Tendência das mortes evitáveis até o 6º dia de vida no estado de São Paulo – 2008 a 2017

OBJECTIVE: To analyze the trend of early neonatal infant mortality in the state of São Paulo according to preventability and region of residence. METHODS: Ecological study with secondary data from 2008 to 2017, obtained from the Sistema de Informação sobre Nascidos Vivos (Sinasc – Live Birth Information System) and the Sistema de Informação sobre Mortalidade (SIM – Mortality Information System). The causes of death were classified according to preventability groups, and the annual percentage changes in the death rates of each preventability group were estimated using the Joinpoint software. RESULTS: The early neonatal component showed a reduction trend with an annual percentage change of -1.18 (95%CI -1.63 to -0.72), less pronounced than the other age components of infant mortality. In the analysis according to preventability, the causes reducible by attention to the woman during pregnancy and those reducible by attention to the fetus and the newborn presented annual percentage change of -1.03 (95%CI: -1.92 to -0.13) and -2.6 (95%CI: -4.07 to -1.11), respectively. In the causes reducible by attention to women during delivery, no reduction trend was observed. Regional discrepancies occurred in the variation of early neonatal infant mortality rates according to type of preventability. CONCLUSIONS: Mortality up to the 6th day of life presented greater difficulty of reduction when compared with the other age components. The absence of a reduction trend in preventable deaths due to the attention to women during delivery points to possible fragility in the attention to delivery.OBJETIVO: Analisar a tendência da mortalidade infantil neonatal precoce no estado de São Paulo segundo evitabilidade e região de residência. MÉTODO: Estudo ecológico com dados secundários de 2008 a 2017, obtidos a partir do Sistema de Informação sobre Nascidos Vivos e do Sistema de Informação sobre Mortalidade. As causas de óbito foram classificadas segundo grupos de evitabilidade, sendo estimadas as variações percentuais anuais das taxas de óbito de cada grupo de evitabilidade, por meio do software Joinpoint. RESULTADOS: O componente neonatal precoce apresentou tendência de redução com variação percentual anual de -1,18 (IC95% -1,63 – -0,72), menos acentuado que os demais componentes etários da mortalidade infantil. Na análise segundo evitabilidade, as causas reduzíveis por atenção à mulher na gestação e as reduzíveis por cuidado ao feto e ao recémnascido apresentaram variação percentual anual, respectivamente de -1,03 (IC95%: -1,92 – -0,13) e -2,6 (IC95%: -4,07 – -1,11). Nas causas reduzíveis por atenção à mulher no parto, não se observou tendência de redução. Ocorreram discrepâncias regionais na variação das taxas de mortalidade infantil neonatal precoce segundo evitabilidade. CONCLUSÕES: A mortalidade até o 6º dia de vida apresentou maior dificuldade de redução na comparação com os outros componentes etários. A ausência de tendência de redução nos óbitos evitáveis pelo cuidado à mulher no parto aponta para possível fragilidade na atenção ao parto

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

AIM: We examined the reduced blood pressure (BP) nocturnal fall in patients with obstructive sleep apnea (OSA) by a meta-analysis including studies that provided data on prevalence rates of non-dipping (ND) pattern during 24-h ambulatory blood pressure monitoring (ABPM). DESIGN: The PubMed, OVID-MEDLINE, and Cochrane CENTRAL literature databases were searched for appropriate articles without temporal restriction up to April 2019 through focused and sensitive search methods. Studies were identified by crossing the search terms as follows: "obstructive sleep apnea", "sleep quality", "non dipping", "reduced nocturnal BP fall", "circadian BP variation", "night-time BP", and "ambulatory blood pressure monitoring". RESULTS: Meta-analysis included 1562 patients with OSA from different clinical settings and 957 non-OSA controls from 14 studies. ND pattern prevalence in patients with OSA widely varied among studies (36.0-90.0%). This was also the case for non-OSA controls (33.0% to 69.0%). Overall, the ND pattern, assessed as an event rate in the pooled OSA population, was 59.1% (confidence interval (CI): 52.0-65.0%). Meta-analysis of the seven studies comparing the prevalence of ND pattern in participants with OSA and controls showed that OSA entails a significantly increased risk of ND (Odds ratio (OR) = 1.47, CI: 1.07-1.89, p < 0.01). After the exclusion of patients with mild OSA, OR increased to 1.67 (CI: 1.21-2.28, p < 0.001). CONCLUSIONS: The present meta-analysis, extending previous information on the relationship between OSA and impaired BP dipping, based on single studies, suggests that this condition increases by approximately 1.5 times the likelihood of ND, which is a pattern associated with a greater cardiovascular risk than normal BP dipping

Food waste accounting - Methodologies, challenges and opportunities

Food waste (FW) is a priority both at global and European level. The United Nations (UN) defined the Sustainable Development Goal 12.3 target of ‘By 2030, halve per capita global FW at the retail and consumer levels and reduce food losses along production and supply chains, including post-harvest losses’. The European Commission has committed to achieve this goal and defined FW as a priority within the Circular Economy Action Plan. In order to support achievement of the SDG 12.3 target on food waste and maximise the contribution of all actors, the Commission to established the EU Platform on Food Losses and Food Waste (FLW) to support all actors in defining measures needed to prevent food waste, sharing best practice, and evaluating progress made over time. The first step to address FW is to have a robust account of FW generated along the Food Supply Chain (FSC). Studies can be found in the literature that estimate FW at the EU level but results are discrepant because of different approaches, e.g. inclusion of inedible fractions of food and type of measurement. Furthermore, each approach presents strengths and weaknesses that may influence its use for specific purposes. At present, a consolidated framework for FW quantification in Europe is still an open challenge. A robust FW accounting system and FW quantification is primordial to enable monitoring FW and measuring distance to FW reduction targets. Such information is necessary to identify the most important FW streams, to define a baseline to monitor FW reduction over time, and to recognise FW flows that may undergo a valorisation process in a circular economy perspective To contribute to the development of harmonized and robust FW accounting methodologies and FW quantification, the Joint Research Centre (JRC), bioeconomy unit (D1) organized a technical workshop entitled ‘Food waste accounting: methodologies, challenges and opportunities’ with speaker’s representative of the main projects related to FW accounting. The aim of the workshop was to share experiences and perspectives on FW quantification at the European scale, highlighting opportunities and challenges in order to improve FW quantification and ensure better decision support in relation to FW reduction and valorisation. A key message from the workshop was that a harmonize methodology for FW accounting is not yet defined and there is the need of improving and matching methodological aspects and policy questions as the information needs are different depending on the area of policy intervention (either prevention, management or valorisation). Together with a clear framework for FW accounting, a clear and consensual FW definition clearly and in standardized way the aim, definitions and terminology (edible/inedible and avoidable/unavoidable), system boundaries, and, units of measurement is very important. This involves defining. This would enable the comparison of existing data across countries, commodities, and FSCs, which would further help exploring patterns and driving factors of FW generation. It was also identified the need to improve data quality and the development of methods to account liquid waste. Moreover, research is necessary to identify systematically types and sources of uncertainty and variability within the FW accounting framework and provide guidelines and tools to assess them. Another challenge to be addressed is the identification of FW drivers is of extreme relevance for both designing properly the framework for primary data collection and defining effective reduction strategies.JRC.D.1-Bio-econom

Programas de información a personas diabéticas desde la oficina de farmacia

La diabetes es uno de los problemas de salud con mayor impacto en todo el mundo ya que esta enfermedad conlleva numerosas morbilidades y empeora de manera grave la calidad de vida del paciente, además de suponer un gran coste en la sociedad. El farmacéutico tiene un papel muy importante para reducir el impacto de esta enfermedad y por ello, gracias a la atención farmacéutica puede realizar numerosas actividades desde la oficina de farmacia como son la detección, prevención, seguimiento de la enfermedad, control de glucemia, apoyo en el autocuidado del paciente, ayudas en las situaciones de hipoglucemias, incluso la educación sanitaria a estas personas desde el punto de vista nutricional y deportivo para poder llevar a cabo un estilo de vida saludable. En cuanto a la detección, el farmacéutico es capaz de llevar a cabo una detección de pacientes con hiperglucemias que no han sido diagnosticados como diabéticos por lo que, mediante estrategias de cribado desde la oficina podría detectarse y derivar al médico. Por todo ello, el presente trabajo final de grado tiene el objetivo de desarrollar sesiones informativas en la oficina de farmacia sobre la diabetes mellitus, tanto en el control de los niveles de glucosa como en las morbilidades asociadas a la enfermedad.Diabetes is one of the health problems with the greatest impact throughout the world since this disease entails numerous morbidities and seriously worsens the patient's quality of life, in addition to entailing a great cost to society. The pharmacist has a very important role in reducing the impact of this disease and therefore, thanks to pharmaceutical care, he or she can carry out numerous activities from the pharmacy office such as detection, prevention, monitoring of the disease, glycemic control, support in patient self-care, help in situations of hypoglycemia, even health education for these people from a nutritional and sports point of view to be able to carry out a healthy lifestyle. Regarding detection, the pharmacist is capable of carrying out a detection of patients with hyperglycemia who have not been diagnosed as diabetics, so through screening strategies from the office they could be detected and referred to the doctor. For all these reasons, this final degree project has the objective of developing information sessions in the pharmacy office on diabetes mellitus, both in the control of glucose levels and in the morbidities associated with the disease

Leaning cross-functionality and the power of identity : a case study of an Italian automotive organization

This thesis discusses the relationship between identity and learning in cross-functional teams (CFTs). It focuses on how aspects of members’ identity affect the process of developing cross-functional (CF) teamwork and examines how emerging identity issues can account for different outcomes in the learning of CF teamwork. More specifically, the research focuses on what these emerging identity issues entail in terms of underlying and action-orienting meanings, and on how this can favour or hinder the learning of CF teamwork. This study argues that the collective process of learning how to operate as a CFT is influenced by relational, social and contextual issues. Theoretically, the thesis offers a number of contributions. A critique of current approaches to CF teamwork is provided, where a review of the relevant literature reveals a largely functionalist stance, with a main focus on researching the factors contributing to the effectiveness of CFTs. The thesis advocates an alternative interpretative stance to investigating the role of identity in learning cross-functionality, offering the possibility of an interpretation which is situated in the specific context and which is open to the understanding of emerging, possibly revealing issues. Furthermore, this thesis argues that, within this interpretative approach, by studying what favours or hinders the learning of CF teamwork, it may be possible to deepen our understanding of CFT dynamics. The learning of CF teaming has also been identified as one of the gaps in the relevant literature. The situated learning theory (SLT) and community of practice approach (Lave and Wenger, 1991) is thus adopted as an appropriate theoretical framework for researching the learning of CF teamwork, which is understood here as a practice. SLT suggests that individual learning should be thought of as emergent, involving opportunities to participate in the practices of the community as well as the development of a social identity which provides a sense of belonging and commitment (Lave and Wenger, 1991; Wenger, 1998). Theoretically and empirically justified, the new insight and main focus of this research consists of the consideration of events occurring not only within a CFT, but also beyond and before it, which are able to shape the identities involved, at different levels. This is beneficial, since it explains the different ways of engaging with the practice of cross-functionality and consequently the different learning outcomes. Within the situated learning literature there is surprisingly little explicit reference to theories of identity construction (Handley et al., 2006). A conceptualization of identity is thus derived by tapping into theories of identity which have not yet been developed in SLT, but which represent a useful theoretical development in this arena of studies. These gaps and issues were addressed by conducting qualitative research in a medium-sized Italian firm manufacturing car parts. In particular, an ethnographic study was carried out, using complementary methods such as direct observation, semi-structured interviews and documentary data. Investigations concerned two skilled workers’ CFTs devoted to developing the product ranges respectively of joints and pumps, and a managers’ CFT whose task was to design a new pump for a particular client. Three identities emerged as especially significant for the meanings they entailed and for the influence they proved to have on learning this practice: the sense of identity derived from relationships characterized by paternalism with significant others at work (i.e. the leaders), and the sense of identity derived from being a worker from Brescia, the specific geographical location of the study, and from being a worker or a manager, understood in terms of occupation and social class

Somatosoroll, una troballa poc habitual a pediatria

Orelles; Sorolls; PediatriaOídos; Ruidos; PediatríaEars; Noises; PediatricsLa mioclònia palatina essencial és una entitat rara. Es tracta de la presència tinnitus objectiu o somatosoroll causat per contraccions involuntàries dels músculs del paladar tou. Pot ser essencial (idiopàtica) o secundària a trastorns neurològics. Nena de sis anys sense antecedents d'interès que és derivada al nostre centre perquè pacient i família escolten un "clic" a l'orella dreta de forma intermitent des de fa un any, aparentment no controlable i que es manté durant el son. Els símptomes es van iniciar associats a otàlgia amb exploració física normal. En l'àmbit ambulatori es va retirar cerumen i va rebre tractament amb corticoides nasals sense resposta clara al tractament. Després de quatre mesos asimptomàtica reinicia de nou la clínica, es repeteix una nova tanda de corticoides nasals i es deriva al nostre centre per valoració otorrinolaringològica. Es realitzen otoscòpia i timpanometria que són normals. A l'exploració física s'objectiva sense necessitat de dispositius un acufen rítmic a la regió auricular dreta que deixa de ser perceptible si ocloem el conducte auditiu extern; la resta d'exploració física és normal i no presenta altres símptomes associats. La pacient és capaç d'interrompre l'acufen col·locant la llengua sobre el paladar tou. Es sol·licita ressonància magnètica cerebral i audiometria per completar l'estudi que són normals. El diagnòstic d'aquesta entitat és d'exclusió. En moltes ocasions es poden visualitzar les contraccions dels músculs del paladar (no en el nostre cas). Habitualment presenta un curs benigne amb tendència a la resolució espontània i no sol precisar tractamen

Desarrollo de una infraestructura de datos espaciales y geoportal mediante software libre en el municipio de Benissa

[ES] El presente proyecto ha sido realizado como Trabajo Final de Grado del Grado en Ingeniería Geomática y Topográfica. Con este proyecto se pretende crear una herramienta que permita accesibilidad a la Información Geográfica del municipio para los visitantes y ciudadanos del municipio de Benissa. Herramienta mediante la cual el usuario podrá compartir, distribuir, visualizar e incluso descargar la Información Geográfica del municipio. Para una mayor facilidad de acceso para el ciudadano, todos los servicios y recursos se implementaran en un geoportal, es decir en un sitio web. El cual incluirá un visualizador interactivo en el que se podrá visualizar la Información Geográfica por capas y un catálogo de metadatos en el que los usuarios podrán consultar información sobre la cartografía. Además se tendrá acceso a las peticiones GetCapabilities de los servicios WMS, WFS y CSW. Estos servicios de Información Geográfica, seguirán los estándares de interoperabilidad del Open Geospatial Consortium. Para que, de este modo, la información pueda ser distribuida e intercambiada entre usuarios.Castells Sala, C. (2016). Desarrollo de una infraestructura de datos espaciales y geoportal mediante software libre en el municipio de Benissa. Universitat Politècnica de València. http://hdl.handle.net/10251/68373TFG

Effects of antihypertensive drugs on carotid intima-media thickness: Focus on angiotensin II receptor blockers. A review of randomized, controlled trials

Carotid intima-media thickness (IMT) and plaques have been shown to have a strong continuous relationship with cardiovascular (CV) morbidity and mortality; therefore, carotid atherosclerosis, as assessed by ultrasonography, can be regarded as a reliable surrogate end-point for therapeutic interventions. In this survey, we report the results of 16 double blind, randomized, controlled studies comparing: 1) antihypertensive drugs versus placebo/no treatment (five trials including 3,215 patients); 2) different active antihypertensive drug regimens (five trials including 4,662 patients); 3) angiotensin-II receptor blockers (ARBs) versus other antihypertensive agents (six trials including 841 patients). Our main findings can be summarized as follows: I) Long-term antihypertensive treatment has a blunting effect on carotid IMT progression, regardless of types of drugs. II) Calcium-channel blockers (CCBs) are more effective than other antihypertensive drugs including diuretics, beta-blockers, and angiotensin converting-enzyme (ACE)-inhibitors in this blunting effect; III) the effect of ARBs compared to other antihypertensive regimens (mostly based on atenolol) on carotid atherosclerosis progression needs to be further elucidated, as a protective effect was demonstrated by some, but not all studies examined. Thus, further studies are needed to clarify the role of ARBs in this therapeutic area

Left ventricular geometry and diastolic function in the hypertensive heart : impact of age

Background and aim. The impact of aging on the relationship between left ventricular (LV) mass/geometry and diastolic function as assessed by updated echocardiographic methods, such as tissue Doppler, is poorly defined. We investigated this issue in a cohort of hypertensive patients. Methods. A total of 660 hypertensives (mean age 65±13 years, 48% men) with preserved LV systolic function underwent a comprehensive echo-Doppler examination for routine clinical indications. For the present analysis, the subjects have been divided in two age groups (<65 or ≥65 years). Results. Overall, 61% of subjects fulfilled the criteria for LVH, 18% for left atrial (LA) enlargement and 11% for altered LV filling index. Concentric LV geometry was 1.4-fold higher in older hypertensives than in younger counterparts; also the prevalence of LA enlargement and altered LV filling was 2.0- and 1.9-fold higher in the former group, respectively. In older hypertensives, at variance from younger ones, neither LV mass nor relative wall thickness (RWT), a continuous index of LV geometry, were independently correlated to conventional as well as tissue Doppler LV diastolic indexes. Conclusions. Our findings suggest the relationship between cardiac hypertrophy and diastolic function in hypertensive subjects is affected by aging-associated factors unrelated to the amount of LV mass as assessed by standard echocardiography. © 2013 Scandinavian Foundation for Cardiovascular Research