Promoting Responsible Research and Innovation (RRI) During Brazilian Activities of Genomic and Epidemiological Surveillance of Arboviruses

Zika infectio

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

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

Controle social no Sistema Estadual de Incentivos a Serviços Ambientais do Acre: relato da experiência de implantação e funcionamento do comitê local de padrões

The social control, the participation and the transparency are important aspects in the policies of incentives and payment for environmental services. The State Commission for Validation and Monitoring - CEVA is the college responsible for ensuring transparency and exert the social control of the State System of Incentives for Environmental Services in Acre - SISA. This article discusses the difficulty in ensuring the transparency in relation to the provided steps in the implementation of social and environmental standards for REDD +, therefore, it is intended to monitor the level of transparency of this commission from the comparison of the provided publications in the guidance document of the International Initiative for the implementation of the mentioned standards with the made publications. The methods used are literature review and documentary survey. Against expected results, the article in question provides a complementary effort to the project of institutionalization of social and environmental standards for REDD + in SISA, with respect to the publication and transparency in the implementation process of the safeguards in this state.O controle social, a participação e a transparência são aspectos relevantes nas políticas de incentivos e pagamentos por serviços ambientais. A Comissão Estadual de Validação e Acompanhamento – CEVA é o colegiado responsável por garantir a transparência e exercer o controle social do Sistema de Incentivos a Serviços Ambientais do Acre - SISA. Este artigo aborda a dificuldade em garantir tal transparência em relação às etapas previstas na implantação dos padrões sociais e ambientais de Redução das Emissões por Desmatamento e Degradação Florestal - REDD+, portanto, o mesmo visa acompanhar o nível de transparência dessa comissão a partir da comparação das publicações previstas no documento de diretrizes da Iniciativa Internacional para implantação dos padrões mencionados com as publicações realizadas. Os métodos utilizados são a pesquisa bibliográfica e o levantamento documental. Em relação aos resultados esperados, o artigo em questão proporciona um esforço complementar ao projeto de institucionalização dos padrões mencionados no SISA, no que tange à publicação e à transparência no processo de implantação das salvaguardas neste Estado

CONTROLE SOCIAL NO SISTEMA ESTADUAL DE INCENTIVOS A SERVIÇOS AMBIENTAIS DO ACRE: RELATO DA EXPERIÊNCIA DE IMPLANTAÇÃO E FUNCIONAMENTO DO COMITÊ LOCAL DE PADRÕES

The social control, the participation and the transparency are important aspects in the policies of incentives and payment for environmental services. The State Commission for Validation and Monitoring - CEVA is the college responsible for ensuring transparency and exert the social control of the State System of Incentives for Environmental Services in Acre - SISA. This article discusses the difficulty in ensuring the transparency in relation to the provided steps in the implementation of social and environmental standards for REDD +, therefore, it is intended to monitor the level of transparency of this commission from the comparison of the provided publications in the guidance document of the International Initiative for the implementation of the mentioned standards with the made publications. The methods used are literature review and documentary survey. Against expected results, the article in question provides a complementary effort to the project of institutionalization of social and environmental standards for REDD + in SISA, with respect to the publication and transparency in the implementation process of the safeguards in this state.O controle social, a participação e a transparência são aspectos relevantes nas políticas de incentivos e pagamentos por serviços ambientais. A Comissão Estadual de Validação e Acompanhamento – CEVA é o colegiado responsável por garantir a transparência e exercer o controle social do Sistema de Incentivos a Serviços Ambientais do Acre - SISA. Este artigo aborda a dificuldade em garantir tal transparência em relação às etapas previstas na implantação dos padrões sociais e ambientais de Redução das Emissões por Desmatamento e Degradação Florestal - REDD+, portanto, o mesmo visa acompanhar o nível de transparência dessa comissão a partir da comparação das publicações previstas no documento de diretrizes da Iniciativa Internacional para implantação dos padrões mencionados com as publicações realizadas. Os métodos utilizados são a pesquisa bibliográfica e o levantamento documental. Em relação aos resultados esperados, o artigo em questão proporciona um esforço complementar ao projeto de institucionalização dos padrões mencionados no SISA, no que tange à publicação e à transparência no processo de implantação das salvaguardas neste Estado

PROGRAMA PRODUTOR DE ÁGUA EM RIO BRANCO, ACRE: RELATO DA EXPERIÊNCIA DE FUNCIONAMENTO DA UNIDADE GESTORA

O projeto denominado Conservação de água e solo na bacia hidrográfica do Riozinho do Rôla, é o primeiro projeto do Programa federal Produtor de Água no bioma amazônico, sendo objetivos: o fomento à compensação por serviços ambientais e o fortalecimento da gestão compartilhada de bacias hidrográficas. A participação de diversos atores sociais no projeto em questão é aspecto relevante, assim como, a transparência e divulgação das ações. Neste artigo propomos a análise da interface do projeto com outras políticas públicas do Acre, visando fortalecimento da gestão da bacia hidrográfica e continuidade das ações do projeto

PROGRAMA PRODUTOR DE ÁGUA EM RIO BRANCO, ACRE: RELATO DA EXPERIÊNCIA DE FUNCIONAMENTO DA UNIDADE GESTORA

O projeto denominado Conservação de água e solo na bacia hidrográfica do Riozinho do Rôla, é o primeiro projeto do Programa federal Produtor de Água no bioma amazônico, sendo objetivos: o fomento à compensação por serviços ambientais e o fortalecimento da gestão compartilhada de bacias hidrográficas. A participação de diversos atores sociais no projeto em questão é aspecto relevante, assim como, a transparência e divulgação das ações. Neste artigo propomos a análise da interface do projeto com outras políticas públicas do Acre, visando fortalecimento da gestão da bacia hidrográfica e continuidade das ações do projeto