Gerenciamento de riscos em programas de aventura

O gerenciamento de riscos em programas de aventura será analisado de maneira sistemática neste trabalho. Os elementos que conformam os padrões de precaução em atividades comerciais de aventura serão tratados de forma crítica. Várias questões relacionadas à polêmica do credenciamento e certificação de programas comerciais de aventura serão analisadas. Os principais conceitos relativos à segurança na concepção, no planejamento, no monitoramento e na execução de programas turísticos de aventura e eventos na natureza serão abordados. Após a revisão conceitual, será exposto o resultado do estudo dos elementos de gerenciamento de riscos, introduzidos na legislação que rege a implementação da política de desenvolvimento do turismo sustentável no Município de Brotas.Risk management in adventure programs has been systematically analyzed within this work. The elements that integrate the standards of care in commercial adventure programming have been critically approached. Different questions related to the debate on accreditation and certification ofadventure programs. The main concepts regarding safety during the conception, planning, monitoring, and execution of adventure tourism programs and events in the wild have been also approached. Following this conceptual revision, the result of the study of risk management topics introduced in the legislation related to the policy of sustainable tourism development in Brotas borough will be displayed

Changes in infant and neonatal mortality and associated factors in eight cohorts from three Brazilian cities

Stillbirth (SBR), perinatal (PMR), neonatal (NMR) and infant mortality rates (IMR) are declining in Brazil and the factors associated with these falls are still being investigated. The objective of the present study was to assess changes in SBR, PMR, NMR and IMR over time and to determine the factors associated with changes in NMR and IMR in eight Brazilian cohorts. All cohorts are population-based (Ribeirão Preto in 1978/79, 1994 and 2010; Pelotas in 1982, 1993 and 2004; and São Luís in 1997/98 and 2010). Were included data on 41440 children. All indicators were decreased, except in the city of Pelotas, from 1993 to 2004, and except SBR in São Luís. Sociodemographic variables seem to be able to explain reductions of NMR and IMR in Ribeirão Preto, from 1978/79 to 1994, and in São Luís. In Ribeirão Preto, from 1994 to 2010 declines in NMR and IMR seem to be explained by reductions in intrauterine growth restriction (IUGR). Newborn’s gestational age had diminished in all cohorts, preventing even greater reductions of NMR and IMR. Improved sociodemographic variables and reduction of IUGR, seem to be able to explain part of the decrease observed. NMR and IMR could have been reduced even more, were it not for the worsening in gestational age distribution

Cerclagem uterina: técnica, eficácia, indicações - Revisão narrativa / Cerclage uterine: technique, effectiveness, indications - Narrative review

INTRODUÇÃO: A cerclagem uterina é uma técnica que visa prolongar a gestação e evitar partos prematuros e abortos em mulheres no segundo trimestre de gravidez e com insuficiência cervical. METODOLOGIA: Estudo do tipo revisão narrativa de literatura, com busca de estudos nas bases de dados PUBMED, SciELO e LILACS. A busca foi realizada em janeiro de 2021, utilizando os seguintes descritores: “Cerclage”, “Cervical”, "Insufficiency", "Incompetence", “Indications”, “Uterine”, “Surgery”. Foram escolhidos artigos entre 2014 e 2020, em inglês, português e espanhol e disponíveis em texto completo. RESULTADOS: Os artigos analisados convergem em definições, técnica e seguimento sobre a cerclagem uterina. DISCUSSÃO: As indicações de cerclagem incluem fatores como história de insuficiência cervical, exame físico e achados ultrassonográficos associados ao histórico de parto prematuro. A técnica de McDonald é a mais utilizada, embora avanços nas técnicas minimamente invasivas sejam promissores. As complicações do procedimento não são frequentes. CONCLUSÃO: A cerclagem uterina é uma opção viável para evitar partos pré-termos, sendo indicada a partir do segundo trimestre da gestação. Ambas as técnicas são eficientes e resultam em benefícios maternos e neonatais

Prevalence of non-communicable diseases in Brazilian children: follow-up at school age of two Brazilian birth cohorts of the 1990's

<p>Abstract</p> <p>Background</p> <p>Few cohort studies have been conducted in low and middle-income countries to investigate non-communicable diseases among school-aged children. This article aims to describe the methodology of two birth cohorts, started in 1994 in Ribeirão Preto (RP), a more developed city, and in 1997/98 in São Luís (SL), a less developed town.</p> <p>Methods</p> <p>Prevalences of some non-communicable diseases during the first follow-up of these cohorts were estimated and compared. Data on singleton live births were obtained at birth (2858 in RP and 2443 in SL). The follow-up at school age was conducted in RP in 2004/05, when the children were 9-11 years old and in SL in 2005/06, when the children were 7-9 years old. Follow-up rates were 68.7% in RP (790 included) and 72.7% in SL (673 participants). The groups of low (<2500 g) and high (≥ 4250 g) birthweight were oversampled and estimates were corrected by weighting.</p> <p>Results</p> <p>In the more developed city there was a higher percentage of non-nutritive sucking habits (69.1% vs 47.9%), lifetime bottle use (89.6% vs 68.3%), higher prevalence of primary headache in the last 15 days (27.9% vs 13.0%), higher positive skin tests for allergens (44.3% vs 25.3%) and higher prevalence of overweight (18.2% vs 3.6%), obesity (9.5% vs 1.8%) and hypertension (10.9% vs 4.6%). In the less developed city there was a larger percentage of children with below average cognitive function (28.9% vs 12.2%), mental health problems (47.4% vs 38.4%), depression (21.6% vs 6.0%) and underweight (5.8% vs 3.6%). There was no difference in the prevalence of bruxism, recurrent abdominal pain, asthma and bronchial hyperresponsiveness between cities.</p> <p>Conclusions</p> <p>Some non-communicable diseases were highly prevalent, especially in the more developed city. Some high rates suggest that the burden of non-communicable diseases will be high in the future, especially mental health problems.</p

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

Gerenciamento de Riscos em Programas de Aventura

o gerenciamento de riscos em programas de aventura será analisado de maneira sistemática neste trabalho. Os elementos que conformam os padrões de precaução em atividades comerciais de aventura serão tratados de forma crítica. V árias questões relacionadas à polêmica do credenciamento e certificação de programas comerciais de aventura serão analisadas. Os principais conceitos relativos à segurança na concepção, no planejamento, no monitoramento e na execução de programas turísticos de aventura e eventos&#13; na natureza serão abordados. Após a revisão conceitual, será exposto o resultado do estudo dos elementos de gerenciamento de riscos, introduzidos na legislação que rege a implementação da política de desenvolvimento do turismo sustentável no Município de Brotas.&#13; &#13; Risk management in adventure programs has been systematically analyzed within this work. The elements that integrate the standards of care in commercial adventure programming have been critically approached. Different questions related to the debate on accreditation and certification of adventure programs. The main concepts regarding safety during the conception, planning, monitoring, and execution of adventure tourism programs and events in the wild have been also approached. Following this conceptual revision, the result of the study of risk management topics introduced in the legislation related to the policy of sustainable tourism development in Brotas borough will be displayed

Perceived exertion, postural control, and muscle recruitment in three different quadruped exercises performed by healthy women

| openaire: EC/H2020/810377/EU//ConnectToBrain Funding Information: This study was financed in part by the [Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES) #1] under Grant [Finance Code 001], [Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) #2] under Grant (CDS-APQ-01730-09-51900) and (CDS-APQ-00923-11-213588), and [Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) #3]. VS was funded by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (ConnectToBrain; grant agreement number 810377). Publisher Copyright: Copyright © 2022 Clemente, de Almeida, Vicente, Fonseca, Souza, Felício and Garcia.Although quadruped exercises (QE) have been a part of rehabilitation and sports programs, there is no clarity on how these exercises challenge the musculoskeletal system. Therefore, this cross-sectional study investigated the perceived exertion, postural demands, and muscle recruitment profiles imposed by three QE postures. Surface electromyographic (sEMG) signals were recorded from transverse abdominis, longissimus dorsi, multifidus, and iliocostalis lumborum from 30 sedentary healthy women, bilaterally. They performed the classic quadruped exercise (CQ), a variation with shoulder flexion (FQ), and the homolateral quadruped (HQ). Borg scores (BS) and the center of pressure (CoP) from the palmar statokinesiogram were also recorded. Surface EMG signals were normalized using the myoelectric activity recorded from two other postures while performing isometric voluntary contractions (IVC). Results were analyzed using one- (CoP) and three-way (sEMG data) ANOVA with Bonferroni post hoc tests (α = 0.05). The Borg scale was analyzed using the Friedman test. The CQ provided lower BS and CoP than HQ (p 0.05) than CQ and FQ. The results suggested that the HQ was the most challenging exercise regarding CoP and BS, although CQ presented a higher symmetrical sEMG activity. Since QE are often prescribed in exercise programs, specific knowledge of the characteristics of each QE makes prescribing safer and more efficient.Peer reviewe