Demografia escrava numa economia não exportadora: Paraná, 1800-1830

Os escravos do Paraná apresentam um particular interesse para a demografia das populações cativas brasileiras. Constata-se neles um significativo equilibrio entre os sexos, baixa idade mediana da população, elevada magnitude de crianças escravas, de sorte que sua feição demográfica revela-se similar áquela encontrada na população livre. Tudo indica que a reprodução natural teve peso decisivo na conformação desta estrutura, e surpreendentemente num período no qual o tráfico de africanos para o Brasil alcançava proporções inéditas.The study of the slave population of Parang is greatly important for the demography of the Brazilian slave population. Some of that population's characteristics are: a considerably balanced male/female ratio, low median age and high proportion of children. These characteristics are similar to those found in the free population. There is a great probability that natural reproduction was decisive in forming that structure; surprisingly, the traffic of African slaves to Brazil was more active than ever by that time

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Donos de Terras e Escravos no Paraná: Padrões e Hierarquias nas Primeiras Décadas do Século XIX

Este artigo trata do período Colonial.O artigo examina o uso da mão-de-obra escrava da parte dos donos da terra, assim como o acesso à terra por parte dos proprietários de escravos. Nas primeiras décadas do século XIX a repartição da terra no Paraná registrou um alto índice de concentração, com os fazendeiros de gado detendo as maiores propriedades. O texto discute hierarquias sociais presentes na sociedade local e a importância da terra e dos escravos na constituição dessas hierarquias. As fontes primárias empregadas na análise foram cadastros de terras e recenseamentos de população.CEVÓtim

Trabalho Infantil em Minas Gerais na Primeira Metade do Século XIX

Since colonial Brazil to the nineteenth century the children began to be included early in the world of labour, independently of their social condition and sex. This article de analyzes the child labour in Minas Gerais in the first half of the nineteenth century. White, freemen and slaves children worked mainly in the domestic weaving and in the agricultural labour, but there were also students. In the range of 11-12 years old around 30% of the children involved in labour, and in 13-14 years old more than 40%.Since colonial Brazil to the nineteenth century the children began to be included early in the world of labour, independently of their social condition and sex. This article de analyzes the child labour in Minas Gerais in the first half of the nineteenth century. White, freemen and slaves children worked mainly in the domestic weaving and in the agricultural labour, but there were also students. In the range of 11-12 years old around 30% of the children involved in labour, and in 13-14 years old more than 40%.Durante a colônia e o século XIX as crianças começavam a participar cedo no mundo do trabalho, independentemente da condição social e do sexo. Este artigo analisa o trabalho infantil em Minas Gerais na primeira metade do século XIX. Livres, libertos e escravos trabalhavam principalmente na tecelagem doméstica e na lavoura, mas também haviam estudantes. Na faixa dos 11 aos 12 anos já estavam envolvidas em atividades ocupacionais em torno de 30% das crianças, e na de 13-14 anos mais de 40%. &nbsp