idosos, os indivíduos imunossuprimidos, e a melhoria do atendimento de emergência, favorecendo a sobrevivência de pacientes críticos. Este artigo teve por objetivo avaliar a acurácia dos indicadores de mortalidade devido à sepse em 2018. Método: Estudo de validação da causa básica dos óbitos ocorridos no Distrito Federal em 2018. Foram identificadas as declarações de óbito cujas causas básicas de morte apontadas foram classificadas como garbage code sepse, as quais foram investigadas por uma equipe multidisciplinar, capacitada para reclassificá-las com códigos que permitem o aprimoramento dos dados em saúde. A fim de avaliar a acurácia, foram calculados os valores de sensibilidade, especificidade, valores preditivos positivo e negativo, razões de verossimilhança positiva e negativa das declarações dos óbitos por sepse, com intervalos de confiança de 95%. Resultados: Um total de 6.244 declarações foram avaliadas, das quais 233 (3,74%) apresentavam a sepse como causa básica antes de serem investigadas e apenas 35 (0,56%) mantiveram-na após a investigação. O preenchimento das declarações com a sepse enquanto causa básica pelos médicos apresentou sensibilidade de 0,9% (IC95%: 0,6 a 1,3) e especificidade de 92,0% (IC95%: 90,9 a 93,1). Conclusão: A baixa acurácia das declarações demonstra a não fidedignidade da causa básica de óbito por sepse, sobretudo, do preenchimento das declarações dos óbitos ocorridos no Distrito Federal em 2018

Congruence of local ecological knowledge (LEK)-based methods and line-transect surveys in estimating wildlife abundance in tropical forests

Effective estimation of wildlife population abundance is an important component of population monitoring, and ultimately essential for the development of conservation actions. Diurnal line-transect surveys are one of the most applied methods for abundance estimations. Local ecological knowledge (LEK) is empirically acquired through the observation of ecological processes by local people. LEK-based methods have only been recognized as valid scientific methods for surveying fauna abundance in the last three decades. However, the agreement between both methods has not been extensively analysed. We compared concomitant abundance data for 91 wild species (mammals, birds and tortoises) from diurnal line transects (9,221 km of trails) and a LEK-based method (291 structured interviews) at 18 sites in Central and Western Amazonia. We used biological and socioecological factors to assess the agreements and divergences between abundance indices obtained from both methods. We found a significant agreement of population abundance indices for diurnal and game species. This relationship was also positive regardless of species sociality (solitary or social), body size and locomotion mode (terrestrial and arboreal); and of sampled forest type (upland and flooded forests). Conversely, we did not find significant abundance covariances for nocturnal and non-game species. Despite the general agreement between methods, line transects were not effective at surveying many species occurring in the area, with 40.2% and 39.8% of all species being rarely and never detected in at least one of the survey sites. On the other hand, these species were widely reported by local informants to occur at intermediate to high abundances. Although LEK-based methods have been long neglected by ecologists, our comparative study demonstrated their effectiveness for estimating vertebrate abundance of a wide diversity of taxa and forest environments. This can be used simultaneously with line-transect surveys to calibrate abundance estimates and record species that are rarely sighted during surveys on foot, but that are often observed by local people during their daily extractive activities. Thus, the combination of local and scientific knowledge is a potential tool to improve our knowledge of tropical forest species and foster the development of effective strategies to meet biodiversity conservation goals

O impacto da pandemia de COVID-19 na população indígena: uma análise científica

A pandemia de COVID-19, desencadeada pelo coronavírus SARS-CoV-2, tem sido um desafio global, afetando diversas comunidades, com destaque para as populações indígenas, historicamente marginalizadas e vulneráveis devido a desigualdades estruturais. O presente artigo trata-se de uma pesquisa bibliográfica, através de uma revisão integrativa da literatura. A análise epidemiológica revela que fatores como superlotação em moradias, falta de acesso a água potável e saneamento básico, além de altas taxas de comorbidades, contribuem para a propagação e impactos severos da doença nessas comunidades. A falta de acesso a serviços de saúde adequados é agravada pela escassez de infraestrutura e profissionais de saúde em áreas remotas, somada a barreiras linguísticas e culturais. Apesar dos desafios, as populações indígenas têm demonstrado resiliência, implementando medidas proativas de prevenção, promovendo solidariedade comunitária e preservando práticas tradicionais de cura. Estratégias de longo prazo incluem a diversificação econômica e o fortalecimento dos sistemas de saúde indígenas. A conclusão ressalta a importância de reconhecer e valorizar os conhecimentos e direitos das comunidades indígenas, promovendo ações colaborativas para construir sociedades mais inclusivas e resilientes

Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units

ObjectiveTo validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2.MethodsObservational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve – AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013–2015, 2015–2017, and 2017–2019.Results41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2–5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94–1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83–0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%–3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%–46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%–100% mortality risk).ConclusionsBoth scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied

Predicting animal abundance through local ecological knowledge: An internal validation using consensus analysis

Given the ongoing environmental degradation from local to global scales, it is fundamental to develop more efficient means of gathering data on species and ecosystems. Local ecological knowledge, in which local communities can consistently provide information on the status of animal species over time, has been shown to be effective. Several studies demonstrate that data gathered using local ecological knowledge (LEK)-based methods are comparable with data obtained from conventional methods (such as line transects and camera traps). Here, we employ a consensus analysis to validate and evaluate the accuracy of interview data on LEK. Additionally, we investigate the influence of social and bioecological variables on enhancing data quality. We interviewed 323 persons in 19 villages in the Western and Central Amazon to determine the level of consensus on the abundance of hunted and non-hunted forest species. These villages varied in size, socio-economic characteristics and in the experience with wildlife of their dwellers. Interviewees estimated the relative abundance of 101 species with a broad spectrum of bioecological characteristics using a four-point Likert scale. High consensus was found for species population abundance in all sampled villages and for 79.6% of interviewees. The village consensus of all species abundance pooled was negatively correlated with village population size. The consensus level was high regardless of the interviewees' hunting experience. Species that are more frequently hunted or are more apparent had greater consensus values; only two species presented a low consensus level, which are rare and solitary species. We show in our study in the Amazon that information gathered by local peoples, Indigenous as well as non-Indigenous, can be useful in understanding the status of animal species found within their environment. The high level of cultural consensus we describe likely arises from knowledge sharing and the strong connection between the persons interviewed and the forest. We suggest that consensus analysis can be used to validate LEK-generated data instead of comparing these types of data with information obtained by conventional methods

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Predicting animal abundance through local ecological knowledge: An internal validation using consensus analysis

Given the ongoing environmental degradation from local to global scales, it is fundamental to develop more efficient means of gathering data on species and ecosystems. Local ecological knowledge, in which local communities can consistently provide information on the status of animal species over time, has been shown to be effective. Several studies demonstrate that data gathered using local ecological knowledge (LEK)‐based methods are comparable with data obtained from conventional methods (such as line transects and camera traps). Here, we employ a consensus analysis to validate and evaluate the accuracy of interview data on LEK. Additionally, we investigate the influence of social and bioecological variables on enhancing data quality. We interviewed 323 persons in 19 villages in the Western and Central Amazon to determine the level of consensus on the abundance of hunted and non‐hunted forest species. These villages varied in size, socio‐economic characteristics and in the experience with wildlife of their dwellers. Interviewees estimated the relative abundance of 101 species with a broad spectrum of bioecological characteristics using a four‐point Likert scale. High consensus was found for species population abundance in all sampled villages and for 79.6% of interviewees. The village consensus of all species abundance pooled was negatively correlated with village population size. The consensus level was high regardless of the interviewees' hunting experience. Species that are more frequently hunted or are more apparent had greater consensus values; only two species presented a low consensus level, which are rare and solitary species. We show in our study in the Amazon that information gathered by local peoples, Indigenous as well as non‐Indigenous, can be useful in understanding the status of animal species found within their environment. The high level of cultural consensus we describe likely arises from knowledge sharing and the strong connection between the persons interviewed and the forest. We suggest that consensus analysis can be used to validate LEK‐generated data instead of comparing these types of data with information obtained by conventional methods. Read the free Plain Language Summary for this article on the Journal blog

The complete genome sequence of Corynebacterium pseudotuberculosis FRC41 isolated from a 12-year-old girl with necrotizing lymphadenitis reveals insights into gene-regulatory networks contributing to virulence

Trost E, Ott L, Schneider J, et al. The complete genome sequence of Corynebacterium pseudotuberculosis FRC41 isolated from a 12-year-old girl with necrotizing lymphadenitis reveals insights into gene-regulatory networks contributing to virulence. BMC Genomics. 2010;11(1): 728