Event attribution of Parnaíba River floods in Northeastern Brazil

The climate modeling techniques of event attribution enable systematic assessments of the extent that anthropogenic climate change may be altering the probability or magnitude of extreme events. In the consecutive years of 2018, 2019, and 2020, rainfalls caused repeated flooding impacts in the lower Parnaíba River in Northeastern Brazil. We studied the effect that alterations in precipitation resulting from human influences on the climate had on the likelihood of flooding using two ensembles of the HadGEM3-GA6 atmospheric model: one driven by both natural and anthropogenic forcings; and the other driven only by natural atmospheric forcings, with anthropogenic changes removed from sea surface temperatures and sea ice patterns. We performed hydrological modeling to base our assessments on the peak annual streamflow. The change in the likelihood of flooding was expressed in terms of the ratio between probabilities of threshold exceedance estimated for each model ensemble. With uncertainty estimates at the 90% confidence level, the median (5% 95%) probability ratio at the threshold for flooding impacts in the historical period (1982–2013) was 1.12 (0.97 1.26), pointing to a marginal contribution of anthropogenic emissions by about 12%. For the 2018, 2019, and 2020 events, the median (5% 95%) probability ratios at the threshold for flooding impacts were higher at 1.25 (1.07 1.46), 1.27 (1.12 1.445), and 1.37 (1.19 1.59), respectively; indicating that precipitation change driven by anthropogenic emissions has contributed to the increase of likelihood of these events by about 30%. However, there are other intricate hydrometeorological and anthropogenic processes undergoing long-term changes that affect the flood hazard in the lower Parnaíba River. Trend and flood frequency analyses performed on observations showed a nonsignificant long-term reduction of annual peak flow, likely due to decreasing precipitation from natural climate variability and increasing evapotranspiration and flow regulation

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background\ud To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.\ud \ud Methods\ud This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).\ud \ud Results\ud Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).\ud \ud Conclusions\ud A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.We thank Mrs. Karianne Aroeira Davidson, Mrs. Anna Maria Ferreira, Mrs. Elisangela Santos and Sandro Sperandei for their technical assistance.This work was supported by grants from Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, the Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Guidelines for the Management of Mucopolysaccharidosis Type I

Universidade Federal de São Paulo, Ctr Referencia Erros Inatos Metab, São Paulo, BrazilUniversidade Federal de São Paulo, Discipline Otorrinolaringol Pediat, São Paulo, BrazilPontificia Univ Catolica Campinas, São Paulo, BrazilUniv Ciencias Saude Alagoas, Maceio, BrazilUniv Fed Minas Gerais, Fac Med, Dept Propedeut Complementar, Belo Horizonte, MG, BrazilUniv São Paulo, Fac Med, Dept Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psicobiol, Discipline Med & Biol Sono, São Paulo, BrazilUniv Estacio Sa, Florianopolis, SC, BrazilAPAE, Triagem Neonatal, Salvador, BA, BrazilUniv Fed Rio Grande do Sul, Dept Bioquim ICBS, Porto Alegre, RS, BrazilHosp Clin Porto Alegre, Serv Genet Med, Porto Alegre, RS, BrazilHosp Reabilitacao, Med Lab Rede Sarah, Belo Horizonte, MG, BrazilFundacao Hosp Estado Minas Gerais, Ctr Geral Pediat, Belo Horizonte, MG, BrazilHosp Restauracao Pernambuco, Serv Hepatol Infantil, Recife, PE, BrazilUniv Fed Minas Gerais, Fac Med, Dept Oftalmol, Belo Horizonte, MG, BrazilHosp Clin Porto Alegre, Setor Mucopolissacaridose, Serv Genet Med, Porto Alegre, RS, BrazilHosp Evangel Londrina Parana, Serv Hematol, Londrina, BrazilClin Doencas Metab Dr Ricardo Pires, Porto Alegre, RS, BrazilHosp Socor, Serv Ortopedia Pediat, Belo Horizonte, MG, BrazilUniv Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Ctr Pesquisas, Lab Terapia Genica, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Disciplina Disturbios Comunicacao Humana, Dept Fonoaudiol, São Paulo, BrazilUniversidade Federal de São Paulo, Ctr Referencia Erros Inatos Metab, São Paulo, BrazilUniversidade Federal de São Paulo, Discipline Otorrinolaringol Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psicobiol, Discipline Med & Biol Sono, São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Disturbios Comunicacao Humana, Dept Fonoaudiol, São Paulo, BrazilWeb of Scienc

A atuação do serviço de saúde na violência sob o olhar de lideranças comunitárias de Londrina (PR) The health team's performance in the context of violence under the perspective of community-based leaderships in Londrina (PR)

Nos últimos anos, no Brasil, observa-se um aumento da violência urbana. A cidade de Londrina, no estado do Paraná, particularmente, vem assistindo a um preocupante aumento dos índices de violência. Isso tem levado as lideranças da cidade a se mobilizarem. O objetivo deste estudo é levantar qual a visão que lideranças comunitárias de duas regiões da periferia da cidade de Londrina, que apresentam diferentes níveis de mobilização popular, têm da atuação de serviços de saúde sobre a problemática da violência. A abordagem utilizada é de pesquisa qualitativa. Foi utilizado o referencial teórico das Representações Sociais e a técnica da análise de conteúdo de Bardin. Foram realizadas entrevistas semi-estruturadas com lideranças identificadas a partir do processo chamado de "bola de neve" ou amostragem em rede. As entrevistas foram realizadas até que se atingiu a saturação das representações sociais, totalizando vinte e seis entrevistas, treze em cada região pesquisada. Os resultados mostraram que, de modo geral, a atuação dos serviços de saúde é considerada precária na visão das lideranças comunitárias. Na região onde a comunidade é mais mobilizada, porém, essa atuação ocorre de maneira mais articulada. Já na região menos mobilizada, a atuação é mais pontual e foram relatados alguns casos de violência contra o profissional de saúde. Este estudo mostra que é necessário que a saúde invista mais na questão da violência, valorizando a parceria com segmentos organizados da comunidade.<br>In the last few years Brazil has been experiencing an increase in urban violence. Particularly in the city of Londrina (state of Paraná), there has been a disturbing growth of violence rates which has caused the city leaderships to take action. The aim of this study is to investigate what community-based leaderships think about the health team's performance regarding the violence issue. The leaderships are from two regions on the periphery of Londrina which have different levels of community mobilization. This is a qualitative study that used the theoretical framework of the Social Representations and Bardin's content analysis technique. Semi-structured interviews were conducted with leaderships chosen through the "snowball" process or network sampling. Interviews were conducted until a saturation of social representations was reached, totaling 26 interviews, 13 in each researched area. Results showed that, in general, the health team's performance is considered poor by the community-based leaderships. In the region where the community is more proactive, this performance is more articulated, whereas in the less proactive one, the performance is more focused and violence against the health professional has been reported. This study shows that it is necessary for health teams to give more attention to the violence issue, forming partnerships with organized segments in the community