A qualitative analysis of child protection professionals' challenges during the COVID-19 pandemic.

PURPOSE: Child Protection Professionals (CPPs) play a key role in providing insights into the child protection system and how it can best support children's right to personal security, particularly during trying times like the COVID-19 pandemic. Qualitative research provides one potential tool to tap into this knowledge and awareness. This research thus expanded earlier qualitative work on CPPs' perceptions of the impact of COVID-19 on their work, including potential struggles and barriers, into the context of a developing country. METHODS: A total of 309 CPPs from all five regions in Brazil answered demographics, pandemic-related resilient behaviors, and open-ended questions regarding their profession during the pandemic. RESULTS: Data went through a three-step process of analysis: (1) pre-analysis; (2) category creation; and (3) coding of responses. Five categories emerged from the analysis: the Pandemic's Impact on CPPs' Work; the Impact of the Pandemic on CPP-Involved Families; Occupational Concerns during the Pandemic; Politics and the Pandemic; and Vulnerability due to the Pandemic. CONCLUSIONS: Our qualitative analyses showed the pandemic resulted in increased challenges for CPPs across several fronts within their workplace. Although each of these categories is discussed separately, they all influenced one another. This highlights the need to continue efforts to support CPPs.

Ozone Impact on Emission of Biogenic Volatile Organic Compounds in Three Tropical Tree Species From the Atlantic Forest Remnants in Southeast Brazil.

Plants emit a broad number of Biogenic Volatile Organic Compounds (BVOCs) that can impact urban ozone (O3) production. Conversely, the O3 is a phytotoxic pollutant that causes unknown alterations in BVOC emissions from native plants. In this sense, here, we characterized the constitutive and O3-induced BVOCs for two (2dO3) and four (4dO3) days of exposure (O3 dose 80 ppb) and evaluated the O3 response by histochemical techniques to detect programmed cell death (PCD) and hydrogen peroxide (H2O2) in three Brazilian native species. Croton floribundus Spreng, Astronium graveolens Jacq, and Piptadenia gonoacantha (Mart.) JF Macbr, from different groups of ecological succession (acquisitive and conservative), different carbon-saving defense strategies, and specific BVOC emissions. The three species emitted a very diverse BVOC composition: monoterpenes (MON), sesquiterpenes (SEQ), green leaf volatiles (GLV), and other compounds (OTC). C. floribundus is more acquisitive than A. graveolens. Their most representative BVOCs were methyl salicylate-MeSA (OTC), (Z) 3-hexenal, and (E)-2-hexenal (GLV), γ-elemene and (-)-ß-bourbonene (SEQ) ß-phellandrene and D-limonene (MON), while in A. graveolens were nonanal and decanal (OTC), and α-pinene (MON). Piptadenia gonoachanta is more conservative, and the BVOC blend was limited to MeSA (OTC), (E)-2-hexenal (GLV), and ß-Phellandrene (MON). The O3 affected BVOCs and histochemical traits of the three species in different ways. Croton floribundus was the most O3 tolerant species and considered as an SEQ emitter. It efficiently reacted to O3 stress after 2dO3, verified by a high alteration of BVOC emission, the emergence of the compounds such as α-Ionone and trans-ß-Ionone, and the absence of H2O2 detection. On the contrary, A. graveolens, a MON-emitter, was affected by 2dO3 and 4dO3, showing increasing emissions of α-pinene and ß-myrcene, (MON), γ-muurolene and ß-cadinene (SEQ) and H2O2 accumulation. Piptadenia gonoachanta was the most sensitive and did not respond to BVOCs emission, but PCD and H2O2 were highly evidenced. Our results indicate that the BVOC blend emission, combined with histochemical observations, is a powerful tool to confirm the species' tolerance to O3. Furthermore, our findings suggest that BVOC emission is a trade-off associated with different resource strategies of species indicated by the changes in the quality and quantity of BVOC emission for each species.

Intra-urban differentials of fetal mortality in clusters of social vulnerability in São Paulo Municipality, Brazil.

This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007-2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.

Evidence of Lactobacillus reuteri to reduce colic in breastfed babies: Systematic review and meta-analysis.

OBJECTIVE: To investigate evidence for the treatment of childhood colic by supplementing Lactobacillus reuteri in infants breastfed with breast milk. METHODS: The study was conducted according to the PRISMA protocol. The databases used for acquiring data were PubMed and Web of Science, applying MeSH terms and free terms. Meta-analysis was conducted using Stata ™ 12.0. The risk of bias was evaluated by the Review Manager (RevMan) 5.3 tool, and the strength of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Ten clinical trials were included in the review. The administration of L. reuteri (DSM 17938 or ATCC55730) was tested in infants (n = 248) versus the control/placebo group (n = 229). Eight articles were included in the meta-analysis. There was a significant response in reducing crying time (minutes/day) and treatment effectiveness (reduction ≥ 50% in average daily crying time) in the first week (p = 0.001 and p = 0.003, respectively). These results were similar in the second, third weeks (p < 0.001 for both outcomes) and fourth weeks (p<0.001 and p = 0.002, respectively). The risk of bias was low for the majority of the studies. Confidence in evidence was considered very low for crying time and low for effectiveness treatment. CONCLUSIONS: The evidence shows that the administration of Lactobacillus reuteri to babies fed with breast milk reduces the crying time in babies diagnosed with colic. But our confidence in the effect estimate is limited.

Foliage visible injury in the tropical tree species, Astronium graveolens is strictly related to phytotoxic ozone dose (PODy).

The present study evaluates the development of visible injury related to phytotoxic ozone dose (PODy) in native tropical species Astronium graveolens Jacq. (Anacardiaceae) and validates the symptoms using structural markers attributed to oxidative burst and hypersensitive responses. Increasing POD0 was associated with increasing O3 visible injury using different metrics as the incidence (INC = number of injured plants/total number of plants × 100), severity (SF = number of injured leaves/total number of leaves on injured plant × 100), and severity leaflet (SFL = number of injured leaflets/total number leaflets injured plant × 100). The effective dose (ED), which represents the POD0 dose responsible for inducing 20 (ED20), 50 (ED50), or 80% (ED80) of visible injury, were used to demonstrate that for this species, the response is similar even when the plants are exposed to diverse climate environments. Further investigation of the INC and SF index may help in long-term forest monitoring sites dedicated to O3 assessment in forests, while the SFL index seems to be an excellent indicator to be used in the short term to investigate the effects of O3.

Evaluation of the retinal vasculature of patients with branch retinal vein occlusion using optical coherence tomography angiography / Avaliação da vasculatura da retina em pacientes com oclusão de ramo da veia central da retina utilizando a angiografia por tomografia de coerência óptica

ABSTRACT Purpose: To evaluate vascular density in super­ficial and deep capillary plexuses of the retina, measured using optical coherence tomography angiography in patients with branch retinal vein occlusion. Affected eyes were compared with the contralateral eye of the same patient and both were compared with normal eyes. Methods: A cross-sectional study including 16 previously untreated patients with branch retinal vein occlusion. Patients with poor quality examinations, bilateral disease, high refractive error, or any other retinal or choroidal disease were excluded. A total of 31 patients without eye disease were also selected as a comparison group. All participants underwent five optical coherence tomography angiographies, and only those with at least two good quality examinations were selected. The Kruskal-Wallis, Wilcoxon signed-rank, and Mann-Whitney U tests were used for the statistical analysis. Results: Vascular density was lower in affected eyes compared with contralateral eyes: whole density (p=0.020 for capillary plexuses superficial; p=0.049 for deep capillary plexuses) and parafoveal density (p=0.020 for capillary plexuses superficial; p=0.011 for deep capillary plexuses). Vascular density was also lower in affected eyes compared with normal eyes: whole density (p<0.001 for capillary plexuses superficial and deep) and parafoveal density (p<0.001 for capillary plexuses superficial and deep). Whole density (p=0.001 for capillary plexuses superficial and deep) and parafoveal density (p=0.001 for capillary plexuses superficial; p<0.001 for deep capillary plexuses) were both lower in the contralateral eyes compared with normal eyes. Following adjustment for arterial hypertension, this difference was no longer observed. Conclusions: Vascular density in capillary plexuses and deep capillary plexuses was lower in the eyes affected by branch retinal vein occlusion. Furthermore, the lower vascular density noted in the contralateral eyes indicates that changes most likely occurred in these eyes prior to the appearance of any clinically detectable alterations, reflecting the early signs of hypertensive retinopathy.

RESUMO Objetivo: Avaliar a densidade vascular do plexo capilar superficial e profundo da retina, usando angiografia por tomografia de coerência óptica em pacientes com oclusão de ramo da veia central da retina, comparando o olho afetado com o contralateral do mesmo paciente e ambos com olhos normais. Métodos: Estudo transversal. Incluídos dezesseis pacientes com oclusão de ramo da veia central da retina sem tratamento prévio. Pacientes com exames de baixa qualidade, altas ametropias, outras patologias de retina ou coróide foram excluídos. Para comparação, trinta e um pacientes sem doença ocular foram selecionados. Todos foram submetidos a cinco exames angiografia por tomografia de coerência óptica, apenas aqueles com pelo menos dois exames de boa qualidade permaneceram no estudo. Os testes Kruskal-Wallis, Wilcoxon, e Mann-Whitney foram utilizados. Resultados: Densidades vasculares mais baixas do plexo capilar superficial e plexo capilar profundo foram observadas quando olhos com oclusão de ramo da veia central da retina foram comparados com os contralaterais: densidade total (p=0,02 para plexo capilar superficial, p=0,049 para plexo capilar profundo), densidade parafoveal (p=0,02 para plexo capilar superficial, p=0,011 para plexo capilar profundo). Comparando olhos acometidos com olhos normais, também foram observadas densidades vasculares mais baixas de plexo capilar superficial e plexo capilar profundo: densidade total (ambos com p<0,001) e densidade parafoveal (ambos com p<0,001). Quando os olhos contralaterais foram comparados aos normais, tanto a densidade total do plexo capilar superficial e plexo capilar profundo (ambos com p=0,001) quanto a densidade parafoveal (plexo capilar superficial com p=0,001, plexo capilar profundo com p<0,001) foram menores. Ao se realizar uma subanálise, minimizando o fator hipertensão arterial, esta diferença não se manteve. Conclusões: Densidades vasculares mais baixas do plexo capilar superficial e do plexo capilar profundo foram observadas em olhos com oclusão de ramo da veia central da retina. Além disso, a presença de densidades vasculares mais baixas nos olhos contralaterais mostra que já existem altera­ções nesses olhos antes das alterações clínicas, devido a al­terações inicias da retinopatia hipertensiva.

Factors associated with hospitalization and neonatal mortality in a cohort of newborns from the Unified Health System in São Paulo. / Fatores associados à internação e à mortalidade neonatal em uma coorte de recém-nascidos do Sistema Único de Saúde, no município de São Paulo.

INTRODUCTION: Newborn care is an important factor associated with hospitalization and neonatal mortality. OBJECTIVE: To analyze factors associated with hospitalization and neonatal mortality of newborns (NBs) admitted to the Unified Health System (SUS), São Paulo, 2012. METHODS: A cohort of NBs from the SUS was obtained by linking data: SUS Hospital Information System, Live Birth Information System, Mortality Information System and National Health Facility Registry. Poisson and Cox regression were performed. RESULTS: 16.5% (9,127) of the NBs were hospitalized, 4.7% (2,613) were admitted to a Neonatal Intensive Care Unit (NICU) and 11.8% (6,514) to a Neonatal Intermediate Care Unit (NIMCU). Maternal age ≥ 35 years (RR = 1.1, IC95% 1.1 - 1.2), inadequate prenatal care (RR = 1.2, IC95% 1.1 - 1.3), hospitalization for obstetric complications (RR = 1.1, IC95% 1.1 - 1.2), prematurity (≤ 32 weeks: RR = 1.6, IC95% 1.5 - 1.8; 32 to 36 weeks: RR = 1.7, IC95% 1.6 - 1,7), low weight (< 1,500 g: RR = 2.4, IC95% 2.1 - 2.6; 1,500 to 2,499 g: RR = 2.6, IC95% 2.5 - 2.7), APGAR 5º < 7 (RR = 1.9, IC95% 1.7 - 2.0), Cesarean section (RR = 1.1, IC95% 1.1 - 1.2) and Congenital Malformation (RR = 1.4, IC95% 1.3 - 1,5) were associated with the hospitalization of newborns. Neonatal mortality was associated with infants under 1,500 g (RR = 9.1, IC95% 6.3 - 13.1), very premature (RR = 2.6, IC95% 1.9 - 3.5), low APGAR (RR = 5.5, IC95% 4.6 - 6.7). CONCLUSION: Inadequate prenatal care, prematurity and low weight were risk factors for hospitalization and neonatal mortality.

Evaluation of the retinal vasculature of patients with branch retinal vein occlusion using optical coherence tomography angiography.

PURPOSE: To evaluate vascular density in super-ficial and deep capillary plexuses of the retina, measured using optical coherence tomography angiography in patients with branch retinal vein occlusion. Affected eyes were compared with the contralateral eye of the same patient and both were compared with normal eyes. METHODS: A cross-sectional study including 16 previously untreated patients with branch retinal vein occlusion. Patients with poor quality examinations, bilateral disease, high refractive error, or any other retinal or choroidal disease were excluded. A total of 31 patients without eye disease were also selected as a comparison group. All participants underwent five optical coherence tomography angiographies, and only those with at least two good quality examinations were selected. The Kruskal-Wallis, Wilcoxon signed-rank, and Mann-Whitney U tests were used for the statistical analysis. RESULTS: Vascular density was lower in affected eyes compared with contralateral eyes: whole density (p=0.020 for capillary plexuses superficial; p=0.049 for deep capillary plexuses) and parafoveal density (p=0.020 for capillary plexuses superficial; p=0.011 for deep capillary plexuses). Vascular density was also lower in affected eyes compared with normal eyes: whole density (p<0.001 for capillary plexuses superficial and deep) and parafoveal density (p<0.001 for capillary plexuses superficial and deep). Whole density (p=0.001 for capillary plexuses superficial and deep) and parafoveal density (p=0.001 for capillary plexuses superficial; p<0.001 for deep capillary plexuses) were both lower in the contralateral eyes compared with normal eyes. Following adjustment for arterial hypertension, this difference was no longer observed. CONCLUSIONS: Vascular density in capillary plexuses and deep capillary plexuses was lower in the eyes affected by branch retinal vein occlusion. Furthermore, the lower vascular density noted in the contralateral eyes indicates that changes most likely occurred in these eyes prior to the appearance of any clinically detectable alterations, reflecting the early signs of hypertensive retinopathy.

CYP1B1 Gene and Phenotypic Correlation in Patients From Northeastern Brazil With Primary Congenital Glaucoma.

PURPOSE: To identify variants in the CYP1B1 gene in northeastern Brazilian patients with primary congenital glaucoma (PCG) and possible genotype-phenotype correlations. MATERIALS AND METHODS: This is a cross-sectional observational study of 17 nonrelated patients with PCG, performed at the Altino Ventura Foundation, Recife, Brazil, between December 2017 and February 2018. All patients underwent an examination, including gathering information from their medical records, slit-lamp examination, fundoscopy, tonography, and measuring corneal diameter and thickness. RESULTS: The mean age at the time of the examination was 27.7 years; 52.9% (n=9) were male, 29.4% (n=5) had history of parental consanguinity. The mean age when the diagnosis was confirmed was 0.53±2.18 years. Horizontal corneal diameter ranged from 12 to 16 mm (mean: 14.05±1.42 mm) and the IOP mean value was 17.31±9.84 mm Hg. Predicted pathogenic variants of the CYP1B1 gene were identified in 4 patients (23.5%). The differences among all clinical parameters did not reach statistical significance between individuals with and without CYP1B1 variants (P-values >0.05). CONCLUSIONS: Two variants which had not been previously related to PCG in Brazil (c.182G>A, c.241T>A) were identified. No statistically significant genotype-phenotype correlations were found.

Adubação nitrogenada e uso de regulador de crescimento na produção de trigo sequeiro / Nitrogen fertilization and growth regulator use in upland wheat production

A adubação nitrogenada é uma importante prática de manejo em gramíneas e bastante complexa, em função dos diversos fatores que influenciam, como condições climáticas, sistemas de cultivo, doses e fontes disponíveis. Objetivou-se com o trabalho, avaliar diferentes doses de nitrogênio em cobertura e o efeito do regulador de crescimento etil-trinexapac no trigo (Triticum aestivumL.). O experimento foi em blocos casualizados em esquema fatorial 5x2, com 4 repetições. Os tratamentos foram compostos por cinco doses de nitrogênio aplicado em cobertura (0, 20, 40, 80 e 160 kg ha-1de N) e duas doses do etil-trinexapac (0 e 100 g ha-1do ingrediente ativo) na cultura do trigo. Foram avaliadas: Massa de matéria seca, altura de planta, altura da folha bandeira, altura de inserção de espiga, distância fonte e dreno, comprimento de espiga, número de espigas por metro quadrado, número de espiguetas por espiga, fertilidade das espiguetas, número de grãos por espiga, número de grãos por espigueta, massa de mil grãos, produtividade de grãos, peso hectolitro e proteína dos grãos. O regulador de crescimento altera os componentes morfológicos do trigo, porém não altera os componentes produtivos e a produtividade de grãos, não justificando seu uso nas condições em que ocorreu o estudo. A adubação nitrogenada não altera os componentes morfológicos das plantas do trigo, mas aumenta o número de espigas por m2 (afilhos) até dose de 52 kg ha-1de N, refletindo no aumento da produtividade até a dose de 59 kg ha-1.

Nitrogen fertilization is an important management practice in grasses and quite complex, due to the different factors that influence such as climatic conditions, cropping systems, rates and available sources. The objective of this work was to evaluate the different rates of side dressing nitrogen and the effect of the trinexapac-ethyl on wheat (Triticum aestivumL.). The experiment was a randomized block design in a 5x2 factorial scheme, with 4 replicates. The treatments were composed of five nitrogen rates applied in side dressing (0, 20, 40, 80 and 160 kg ha-1 of N) and two rates of etil-trinexapac (0 e 100 g ha-1 do active ingredient) in the wheat crop. The following variables were evaluated: shoot dry matter, plant height, flag leaf height, ear insertion height, distance of source and drain, ear length, number of ears per square meter, number of spikelets per ear, fertility of spikelets, number of grains per ear, number of grains per spikelet, mass of one thousand grains, grain yield), hectoliter weight, and grain protein. The growth regulator changes the morphological components of wheat, but does not alter the productive components and yield of grains, not justifying their use under the conditions under which the study took place. Nitrogen fertilization does not alter the morphological components of wheat plants, but increases the number of ears per m2 up to a rate of 52 kg ha-1 of N, reflecting the increase in productivity up to the rate of 59 kg ha-1.

Adubação nitrogenada e uso de regulador de crescimento na produção de trigo sequeiro / Nitrogen fertilization and growth regulator use in upland wheat production

A adubação nitrogenada é uma importante prática de manejo em gramíneas e bastante complexa, em função dos diversos fatores que influenciam, como condições climáticas, sistemas de cultivo, doses e fontes disponíveis. Objetivou-se com o trabalho, avaliar diferentes doses de nitrogênio em cobertura e o efeito do regulador de crescimento etil-trinexapac no trigo (Triticum aestivumL.). O experimento foi em blocos casualizados em esquema fatorial 5x2, com 4 repetições. Os tratamentos foram compostos por cinco doses de nitrogênio aplicado em cobertura (0, 20, 40, 80 e 160 kg ha-1de N) e duas doses do etil-trinexapac (0 e 100 g ha-1do ingrediente ativo) na cultura do trigo. Foram avaliadas: Massa de matéria seca, altura de planta, altura da folha bandeira, altura de inserção de espiga, distância fonte e dreno, comprimento de espiga, número de espigas por metro quadrado, número de espiguetas por espiga, fertilidade das espiguetas, número de grãos por espiga, número de grãos por espigueta, massa de mil grãos, produtividade de grãos, peso hectolitro e proteína dos grãos. O regulador de crescimento altera os componentes morfológicos do trigo, porém não altera os componentes produtivos e a produtividade de grãos, não justificando seu uso nas condições em que ocorreu o estudo. A adubação nitrogenada não altera os componentes morfológicos das plantas do trigo, mas aumenta o número de espigas por m2 (afilhos) até dose de 52 kg ha-1de N, refletindo no aumento da produtividade até a dose de 59 kg ha-1.(AU)

Nitrogen fertilization is an important management practice in grasses and quite complex, due to the different factors that influence such as climatic conditions, cropping systems, rates and available sources. The objective of this work was to evaluate the different rates of side dressing nitrogen and the effect of the trinexapac-ethyl on wheat (Triticum aestivumL.). The experiment was a randomized block design in a 5x2 factorial scheme, with 4 replicates. The treatments were composed of five nitrogen rates applied in side dressing (0, 20, 40, 80 and 160 kg ha-1 of N) and two rates of etil-trinexapac (0 e 100 g ha-1 do active ingredient) in the wheat crop. The following variables were evaluated: shoot dry matter, plant height, flag leaf height, ear insertion height, distance of source and drain, ear length, number of ears per square meter, number of spikelets per ear, fertility of spikelets, number of grains per ear, number of grains per spikelet, mass of one thousand grains, grain yield), hectoliter weight, and grain protein. The growth regulator changes the morphological components of wheat, but does not alter the productive components and yield of grains, not justifying their use under the conditions under which the study took place. Nitrogen fertilization does not alter the morphological components of wheat plants, but increases the number of ears per m2 up to a rate of 52 kg ha-1 of N, reflecting the increase in productivity up to the rate of 59 kg ha-1.(AU)

[Hospitalizations due to complications of pregnancy and maternal and perinatal outcomes in a cohort of pregnant women in the Brazilian Unified National Health System in São Paulo, Brazil]. / Internações por complicações obstétricas na gestação e desfechos maternos e perinatais, em uma coorte de gestantes no Sistema Único de Saúde no Município de São Paulo, Brasil.

Maternal morbidity, fetal mortality, and neonatal mortality are important indicators of maternal and child health. The study aimed to describe maternal and perinatal outcomes (low birth weight, prematurity, fetal and neonatal deaths, postpartum hospitalizations, and readmission of newborns) in a cohort of pregnant women whose deliveries were covered by the Brazilian Unified National Health System (SUS) in the city of São Paulo, Brazil, in the second semester of 2012. We obtained a retrospective cohort of 55,404 pregnant women with deterministic and probabilistic linkage of data from the Hospital Information System of the SUS (SIH/SUS), Information System on Live Births (SINASC), Mortality Information System (SIM), and National Registry of Health Establishments (CNES) databases. Hospitalizations due to obstetric complications occurred in 4.3% of the women. The most frequent diagnoses were infection, hypertensive disease of pregnancy, and diabetes. Hospitalizations prior to childbirth were more common in pregnant women 35 years or older and those with a history of multiple pregnancies and low schooling. Postpartum hospitalizations were three times greater and maternal mortality was nine times greater in pregnant women with a history of previous hospitalization due to obstetric complications. Adverse perinatal outcomes (fetal and neonatal mortality and low birth weight) were twice as frequent in infants of women with previous hospitalization when compared to those without. A similar pattern was seen in hospitalization of newborns soon after birth and in hospital readmission. Adverse maternal and perinatal outcomes were more frequent in pregnant women with a history of previous hospitalization.

A morbidade materna, a mortalidade neonatal e a mortalidade fetal são importantes indicadores da saúde materna infantil. O estudo tem por objetivo descrever desfechos maternos e perinatais (baixo peso ao nascer, prematuridade, óbito fetal e neonatal, internações pós-parto e readmissão dos recém-nascidos) de uma coorte de gestantes cujos partos foram financiados pelo Sistema Único de Saúde (SUS) no Município de São Paulo, Brasil, no segundo semestre de 2012. Foi obtida uma coorte retrospectiva de 55.404 gestantes com vinculação (determinística e probabilística) das informações do Sistema de Informações Hospitalares do SUS (SIH/SUS), Sistema de Informações sobre Nascidos Vivos (SINASC), Sistema de Informações sobre Mortalidade (SIM) e Cadastro Nacional de Estabelecimentos de Saúde (CNES). Internações por complicações obstétricas da gestação ocorreram em 4,3% das gestantes. Diagnósticos mais frequentes foram: infecções, doenças hipertensivas e diabetes. As internações prévias ao parto foram mais frequentes nas gestantes a partir de 35 anos, de gestações múltiplas e com baixa escolaridade. As internações das gestantes no pós-parto foram 3 vezes maior e a mortalidade materna 9 vezes maior entre as gestantes com internação prévia por complicações obstétricas. Os desfechos perinatais (mortalidade fetal e neonatal, prematuridade e baixo peso ao nascer) foram 2 vezes mais frequentes entre os conceptos de gestantes com internação prévia que aquelas sem internação. Comportamento semelhante foi encontrado com relação à internação dos recém-nascidos logo após o parto e na readmissão hospitalar. Desfechos maternos e perinatais negativos foram mais frequentes em gestantes com internação prévia ao parto.

La morbilidad materna, la mortalidad neonatal y la mortalidad fetal son importantes indicadores de la salud materna infantil. El objetivo del estudio fue describir desenlaces maternos y perinatales (bajo peso al nacer, prematuridad, óbito fetal y neonatal, internamientos posparto y readmisión de los recién nacidos) de una cohorte de gestantes, cuyos partos fueron financiados por el Sistema Único de Salud (SUS) en el municipio de Sao Paulo, durante el segundo semestre de 2012. Se obtuvo una cohorte retrospectiva de 55.404 gestantes con vinculación (determinística y probabilística) de la información del Sistema de Información Hospitalaria de SUS (SIH/SUS), Sistema de Información sobre Nacidos Vivos (SINASC), Sistema de Información sobre Mortalidad (SIM) y Registro Nacional de Establecimientos de Salud (CNES). Se produjeron internamientos por complicaciones obstétricas en la gestación en un 4,3% de las gestantes. Los diagnósticos más frecuentes fueron: infecciones, enfermedades relacionadas con la hipertensión y diabetes. Los internamientos previos al parto fueron más frecuentes en las gestantes a partir de 35 años, con gestaciones múltiples y con baja escolaridad. Los internamientos de las gestantes en el posparto fueron 3 veces mayores y la mortalidad materna 9 veces mayor entre las gestantes con un internamiento previo por complicaciones obstétricas. Los desenlaces perinatales (mortalidad fetal y neonatal, prematuridad y bajo peso al nacer) fueron 2 veces más frecuentes entre los conceptos de gestantes con internamiento previo que aquellas sin internamiento. Un comportamiento semejante se encontró en relación con el internamiento de los recién nacidos inmediatamente tras el parto y en la readmisión hospitalaria. Desenlaces maternos y perinatales negativos fueron más frecuentes en gestantes con internamiento previo al parto.

KIR and HLA ligands demonstrate genetic inheritance diversity in Japanese descendants from Paraná, Brazil.

In order to investigate killer immunoglobulin-like receptors (KIR) and their ligands, human leukocyte antigen (HLA), diversity in the Brazilian population influenced by migrations, unrelated Brazilian Japanese descendants were selected and genotyped for the KIR genes and HLA class I allele groups. Genetic heterogeneity in Brazil Paraná Japanese was observed for KIR genes, whose frequency distributions demonstrated similarity with mixed Brazilian populations and with the Japanese population, suggesting gene flow. The data contributed to the identification of the genetic constitution of the Brazilian population influenced by immigrations and two new genotypes were defined.

Ozone affects leaf physiology and causes injury to foliage of native tree species from the tropical Atlantic Forest of southern Brazil.

In southern Brazil, the recent increase in tropospheric ozone (O3) concentrations poses an additional threat to the biodiverse but endangered and fragmented remnants of the Atlantic Forest. Given the mostly unknown sensitivity of tropical species to oxidative stress, the principal objective of this study was to determine whether the current O3 levels in the Metropolitan Region of Campinas (MRC), downwind of São Paulo, affect the native vegetation of forest remnants. Foliar responses to O3 of three tree species typical of the MRC forests were investigated using indoor chamber exposure experiments under controlled conditions and a field survey. Exposure to 70ppb O3 reduced assimilation and leaf conductance but increased respiration in Astronium graveolens while gas exchange in Croton floribundus was little affected. Both A. graveolens and Piptadenia gonoacantha developed characteristic O3-induced injury in the foliage, similar to visible symptoms observed in >30% of trees assessed in the MRC, while C. floribundus remained asymptomatic. The underlying structural symptoms in both O3-exposed and field samples were indicative of oxidative burst, hypersensitive responses, accelerated cell senescence and, primarily in field samples, interaction with photo-oxidative stress. The markers of O3 stress were thus mostly similar to those observed in other regions of the world. Further research is needed, to estimate the proportion of sensitive forest species, the O3 impact on tree growth and stand stability and to detect O3 hot spots where woody species in the Atlantic Forest are mostly affected.

Internações por complicações obstétricas na gestação e desfechos maternos e perinatais, em uma coorte de gestantes no Sistema Único de Saúde no Município de São Paulo, Brasil / Hospitalizations due to complications of pregnancy and maternal and perinatal outcomes in a cohort of pregnant women in the Brazilian Unified National Health System in São Paulo, Brazil / Internamientos por complicaciones obstétricas en la gestación y desenlaces maternos y perinatales, en una cohorte de gestantes en el Sistema Único de Salud en el municipio de São Paulo, Brasil

A morbidade materna, a mortalidade neonatal e a mortalidade fetal são importantes indicadores da saúde materna infantil. O estudo tem por objetivo descrever desfechos maternos e perinatais (baixo peso ao nascer, prematuridade, óbito fetal e neonatal, internações pós-parto e readmissão dos recém-nascidos) de uma coorte de gestantes cujos partos foram financiados pelo Sistema Único de Saúde (SUS) no Município de São Paulo, Brasil, no segundo semestre de 2012. Foi obtida uma coorte retrospectiva de 55.404 gestantes com vinculação (determinística e probabilística) das informações do Sistema de Informações Hospitalares do SUS (SIH/SUS), Sistema de Informações sobre Nascidos Vivos (SINASC), Sistema de Informações sobre Mortalidade (SIM) e Cadastro Nacional de Estabelecimentos de Saúde (CNES). Internações por complicações obstétricas da gestação ocorreram em 4,3% das gestantes. Diagnósticos mais frequentes foram: infecções, doenças hipertensivas e diabetes. As internações prévias ao parto foram mais frequentes nas gestantes a partir de 35 anos, de gestações múltiplas e com baixa escolaridade. As internações das gestantes no pós-parto foram 3 vezes maior e a mortalidade materna 9 vezes maior entre as gestantes com internação prévia por complicações obstétricas. Os desfechos perinatais (mortalidade fetal e neonatal, prematuridade e baixo peso ao nascer) foram 2 vezes mais frequentes entre os conceptos de gestantes com internação prévia que aquelas sem internação. Comportamento semelhante foi encontrado com relação à internação dos recém-nascidos logo após o parto e na readmissão hospitalar. Desfechos maternos e perinatais negativos foram mais frequentes em gestantes com internação prévia ao parto.

Maternal morbidity, fetal mortality, and neonatal mortality are important indicators of maternal and child health. The study aimed to describe maternal and perinatal outcomes (low birth weight, prematurity, fetal and neonatal deaths, postpartum hospitalizations, and readmission of newborns) in a cohort of pregnant women whose deliveries were covered by the Brazilian Unified National Health System (SUS) in the city of São Paulo, Brazil, in the second semester of 2012. We obtained a retrospective cohort of 55,404 pregnant women with deterministic and probabilistic linkage of data from the Hospital Information System of the SUS (SIH/SUS), Information System on Live Births (SINASC), Mortality Information System (SIM), and National Registry of Health Establishments (CNES) databases. Hospitalizations due to obstetric complications occurred in 4.3% of the women. The most frequent diagnoses were infection, hypertensive disease of pregnancy, and diabetes. Hospitalizations prior to childbirth were more common in pregnant women 35 years or older and those with a history of multiple pregnancies and low schooling. Postpartum hospitalizations were three times greater and maternal mortality was nine times greater in pregnant women with a history of previous hospitalization due to obstetric complications. Adverse perinatal outcomes (fetal and neonatal mortality and low birth weight) were twice as frequent in infants of women with previous hospitalization when compared to those without. A similar pattern was seen in hospitalization of newborns soon after birth and in hospital readmission. Adverse maternal and perinatal outcomes were more frequent in pregnant women with a history of previous hospitalization.

La morbilidad materna, la mortalidad neonatal y la mortalidad fetal son importantes indicadores de la salud materna infantil. El objetivo del estudio fue describir desenlaces maternos y perinatales (bajo peso al nacer, prematuridad, óbito fetal y neonatal, internamientos posparto y readmisión de los recién nacidos) de una cohorte de gestantes, cuyos partos fueron financiados por el Sistema Único de Salud (SUS) en el municipio de Sao Paulo, durante el segundo semestre de 2012. Se obtuvo una cohorte retrospectiva de 55.404 gestantes con vinculación (determinística y probabilística) de la información del Sistema de Información Hospitalaria de SUS (SIH/SUS), Sistema de Información sobre Nacidos Vivos (SINASC), Sistema de Información sobre Mortalidad (SIM) y Registro Nacional de Establecimientos de Salud (CNES). Se produjeron internamientos por complicaciones obstétricas en la gestación en un 4,3% de las gestantes. Los diagnósticos más frecuentes fueron: infecciones, enfermedades relacionadas con la hipertensión y diabetes. Los internamientos previos al parto fueron más frecuentes en las gestantes a partir de 35 años, con gestaciones múltiples y con baja escolaridad. Los internamientos de las gestantes en el posparto fueron 3 veces mayores y la mortalidad materna 9 veces mayor entre las gestantes con un internamiento previo por complicaciones obstétricas. Los desenlaces perinatales (mortalidad fetal y neonatal, prematuridad y bajo peso al nacer) fueron 2 veces más frecuentes entre los conceptos de gestantes con internamiento previo que aquellas sin internamiento. Un comportamiento semejante se encontró en relación con el internamiento de los recién nacidos inmediatamente tras el parto y en la readmisión hospitalaria. Desenlaces maternos y perinatales negativos fueron más frecuentes en gestantes con internamiento previo al parto.

Tillandsia usneoides: A successful alternative for biomonitoring changes in air quality due to a new highway in São Paulo, Brazil.

Tillandsia usneoides is an aerial epiphytic bromeliad that absorbs water and nutrients directly from the atmosphere by scales covering its surface. We expanded the use of this species as a broader biomonitor based on chemical and structural markers to detect changes in air quality. The usefulness of such comprehensive approach was tested during the construction and opening of a highway (SP-21) in São Paulo State, Brazil. The biomonitoring study was performed from 2009 to 2012, thus comprising the period during construction and after the highway inauguration. Metal accumulation and structural alterations were assessed, in addition to microscopy analyses to understand the metal chelation in plant tissues and to assess the causes of alterations in the number and shape of scale cells. Altogether, our analyses support the use of this species as a wide biomonitor of air quality in urbanized areas.

S-nitrosoglutathione spraying improves stomatal conductance, Rubisco activity and antioxidant defense in both leaves and roots of sugarcane plants under water deficit.

Water deficit is a major environmental constraint on crop productivity and performance and nitric oxide (NO) is an important signaling molecule associated with many biochemical and physiological processes in plants under stressful conditions. This study aims to test the hypothesis that leaf spraying of S-nitrosoglutathione (GSNO), an NO donor, improves the antioxidant defense in both roots and leaves of sugarcane plants under water deficit, with positive consequences for photosynthesis. In addition, the roles of key photosynthetic enzymes ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) and phosphoenolpyruvate carboxylase (PEPC) in maintaining CO2 assimilation of GSNO-sprayed plants under water deficit were evaluated. Sugarcane plants were sprayed with water or GSNO 100 µM and subjected to water deficit, by adding polyethylene glycol (PEG-8000) to the nutrient solution. Sugarcane plants supplied with GSNO presented increases in the activity of antioxidant enzymes such as superoxide dismutase in leaves and catalase in roots, indicating higher antioxidant capacity under water deficit. Such adjustments induced by GSNO were sufficient to prevent oxidative damage in both organs and were associated with better leaf water status. As a consequence, GSNO spraying alleviated the negative impact of water deficit on stomatal conductance and photosynthetic rates, with plants also showing increases in Rubisco activity under water deficit.

Gestantes usuárias do Sistema Único de Saúde no município de São Paulo: desfechos de uma coorte de dados secundários / Pregnant users of the Unified Health System in the city of São Paulo outcomes of a cohort of secondary data

Introdução: Apesar da melhoria dos indicadores da saúde materno infantil, os valores ainda são elevados, com a mortalidade neonatal respondendo pela mortalidade infantil e a mortalidade fetal pela perinatal. Apesar da melhoria da cobertura e qualidade dos dados dos sistemas de informação sobre nascidos vivos e mortalidade, esses não tem informação sobre a morbidade materna e do recém-nascido, disponíveis no Sistema de Informação Hospitalar do SUS e possíveis de serem vinculadas. Objetivo geral: Descrever e analisar o seguimento da gestação, do parto e dos desfechos dos nascimentos das gestantes usuárias do SUS residentes no município de São Paulo no período de 12/08/2011 a 27/01/2013. Objetivos específicos: Obter uma coorte de gestantes SUS com dados secundários. Identificar internações anteriores ao parto por complicações obstétricas, prevalência das gestações de alto risco, tipo de saída após o parto (alta, internação e uso de UTI e óbito materno) e tempo de permanência da internação do parto, no período de 12 de agosto de 2011 a 31 de dezembro de 2012. Caracterizar e estimar a razão de morte fetal e a mortalidade neonatal precoce dos nascidos vivos extraídos da coorte de gestantes SUS no município de São Paulo no período de 01 de junho de 2012 a 27 de janeiro de 2013. Identificar se há diferença da sobrevida dos óbitos neonatais segundo peso ao nascer e uso de UTI neonatal. Identificar potenciais fatores de risco para a mortalidade fetal e neonatal precoce para os nascimentos da coorte de gestante SUS. Metodologia: Tratou-se de um estudo do tipo coorte retrospectiva de população fixa das gestantes cujos nascimentos (nascido vivo e óbito fetal) ocorreram em hospitais da rede SUS no município de São Paulo no período de 01 de junho de 2012 a 31 de dezembro de 2012. Foram investigadas as internações e as readmissões hospitalares das gestantes atendidas nos hospitais SUS ocorridas no período de 12 de agosto de 2011 a dezembro de 2012. Como também, as internações dos recém-nascidos ocorridas no período de 01 de junho de 2012 a 27 de janeiro de 2013. Foram realizadas vinculações pelo método determinístico e probabilístico dos documentos base dos sistemas de informação em saúde (SIS). Foram conduzidas análises de regressão de Cox e regressão logística. Resultados: Foram vinculados 98,3 por cento das declarações de nascidos vivos (DNV) à autorização de internação hospitalar (AIH), 93,8 por cento dos óbitos fetais às AIHs, 93 por cento das AIHs dos recém-nascidos internados ao par anterior e 99,4 por cento dos óbitos neonatais a sequencia de eventos ditas anteriores. 4,3 por cento das gestantes foram internadas prévio ao parto por complicações obstétricas. Maior mortalidade neonatal, razão de morte fetal e internação dos RNs após o nascimento ocorreram em gestantes que internaram por complicações obstétricas. No estudo de sobrevida, houve aumento da sobrevida com o aumento do peso ao nascer. RNs internados em UTIN após o nascimento tiveram menor sobrevida que os RNs não internados. Os fatores de risco para a mortalidade neonatal foram: o número insuficiente de consulta de pré-natal, nascer em hospital de baixo volume de parto, prematuridade, baixo peso ao nascer, APGAR 5º < 7, presença de anomalia congênita e internação após o nascimento. Não realizar consulta de pré-natal, prematuridade extrema (<32 semanas), baixo peso ao nascer (<2499 gramas) e presença de malformação congênita foram fatores de risco comuns aos óbitos fetais e aos neonatais precoces. Raça/cor da mãe não branca e idade materna igual ou superior a 35 anos foram fatores de risco somente para os óbitos fetais. Nascimentos em hospitais com baixo e médio volume de parto foram associados à maior mortalidade neonatal precoce. Conclusão: Gestantes que apresentaram complicações obstétricas tiveram desfechos mais desfavoráveis da gestação, como internação pós-parto e mortalidade materna. Foi identificada também nesse grupo maior readmissão hospitalar dos RNs, maior prevalência de prematuridade e de baixo peso ao nascer, maior mortalidade fetal e neonatal. Internação na gestação e readmissão hospitalar do RN deve ser considerada como eventos sentinelas no monitoramento da assistência ao parto e ao recémnascido na população SUS. A concentração dos óbitos nos primeiros dias de vida refletem as fragilidades na assistência aos recém-nascidos, a gravidade das doenças dos recém-nascidos, as más condições de nascimento e a presença de malformações incompatíveis com a vida. Óbitos fetais e neonatais precoces são influenciados pelas mesmas características proximais dos recém-nascidos. Esforços devem ser direcionados para o aumento da adesão às consultas de pré-natal nas unidades básicas de saúde, com atenção especial para as gestantes não brancas

Introduction: Despite the improvement in maternal and child health indicators, values are still high, with neonatal mortality accounting for infant mortality and perinatal fetal mortality. Despite improved coverage and data quality of information systems on live births and mortality, these do not have information on maternal and newborn morbidity, available in the SUS Hospital Information System and possible to be linked. General objective: Describe and analyze the follow-up of gestation, delivery and outcomes of the births of pregnant women users of SUS residents in the city of São Paulo from August 12, 2011 to January 27, 2013. Specific objectives: Obtain a cohort of SUS pregnant women with secondary data. Identify hospitalizations prior to delivery for obstetric complications, prevalence of high-risk pregnancies, type of delivery after childbirth (discharge, hospitalization and use of ICU and maternal death) and length of hospital stay during the period of August 12, 2011 to December 31, 2012. Characterize and estimate the fetal death rate and early neonatal mortality of live births extracted from the cohort of pregnant women SUS in the city of São Paulo from June 1, 2012 to January 27, 2013. Identify if there is difference in survival of neonatal deaths according to birth weight and neonatal ICU use. Identify potential risk factors for early fetal and neonatal mortality for the births of the SUS pregnant cohort. METHODS: This was a retrospective cohort study of the fixed population of pregnant women whose births (live birth and fetal death) occurred in hospitals of the SUS network in the city of São Paulo from June 1, 2012 to December 31, 2012. The hospitalizations and the hospital readmissions of the pregnant women attended in the SUS hospitals were investigated during the period from August 12, 2011 to December 2012. As well as the hospitalizations of the newborns that occurred in the period from June 1, 2012 to 27 Of January of 2013. Links were made through the deterministic and probabilistic method of the basic documents of the health information systems (SIS). Cox regression and logistic regression analyzes were performed. Results: 98.3 per cent of live birth certificates (DNV) were linked to hospital admission authorization (AIH), 93.8 per cent of fetal deaths to AIHs, 93 per cent of AIHs of newborns hospitalized at the previous pair, and 99, 4 per cent of neonatal deaths in the sequence of events mentioned above. 4.3 per cent of pregnant women were hospitalized prior to delivery due to obstetric complications. Higher neonatal mortality, fetal death rate and hospitalization of newborns after birth occurred in pregnant women hospitalized for obstetric complications. In the survival study, there was an increase in survival with an increase in birth weight. RNs hospitalized at the NICU after birth had lower survival rates than the non-hospitalized NB. The risk factors for neonatal mortality were: insufficient number of prenatal visits, hospital birth with low birth volume, prematurity, low birth weight, APGAR 5 <7, presence of congenital anomaly and hospitalization after birth. Preterm consultation, extreme prematurity (<32 weeks), low birth weight (<2499 grams) and presence of congenital malformation were common risk factors for fetal deaths and early neonatal deaths. Race / color of non-white mother and maternal age equal to or greater than 35 years were risk factors only for fetal deaths. Births in hospitals with low and medium volume of delivery were associated with higher preterm neonatal mortality. Conclusion: Pregnant women who presented obstetric complications had more unfavorable outcomes of pregnancy, such as postpartum hospitalization and maternal mortality. Also in this group, greater readmission of the newborns of the newborns, greater prevalence of prematurity and of low birth weight, greater fetal and neonatal mortality were also identified. Nursing admission and hospital readmission of the newborn should be considered as sentinel events in the monitoring of delivery care and the newborn in the SUS population. The concentration of deaths in the first days of life reflects weaknesses in the care of newborns, the severity of newborn diseases, poor birth conditions and the presence of malformations incompatible with life. Early fetal and neonatal deaths are influenced by the same proximal characteristics of newborns. Efforts should be directed towards increasing adherence to prenatal consultations in basic health units, with special attention to non-white women. Key Words: Linkage, hospital admissions for obstetric complications, neonatal mortality, fetal mortality

Ozone stomatal flux and O3 concentration-based metrics for Astronium graveolens Jacq., a Brazilian native forest tree species.

The current levels of surface ozone (O3) are high enough to negatively affect trees in large regions of São Paulo State, southeastern Brazil, where standards for the protection of vegetation against the adverse effects of O3 do not exist. We evaluated three O3 metrics - phytotoxic ozone dose (POD), accumulated ozone exposure over the threshold of 40 ppb h (AOT40), and the sum of all hourly average concentrations (SUM00) - for the Brazilian native tropical tree species Astronium graveolens Jacq. We used the DO3SE (Deposition of Ozone for Stomatal Exchange) model and calculated PODY for different thresholds (from 0 to 6 mmol O3 m(-2) PLA s(-1)), evaluating the model's performance through the relationship between measured and modelled conductance. The response parameters were: visible foliar injury, considered as incidence (% injured plants), severity (% injured leaves in relation to the number of leaves on injured plants), and leaf abscission. The model performance was suitable and significant (R(2) = 0.58; p < 0.001). POD0 was better correlated to incidence and leaf abscission, and SUM00 was better correlated to severity. The highest values of O3 concentration-based metrics (AOT40 and SUM00) did not coincide with those of POD0. Further investigation may improve the model and contribute to the proposition of a national standard for the protection of native species.

Tillandsia usneoides: a successful alternative for biomonitoring changes in air quality due to a new highway in São Paulo, Brazil.

Tillandsia usneoides is an aerial epiphytic bromeliad that absorbs water and nutrients directly from the atmosphere by scales covering its surface. We expanded the use of this species as a broader biomonitor based on chemical and structural markers to detect changes in air quality. The usefulness of such comprehensive approach was tested during the construction and opening of a highway (SP-21) in São Paulo State, Brazil. The biomonitoring study was performed from 2009 to 2012, thus comprising the period during construction and after the highway inauguration. Metal accumulation and structural alterations were assessed, in addition to microscopy analyses to understand the metal chelation in plant tissues and to assess the causes of alterations in the number and shape of scale cells. Altogether, our analyses support the use of this species as a wide biomonitor of air quality in urbanized areas.