Clinical features and natural history of the first 2073 suspected COVID-19 cases in the Corona São Caetano primary care programme: a prospective cohort study.

BACKGROUND: Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. METHODS: The Corona São Caetano programme is a primary care initiative providing care to all residents with COVID-19 in São Caetano do Sul, Brazil. It was designed to capture standardised clinical data on community COVID-19 cases. After triage of potentially severe cases, consecutive patients presenting to a multimedia screening platform between 13 April and 13 May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days with phone calls every 2 days. RT-PCR-negative patients were offered additional SARS-CoV-2 serology testing to establish their infection status. We describe the clinical, virological and natural history features of this prospective population-based cohort. FINDINGS: Of 2073 suspected COVID-19 cases, 1583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95% CI 25.9 to 30.3) were positive; 604/1136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of confirmed COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever (OR 3.0, 95% CI 2.4 to 3.9), anosmia (OR 3.3, 95% CI 2.6 to 4.4) and ageusia (OR 2.9, 95% CI 2.3 to 3.8) were most strongly associated with a positive COVID-19 diagnosis by RT-PCR or serology. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia and closer to symptom onset. The rates of hospitalisation and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalised group. CONCLUSION: COVID-19 presents in a similar way to other mild community-acquired respiratory diseases, but the presence of fever, anosmia and ageusia can assist the specific diagnosis. Most patients recovered without requiring hospitalisation with a low fatality rate compared with other hospital-based studies

Tierras nuevas y la construcción del Estado en Brasil y Argentina

The advance of the frontier in Latin America has occurred in association with the predominance of large landholdings (latifundia) and oligarchic societies. In spite of the existence of free land, one of the fundamental premises of Turner's frontier thesis, in countries such as Brazil and Argentina, is that the concentration of land ownership has been one of the most permanent characteristics of the moving frontier. The main causes that explain this particular historical feature are: the colonial heritage and the Nineteenth century land laws. In this article we shall try to bring into focus some of the central aspects of the Portuguese and Spanish heritage, particularly in the field of territorial administration. We shall also examine the Brazilian 1850 land law and the Avellaneda land law (Argentina) of 1876. Finally we will try to establish meaningful connections between moving frontier and state building in the Nineteenth century.En América Latina el desplazamiento de la frontera corrió paralelo a la expansión del latifundio y a la consolidación del poder de las oligarquías. Aun en países como Brasil y Argentina, en los cuales la premisa básica de Turner estaba presente, es decir, la existencia de "tierras libres", la marcha de la frontera no democratizó el acceso a la tierra. Las causas más señaladas para explicar ese efecto son: la herencia del latifundio colonial y las características de la legislación agraria adoptada en el siglo XIX. En este trabajo, buscamos llamar la atención hacia algunos aspectos de la herencia colonial ibérica y sobre la influencia que ejercieron en la visión del territorio y en la administración de los "fondos territoriales". También examinamos la ley de tierras de 1850 (Brasil) y la ley Avellaneda de 1876 (Argentina). Finalmente, agregamos otra dimensión explicativa: la que establece una relación entre el proceso de concentración de poder característico del State building y el desplazamiento de la frontera

Tierras nuevas y la construcción del Estado en Brasil y Argentina

The advance of the frontier in Latin America has occurred in association with the predominance of large landholdings (latifundia) and oligarchic societies. In spite of the existence of free land, one of the fundamental premises of Turner's frontier thesis, in countries such as Brazil and Argentina, is that the concentration of land ownership has been one of the most permanent characteristics of the moving frontier. The main causes that explain this particular historical feature are: the colonial heritage and the Nineteenth century land laws. In this article we shall try to bring into focus some of the central aspects of the Portuguese and Spanish heritage, particularly in the field of territorial administration. We shall also examine the Brazilian 1850 land law and the Avellaneda land law (Argentina) of 1876. Finally we will try to establish meaningful connections between moving frontier and state building in the Nineteenth century.En América Latina el desplazamiento de la frontera corrió paralelo a la expansión del latifundio y a la consolidación del poder de las oligarquías. Aun en países como Brasil y Argentina, en los cuales la premisa básica de Turner estaba presente, es decir, la existencia de "tierras libres", la marcha de la frontera no democratizó el acceso a la tierra. Las causas más señaladas para explicar ese efecto son: la herencia del latifundio colonial y las características de la legislación agraria adoptada en el siglo XIX. En este trabajo, buscamos llamar la atención hacia algunos aspectos de la herencia colonial ibérica y sobre la influencia que ejercieron en la visión del territorio y en la administración de los "fondos territoriales". También examinamos la ley de tierras de 1850 (Brasil) y la ley Avellaneda de 1876 (Argentina). Finalmente, agregamos otra dimensión explicativa: la que establece una relación entre el proceso de concentración de poder característico del State building y el desplazamiento de la frontera

La ocupación de la tierra en la formación de la sociedad nacional del Brasil

El artículo examina el largo proceso de implementación de la Ley de Tierras de 1850, promulgada por el estado imperial en una sociedad brasileña todavía esclavista y arcaica. Se describe el proceso de constitución de la propiedad privada de la tierra en el Brasil, que comprendió el pasaje de las tierras del dominio regio y, posteriormente, del dominio público, al privado, y se destacan las diferentes características que el mismo fue adquiriendo a medida que el estado y la sociedad brasileña fueron constituyéndose. El trabajo toma distancia de la tesis simplista que destaca unilateralmente como resultado del proceso la exclusión de la propiedad de la tierra de los grupos más pobres de la población, en particular los ex esclavos e inmigrantes. Aunque se señala que el resultado de este proceso fue la adaptación de la ley a los intereses de algunos grupos de la población en detrimento de otros, se reconoce que la ley sirvió de base a la regulación de la propiedad de la tierra. Ocupa un lugar destacado en el análisis el papel desempeñado por los coroneles en el proceso de apropiación de las "tierras devueltas"

Rainfall Runoff Balance Enhanced Model Applied to Tropical Hydrology

The integrative and comprehensive analysis considering the spatial and temporal representation of the hydrological process, such as the distribution of rainfall, land cover and land use, is a challenge for the water resources management. In tropical areas, energy availability throughout the year defines the rainfall distribution and evapotranspiration rate according to vegetation heterogeneity. To quantify water balance in tropical areas including these heterogeneities in the soil-vegetation-atmosphere relationship, we developed a fully distributed hydrological model called the Rainfall Runoff Balance Enhanced Model (RUBEM). The model was developed under a physics-based process structure, using remote sensing data to represent soil-water balance patterns, such as evapotranspiration, interception, baseflow, lateral flow, recharge, and runoff. The calibration procedure was based on nine global parameters. RUBEM could represent the spatio-temporal heterogeneities (soil, land use and land cover (LULC), topography, vegetation, and climate) in three basins in a tropical area. The results showed good adherence between the processes governing the soil-vegetation-atmosphere relationship according to the humidity indicator and the runoff coefficient. Overall, RUBEM can be used to help improve the management and planning of integrated water resources under climate, land use, and land cover changes in tropical regions

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit