Práticas do disclosure voluntário socioambiental em cooperativas agropecuárias brasileiras

The objective of this article is to describe the voluntary disclosure of socio-environmental practices in Brazilian agricultural cooperatives. In order to reach the outlined objective, we analysed the annual reports on the websites of a non-probabilistic sample of the largest Brazilian agricultural cooperatives, referring to the period of 2015. For data analysis, the averages by subcategory and three indices of disclosure rate were used: Disclosure Index (DI), Business Disclosure Index (SDI) and General Business Disclosure Index (IGDE), General Index of Social Disclosure (IGDs). In addition, a fifth disclosure index was developed: the General Index of Environmental Disclosure (IGDa). The results obtained allow us to affirm that there is more disclosure of social information than environmental information, especially in relation to employees, concerns with the community and education, and that there is still a long way to go regarding good socio-environmental voluntary disclosure of agricultural and livestock cooperatives.O objetivo deste artigo é descrever o disclosure voluntário socioambiental em cooperativas agropecuárias brasileiras. A fim de atingir o objetivo traçado, foram analisados os relatórios anuais presentes nos websites de uma amostra não-probabilística das maiores cooperativas agropecuárias brasileiras, referentes ao período de 2015. Para a análise dos dados, foram utilizadas as médias por subcategoria e três índices de avalição de disclosure: Índice de Disclosure (ID), Índice de Disclosure das Empresas (IDE) e Índice Geral de Disclosure das Empresas (IGDE), Índice Geral de Disclosure social (IGDs). Além disso, foi desenvolvido um quinto índice de avaliação do disclosure: o Índice Geral de Disclosure ambiental (IGDa). Os resultados obtidos permitem afirmar que há mais divulgações de informações sociais do que ambientais, com destaque para, relação com empregados, preocupação com a comunidade e com educação, e que ainda falta muito para alcançar uma boa aderência de disclosure voluntário socioambiental pelas cooperativas agropecuárias analisadas

Algorithm for the management of the geriatric patient at the anesthesia and geriatrics preoperative consultation

Introducción: los procedimientos quirúrgicos en pacientes adultos mayores son cada vez más frecuentes; se caracterizan por tener mayor morbimortalidad que en pacientes más jóvenes, por lo que es esencial una apropiada evaluación preoperatoria. Objetivo: diseñar un algoritmo para el adecuado tratamiento preoperatorio electivo del paciente geriátrico en el Hospital “Arnaldo Milián Castro”. Método: se realizó un estudio de desarrollo, descriptivo y transversal con enfoque cuantitativo y cualitativo. De un universo de 1 351 pacientes se seleccionó una muestra intencional de 1 346 pacientes que cumplieron criterios. Resultados: los adultos mayores acudieron con mayor frecuencia en los meses de febrero y agosto, predominó el sexo masculino y disminuyeron los casos en consultas a medida que aumentó la edad, Ranchuelo fue el municipio de mayor afluencia, prevalecieron los que tenían riesgo quirúrgico grado III y fueron diferidos, en su mayoría, los casos de mayor riesgo quirúrgico. Las Especialidades de Cirugía General y Ortopedia aportaron la mayor parte de los pacientes, aunque los que presentaron enfermedades ortopédicas fueron los más diferidos de la cirugía y las principales causas fueron la descompensación de enfermedades crónicas como la hipertensión arterial y la falta de complementarios. Conclusiones: con la participación de un grupo focal se elaboró una propuesta de algoritmo para el adecuado manejo de los adultos mayores que requieren interconsultas de Anestesia y Geriatría que fue valorada positivamente por expertos que emitieron sugerencias que permiten una propuesta de algoritmo más completa.Introduction: surgical procedures in elderly patients are increasingly frequent; they are characterized by a greater morbidity and mortality than in younger patients, so it is essential an appropriate preoperative assessment. Objective: to design an algorithm for the adequate elective preoperative treatment of the geriatric patient at the Arnaldo Milián Castro Hospital. Method: a descriptive and cross-sectional development study was conducted with a quantitative and qualitative approach. An intentional sample of 1346 patients, who met the inclusion criteria, was selected from a universe of 1351 patients. Results: older adults came with greater frequency in the months of February and August. Males predominated, and cases in consultations decreased as age increased. Ranchuelo was the municipality with greater inflow, and those patients who had surgical risk grade III predominated, and, in most cases, the cases of greater surgical risk were deferred. The Specialties of General Surgery and Orthopedics send most of the patients, although those who had orthopedic conditions were the most delayed in surgery, and the main causes were the decompensation of chronic diseases such as hypertension and the lack of complementary tests. Conclusions: with the participation of a focus group, an algorithm proposal was designed for the adequate management of older adults who need interconsultations of anesthesia and geriatrics. It was positively evaluated by experts who issued suggestions that allow a more complete algorithm proposal

Percepção dos revendedores e centrais de coleta do Inpev na região da Alta Paulista, como participantes da logística reversa das embalagens de agrotóxicos

O presente artigo procurou verificar como as revendas e as centrais de coleta participam na logística reversa das embalagens vazias de agrotóxicos. Com base em pesquisa documental e bibliográfica, para compreender a determinação da legislação para a implementação da logística reversa, foi realizada uma pesquisa de campo com aplicação de questionário (roteiro de entrevistas) junto a quatro revendedores e duas centrais de coleta, em ponto da região agrícola da Alta Paulista, Interior do Estado de São Paulo. O objetivo foi verificar como esses agentes percebem o procedimento da logística reversa das embalagens de agrotóxicos proposto pela legislação brasileira, em seu papel, delimitado pela legislação. Verificou-se que procuram cumprir a legislação, mas que há falhas operacionais em vista de falta de estrutura física necessária e lacunas na legislação no que se refere a controles sobre devoluções, mas que poderia ser sanado com apoio do poder público

Predicting survival in patients with 'non-high-risk' acute variceal bleeding receiving β-blockers+ligation to prevent re-bleeding.

BACKGROUND&AIMS Pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in high-risk acute variceal bleeding (AVB; i.e., Child-Turcotte-Pugh [CTP] B8-9+active bleeding/C10-13). Nevertheless, 'non-high-risk' patients with poor outcomes remain despite the combination of non-selective beta-blockers (NSBB) and endoscopic variceal ligation (EVL) for secondary prophylaxis. We investigated prognostic factors for re-bleeding and mortality in 'non-high-risk' AVB to identify subgroups who may benefit from more potent treatments (i.e., TIPS) to prevent further decompensation and mortality. METHODS 2225 adults with cirrhosis and variceal bleeding were prospectively recruited at 34 centres between 2011-2015; for the purpose of this study, case definitions and information on prognostic indicators at index AVB and on day 5 were further refined in low-risk patients. 581 well-characterised low-risk patients without failure to control bleeding or TIPS contraindications who were managed by NSBB/EVL were finally included. Patients were followed for one year. RESULTS Overall, 90 patients (15%) re-bled and 70 (12%) patients died during follow-up. Using clinical routine data, no meaningful predictors of re-bleeding were identified. However, re-bleeding (included as a time-dependent co-variable) increased mortality, even after accounting for differences in patient characteristics (adjusted cause-specific hazard ratio:2.57[95%CI:1.43-4.62];p=0.002). A nomogram including CTP, creatinine, and sodium measured at baseline accurately (concordance: 0.752) stratified the risk of death. CONCLUSION The majority of 'non-high-risk' patients with AVB have an excellent outcome, if treated according to current recommendations. However, about one fifth of patients, i.e., those with CTP ≥8 and/or high creatinine levels or hyponatremia, have a considerable risk of death within 1 year of the index bleed. Future clinical trials should investigate whether elective TIPS placement reduces mortality in these patients