Pode o subalterno falar e o/a pesquisador/a escutar?

O objetivo dessa mesa é pensar os sujeitos históricos e a subalternidade enquanto condição e a interseccionalidade entre as diversas categorias, relações de poder e sistemas de opressão. Assim, qual o papel do(a) pesquisador(a) ao lidar com estes sujeitos nas suas pesquisas, quais as implicações éticas disso? Que debates teóricos e metodológicos se apresentam

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

A docência em História e a evasão escolar no Ensino Médio

Este texto se propõe a discutir o tema da evasão escolar no ensino médio e sua problemática específica para a prática da docência na área das Ciências Humanas. Durante a nossa experiência no estágio de docência em História no ensino médio, este problema provocou um exercício de reflexão acerca da evasão e do abandono da sala de aula pelos estudantes. O objetivo deste artigo será o de apresentar a partir dos dados gerais coletados sobre o tema da evasão escolar no ensino médio e de nossa experiência em sala de aula, alguns dos desafios e das estratégias para a prática docente em História neste contexto

Nem decalque e nem cópia, mas criação heróica : o sujeito histórico indígena no pensamento de José Carlos Mariátegui

O peruano José Carlos Mariátegui foi um dos percussores do pensamento marxista na América Latina. Mais do que um difusor do marxismo em sua fase inicial no continente, Mariátegui elaborou uma criativa e rigorosa análise das realidades peruana e latino-americana. Entre suas inúmeras contribuições, destacamos o seu conceito de sujeito histórico, que introduz a figura do índio como componente estratégico para o socialismo na América Latina. Compreendendo que não existiria possibilidade de construção de um projeto de uma nova sociedade que não inclui-se o indígena, setor majoritário na população peruana e objeto de uma profunda exploração e exclusão, ao colocar em sua devida centralidade para o Peru – e para a América Latina em geral - elaborou uma fecunda análise da realidade latino-americana. A concepção histórica de Mariátegui enfrentou, a uma só vez, o positivismo e o determinismo, buscando compreender as especificidades históricas de nosso continente, sem renunciar a um olhar universal. Sua obra evidencia a possibilidade de produção de uma teoria que escapa aos limites do eurocentrismo e demonstra uma capacidade de autonomia do pensamento crítico

Marxismo, Eurocentrismo e América Latina : uma análise a partir da obra de José Carlos Mariátegui

Esta pesquisa procurou investigar as tensões teóricas existentes entre o marxismo e o eurocentrismo, a partir de uma análise do pensamento marxista e latino-americano do peruano José Carlos Mariátegui. O eurocentrismo, ao generalizar a experiência europeia para o resto do mundo, produziu distorções e legitimou desigualdades com múltiplas e variadas incidências. Mesmo o marxismo, a mais radical das críticas ao sistema capitalista, reproduziu o problema do eurocentrismo, principalmente na sua versão hegemônica. A América Latina, como continente de enunciação de um marxismo periférico, teve em Mariátegui o primeiro pensador marxista a realizar este desafio. Seu pensamento apresenta aspectos inovadores, provocativos e atuais, ainda que não livre de limites. Ao explorar esta questão controversa, o presente estudo buscou assim analisar a dinâmica de penetração e ruptura do eurocentrismo dentro do próprio campo marxista, principalmente pela sua versão periférica e latino-americana, personificada na obra original de José Carlos Mariátegui.The present study examines the theoretical tensions between Marxism and Eurocentrism through the Peruvian thinker José Carlos Mariátegui. The great problem of Eurocentrism is its ability to generalize the European experience to the rest of the world and promote inequality regards the non-hegemonic knowledge and thinking. Even the Marxism, the most important critic to capitalist system, was able to reproduce the problem of Eurocentrism in its hegemonic version. José Carlos Mariátegui was the first thinker to consider this challenge in Latin America, which is an important continent of enunciation of peripheral Marxism. The richness of Mariátegui’s thinking brought to Marxist field innovative and current aspects, even with limits. The present study sought to demonstrate the controversial question about the reproduction and rupture of Eurocentrism within Marxism, mostly in the original and Latin American Marxism of José Carlos Mariátegui

Nem decalque e nem cópia, mas criação heróica : o sujeito histórico indígena no pensamento de José Carlos Mariátegui

O peruano José Carlos Mariátegui foi um dos percussores do pensamento marxista na América Latina. Mais do que um difusor do marxismo em sua fase inicial no continente, Mariátegui elaborou uma criativa e rigorosa análise das realidades peruana e latino-americana. Entre suas inúmeras contribuições, destacamos o seu conceito de sujeito histórico, que introduz a figura do índio como componente estratégico para o socialismo na América Latina. Compreendendo que não existiria possibilidade de construção de um projeto de uma nova sociedade que não inclui-se o indígena, setor majoritário na população peruana e objeto de uma profunda exploração e exclusão, ao colocar em sua devida centralidade para o Peru – e para a América Latina em geral - elaborou uma fecunda análise da realidade latino-americana. A concepção histórica de Mariátegui enfrentou, a uma só vez, o positivismo e o determinismo, buscando compreender as especificidades históricas de nosso continente, sem renunciar a um olhar universal. Sua obra evidencia a possibilidade de produção de uma teoria que escapa aos limites do eurocentrismo e demonstra uma capacidade de autonomia do pensamento crítico