Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Deficiência mental, imaginação e mediação social: um estudo sobre o brincar Mental deficiency, imagination and social mediation: a study of play behavior

neste trabalho abordamos a importância da imaginação para o desenvolvimento e focalizamos o brincar como uma instância particularmente propícia a esse processo. O papel formativo atribuído a essa atividade é geralmente pequeno, e tende a ser tratada de maneira muito ambígua no trabalho educacional. Esse problema se intensifica quando a deficiência mental está envolvida, devido ao descrédito adicional em relação às possibilidades da criança. Com base na perspectiva histórico-cultural, realizamos um estudo sobre o brincar de doze sujeitos, na faixa etária de 4 a 6 anos, que freqüentavam uma instituição especial. A maioria deles tinha déficits nas áreas de cognição e linguagem; alguns enfrentavam também sérias limitações motoras. O objetivo foi investigar relações entre a mediação de outros - adultos e parceiros - e as ações imaginativas da criança, em termos da capacidade de transcender o campo perceptual imediato e compor seqüências de faz-de-conta. O trabalho de campo consistiu de sessões semanais de brincadeira livre, durante um período de sete meses. As atividades foram gravadas em vídeo, e as análises se guiaram por uma abordagem microgenética. Os achados mostram que, quando deixadas com seus próprios recursos, essas crianças apresentam uma baixa disposição a entrar em brincadeiras coletivas e a compartilhar de diálogos. No entanto, dependendo das formas de mediação dentro do grupo, elas podem engajar-se em situações imaginárias relativamente complexas, com características que sugerem contribuições para o desenvolvimento intelectual, na compreensão do contexto cultural, bem como para a emergência de elaborações criativas sobre o mundo.<br>in this paper we address the importance of imagination in development and focus on play as an especially privileged instance in this process. The formative role ascribed to this activity is often small, and it tends to be treated in a very ambiguous way in educational work. This problem is magnified when mental deficiency is involved, due to the added discredit of the child's possibilities. Based on the historical-cultural perspective we carried out a study on the play of twelve subjects, 4 to 6 year-old, who attended a special institution. Most of them had deficits in the areas of cognition and language; some also presented serious motor limitations. The objective was to investigate the relation between the mediation of others - adults and peers - and the child's imaginative actions, concerning his ability to transcend the immediate perceptual field and to compose make-believe sequences. The field work consisted of weekly sessions of free play, over a seven month period. The activities were video recorded, and the analyses were guided by a microgenetic approach. The findings show that, when left to their own resources, the subjects present a low inclination to join in collective play and to share in dialogues. However, depending on the forms of mediation within the group, they can engage in relatively complex imaginary situations, with characteristics that suggest contributions to intellectual development, in the comprehension of the cultural context, as well as to the emergence of creative elaborations about the world

Ações afirmativas e o debate sobre racismo no Brasil Afirmative actions and the debate on racism in Brazil

O tema "ações afirmativas" tem dividido a opinião pública e esquentado o debate acadêmico. Enquanto alguns especialistas e militantes negros entendem a introdução de ações afirmativas como uma forma de combate ao racismo, uma vez que, segundo esta interpretação, a discriminação positiva ajudará os historicamente desprivilegiados a criar e fortalecer uma identidade positiva, outros vêem em tais medidas um ataque perigoso contra a "maneira tradicional brasileira" de se relacionar com as "diferenças humanas" e temem que políticas como essas possam instigar conflitos raciais abertos. Embora os defensores e opositores à introdução de projetos de ação afirmativa raramente explicitem o que entendem por racismo e como interpretam este fenômeno social, é possível detectar nesses discursos distintas linhas de argumentação que remetem a orientações teóricas diferentes no que diz respeito à análise de categorias como "raça" e "cor".<br>The "affirmative action" issue has split the public opinion and heated up the academic debate. While some experts and black activists see the affirmatives actions as a way to fight racism, since the positive discrimination could help the historically underprivileged to create and empower a positive identity, others see such measures as a dangerous attack against the "traditional brazilian way" of dealing with "human differences". The latter fear that such policies may unleash racial conflicts. Although both sides barely explain what they mean for racism and how they understand that social phenomenon, it is possible to discern in those discourses different lines of argument, which can be related to different theoretical orientations about the analysis of such concepts as "race" and "color"