Jogos e brincadeiras no processo de ensino e aprendizagem na educação infantil : critérios de escolha

O presente trabalho, teve como principal motivação compreender a importância dos jogos e das brincadeiras no processo de ensino-aprendizagem na Educação Infantil bem como analisar de que modo os docentes os escolhem para prática na escola. Em busca de esclarecer estas inquietações, realizou-se uma investigação, partindo de estudos teóricos sobre o assunto e para compreender a abordagem do tema no contexto escolar. Posteriormente, foi realizado um contato com professoras de Educação Infantil a fim de compreender sua realidade, por meio de questionário on-line. Os jogos e as brincadeiras têm grande importância para o desenvolvimento das crianças, portanto, é necessário que estejam presentes nas práticas docentes e, por isso, é fundamental saber inseri-los em tais práticas. Ao concluir a coleta dos dados do referido questionário, observou-se que esse é um assunto presente tanto em formação inicial quanto continuada, de professores de Educação Infantil. Após análise dos dados foi possível compreender um pouco sobre os critérios usados pelos docentes na escolha de brincadeiras e jogos, as quais buscam fazer escolhas adequadas aos objetivos de aprendizagem e desenvolvimento das crianças.The main motivation of the present work was to understand the importance of games and toys in the teaching-learning process in Preschool Education as well as to analyze how teachers choose to practice them at school. In order to clarify these concerns, an investigation was carried out, starting from theoretical studies on the subject and to understand the approach to the theme in the school context. Subsequently, a contact was made with Preschool teachers in order to understand their reality, with an online questionnaire. Games and toys have great importance for the development of children, therefore, it is necessary that they are present in teaching practices and, wherefore, it is essential to know how to insert them in such practices. At the end of the data collection from this questionnaire, it was observed that this is a subject that is present in both the initial and continuing education of Preschool teachers. After analyzing the data it was possible to understand a little about the criteria used by teachers when choosing toys and games, which seek to make choices appropriate to the learning and development goals of children

Sigh in Patients With Acute Hypoxemic Respiratory Failure and ARDS: The PROTECTION Pilot Randomized Clinical Trial

Feasibility; Sigh; VentilationFactibilidad; Suspiro; VentilaciónFactibilitat; Sospir; VentilacióBackground Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase release of surfactant. Research Question Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study Design and Methods We conducted a multicenter noninferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or ARDS undergoing PSV. Patients were randomized to the no-sigh group and treated by PSV alone, or to the sigh group, treated by PSV plus sigh (increase in airway pressure to 30 cm H2O for 3 s once per minute) until day 28 or death or successful spontaneous breathing trial. The primary end point of the study was feasibility, assessed as noninferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiologic parameters in the first week from randomization, 28-day mortality, and ventilator-free days. Results Two-hundred and fifty-eight patients (31% women; median age, 65 [54-75] years) were enrolled. In the sigh group, 23% of patients failed to remain on assisted ventilation vs 30% in the no-sigh group (absolute difference, –7%; 95% CI, –18% to 4%; P = .015 for noninferiority). Adverse events occurred in 12% vs 13% in the sigh vs no-sigh group (P = .852). Oxygenation was improved whereas tidal volume, respiratory rate, and corrected minute ventilation were lower over the first 7 days from randomization in the sigh vs no-sigh group. There was no significant difference in terms of mortality (16% vs 21%; P = .337) and ventilator-free days (22 [7-26] vs 22 [3-25] days; P = .300) for the sigh vs no-sigh group. Interpretation Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.The PROTECTION trial was supported, in part, by an ESICM Clinical Research Award (ESICM, Brussels, Belgium) and by “Ricerca Corrente” of the Policlinico Hospital (Milan, Italy)

DENALI: il Data Warehouse di Sanità Pubblica della Regione Lombardia

n/

Phenology and phyllochron of seven strawberry cultivars grown in substrate and greenhouse in the Brazilian subtropics

Knowing the phenology and phyllochron of strawberry cultivars allows the establishment of phytotechnical managements aimed at enhancing the productive chain of this horticultural crop. Thus, the objective of this work was to investigate whether phenology and phyllochron differ among strawberry cultivars grown in substrate and greenhouse. The treatments were seven strawberry cultivars arranged in a randomized block design, with four replications. Leaf emission rate, occurrence and duration of phenological stages were evaluated. ‘Fronteras’ was considered the earliest to start fruiting, as it had the lowest phyllochron value, while ‘Albion’ was the latest. Through multivariate analysis, the formation of two groups among strawberry cultivars was observed according to their phenological characteristics. Group 1 gathered the five strawberry cultivars classified as having neutral-days in terms of flowering and group 2 was composed of the two short-day cultivars. It is concluded that, under the cultivation conditions of southern Brazil, ‘Fronteras’ is the earliest to start the fruit harvest, provided it is transplanted in May, and ‘Albion’ is the latest. Neutral-day cultivars have a shorter transplant cycle until the beginning of harvest, while short-day cultivars require a longer interval for this transition, with a prolonged vegetative period.Knowing the phenology and phyllochron of strawberry cultivars allows the establishment of phytotechnical managements aimed at enhancing the productive chain of this horticultural crop. Thus, the objective of this work was to investigate whether phenology and phyllochron differ among strawberry cultivars grown in substrate and greenhouse. The treatments were seven strawberry cultivars arranged in a randomized block design, with four replications. Leaf emission rate, occurrence and duration of phenological stages were evaluated. ‘Fronteras’ was considered the earliest to start fruiting, as it had the lowest phyllochron value, while ‘Albion’ was the latest. Through multivariate analysis, the formation of two groups among strawberry cultivars was observed according to their phenological characteristics. Group 1 gathered the five strawberry cultivars classified as having neutral-days in terms of flowering and group 2 was composed of the two short-day cultivars. It is concluded that, under the cultivation conditions of southern Brazil, ‘Fronteras’ is the earliest to start the fruit harvest, provided it is transplanted in May, and ‘Albion’ is the latest. Neutral-day cultivars have a shorter transplant cycle until the beginning of harvest, while short-day cultivars require a longer interval for this transition, with a prolonged vegetative period

Hepatitis B and C in Europe: an update from the Global Burden of Disease Study 2019

© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Background In 2016, the World Health Assembly adopted the resolution to eliminate viral hepatitis by 2030. This study aims to provide an overview of the burdens of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Europe and their changes from 2010 to 2019 using estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We used GBD 2019 estimates of the burden associated with HBV-related and HCV-related diseases: acute hepatitis, cirrhosis and other chronic liver diseases, and liver cancer. We report total numbers and age-standardised rates per 100 000 for mortality, prevalence, incidence, and disability-adjusted life-years (DALYs) from 2010 to 2019. For each HBV-related and HCV-related disease and each measure, we analysed temporal changes and percentage changes for the 2010–19 period. Findings In 2019, across all age groups, there were an estimated 2·08 million (95% uncertainty interval [UI] 1·66 to 2·54) incident cases of acute hepatitis B and 0·49 million (0·42 to 0·57) of hepatitis C in Europe. There were an estimated 8·24 million (7·56 to 8·88) prevalent cases of HBV-related cirrhosis and 11·87 million (9·77 to 14·41) of HCV-related cirrhosis, with 24·92 thousand (19·86 to 31·03) deaths due to HBV-related cirrhosis and 36·89 thousand (29·94 to 45·56) deaths due to HCV-related cirrhosis. Deaths were estimated at 9·00 thousand (6·88 to 11·62) due to HBV-related liver cancer and 23·07 thousand (18·95 to 27·31) due to HCV-related liver cancer. Between 2010 and 2019, the age-standardised incidence rate of acute hepatitis B decreased (–22·14% [95% UI –35·44 to –5·98]) as did its age-standardised mortality rate (–33·27% [–43·03 to –25·49]); the age-standardised prevalence rate (–20·60% [–22·09 to –19·10]) and mortality rate (–33·19% [–37·82 to –28·13]) of HBV-related cirrhosis also decreased in this time period. The age-standardised incidence rate of acute hepatitis C decreased by 3·24% (1·17 to 5·02) and its age-standardised mortality rate decreased by 35·73% (23·48 to 47·75) between 2010 and 2019; the age-standardised prevalence rate (–6·37% [–8·11 to –4·32]), incidence rate (–5·87% [–11·24 to –1·01]), and mortality rate (–11·11% [–16·54 to –5·53]) of HCV-related cirrhosis also decreased. No significant changes were observed in age-standardised rates of HBV-related and HCV-related liver cancer, although we observed a significant increase in numbers of cases of HCV-related liver cancer across all ages between 2010 and 2019 (16·41% [2·81 to 30·91] increase in prevalent cases). Substantial reductions in DALYs since 2010 were estimated for acute hepatitis B (–27·82% [–36·92 to –20·24]), acute hepatitis C (–27·07% [–15·97 to –39·34]), and HBV-related cirrhosis (–30·70% [–35·75 to –25·03]). A moderate reduction in DALYs was estimated for HCV-related cirrhosis (–6·19% [–0·19 to –12·57]). Only HCV-related liver cancer showed a significant increase in DALYs (10·37% [4·81–16·63]). Changes in age-standardised DALY rates closely resembled those observed for overall DALY counts, except for HCV-liver related cancer (–2·84% [–7·75 to 2·63]). Interpretation Although decreases in some HBV-related and HCV-related diseases were estimated between 2010 and 2019, HBV-related and HCV-related diseases are still associated with a high burden, highlighting the need for more intensive and coordinated interventions within European countries to reach the goal of elimination by 2030.Funding by Bill & Melinda Gates Foundation.info:eu-repo/semantics/publishedVersio

Alveolar pentraxin 3 as an early marker of microbiologically confirmed pneumonia: a threshold-finding prospective observational study

Introduction: Timely diagnosis of pneumonia in intubated critically ill patients is rather challenging. Pentraxin 3 (PTX3) is an acute-phase mediator produced by various cell types in the lungs. Animal studies have shown that, during pneumonia, PTX3 participates in fine-tuning of inflammation (for example, microbial clearance and recruitment of neutrophils). We previously described an association between alveolar PTX3 and lung infection in a small group of intubated patients. The aim of the present study was to determine a threshold level of alveolar PTX3 with elevated sensitivity and specificity for microbiologically confirmed pneumonia. Methods: We recruited 82 intubated patients from two intensive care units (San Gerardo Hospital, Monza, Italy, and Massachusetts General Hospital, Boston, MA, USA) undergoing bronchoalveolar lavage (BAL) as per clinical decision. We collected BAL fluid and plasma samples, together with relevant clinical and microbiological data. We assayed PTX3 and soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) in BAL fluid and PTX3, sTREM-1, C-reactive protein (CRP) and procalcitonin (PCT) in plasma. Two blinded independent physicians reviewed patient data to confirm pneumonia. We determined the PTX3 threshold in BAL fluid for pneumonia and compared it to other biomarkers. Results: Microbiologically confirmed pneumonia of bacterial (n =12), viral (n =4) or fungal (n =8) etiology was diagnosed in 24 patients (29%). PTX3 levels in BAL fluid predicted pneumonia with an area under the receiving operator curve of 0.815 (95% CI =0.710 to 0.921, P <0.0001), whereas none of the other biomarkers were effective. In particular, PTX3 levels ≥1 ng/ml in BAL fluid predicted pneumonia in univariate analysis (β =2.784, SE =0.792, P <0.001) with elevated sensitivity (92%), specificity (60%) and negative predictive value (95%). Net reclassification index PTX3 values ≥1 ng/ml in BAL fluid for pneumonia indicated gain in sensitivity and/or specificity vs. all other mediators. These results did not change when we limited our analyses only to confirmed cases of bacterial pneumonia. Moreover, when we considered only the 70 patients who fulfilled the clinical criteria for the diagnosis of pneumonia at BAL fluid sampling, the diagnostic accuracy of PTX levels was confirmed in univariate and ROC curve analysis. Conclusions: In this hypothesis-generating convenience sample, a PTX3 level ≥1 ng/ml in BAL fluid was discriminative of microbiologically confirmed pneumonia in mechanically ventilated patients. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0562-5) contains supplementary material, which is available to authorized users

Valutazione dei processi assistenziali e del carico economico dei soggetti con ospedalizzazione incidente di infarto acuto del miocardio mediante il Data Warehouse DENALI

Aims: this study wants to estimate the economic burden of incident Acute Myocardial Infarction (AMI) registered in Lombardy (about 9.2 million residents). Method and results: a longitudinal study was conducted using a Data Warehouse (DENALI) that organised Healthcare Administrative databases of Lombardy related to eligibility criteria, hospital discharges (HDs), pharmaceutical and outpatient claims of citizens. All individuals with a HD for a first event of AMI during 2003 were identified and followed for 12 months. During 2003 12,049 individuals (64% males, mean age 70 +/-13 y.o.) had a HD for incident AMI. The total cost during the first year was € 163 million, corresponding to the 1% of the healthca re budget of Lombardy. The monthly cost in the first year was € 1,249 per person (77% attributable to HDs, 15% to pharmaceuticals and 8% to outpatient care). While most of the uptake of drugs used in secondary prevention was quick and happened in the first 3 months after the index event, the phenomenon of non persistence at 12 months was relevant. Conclusion: this large study on the burden of AMI shows the epidemiologic, economic and clinical impact of the disease. DENALI, with its large population followed over time, is a powerful and dynamic tool for epidemiologic and health economic research

Impact of COVID-19 Lockdown, during the Two Waves, on Drug Use and Emergency Department Access in People with Epilepsy: An Interrupted Time-Series Analysis

BACKGROUND: In 2020, during the COVID-19 pandemic, Italy implemented two national lockdowns aimed at reducing virus transmission. We assessed whether these lockdowns affected anti-seizure medication (ASM) use and epilepsy-related access to emergency departments (ED) in the general population. METHODS: We performed a population-based study using the healthcare administrative database of Tuscany. We defined the weekly time series of prevalence and incidence of ASM, along with the incidence of epilepsy-related ED access from 1 January 2018 to 27 December 2020 in the general population. An interrupted time-series analysis was used to assess the effect of lockdowns on the observed outcomes. RESULTS: Compared to pre-lockdown, we observed a relevant reduction of ASM incidence (0.65; 95% Confidence Intervals: 0.59-0.72) and ED access (0.72; 0.64-0.82), and a slight decrease of ASM prevalence (0.95; 0.94-0.96). During the post-lockdown the ASM incidence reported higher values compared to pre-lockdown, whereas ASM prevalence and ED access remained lower. Results also indicate a lower impact of the second lockdown for both ASM prevalence (0.97; 0.96-0.98) and incidence (0.89; 0.80-0.99). CONCLUSION: The lockdowns implemented during the COVID-19 outbreaks significantly affected ASM use and epilepsy-related ED access. The potential consequences of these phenomenon are still unknown, although an increased incidence of epilepsy-related symptoms after the first lockdown has been observed. These findings emphasize the need of ensuring continuous care of epileptic patients in stressful conditions such as the COVID-19 pandemic

Asteroid photometry and lightcurve analysis at Gora's Observatories

Synodic rotation periods and amplitudes are reported for 179 Klytaemnestra, 372 Palma, 504 Cora, 739 Mandeville, 749 Malzovia, 925 Alphonsina, 1015 Christa, 1086 Nata, and 1794 Finsen.Fil: Colazo, Milagros Rita. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomía Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomía Teórica y Experimental; ArgentinaFil: Fornari, César. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Santucho, Marcos Ariel. Gora-grupo de Observadores de Rotaciones de Asteroides; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mottino, Aldo Domingo. Gora-grupo de Observadores de Rotaciones de Asteroides; Argentina. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Colazo, Carlos Roberto. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Melia, Raúl. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Vasconi, Nicolás. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Arias, Daniela. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Pittari, Claudio. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Suarez, Nestor Eduardo. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Pulver, Eduardo. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Ferrero, Guillermo Oscar. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Chapman, Andrés. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Girardini, Carla. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba; Argentina. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Rodríguez, Elisa. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Amilibia, Guillermo. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Anzola, Marcos. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Tornatore, Marina. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Nolte, Ricardo. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Morero, Sergio. Gora-grupo de Observadores de Rotaciones de Asteroides; ArgentinaFil: Oey, Julián. Blue Mountains Observatory; Australi

Antidepressants Drug Use during COVID-19 Waves in the Tuscan General Population: An Interrupted Time-Series Analysis

In Italy, during the COVID-19 waves two lockdowns were implemented to prevent virus diffusion in the general population. Data on antidepressant (AD) use in these periods are still scarce. This study aimed at exploring the impact of COVID-19 lockdowns on prevalence and incidence of antidepressant drug use in the general population. A population-based study using the healthcare administrative database of Tuscany was performed. We selected a dynamic cohort of subjects with at least one ADs dispensing from 1 January 2018 to 27 December 2020. The weekly prevalence and incidence of drug use were estimated across different segments: pre-lockdown (1 January 2018-8 March 2020), first lockdown (9 March 2020-15 June 2020), post-first lockdown (16 June 2020-15 November 2020) and second lockdown (16 November 2020-27 December 2020). An interrupted time-series analysis was used to assess the effect of lockdowns on the observed outcomes. Compared to the pre-lockdown we observed an abrupt reduction of ADs incidence (Incidence-Ratio: 0.82; 95% Confidence-Intervals: 0.74-0.91) and a slight weekly decrease of prevalence (Prevalence-Ratio: 0.997; 0.996-0.999). During the post-first lockdown AD use increased, with higher incidence- and similar prevalence values compared with those expected in the absence of the outbreak. This pandemic has impacted AD drug use in the general population with potential rebound effects during the period between waves. This calls for future studies aimed at exploring the mid-long term effects of this phenomenon