EPIDEMIOLOGICAL STUDY OF POST-NEONATAL MORTALITY ASSOCIATED WITH AVOIDABLE CAUSES IN PALMAS, TOCANTINS AND BRAZIL

A mortalidade infantil, em especial a pós neonatal, é um sensível indicador da qualidade de vida de uma população. Objetivou-se apresentar o coeficiente de mortalidade pós neonatal de Palmas, Tocantins e Brasil, no triênio 2014-2016 e expor as principais causas evitáveis desses óbitos. Trata-se de um estudo descritivo exploratório que analisa dados públicos disponibilizados pelo Sistema de Informações sobre Mortalidade (SIM) e Sistema de Informação sobre Nascidos Vivos (SINASC). Os resultados apresentaram como principais fatores vinculados a mortalidade pós neonatal a deficiência no diagnóstico e tratamento, em ações de promoção vinculadas a atenção primária, na atenção ao recém-nascido (RN), a gestação e ao parto, e imunizações. Encontrou-se uma redução significativa da mortalidade em Palmas-TO, o oposto dos panoramas Estadual e Nacional. As taxas de mortalidade apresentaram variações. Palmas e Tocantins aumentaram seu valor de 2014 (1,55/1.000 nascidos vivos (NV) e 2,00/1.000 NV, respectivamente) para 2015 (2,30/1.000 NV e 2,07/1.000 NV, respectivamente) e reduziram de 2015 para 2016 (1,34/1.000 NV e 2,06/1.000 NV, respectivamente); o Brasil reduziu seu valor de 2014 (2,05/1.000 NV) para 2015 (1,88/1.000 NV) e aumentou de 2015 para 2016 (2,21/1000 NV). Foi possível concluir que a capacitação e atualização dos profissionais seriam a chave para maior integração com a comunidade, melhoria nos atendimentos, diagnósticos precisos e atuação precoce nas patologias vinculadas à saúde materno-infantil.Infant mortality, especially post neonatal mortality, is a sensitive indicator of the quality of life of a population. The objective of this study was to present the post-neonatal mortality coefficient of Palmas, Tocantins and Brazil in the 2014-2016 triennium and to present the main avoidable causes of these deaths. It is an exploratory descriptive study that analyzes public data provided by the Mortality Information System (SIM) and the Live Birth Information System (SINASC). The results showed a significative reduction of the mortalities in Palmas-TO, the opposite of the State and National scenarios. Mortality rates presented variations, Palmas and Tocantins increased their value from 2014 (1,55/1000 born lives (BL) and 2,00/1000 BL respectively) to 2015 (2,30/1000 BL and 2,07/1000 BL respectively) and reduced from 2015 to 2016 (1,34/1000 BL and 2,06/1000 BL respectively); Brazil reduced its value from 2014 (2,05/1000 BL) to 2015 (1,88/1000 BL) and increased from 2015 to 2016 (2,21/1000 BL). It was identified that the decline in the absolute number of deaths in Palmas-TO is due to actions of health promotion, diagnosis and treatment and attention to gestation. Thus, the local decline in mortality is linked to early diagnosis, quality of care, access to primary health services and the availability of these services at the national level, associated with integral management mechanisms for maternal and child health

Wild dogs at stake: deforestation threatens the only Amazon endemic canid, the short-eared dog (Atelocynus microtis)

The persistent high deforestation rate and fragmentation of the Amazon forests are the main threats to their biodiversity. To anticipate and mitigate these threats, it is important to understand and predict how species respond to the rapidly changing landscape. The short-eared dog Atelocynus microtis is the only Amazon-endemic canid and one of the most understudied wild dogs worldwide. We investigated short-eared dog habitat associations on two spatial scales. First, we used the largest record database ever compiled for short-eared dogs in combination with species distribution models to map species habitat suitability, estimate its distribution range and predict shifts in species distribution in response to predicted deforestation across the entire Amazon (regional scale). Second, we used systematic camera trap surveys and occupancy models to investigate how forest cover and forest fragmentation affect the space use of this species in the Southern Brazilian Amazon (local scale). Species distribution models suggested that the short-eared dog potentially occurs over an extensive and continuous area, through most of the Amazon region south of the Amazon River. However, approximately 30% of the short-eared dog's current distribution is expected to be lost or suffer sharp declines in habitat suitability by 2027 (within three generations) due to forest loss. This proportion might reach 40% of the species distribution in unprotected areas and exceed 60% in some interfluves (i.e. portions of land separated by large rivers) of the Amazon basin. Our local-scale analysis indicated that the presence of forest positively affected short-eared dog space use, while the density of forest edges had a negative effect. Beyond shedding light on the ecology of the short-eared dog and refining its distribution range, our results stress that forest loss poses a serious threat to the conservation of the species in a short time frame. Hence, we propose a re-assessment of the short-eared dog's current IUCN Red List status (Near Threatened) based on findings presented here. Our study exemplifies how data can be integrated across sources and modelling procedures to improve our knowledge of relatively understudied species

Pesca do apaiari, Astronotus ocellatus (Agassiz, 1831), e perfil socioeconômico dos pescadores artesanais de uma região da Amazônia brasileira

The artisanal fishery is an important economic and subsistence activity among traditional populations in the Amazon Region. Therefore, the aim of this study was to characterize the fishery of apaiari, Astronotus ocellatus (Agassiz, 1831), and to present a socioeconomic profile of artisanal fishermen in the region lakes of Pracuúba, Amapá, Brazil. From May to August 2011 interviews were conducted using standardized forms with fishermen selected by "snowball" method and aged above 18 years old. A total of 68 fishing workers were interviewed, of which 55 were men and 13 women. It was possible to observe that fishing workers have a wide knowledge of fishery in the Region, including apaiari fishery, and that social and economic lives of the Pracuúba population depend totally of the artisanal fishery

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Efeitos de 16 semanas de treinamento com pesos em mulheres na pos-menopausa

O presente estudo analisou as adaptações do sistema cardiovascular, cardiorrespiratório, alterações na composição corporal e força máxima em mulheres na pós-menopausa submetidas a 16 semanas de treinamento com pesos (TP). Foram estudadas 20 voluntárias entre 45 e 65 anos, na pós-menopausa (12 meses sem menstruação), sem utilização de terapia de reposição de hormonal (TRH). As voluntárias foram submetidas a uma avaliação cardiológica (teste de esforço) para avaliar a existência de patologias que contra indicassem a participação no projeto. O TP teve freqüência de três sessões semanais em dias alternados, com duração aproximada de 60 min/sessão, consistindo de nove exercícios com três séries de 10 repetições e exercícios alternados por segmentos na primeira etapa e três séries de oito repetições e exercícios localizados por articulação na segunda etapa, para membros superiores, inferiores e tronco. A avaliação da força muscular foi realizada por meio do teste de 1-RM. A potência aeróbia foi avaliada em teste de esforço na esteira, onde foi determinado o valor do consumo máximo de oxigênio (VO2 max), atingido na exaustão física. A composição corporal foi obtida pelo método de dobras cutâneas. A análise estatística dos dados foi realizada no programa Bioestat 5.0. Para constatar a normalidade dos dados foi utilizado o teste de Shapiro Wilks e para a comparação entre os momentos (pré e pós) foi utilizado o teste t Student para amostras pareadas. Para os dados de 1-RM, tratados como não normais, foi utilizado o teste de Wilcoxon. O nível de significância adotado foi de p<0,05. Os resultados encontrados mostraram diferenças estatísticas com aumento das cargas levantadas nos testes de 1-RM, aumento da massa magra (MM) e diminuição da massa gorda (MG). Não encontramos diferenças significantes estatisticamente para os valores de VO2 max e massa corporal total (MCT).Assim, podemos concluir que 16 semanas de treinamento não foram suficientes para melhorar a potencia aeróbia das mulheres, porém melhorou o perfil da composição corporal que esta relacionado ao risco de desenvolvimento de doenças cardiovasculares.Também houve melhora no teste de 1-RM.This study analyzed the changes in the cardiovascular system, cardiorrespiratory system, body composition and power straing in postmenopausal women under 16 weeks of resistance training (TP). Were studied 20 subjects between 45 and 65 years in the postmenopausal (12 months without menstruation), without the use of hormonal replacement therapy for (HRT). The subjects were subjected to a cardiological assessment (testing effort) to assess the existence of diseases against which indicates the involvement in the project. The TP was attended by three sessions per week on alternate days, with approximate duration of 1 hour / session, consisting of nine exercises with three sets of 10 repetitions and exercises by alternating segments in the first stage and three sets of eight repetitions and tracked by joint exercises in the second stage, for the upper, lower and trunk. The muscle strengths assessment was done using the test of 1-RM. The aerobic power was evaluated in an effort in treadmill test, which were determined the values of maximum oxygen consumption (VO2 max), achieved in exhaustion physics. The body composition was obtained by the method of skin folds. The statistical data analysis was performed in the program BioEstat 5.0. To see the normality of the data was used to test Shapiro Wilks and to compare the moment (pre and post) was used the Student t test for paired samples. For items of 1-RM, not treated as normal, we used the Wilcoxon test. The significance level is p< 0.05. The results showed significant effects for the increase in charges raised in the tests of 1-RM, increased lean body mass (MM) and decreased fat mass (MG). We found no statistically significant differences in the values of VO2 max and total body mass. Although, we can conclude that 16 weeks of training was not enough to improve aerobic power of women, but improved the profile of body composition that relates directly to the cardiovascular system

Relações da força muscular com indicadores de hipertrofia após 32 semanas de treinamento com pesos em mulheres na pós-menopausa

O objectivo do presente estudo foi avaliar o comportamento da força muscular e a participação dos indicadores de hipertrofia, nos ganhos de força após 32 semanas de treinamento com pesos (TP), prescrito por zona alvo de repetições máximas, em mulheres na pós-menopausa. Participaram desta pesquisa 14 mulheres saudáveis e não ativas fisicamente. O TP teve frequência semanal de três vezes, em dias alternados. A composição corporal foi mensurada pela técnica das dobras cutâneas. Os indicadores de hipertrofia foram representados pela massa magra total e regional: área muscular do braço (AMB) e coxa (AMC). A força muscular foi avaliada pelo teste de uma repetição máxima nos exercícios leg press horizontal e rosca direta. Para análise estatística foi utilizado o teste de Friedman. Os resultados mostraram que a força muscular apresentou aumentos graduais e significantes durante a intervenção, que houve aumento da AMB e não houve diferença nos valores de AMC. A rosca direta mostrou forte associação com a AMB durante todos os momentos do estudo. Já o leg press pareceu estar mais efetivamente associado ao componente neural de ganhos de força, visto que a AMC não apresentou modificações significantes. Após 32 semanas de TP a força muscular aumentou significantemente, independentemente dos ganhos de massa magra

Risk attitudes in self-service restaurants

Objetivo: O objetivo deste estudo foi avaliar as possibilidades de contaminação dos alimentos no balcão de distribuição, causada por usuários de Unidades Produtoras de Refeições. Métodos: A coleta de informações foi realizada em 10 Unidades Produtoras de Refeições do Distrito Federal, via observação direta de 12 atitudes de risco cometidas pelos consumidores (n=3.447), no período de outubro de 2003 a setembro de 2004. O horário selecionado para observação das atitudes foi o de maior movimento de cada unidade; a amostra foi sistematizada a cada 5 consumidores. O instrumento para coletar os dados relacionava as possíveis atitudes de risco de contaminação, no momento em que cada consumidor montava sua refeição. Resultados: Os resultados obtidos demonstram que há probabilidade de contaminação alimentar causada por consumidores dos restaurantes de auto-serviço. Em 96% dos casos observados, os usuários não costumavam higienizar as mãos antes de se servirem. Observou-se também que não houve preocupação com o uso exclusivo de utensílios de servir por parte de 50% desses consumidores, enquanto 56% conversavam ou falavam sobre as preparações. Conclusão: Conclui-se que é necessário conscientizar os consumidores, principalmente os usuários de auto-serviço, a fim de evitar a contaminação de alimentos e as possíveis ocorrências de toxinfecções alimentares.Objective: The objective of this study is to evaluate the possible forms of food contamination by the costumer during the distribution period. Methods: Data collection was performed in 10 food service units in Distrito Federal via direct observation of 12 risk attitudes (n=3,447) between October 2003 and September 2004. The risk attitudes were observed during the peak hour of each restaurant; the sample was systematized for each 5 consumers. The data collection instrument related the possible risk attitudes of the consumers while serving themselves. Results: The obtained results demonstrate that there is a probability of contamination of the food by the consumers in restaurants, especially because 96% of the observed individuals did not wash their hands before serving themselves. Furthermore, 50% of the consumers were not concerned with the exclusive use of utensils, while 56% talked about the foods. Conclusions: The obtained data show that there is a need to improve the consumer’s awareness, especially in self-service restaurants. Food contamination by consumers needs to be prevented in order to avoid food intoxication