Uma avaliação do PRONAF no período 1995-2018

Este artigo apresenta uma avaliação do desempenho do crédito à agricultura familiar brasileira entre os anos de 1995 a 2018 no âmbito do Programa Nacional de Fortalecimento da Agricultura Familiar (PRONAF). Examinam-se estatísticas de volume financiado, número de contratos e distribuição dos recursos quanto a regiões, tipo de beneficiário e tipo de cultura. Os dados mostram a forte expansão do montante de crédito a partir de 2003, seguida de contração iniciada com a recessão econômica de 2015-2016, bem como a concentração dos recursos na região Sul, em agricultores de maior porte e na lavoura de soja. O artigo contrasta, ainda, estes resultados com as expectativas despertadas com a criação do PRONAF em meados dos anos 1990.This paper aims at analysing the performance of PRONAF, a rural credit policy directed at Brazilian family farming, from 1995 to 2018. Evidence comprises credit volume, number of contracts, and the distribution of the resources according to regions, kind of beneficiary and crops. The outcomes show a strong expansion of both credit volume and number of contracts from 2003 on, followed by a deep contraction associated to the economic recession of 2015-2016, as well as some degree of credit concentration in the Southern region of the country, higher-size family farming, and producers of soya. The paper also contrasts actual outcomes with the expectations arisen the creation of PRONAF in the mid-1990s

Quality control of B-lines analysis in stress Echo 2020

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio

Amplitude e restrições ao acesso de Pronaf Investimento no Rio Grande do Sul : um estudo de três operações de financiamento envolvendo cooperativas de crédito rural, cooperativas de produção agropecuária e o Banco Regional de Desenvolvimento do Extremo Sul

Passados dez anos da sua criação, é inconteste a relevância do Pronaf como fonte de recursos para o financiamento e para o fornecimento de liquidez para os agricultores familiares. Mas persistem dificuldades de acesso, particularmente ao Pronaf Investimento, justamente a modalidade que permite que estes agricultores realizem investimentos na sua estrutura produtiva, decisivos para a sua reprodução social. Com o objetivo de contribuir com o debate acerca do financiamento do desenvolvimento rural, este trabalho analisou o processo de intermediação financeira do Pronaf Investimento realizado através do Sistema BNDES, envolvendo o BRDE, cooperativas de crédito rural como instituições financeiras repassadoras e cooperativas de produção agropecuária como avalistas das operações de financiamento dos agricultores. Foi procedida uma avaliação do desempenho do Pronaf e, em seguida, relatadas as restrições ao acesso de Pronaf Investimento causadas pela insuficiência de limites operacionais por parte das cooperativas de crédito rural e sua relação com as regras do Sistema Financeiro Nacional derivadas do Acordo de Capital da Basiléia. Por fim, foram relatadas três operações de financiamento envolvendo cooperativas de crédito rural, cooperativas de produção agropecuária e o BRDE. As hipóteses inicialmente aventadas foram confirmadas. Os dirigentes das cooperativas de crédito rural apontaram a insuficiência de limites operacionais por parte das suas respectivas cooperativas como a mais significativa restrição ao acesso de Pronaf Investimento e as operações analisadas permitiram a superação destes limites, assim como a elevação do montante disponível de recursos de R$1,205 milhão de reais para R$ 4,855 milhões de reais. Portanto, pode-se afirmar que é possível superar a principal restrição ao acesso de Pronaf Investimento onde atuam cooperativas de crédito rural, qual seja, o limite operacional estabelecido pelas regras derivadas do Acordo de Capital da Basiléia, e que esta superação propicia um aumento do repasse de Pronaf Investimento, fator decisivo para o financiamento da agricultura familiar

Uma avaliação do PRONAF no período 1995-2018

Este artigo apresenta uma avaliação do desempenho do crédito à agricultura familiar brasileira entre os anos de 1995 a 2018 no âmbito do Programa Nacional de Fortalecimento da Agricultura Familiar (PRONAF). Examinam-se estatísticas de volume financiado, número de contratos e distribuição dos recursos quanto a regiões, tipo de beneficiário e tipo de cultura. Os dados mostram a forte expansão do montante de crédito a partir de 2003, seguida de contração iniciada com a recessão econômica de 2015-2016, bem como a concentração dos recursos na região Sul, em agricultores de maior porte e na lavoura de soja. O artigo contrasta, ainda, estes resultados com as expectativas despertadas com a criação do PRONAF em meados dos anos 1990.This paper aims at analysing the performance of PRONAF, a rural credit policy directed at Brazilian family farming, from 1995 to 2018. Evidence comprises credit volume, number of contracts, and the distribution of the resources according to regions, kind of beneficiary and crops. The outcomes show a strong expansion of both credit volume and number of contracts from 2003 on, followed by a deep contraction associated to the economic recession of 2015-2016, as well as some degree of credit concentration in the Southern region of the country, higher-size family farming, and producers of soya. The paper also contrasts actual outcomes with the expectations arisen the creation of PRONAF in the mid-1990s

Quality control of regional wall motion analysis in stress Echo 2020

Background: The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria.Methods: One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE videoclips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31 years (mean value 18 years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (&gt;= 90%).Results: Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7 +/- 13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r = -0.161, p = 0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p &lt; 0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt.Conclusions: In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit. (C) 2017 Elsevier B.V. All rights reserved

Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography

Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve

Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes

: An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12&nbsp;years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = -&nbsp;0.271, p &lt; 0.001) and heart rate reserve (r = -.239, p &lt; 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8&nbsp;ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p &lt; 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion

Feasibility and value of two-dimensional volumetric stress echocardiography

Stroke volume response during stress is a major determinant of functional status in heart failure and can be measured by two-dimensional (2-D) volumetric stress echocardiography (SE). The present study hypothesis is that SE may identify mechanisms underlying the change in stroke volume by measuring preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) with systolic blood pressure and end-systolic volume (ESV)