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The spread of COVID-19 in Peru resulted in the declaration of a national health emergency, in which Indigenous peoples were identified as being particularly vulnerable due to their pre-existing poor health indicators and disadvantaged social conditions. The aim of this paper is to examine how the Peruvian government responded to the health and food needs of the Shawi and Ashaninka Indigenous peoples of Peru during the first 18 months of the pandemic (March 2020-August 2021). This study uses both official policy documents and real-world experiences to evaluate policy responses in terms of their immediate impact and their longer-term sustainability and contribution to the improvement of health, well-being and justice for Indigenous communities. Four health and food security responses were evaluated: the Amazon Health Plan and Indigenous Command; food aid; cash aid; and COVID-19 vaccination. We employed the Multidimensional Injustice Framework to analyse the justice implications of the design and implementation of responses. Data collection included 71 interviews with government officials (n = 7), Indigenous leaders (n = 31) and community members (n = 33). The results show how national and regional governments released policies to address the health and food needs of Indigenous peoples directly or indirectly, as part of a broader focus on vulnerable people. However, justice implications were not sufficiently addressed in the design or implementation of the responses. On the distributive dimension, Indigenous communities were prioritized to receive health goods and services, nevertheless, the distribution had shortcomings that impeded their collection and Indigenous food systems and livelihoods were largely overlooked. On the procedural dimension, Indigenous representatives were included to provide culturally sensitive feedback on health interventions, but without funding, and furthermore, the community members had only passive participation. This paper points out the importance of considering and addressing justice implications for more effective and fairer health and food policy responses to current and future health crises.
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COVID-19 , Humanos , Peru , Vacinas contra COVID-19 , Justiça Social , Política Nutricional , Segurança Alimentar , Formulação de Políticas , Povos IndígenasRESUMO
BACKGROUND: In recent decades, the use of near-infrared light and fluorescence-guidance during open and laparoscopic surgery has exponentially expanded across various clinical settings. However, tremendous variability exists in how it is performed. OBJECTIVE: In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and nonconsensus across 4 areas of practice: fundamentals; patient selection/preparation; technical aspects; and effectiveness and safety. METHODS: A Delphi survey was conducted among 19 international experts in fluorescence-guided surgery attending a 1-day consensus meeting in Frankfurt, Germany on September 8th, 2019. Using mobile phones, experts were asked to anonymously vote over 2 rounds of voting, with 70% and 80% set as a priori thresholds for consensus and vote robustness, respectively. RESULTS: Experts from 5 continents reached consensus on 41 of 44 statements, including strong consensus that near-infrared fluorescence-guided surgery is both effective and safe across a broad variety of clinical settings, including the localization of critical anatomical structures like vessels, detection of tumors and sentinel nodes, assessment of tissue perfusion and anastomotic leaks, delineation of segmented organs, and localization of parathyroid glands. Although the minimum and maximum safe effective dose of ICG were felt to be 1 to 2âmg and >10âmg, respectively, there was strong consensus that determining the optimum dose, concentration, route and timing of ICG administration should be an ongoing research focus. CONCLUSIONS: Although fluorescence imaging was almost unanimously perceived to be both effective and safe across a broad range of clinical settings, considerable further research remains necessary to optimize its use.
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Verde de Indocianina , Linfonodo Sentinela , Consenso , Técnica Delphi , Humanos , Imagem Óptica/métodosRESUMO
In this study, Nerium oleander L. leaves were used as biomonitors to evaluate environmental pollutants levels in a sub-region in the Metropolitan Area of Rio de Janeiro City (Brazil) through X-ray Fluorescence (XRF). Control samples were collected in a rural zone next to the Parque Estadual da Pedra Branca/RJ. The samples were collected during all seasons of 2015 (summer, fall, winter and spring). The concentration of 13 elements (S, Cl, K, Ca, Mn, Fe, Cu, Zn, Br, Rb, Sr, Ba and Pb) was determined. Most of the elements showed, during all seasons, median concentrations of sampling sites higher than the results obtained from the control sites. The principal component analysis (PCA) showed the grouping of the elements in two main factors that can be associated to emission sources of these elements. The elements Cl, K, Ca, Cu, Rb and Sr can be associated as a possible influence from the soil (root uptake and/or resuspension). On the other hand, the elements Fe, Cu, Zn, and Pb can be associated to vehicle and industry emission sources. The study showed that the XRF technique applied to Nerium oleander L. leaves is efficient to environmental pollution analysis in Metropolitan Regions since it is precise, fast and low-cost, besides allowing the monitoring of pollution levels over time.
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Poluição do Ar/análise , Metais Pesados/análise , Nerium/química , Folhas de Planta/química , Brasil , Cidades , Monitoramento Ambiental/métodos , Espectrometria por Raios XRESUMO
Sparse sampling functional MRI (ssfMRI) enables stronger primary auditory cortex blood oxygen level-dependent (BOLD) signal by acquiring volumes interspersed with silence, reducing the physiological artifacts associated with scanner noise. Recent calculations of type I error rates associated with resting-state fMRI suggest that the techniques used to model the hemodynamic response function (HRF) might be resulting in higher false positives than is generally acceptable. In the present study, we analyze ssfMRI to determine type I error rates associated with whole brain and primary auditory cortex voxel-wise activation patterns. Study participants (n = 15, age 27.62 ± 3.21 years, range: 22-33 years; 6 females) underwent ssfMRI. An optimized paradigm was used to determine the HRF to auditory stimuli, which was then substituted for silent stimuli to ascertain false positives. We report that common techniques used for analyzing ssfMRI result in high type I error rates. The whole brain and primary auditory cortex voxel-wise analysis resulted in similar error distributions. The number of type I errors for P < 0.05, P < 0.01, and P < 0.001 for the whole brain was 7.88 ± 9.29, 2.37 ± 3.54, and 0.53 ± 0.96% and for the auditory cortex was 9.02 ± 1.79, 2.95 ± 0.91, and 0.58 ± 0.21%, respectively. When conducting a ssfMRI analysis, conservative α level should be employed (α < 0.001) to bolster the results in the face of false positive results.
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OBJECTIVE: Several studies have reported unique ethnic phenotypes of inflammatory bowel disease (IBD). An appreciation of disease manifestations in different populations may improve clinical outcomes. There are no studies examining IBD in patients of Haitian or Cape Verdean descent. We sought to define the IBD phenotype in these populations. MATERIALS AND METHODS: This was a retrospective review comparing Haitian and Cape Verdean immigrant IBD patients to Caucasians, all receiving care at Boston Medical Center in Boston, Massachusetts, USA. The following variables were analyzed: family history, smoking history, vaccinations/cancer screening, age of diagnosis, disease duration, disease location, medication use, and complications. RESULTS: Thirty-one Haitians and 21 Cape Verdeans were matched to Caucasian controls. Haitians (mean age 42 years) and Cape Verdeans (mean age 47 years) with Crohn's disease were diagnosed with IBD later than Caucasians (mean age 31 years, p = 0.04 and 0.02, respectively). Haitians with Crohn's were less likely to have a history of tobacco use compared to Caucasians (13% vs. 51%, p = 0.02). Cape Verdeans with Crohn's were less likely to have perianal involvement (0% vs. 50%, p = 0.01). Haitians with IBD were less likely to have ever used glucocorticoids (48% vs. 76%, p = 0.02). There was no difference in vaccination rates, cancer screening, or disease complications. CONCLUSIONS: This study demonstrates differences in IBD presentation and disease course among Haitians and Cape Verdeans. Our results suggest a more mild disease in these ethnic groups. Future studies are needed to identify the influence of environmental factors.
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Cirurgia Colorretal/classificação , Hospitalização/estatística & dados numéricos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/etnologia , Doenças Inflamatórias Intestinais/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cabo Verde , Progressão da Doença , Emigrantes e Imigrantes , Feminino , Haiti , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fenótipo , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Estados Unidos , Adulto JovemAssuntos
Antivirais/uso terapêutico , Produtos Biológicos/uso terapêutico , Controle de Doenças Transmissíveis/organização & administração , Ensaios de Uso Compassivo/ética , Drogas em Investigação/uso terapêutico , Ética Médica , Doença pelo Vírus Ebola/tratamento farmacológico , Animais , Antivirais/economia , Produtos Biológicos/economia , Canadá , Ensaios de Uso Compassivo/economia , Drogas em Investigação/economia , Financiamento Governamental/economia , Financiamento Governamental/ética , Doença pelo Vírus Ebola/epidemiologia , Humanos , Soros Imunes , Libéria , Camundongos , Estados UnidosRESUMO
OBJECTIVE: To analyse the biological factors affecting birthweight and to derive customized birthweight standards for a Spanish population. METHODS: A retrospective cohort was created with all the singleton pregnancies delivered at term and free of pathology in our Institution. Birthweight was modeled by multiple linear regression from maternal (ethnic origin, maternal height, booking weight, smoking, and parity), and fetal (gender, gestational age) characteristics. RESULTS: In addition to gestational age and sex, height, booking weight, ethnic origin, parity, and smoking all have significant and independent effects on birthweight. Women from East-Asia, Morocco and South-America had newborns on average 83 g, 74 g and 95 g heavier than White-European Spanish women. The effect of smoking was found to be dose-related. CONCLUSION: We found the relative effect of the maternal and fetal characteristics to be very similar to that reported in previous studies. We report coefficients for ethnic groups that account for a sizeable proportion of the population composition of several European countries.
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Peso ao Nascer , Recém-Nascido , Estudos de Coortes , Ásia Oriental/etnologia , Feminino , Idade Gestacional , Humanos , Modelos Lineares , Masculino , Marrocos/etnologia , Valores de Referência , Estudos Retrospectivos , América do Sul/etnologia , EspanhaRESUMO
Flow direction reversal (FDR) was proposed as a novel method to increase net water production (NWP) during cross-flow ultrafiltration. The design of the pilot-plant study allowed measurement of specific flux recovery after each chemically assisted backwash (BW) combined with FDR and after each FDR at the midpoint of each BW/FDR cycle. The percent recovery of specific flux was higher following FDR (55%) than combined BW and FDR (53%) at lower chemical dosages; however, the percent increase in specific flux recovery by FDR was much lower (20%) when the chemical dose was doubled. A mathematical model was developed to predict the NWP achieved by any combination ofBW/ FDR and FDR frequency. For example, the advantage of introducing FDR was demonstrated at the lower chlorine dose, whereby the percent increase in NWP by alternating 15-minute intervals of BW/FDR with FDR over BW/ FDR alone was 10% for 30-minute BW/FDR intervals and 2% for 15-minute BW/FDR intervals.