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

Hydropower development in Amazonia Social and environmental dimensions, responsibilities, and future prospects of a public policy

SIGLEAvailable from British Library Document Supply Centre- DSC:DX187980 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Análise energética em sistema de produção de suínos com aproveitamento dos desejos como biofertilizante em pastagem Energy analysis in a swine production system with use of manure as biofertilizer in pasture

O objetivo deste trabalho foi estimar a quantidade de energia para a produção de suínos, em ciclo completo, e o balanço energético do sistema com reaproveitamento dos resíduos gerados como biofertilizante, em área de pastagem, utilizando dados médios de cinco ciclos, em granja comercial no município de Diamantina - MG. Quantificou-se o coeficiente energético de cada componente envolvido no processo produtivo de suínos terminados, tratamento dos resíduos e produção de pastagem de Brachiaria decumbens, nas formas de ração, trabalho humano, energia elétrica, máquinas e equipamentos, combustíveis e lubrificantes, instalações, produção de suínos vivos e produção de Brachiaria decumbens. A quantidade média de energia para produzir 1 kg de suíno vivo foi de 53,35 MJ. De toda energia empregada no sistema, 76,03% (1.067.106,07 MJ) referem-se às entradas e 23,97% (331.400 MJ) às saídas, resultando em coeficiente de eficiência energética de 0,31. A energia transformada em suínos para abate correspondeu a 55,58% (184.200 MJ) das saídas, ao passo que a pastagem de Brachiaria decumbens assumiu o valor de 44,42% (147.200 MJ).<br>This work objective was to esteem the amount of energy employed in a complete cycle swine production and the energy balance of the system with utilization of the generated manure as biofertilizer in pasture area, by using five cycles' average data, in a commercial farm in Diamantina municipal district - MG Brazil. The energy coefficient of each involved component was quantified in the productive process of finished swine, residues treatment and Brachiaria decumbens pasture production, in the form of ration, human labor, electric power, machines and equipments, fuel and lubricants, buildings, finished swine production and Brachiaria decumbens production. The average quantity of energy to produce 1 kg of alive swine was of 53.35 MJ. Of total employed energy in the system 76.03% (1,067,106.07 MJ) refers to the inputs and 23.97% (331,400 MJ) refers to the outputs, resulting in an energy efficiency coefficient of 0.31. The energy converted in swine for abate corresponded to 55.58% (184,200 MJ) of the outputs, while the pasture of Brachiaria decumbens reached a value of 44.42% (147,200 MJ)

O impacto dos efeitos da ocupação sobre a saúde de trabalhadores: II - Mortalidade The impact of occupation on worker's health: II - Mortality

Foi realizada revisão bibliográfica analítica com o objetivo de quantificar o impacto dos efeitos da ocupação sobre a mortalidade de trabalhadores em suas implicações sobre o setor saúde. As repercussões sobre a mortalidade de trabalhadores são medidas através das mortes diretamente relacionadas com o trabalho (acidentes do trabalho fatais e intoxicações fatais) e das indiretamente relacionadas. Partindo das grandes causas de morte entre adultos - doenças cardiovasculares, câncer e mortes violentas - e explorando as informações obtidas em estudos epidemiológicos realizados em outros países, estimou-se a força da contribuição da ocupação sobre a mortalidade. O peso e a complexidade das repercussões sobre o setor saúde pressupõem um desempenho mais ativo na definição de políticas e responsabilidades, e na organização de ações destinadas a identificar, reduzir ou eliminar a participação dos riscos ocupacionais nas grandes causas de doença e morte.<br>An attempt to estimate the impact of occupation on worker's health was made as part of the rationale for the progressive integration of Occupational Health into the Health Sector. In this second study, based on a critical review of the literature, the repercussions on mortality are discussed on this basis analysis of the Brazilian data on deaths directly related to occupation (fatal occupational accidents and acute poisonings), as well as on those indirectly so related. The analysis of the major causes of adult deaths - cardiovascular diseases, cancer and violent deaths - compared with the proportion of "work-relatedness" according to several epidemiologic studies carried out in developed countries, make possible an estimation of the influence of the contribution of occupation on mortality. The size of this contribution is the main argument for an active involvement of the health sector in Occupational Health issues, because of the heavy toll in terms of adult morbidity and mortality exacted on industrialized societies