Sistemas agroflorestais: implantação da tecnologia em área de agricultura familiar em Caroebe, RR.

A Embrapa Roraima sistematizou a experiência de implantação de sistemas agroflorestais (SAFs) em área de agricultura familiar no município de Caroebe, RR, onde procurou conhecer e estudar os pontos positivos e negativos da metodologia usada para o repasse dessa tecnologia para agricultores familiares pertencentes à Cooperativa de Agricultores e Agricultoras Familiares do Caroebe (Cooparfac).bitstream/item/176942/1/COLECAO-SISTEMATIZACAO-EXPERIENCIAS-vol-17.pd

Projeto GeoMucajaí: Dinâmica de uso e cobertura da terra no município de Mucajaí em Roraima.

bitstream/item/174187/1/Folder-GeoMucajai2.pd

Processo participativo sobre degradação da terra em regiões do Semiárido brasileiro.

A degradação da terra é um fenômeno complexo que afeta bilhões de pessoas em todas as partes do mundo e para ser compreendida em sua totalidade necessita de uma análise integrada que considere questões sociais, econômicas e ambientais. O bioma Caatinga é suscetível ao processo de degradação, entendido como um processo de perda de produtividade biológica ou econômica das terras. O presente relatório visa apresentar os resultados obtidos a partir de oficinas participativas realizadas em novembro e dezembro de 2022 com foco em duas regiões do bioma Caatinga, que compreendem Queimadas/PB, Petrolina/PE, e municípios selecionados próximos destes dois. Estas oficinas tiveram como objetivo identificar de maneira participativa variáveis socioecológicas locais que permitam compreender as especificidades ligadas aos processos de degradação da terra, para cada região. A pesquisa é uma etapa do projeto de pesquisa PCI intitulado ?Análise sistêmica socioecológica de impactos no Cerrado e Caatinga?, financiado pelo CNPq, e está inserida no âmbito do Projeto Temático NEXUS - ?Transição para a sustentabilidade e o nexo agricultura-energia-água: explorando uma abordagem integradora com casos de estudo nos biomas Cerrado e Caatinga?, liderado pela Divisão de Impactos, Adaptação e Vulnerabilidades do INPE, com apoio financeiro da Fapesp (Processo 2017/22269-2). A pesquisa baseou-se no uso de metodologias participativas em oficinas presenciais, nas quais foram feitas perguntas apoiadas no modelo Força-Motriz, Pressão, Estado, Impacto e Resposta, discussões em grupo, realização de mapeamento participativo e encontro de validação dos dados. A partir das respostas às perguntas foi possível identificar as principais causas da degradação nas regiões, como desmatamento e queimadas; as consequências geradas por ela, como a perda de produtividade agropecuária e êxodo rural; as soluções que os grupos indicaram para reverter a degradação, como políticas e disponibilidade de crédito para estimular práticas agroecológicas e maior proximidade com a Ciência; e as iniciativas que já ocorrem no território, como ações de associações, cooperativas, organizações não-governamentais e órgãos públicos; além da espacialização das áreas mais críticas em termos de degradação na visão dos participantes. Espera-se que os resultados aqui apresentados sejam utilizados pelos gestores públicos e população como uma ferramenta de análise do território, bem como em pesquisas científicas que versam sobre o tema degradação. da terra, como em projetos do INPE e de seus parceiros.sid.inpe.br/mtc-m21d/2023/04.18.16.48-RP

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

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