Quadro epdiemiológico das mortes súbitas na infância em cidades gaúchas (Brasil)

All post-perinatal infant deaths occurring within a one-year period in 10 cities in the State of Rio Grande do Sul (Brazil), the metropolitan area of Porto Alegre included, were investigated in a case-control study. Seventy-two sudden infant deaths (SID) were identified through a complex monitoring system. These were investigated in detail through medical interviews with the children's parents and through the review of medical records. Such deaths were more common in males, during the first three months of life, and in the winter. The comparison of each case with two neighborhood control infants through multiple conditional logistic regression identified the following risk factors: low socio-economic level (measured by family income and maternal education), low birthweight, presence of other children in the household, low maternal age, maternal smoking, and mixed or artificial feeding. None of the 72 deaths had been certified as such by the physicians who filled in the death certificates, the majority of which referred to "bronchopneumonia" as the undereying cause.Foram investigados os óbitos infantis pós-perinatais ocorridos no período de um ano, em 10 cidades gaúchas, incluindo a região metropolitana de Porto Alegre, por meio de estudo de casos e controles. Setenta e duas mortes súbitas na infância (MSI) foram identificadas através de amplo sistema de monitorização de óbitos e investigadas em pormenores através de entrevistas médicas com os pais da criança e revisão de prontuários ambulatoriais e hospitalares. Os óbitos foram mais comuns em meninos, no primeiro trimestre de vida e durante o inverno. A comparação de cada caso de MSI com duas crianças-controle da mesma vizinhança, através de regressão logística condicional múltipla, identificou os seguintes fatores de risco: baixo nível socioeconômico (medido através da renda familiar e da escolaridade materna), baixo peso ao nascer, presença de outras crianças no domicílio, mães jovens e fumantes e aleitamento misto ou artificial. Nenhuma das 72 MSI foi reconhecida como tal pelos médicos que preencheram os atestados de óbito, sendo as mesmas atribuídas predominantemente a "broncopneumonias"

Quadro epdiemiológico das mortes súbitas na infância em cidades gaúchas (Brasil) Epidemiology of sudden infant deaths in cities of Rio Grande do Sul, Brazil. A comparative study of cases and controls

Foram investigados os óbitos infantis pós-perinatais ocorridos no período de um ano, em 10 cidades gaúchas, incluindo a região metropolitana de Porto Alegre, por meio de estudo de casos e controles. Setenta e duas mortes súbitas na infância (MSI) foram identificadas através de amplo sistema de monitorização de óbitos e investigadas em pormenores através de entrevistas médicas com os pais da criança e revisão de prontuários ambulatoriais e hospitalares. Os óbitos foram mais comuns em meninos, no primeiro trimestre de vida e durante o inverno. A comparação de cada caso de MSI com duas crianças-controle da mesma vizinhança, através de regressão logística condicional múltipla, identificou os seguintes fatores de risco: baixo nível socioeconômico (medido através da renda familiar e da escolaridade materna), baixo peso ao nascer, presença de outras crianças no domicílio, mães jovens e fumantes e aleitamento misto ou artificial. Nenhuma das 72 MSI foi reconhecida como tal pelos médicos que preencheram os atestados de óbito, sendo as mesmas atribuídas predominantemente a "broncopneumonias".All post-perinatal infant deaths occurring within a one-year period in 10 cities in the State of Rio Grande do Sul (Brazil), the metropolitan area of Porto Alegre included, were investigated in a case-control study. Seventy-two sudden infant deaths (SID) were identified through a complex monitoring system. These were investigated in detail through medical interviews with the children's parents and through the review of medical records. Such deaths were more common in males, during the first three months of life, and in the winter. The comparison of each case with two neighborhood control infants through multiple conditional logistic regression identified the following risk factors: low socio-economic level (measured by family income and maternal education), low birthweight, presence of other children in the household, low maternal age, maternal smoking, and mixed or artificial feeding. None of the 72 deaths had been certified as such by the physicians who filled in the death certificates, the majority of which referred to "bronchopneumonia" as the undereying cause

Energy and environmental performances of hybrid photovoltaic irrigation systems in Mediterranean intensive and super-intensive olive orchards

Over the last decades, traditional olive production has been converted to intensive and super-intensive cultivation systems, characterized by high plant density and irrigation. Although this conversion improves product quality and quantity, it requires a larger amount of energy input. The new contributions in this paper are, first, an analysis of the energy and environmental performance of two commercial-scale high peak-power hybrid photovoltaic irrigation systems (HPVIS) installed at intensive and super-intensive Mediterranean olive orchards; second, an analysis of PV hybrid solutions, comparing PV hybridization with the electric power grid and with diesel generators; and finally, a comparison of the environmental benefits of HPVIS with conventional power sources. Energy and environmental performances were assessed through energy and carbon payback times (EPBT and CPBT). The results show EPBT of 1.98 and 4.58 years and CPBT of 1.86 and 9.16 years for HPVIS in Morocco and Portugal, respectively. Moreover, the HPVIS were able to achieve low emission rates, corresponding to 48 and 103 g CO2e per kWh generated. The EPBT and CPBT obtained in this study were directly linked with the irrigation schedules of the olive orchards; therefore, weather conditions and irrigation management may modify the energy and environmental performances of HPVIS. The consumption of grid electricity and diesel fuel, before and after the implementation of HPVIS, was also analyzed. The results obtained show fossil energy savings of 67% for the Moroccan farm and 41% for the Portuguese installation. These savings suggest that the energy produced by HPVIS in olive orchards will avoid the emissions of a large amount of greenhouse gas and the exploitation of natural resources associated with fossil fuel production

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery