Aspirin and calcium to prevent preeclampsia in chronic hypertensive women with abnormal uterine artery Doppler ultrasound

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de ObstetríciaUNIFESP, EPM, Depto. de ObstetríciaSciEL

CONTROLE RESIDUAL DE CAPIM AMARGOSO NA SOJA CULTIVADA EM REGIÃO DE CERRADO

For decision-making in the control of weeds in soybean crops, it is necessary to evaluate the species present, their density and their capacity to negatively interfere in crop yields. The objective of this study was to evaluate the residual effect of herbicides applied in pre-emergence on the control of Digitaria insularis (biotype of sourgrass) in soybean cultivated in the Cerrado region. The experimental design was a randomized block design, with 8 treatments, with 4 replicates, involving 7 formulated herbicides. The evaluated treatments were divided into T1 (control); T2- (paraquat); T3 (paraquat + flumioxazine); T4 (paraquat + imazethapyr); T5 (paraquat + [imazethapyr + flumioxazine]); T6 (paraquat + diclosulan); T7 (paraquat + [clomazone + carfentrazone]); T8 (paraquat + s-metalaclor). The application of pre-emergence herbicides in the soybean crop did not cause damage to its emergence and the high infestation of weeds observed in the control treatment resulted in the soybean crop. Pre-emergence herbicide treatments promoted a residual effect that culminated in the control of Digitaria insularis (biotype of sourgrass), in the cultivation of soybeans grown in the Cerrado region.Para tomada de decisão no controle de plantas daninhas em lavouras de soja, é necessário avaliação das espécies presentes, densidade e capacidade destas interferirem de forma negativa nos rendimentos da cultura. O estudo teve por objetivo avaliar o efeito residual de herbicidas aplicados em pré-emergência no controle do Digitaria insularis (capim-amargoso) na cultura da soja cultivado na região do Cerrado. O delineamento experimental utilizado foi em blocos ao acaso, com 8 tratamentos e 4 repetições. Os tratamentos avaliados foram divididos em T1 (testemunha); T2- (paraquat); T3 (paraquat + flumioxazina); T4 (paraquat + imazethapyr); T5 (paraquat + [imazethapyr + flumioxazina]); T6 (paraquat + diclosulan); T7 (paraquat + [clomazona + carfentrazona]); T8 (paraquat + s-metalaclor). A aplicação de herbicidas em pré-emergência na cultura da soja não causou danos a sua emergência e a alta infestação de plantas daninhas observada no tratamento testemunha acarretou o estiolamento da cultura da soja. Os tratamentos com herbicida aplicados em pré-emergência, promoveram efeito residual que culminou no controle da Digitaria insularis (capim-amargoso), na cultura da soja cultivada em região do Cerrado

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

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

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Inclusão, integração ou inserção de pessoas com deficiência : um estudo em uma organização pública e uma organização privada da cidade de Rio Branco-Acre

Este trabalho consiste em um estudo sobre a inclusão de pessoas com deficiência nas organizações do município de Rio Branco – Acre. O objetivo geral foi analisar se a implementação das políticas organizacionais de inclusão das pessoas com deficiência no mercado de trabalho nas organizações localizadas na cidade de Rio Branco-Acre possibilita, inserção, integração ou inclusão. Como quadro teórico optou-se por discutir inicialmente os conceitos de deficiência e sua evolução ao longo da história, apresentar as teorias da deficiência (modelo médico da deficiência e modelo social da deficiência), os conceitos de inserção, integração e inclusão, descrever a gênese das políticas públicas de inclusão, com o intuito de demonstrar como as políticas de inclusão das pessoas com deficiência no mercado de trabalho, são influenciadas pelo modelo teórico predominante em cada época. Foi realizada a apresentação de um modelo conceitual de pesquisa, criado por Campos, Vasconcellos e Kuglianskas (2013), que apresentava práticas importantes para a realização da inclusão efetiva de pessoas com deficiência nas organizações e ainda, as principais pesquisas realizadas sobre a inclusão de pessoas com deficiência no mercado de trabalho nos últimos anos, constando objetivos, metodologia e resultados. Em seguida a partir das dimensões de acessibilidade (arquitetônica, comunicacional, metodológica, instrumental, programática e atitudinal) de Sassaki (2006), foram definidas as categorias de análise e atributos utilizados para responder à pergunta da pesquisa, assim, utilizando-se de uma abordagem qualitativa e descritiva, o estudo foi conduzido através da estratégia de estudo de caso (multicaso) e pesquisa longitudinal. As principais fontes de dados foram: pesquisa bibliográfica, pesquisa documental e entrevistas semiestruturadas, utilizando-se a análise de conteúdo (BARDIN, 1977). Assim, foram estudadas duas organizações localizadas no município de Rio Branco, uma do setor público e outra do setor privado, identificando suas práticas e relacionando-as com as dimensões propostas por Sassaki (2006), verificando desta forma, se as organizações atuam para remover as barreiras de acessibilidade, concluindo-se no entanto, que as organizações pesquisadas localizadas no município de Rio Branco – Acre, embora nos últimos anos tenham evoluído na questão da inclusão das pessoas com deficiência no mercado de trabalho, ainda não estão praticando plenamente a inclusão, tendo em vista que ainda é possível verificar em suas práticas aspectos vinculados aos conceitos de integração e até mesmo de inserção. Além disso, verificou-se a importância do Estado para a realização de inclusão, uma vez que um dos pilares motivadores da inclusão é a existência de legislação, assim como, detectou-se a influência do preconceito, estudado nas barreiras atitudinais, nas ações que permeiam as demais barreiras estudadas. Evidenciando-se então a necessidade de mudança de comportamento através da aquisição de conhecimento a respeito do tema, pois só o conhecimento pode libertar a sociedade dos estigmas e preconceitos existentes em relação as pessoas com deficiência.This study consists of a study about the inclusion of people with disabilities in the organizations of the municipality of Rio Branco - Acre. The general objective was to analyze whether the implementation of organizational policies for inclusion of people with disabilities in the labor market in organizations, located in the city of Rio Branco-Acre, allows insertion, integration or inclusion. As a theoretical framework it was decided to initially discuss the concepts of disability and its evolution throughout history, present theories of disability (medical model of disability and social model of disability), concepts of insertion, integration and inclusion, describe the genesis of public inclusion policies, in order to demonstrate how the inclusion policies of people with disabilities in the labor market are influenced by the theoretical model prevailing in each era. A conceptual research model created by Campos, Vasconcellos and Kuglianskas (2013) was presented, presenting important practices for the effective inclusion of people with disabilities in organizations and the main research carried out on inclusion of people with disabilities in the labor market in recent years, including objectives, methodology and results. Then, from the dimensions of accessibility (architectural, communicational, methodological, instrumental, programmatic and attitudinal) that according to Sassaki (2006), it is necessary for people with disabilities to be able to move autonomously and that they must be guaranteed by the organizations and by the society, the categories of analysis and attributes used to answer the research question were defined, thus, using a qualitative and descriptive approach, the study was conducted through the case study (multicase) and longitudinal research strategy. The main sources of data were: bibliographic research, documentary research and semi-structured interviews, using content analysis (BARDIN, 1977). Thus, two organizations located in the city of Rio Branco, one in the public sector and the other in the private sector, were identified, identifying their practices and relating them to the dimensions of accessibility proposed by Sassaki (2006), verifying in this way, if organizations act to remove accessibility barriers, it is concluded, however, that the organizations surveyed located in the municipality of Rio Branco - Acre, although in recent years have evolved on the issue of inclusion of people with disabilities in the labor market, are not yet fully practicing inclusion, since it is still possible to verify in their practices aspects linked to the concepts of integration and even insertion. In addition, it was verified the importance of the State for the accomplishment of inclusion, since one of the pillars motivating the inclusion is the existence of legislation, as well as, the influence of the prejudice, studied in the attitudinal barriers, in the actions that permeate the other barriers studied. The need to change behavior through the acquisition of knowledge about the subject is evident, since only knowledge can free society from the existing stigmas and prejudices towards people with disabilities

Uso do ácido acetilsalicílico, em baixas doses, para a prevenção da pré-eclâmpsia em primigestas: aderência ao tratamento

BV UNIFESP: Teses e dissertaçõe