Condicionantes da eficiência técnica da piscicultura na Região Noroeste Paulista.

A aquicultura contribui positivamente para a oferta de pescados no país, sendo a tilápia responsável pela maior proporção das espécies produzidas no Brasil. Objetivou-se analisar a eficiência técnica de piscicultores da região Noroeste Paulista, bem como investigar variáveis que afetam a sua eficiência. Metodologicamente, para mensurar os escores de eficiência, utilizou-se a técnica não paramétrica Análise Envoltória de Dados (DEA). Já para encontrar as variáveis explicativas da eficiência, empregou-se o modelo econométrico Tobit. Os resultados apontaram que 36% das propriedades atingiram eficiência máxima, com 80% de eficiência global. Quanto aos retornos de escala ineficientes, 63% foram crescentes, podendo expandir a produção obtida. Características como organização coletiva, assistência técnica e tecnologia adotada tendem a elevar a eficiência; o endividamento é apontado como um fator que influencia de maneira negativa nos escores. Conclui-se que a ineficiência apontada na piscicultura da região pode ser elevada com melhoria no manejo e capacitação técnica e gerencial aos piscicultores

Eficiência técnica da tilapicultura em São Paulo, Brasil: aplicação da análise envoltória de dados.

A piscicultura brasileira possui grande expressividade para o desenvolvimento social e econômico. Neste sentido, o processo de gestão nas principais regiões produtoras de tilápia do país, dentre as quais em São Paulo, não se resume apenas gerar indicadores econômicos de viabilidade. Dentro desta temática, como proposta de mensurar o desempenho em sistemas produtivos, o presente trabalho objetivou avaliar a eficiência técnica dos polos produtores de Ilha Solteira e do Médio Paranapanema, de forma a gerar informações que contribuam efetivamente para ações que visem ganhos de competitividade no setor produtivo. Metodologicamente, para mensurar os escores de eficiência, utilizou-se a técnica não paramétrica de Análise Envoltória de Dados. Os resultados apontaram que a eficiência média global foi de 80% e 58% para Ilha Solteira e Médio Paranapanema, de forma que os piscicultores devem otimizar o uso de insumos em 20% e 42% respectivamente, relacionados sobretudo ao número de pessoas na atividade e salário pago, de forma proporcional à produção obtida. Conclui-se que os sistemas produtivos das regiões de São Paulo devem dar maior atenção à infraestrutura relacionada ao fator trabalho, assim como o desempenho comparativo entre unidades piscícolas contribui para otimizar o uso dos recursos, tornando o processo produtivo mais eficiente

Indexing of works of fiction in libraries: evaluation and adequacy of the Model for Fiction Indexing (MENTIF)

A indexação de obras de ficção para catálogos de bibliotecas necessita de metodologia apropriada á estrutura textual de narrativa de ficção. A falta de uma metodologia de indexação limita a representação e recuperação de assuntos no catálogo. A proposta metodológica do Modelo de Indexação de ficção (MENTIF) amplia pontos de acesso de assunto aos registros bibliográficos na recuperação desses conteúdos por outros termos diferentes da representação de forma “literatura de ficção”. A investigação sobre indexação de obras de ficção tem como objetivo o relato da avaliação e adequação do Modelo para Indexação de Ficção (MENTIF) realizada por pesquisadores e catalogadores. Para isso foram realizadas quatro etapas de avaliação que incluíram análise de registros bibliográficos e aplicação de questionários para levantamento de dados sobre satisfação e insatisfação. Os resultados obtidos proporcionaram a adequação do MENTIF conforme estratégias cognitivas e sociocognitivas dos profissionais catalogadores e em função da restrição de tempo para a tarefa.The Indexing of works of fiction to libraries catalogs requires an appropriate methodology linked to the textual structure of fiction narratives. The lack of an indexing methodology limits the representation and retrieval of subjects in the catalog. The methodological proposal of the Fiction Indexing Model (MENTIF) increases subject access points to the bibliographic records in the retrieval of these contents by other terms other than "fiction literature" representation. The research on indexing of works of fiction has as its objective to adjust the Model for Fiction Indexing (MENTIF) performed by researchers and catalogers. For this purpose, four evaluation stages were carried out, which included analysis of bibliographic records and the application of questionnaires to collect data regarding satisfaction and dissatisfaction. The results obtained allowed an adjustment of the MENTIF in accordance with the time restriction for the task as well as considering the catalogers cognitive and socio-cognitive strategies.Facultad de Humanidades y Ciencias de la Educació

Humanistic and economic impact of moderate to severe plaque psoriasis in Brazil

Introduction Psoriasis is an immune-mediated, chronic, inflammatory disease, which has a substantial humanistic and economic burden. This study aimed to assess the impact of this disease on health-related quality of life (HRQoL), work productivity, and direct and indirect costs from a societal perspective among Brazilian patients. Methods This is a cross-sectional, observational, multicenter study, enrolling patients with moderate to severe plaque psoriasis according to physician evaluation. Data collection was performed from December 2015 to November 2016 through face-to-face interviews using a structured questionnaire and five standardized patient-reported outcomes instruments. Direct costs were estimated by multiplying the amount of resources used (12-month recall period) by the corresponding unit cost. Indirect costs were grouped in two time horizons: annual costs (income reduction and absenteeism) and lifetime costs (demission and early retirement). Results A total of 188 patients with moderate to severe plaque psoriasis were included, with mean age of 48.0 (SD 13.1). “Anxiety and depression” and “pain and discomfort” were the most impaired dimensions, according to the EuroQol Five-Dimension-Three-Level (EQ-5D-3L). The highest effect was found for “symptoms and feelings” [mean (SD) 2.4 (1.7)] Dermatology Life Quality Index (DLQI) subscale. Psoriatic arthritis (PsA) presence and biologic-naïve status were associated with worse HRQoL. Presenteeism was more frequent than absenteeism, according to the Work Productivity and Activity Impairment questionnaire-General Health (WPAI-GH) [17.4% vs. 6.3%], while physical demands and time management were the most affected Work Limitations Questionnaire (WLQ) subscales [means (SD) 23.5 (28.5) and 17.7 (24.9), respectively]. The estimated annual cost per patient was USD 4034. Direct medical costs accounted for 87.7% of this estimate, direct non-medical costs for 2.4%, and indirect costs for 9.9%. Conclusions Results evidenced that moderate to severe plaque psoriasis imposes substantial costs to society. Our data showed that this disease negatively affects both work productivity and HRQoL of Brazilian patients. Subgroups with PsA and biologic-naïve patients presented lower HRQoL, showing the impact of this comorbidity and the relevance of biologics in psoriasis treatment

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed cby the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society.

peer reviewe

Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups

Background: Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovascular disease (primary prevention). Methods: In CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), 4401 participants with type 2 diabetes mellitus and chronic kidney disease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care. Results: Primary prevention participants (n=2181, 49.6%) were younger (61 versus 65 years), were more often female (37% versus 31%), and had shorter duration of diabetes mellitus (15 years versus 16 years) compared with secondary prevention participants (n=2220, 50.4%). Canagliflozin reduced the risk of major cardiovascular events overall (hazard ratio [HR], 0.80 [95% CI, 0.67-0.95]; P=0.01), with consistent reductions in both the primary (HR, 0.68 [95% CI, 0.49-0.94]) and secondary (HR, 0.85 [95% CI, 0.69-1.06]) prevention groups (P for interaction=0.25). Effects were also similar for the components of the composite including cardiovascular death (HR, 0.78 [95% CI, 0.61-1.00]), nonfatal myocardial infarction (HR, 0.81 [95% CI, 0.59-1.10]), and nonfatal stroke (HR, 0.80 [95% CI, 0.56-1.15]). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P for interaction &gt;0.5 for each outcome). Conclusions: Canagliflozin significantly reduced major cardiovascular events and kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, including in participants who did not have previous cardiovascular disease