Observando por meio da lupa da COVID-19: um exame das disparidades nas capitais brasileiras

Introduction: To identify the correlation socioeconomic and health indicators with the progress of the COVID-19 epidemic in Brazilian capitals. Methods: Ecological study with cases data confirmed by COVID-19 registered from March to June/2020, Municipal Human Development Index, Gross Domestic Product per capita, percentage of households in subnormal agglomerates and Infant Mortality Rate. The advance of the epidemic was characterized by the growth of cases, and their correlation by Pearson's correlation matrix. Results: Was observed the growing increase trend of COVID-19 in all Brazil’s capitals. The incidence in March was higher in the capitals of the Southeast and in the other months in the North. The mortality rate was higher in Southeast’s capitals in the first three months and, in June, the rate of North’s capital is equals to the Southeast. Greater growth in COVID-19 cases was observed in the capitals of the North and Northeast in all the periods evaluated. This growth showed a positive correlation with the Infant Mortality Rate (r=0,609; p<0,001) and negative correlation with Municipal Human Development Index (r=-0,511; p=0,007). Conclusions: These findings signal regional differentials that act as a condition for the dynamics of COVID-19. The epidemic has been a magnifying glass for inequalities in the country, exposing historical inequities in the health of the brazilian population. The recognition of this scenario of inequalities in the dynamics of transmission COVID-19 offers a targeting for proposing measures that impact the social determinants and the urban environment.Introducción: Identificar la correlación entre indicadores socioeconómicos y de salud con el avance de la epidemia de COVID en las capitales brasileñas. Métodos: Estudio ecológico con datos de casos confirmados, de marzo a junio, Índice de Desarrollo Humano Municipal (IDHM), Producto Interno Bruto per cápita, porcentaje de hogares subnormales y Tasa de Mortalidad Infantil (TMI). El avance de la epidemia se caracterizó por el crecimiento de casos en el período y su correlación con variables socioeconómicas y de salud, mediante la matriz de correlación de Pearson. Resultados: Hubo una tendencia creciente al aumento de casos en todas las capitales. La incidencia en marzo fue mayor en las capitales del Sureste y, en otros meses, en el Norte. La tasa de mortalidad hasta mayo fue mayor en las capitales del sureste, y en junio similar en el norte y sureste. En cada período analizado se observó un mayor crecimiento de casos en las capitales del Norte y Nordeste. El crecimiento se correlacionó positivamente con IMT (r = 0,609; p <0,001) y negativo con MHDI (r = -0,511; p = 0,007). Discusión: La epidemia ha sido una lupa para las desigualdades en el país, exponiendo las inequidades en salud. El reconocimiento de los diferenciales regionales como condicionantes de la dinámica de COVID ofrece orientación para las medidas que se centran en sus determinantes sociales.Introdução: Identificar correlação entre indicadores socioeconômicos e de saúde com o avanço da epidemia de COVID nas capitais brasileiras. Métodos: Estudo ecológico com dados de casos confirmados, de março a junho, Índice de Desenvolvimento Humano Municipal (IDHM), Produto Interno Bruto per capita, percentual de domicílios subnormais e Taxa de Mortalidade Infantil (TMI). Caracterizou-se o avanço da epidemia pelo crescimento de casos no período, e, sua correlação com variáveis ​​socioeconômicas e de saúde, pela matriz de correlação de Pearson. Resultados:Ocorrência crescente do aumento de casos em todas as capitais. O aumento em março foi maior nas capitais do Sudeste e, nos outros meses nas do Norte. A taxa de mortalidade até maio era maior em capitais do Sudeste, e em junho semelhante no Norte e Sudeste. Verificou-se, para cada período analisado, maior crescimento de casos nas capitais do Norte e Nordeste. O crescimento teve correlação positiva com a TMI (r = 0,609; p <0,001) e negativa com IDHM (r = -0,511; p = 0,007). Discussão: A epidemia tem sido uma lupa para as desigualdades no país, desnudando as iniquidades na saúde. O reconhecimento dos diferenciais regionais como condicionantes da dinâmica da COVID oferece direcionamento para medidas com foco em seus determinantes sociais

"PRESSÃO INTRA-ABDOMINAL NA PROFILAXIA": REVISÃO INTEGRATIVA

Objective: Provide clinical and scientific knowledge about intra-abdominal hypertension and abdominal compartment syndrome necessary for decision-making and intervention. Methods: Integrative review carried out in the database: PubMED. Cielo; Medline and Lilux. Includes work from March 2013 to July 2021. However, pediatric research, animal models, secondary articles, dissertations, and dissertations are not included. Results: 142 articles were found, of which 20 were selected for the final sample. The results were divided into 4 levels: medical personnel's knowledge of intra-abdominal pressure; and emphasizes risk factors, diagnosis, and treatment. Final Considerations: Abdominal hypertension is important in intensive care and can evolve into celiac disease syndrome. These are recurrent conditions and independent predictors of death. Early diagnosis helps prevent many complications. Learning to diagnose and identify risk factors is essential to optimize the treatment of these diseases.Objetivo: Fornecer conhecimentos clínicos e científicos sobre hipertensão intra-abdominal e síndrome compartimental abdominal necessários à tomada de decisão e intervenção. Métodos: Revisão integrativa realizada na base de dados: PubMED. Cielo; Medline e Lilux. Inclui trabalhos de março de 2013 a julho de 2021. No entanto, pesquisas pediátricas, modelos animais, artigos secundários, dissertações e dissertações não estão incluídas. Resultados: foram encontrados 142 artigos, dos quais 20 foram selecionados para a amostra final. Os resultados foram divididos em 4 níveis: conhecimento do pessoal médico sobre pressão intra-abdominal; e enfatiza fatores de risco, diagnóstico e tratamento. Considerações Finais: A hipertensão abdominal é importante na terapia intensiva e pode evoluir para síndroma da doença celíaca. Estas são condições recorrentes e preditores independentes de morte. O diagnóstico precoce ajuda a prevenir muitas complicações. Aprender a diagnosticar e identificar fatores de risco é fundamental para otimizar o tratamento dessas doenças

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Modelagem e otimização do sistema de atendimento de um restaurante baseado em Teoria de Filas

O artigo analisa o sistema de formação de filas em um restaurante localizado no sudeste do Pará, com o objetivo de avaliar a eficiência do atendimento e identificar possíveis gargalos. A teoria das filas é utilizada como uma ferramenta para compreender o comportamento do sistema e propor melhorias no arranjo produtivo. A metodologia, fundamentalmente de base quantitativa, adotada envolve a coleta de dados relacionados à chegada dos clientes na fila, tempo de atendimento e tempo de recebimento da marmita, seguido pela análise estatística desses dados. Os resultados obtidos permitem avaliar o desempenho do restaurante em medição como tempo médio de espera na fila, taxa de ocupação do servidor e tempo médio no sistema. Com base nessas análises, são identificados pontos de melhoria, como a segmentação das filas e o uso de placas de aviso para diferenciar os tipos de atendimento oferecidos. Essas sugestões visam otimizar o processo de atendimento, reduzir o tempo de espera dos clientes e proporcionar uma melhor experiência no restaurante.

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status