Orientação a pais por chamadas de áudio durante a pandemia de covid-19 / Support for parents via audio calls during the covid-19 pandemic / Orientación de los padres mediante llamadas de audio durante la pandemia de covid-19

O distanciamento social ocasionado pela pandemia de Covid-19 levou a profundas mudanças na rotina das famílias com crianças pequenas, aumentando o estresse no ambiente doméstico. Este estudo analisou a experiência de planejamento e implementação de um projeto de extensão universitária que ofereceu orientação a pais com filhos de 0 a 11 anos por meio de chamadas de áudio durante a pandemia. O protocolo de atendimento foi desenvolvido para atender às necessidades de famílias de baixa renda e listava problemas específicos relacionados ao confinamento em casa e ao fechamento das escolas seguidos por uma variedade de estratégias de enfrentamento. A análise de 223 queixas relatadas pelos usuários em 130 ligações revelou que 94% dos problemas referidos pelos pais foram contemplados pelo protocolo de atendimento e estavam relacionados aos problemas externalizantes (39%) ou internalizantes (26%) das crianças ou ao declínio do bem-estar subjetivo dos pais (29%). Serviços de apoio devem orientar os pais quanto ao uso de práticas responsivas e assertivas que promovam o bem-estar emocional da criança e estabeleçam expectativas comportamentais em contextos estressantes. A diminuição dos conflitos entre pais e filhos resultante do uso dessas estratégias tende a reduzir o sofrimento dos pais, aumentando sua sensação de bem-estar subjetivo. Recomenda-se ampla divulgação dessas iniciativas e seguimento dos casos.(AU)

The social distancing the COVID-19 pandemic entailed has led to profound changes in the routine of families with young children, increasing stress in the home environment. This study analyzed the experience of planning and implementing a university extension program that offered support to parents with children from 0 to 11 years old via audio calls during the COVID-19 pandemic. The service protocol was developed to meet the needs of low-income families and listed specific problems related to home confinement and school closure followed by a variety of coping strategies. The analysis of 223 complaints reported by users in 130 calls revealed that 94% of the problems reported by parents were addressed by the protocol and were related to children's externalizing (39%) or internalizing (26%) problems or to the decline in parents' subjective well-being (29%). Support services should guide parents on the use of responsive and assertive practices that promote the child's emotional well-being and set behavioral expectations in stressful contexts. The reduction in conflicts between parents and children resulting from the use of these strategies tends to reduce parents' suffering, increasing their sense of subjective well-being. Wide dissemination of these initiatives and case follow-up are recommended.(AU)

La distancia social causada por la pandemia de COVID-19 condujo a cambios profundos en la rutina de las familias con niños pequeños, aumentando el estrés en el entorno del hogar. Este estudio analizó la experiencia de planificar e implementar un proyecto de extensión universitaria que ofreció orientación a los padres con niños de cero a 11 años a través de llamadas de audio durante la pandemia COVID-19. El protocolo de atención se desarrolló para satisfacer las necesidades de las familias de bajos ingresos y enumeró problemas específicos relacionados con el confinamiento en el hogar y el cierre de la escuela, seguido de una variedad de estrategias de afrontamiento. El análisis de 223 quejas informadas por los usuarios en 130 llamadas reveló que el 94% de los problemas informados por los padres fueron abordados por el protocolo de atención y estaban relacionados con los problemas de externalización (39%) o internalización (26%) de los niños o la disminución del bienestar subjetivo de los padres (29%). Los servicios de apoyo deberían aconsejar a los padres sobre el uso de prácticas receptivas y asertivas que promuevan el bienestar emocional del niño y establezcan expectativas de comportamiento en contextos estresantes. La reducción de los conflictos entre padres e hijos como resultado del uso de estas estrategias tiende a reducir el sufrimiento de los padres, aumentando su sensación de bienestar subjetivo. Se recomienda una amplia difusión de estas iniciativas y seguimiento de casos.(AU)

Abordagem de narrativas como método de pesquisa em saúde pública: aproximações conceituais e contribuições da psicanálise / Narrative research in public health: conceptual approximations and contributions from psychoanalysis / Enfoque en narrativas como método de investigación en salud pública: aproximaciones conceptuales y aportaciones del psicoanálisis

Este artigo refere-se à parte de uma pesquisa de doutorado, realizada em hospital de alta complexidade do Sistema Único de Saúde, cujos participantes são os profissionais de saúde. O objetivo deste artigo é analisar o potencial da abordagem das narrativas como método de pesquisa e intervenção nos serviços de saúde, traçando aproximações com a teoria psicanalítica. Sua relevância no campo da Saúde Pública está calcada no reconhecimento do papel do sujeito como agente de mudanças. O texto divide-se em duas partes: na primeira, explora as especificidades do trabalho na área da saúde, o paradigma da saúde pública no que concerne à gestão e possíveis contribuições da clínica ampliada para esse modelo. Na segunda parte, analisa o uso das narrativas como método de pesquisa nesse campo e as aproximações conceituais entre a narrativa em Walter Benjamin e a psicanálise em Freud. Busca na literatura referências sobre experiências análogas que fundamentem a proposta ora realizada e conclui pela importância de, no momento atual, apostar na força germinativa das narrativas como fonte criativa de novas formas de cuidar.(AU)

This article derives from a PhD research conducted with health professionals at a high-complexity public hospital from the Brazilian Unified Health System (SUS). It analyzes the potential of the narrative as a research and intervention method in health services, outlining approximations with psychoanalysis. In the field of Public Health, the narrative approach acknowledges the individual as an agent of change. The text is divided into two parts. The first presents an overview of the peculiarities involved in healthcare, the Public Health paradigm regarding service management and possible contributions from the expanded clinic to this model. The second analyzes the use of narratives as a research method in this field and the conceptual approximations between Benjamin's narrative and Freud's psychoanalysis. It searches the literature for references on similar experiences to support the present proposal and concludes by highlighting the importance of betting on the creative power of narratives as a source for new ways to care.(AU)

Este artículo es parte de una investigación doctoral, realizada con los profesionales de la salud de un hospital de alta complejidad del Sistema Único de Salud de Brasil. Su propósito es analizar el potencial del enfoque en narrativas como método de investigación e intervención en los servicios de salud, esbozando aproximaciones entre las narrativas y la teoría del psicoanálisis. Su relevancia en el campo de la salud pública se basa en el reconocimiento del rol del sujeto como agente de cambio. El texto se divide en dos partes: La primera investiga las especificidades del trabajo en el área de la salud, el paradigma de la salud pública en la gestión de los servicios y las posibles contribuciones de la clínica ampliada a este modelo. En la segunda parte, analiza el uso de narrativas como método de investigación en este campo y las aproximaciones conceptuales entre la narrativa de Walter Benjamin y el psicoanálisis de Freud. Este estudio busca en la literatura referencias sobre experiencias similares que apoyen la propuesta ahora realizada y concluye con la importancia de, en el momento actual, apostar por el poder de las narrativas como fuente creadora de nuevas formas de cuidar.(AU)

Economic estimation of Bitcoin mining's climate damages demonstrates closer resemblance to digital crude than digital gold.

This paper provides economic estimates of the energy-related climate damages of mining Bitcoin (BTC), the dominant proof-of-work cryptocurrency. We provide three sustainability criteria for signaling when the climate damages may be unsustainable. BTC mining fails all three. We find that for 2016-2021: (i) per coin climate damages from BTC were increasing, rather than decreasing with industry maturation; (ii) during certain time periods, BTC climate damages exceed the price of each coin created; (iii) on average, each $1 in BTC market value created was responsible for $0.35 in global climate damages, which as a share of market value is in the range between beef production and crude oil burned as gasoline, and an order-of-magnitude higher than wind and solar power. Taken together, these results represent a set of sustainability red flags. While proponents have offered BTC as representing "digital gold," from a climate damages perspective it operates more like "digital crude".

An integrated data framework for policy guidance during the coronavirus pandemic: Towards real-time decision support for economic policymakers.

Usually, official and survey-based statistics guide policymakers in their choice of response instruments to economic crises. However, in an early phase, after a sudden and unforeseen shock has caused unexpected and fast-changing dynamics, data from traditional statistics are only available with non-negligible time delays. This leaves policymakers uncertain about how to most effectively manage their economic countermeasures to support businesses, especially when they need to respond quickly, as in the COVID-19 pandemic. Given this information deficit, we propose a framework that guided policymakers throughout all stages of this unforeseen economic shock by providing timely and reliable sources of firm-level data as a basis to make informed policy decisions. We do so by combining early stage 'ad hoc' web analyses, 'follow-up' business surveys, and 'retrospective' analyses of firm outcomes. A particular focus of our framework is on assessing the early effects of the pandemic, using highly dynamic and large-scale data from corporate websites. Most notably, we show that textual references to the coronavirus pandemic published on a large sample of company websites and state-of-the-art text analysis methods allowed to capture the heterogeneity of the pandemic's effects at a very early stage and entailed a leading indication on later movements in firm credit ratings. While the proposed framework is specific to the COVID-19 pandemic, the integration of results obtained from real-time online sources in the design of subsequent surveys and their value in forecasting firm-level outcomes typically targeted by policy measures, is a first step towards a more timely and holistic approach for policy guidance in times of economic shocks.

Estimation of Utility Values for Computing Quality-adjusted Life Years Associated With Homelessness.

BACKGROUND: There is a lack of data-driven evidence about the burden of homelessness, and lack of a holistic measure of effectiveness for evaluating interventions targeting homelessness. Quality-adjusted life years (QALYs) can help holistically capture the burden of homelessness, and facilitate the valuation and comparison of interventions designed to address homelessness. OBJECTIVE: This study estimated utility values required to compute the QALYs associated with homelessness, and also examined individual-level characteristics that affect these values. RESEARCH DESIGN: The study is cross-sectional and derived from a large national survey conducted during the coronavirus disease 2019 pandemic. SUBJECTS: A sample of 6607 middle- and low-income adults in the United States. MEASURES: A self-completion standard gamble survey was used to estimate utility values associated with homelessness. Linear regression was used to analyze the association between individual-level characteristics and these utility values. RESULTS: The study estimated the average utility value associated with homelessness as 43.4% among the study participants. This implies that 1 year of life as a homeless individual is perceived to be equivalent to less than half a year of life as a stably housed individual in good health. The study also found that individuals who have experienced homelessness and financial distress value life as a homeless person considerably less than those who have not had these experiences. CONCLUSIONS: The method developed in this study can be used to estimate QALYs in studies evaluating homelessness interventions, thereby establishing the societal value of these interventions and informing policy and budgetary decision-making. Future studies estimating the utility values associated with homelessness in the general population, as well as specific homeless groups, are required to provide more generalizable evidence.

Systematic framework to assess social impacts of sharing platforms: Synthesising literature and stakeholder perspectives to arrive at a framework and practice-oriented tool.

(1) BACKGROUND: Research and user experience suggests both positive and negative social impacts resulting from practices in the sharing economy: social cohesion vs. gentrification; inclusiveness vs. discrimination; flexible employment vs. exploitation. However, as yet, there is no framework for understanding or assessing these social impacts holistically. (2) OBJECTIVE: We aim to improve understanding of the social impacts of sharing platforms and develop a systematic framework to assess these impacts. (3) METHODS: We conduct a narrative literature review and stakeholder workshop, integrating insights to produce a systematic social impact assessment framework and a practice-oriented tool. (4) RESULTS: We identify four social aspects-trust, empowerment, social justice, and inclusivity-and eighteen indicators that make up the framework. We describe each indicator and its relevance to the sharing economy as well as suggest measurable variables in the form of a practice-oriented tool. (5) CONCLUSIONS: The framework and tool are the first holistic method for assessing social impact in the sharing economy, which may inform researchers, sharing platforms, regulators, investors, and citizens to mitigate adverse social impacts while enhancing the overall net social value of the sharing economy.

Moedas complementares digitais e políticas públicas durante a crise da COVID-19 / Monedas complementarias digitales y políticas públicas durante la crisis de COVID-19 / Digital complementary currencies and public policies during the COVID-19 pandemic

Resumo Programas de renda básica têm sido utilizados em todo o mundo como uma ferramenta para mitigar os efeitos adversos da crise da COVID-19. No Brasil, a implementação de iniciativas federais de renda básica emergencial (RBE) enfrenta um duplo desafio: a logística de distribuição de dinheiro e os critérios de elegibilidade dos cidadãos. No entanto, iniciativas de moedas complementares existem há muitos anos no Brasil, estando associadas especialmente aos bancos comunitários, os quais operam no nível local e possuem conhecimento mais aprofundado sobre as necessidades dos moradores. Este artigo analisa o uso de moedas digitais complementares no enfrentamento de desafios de distribuição de renda. Apresentamos o caso da moeda complementar digital Mumbuca E-Dinheiro, adotada pelo município de Maricá (RJ). Discutimos como esta iniciativa permitiu a distribuição de renda de forma rápida e segura com o objetivo de mitigar os efeitos da pandemia da COVID-19 no Brasil. Sugerimos que, no momento atual, a RBE poderia ser paga através do E-dinheiro, começando pelos municípios nos quais ele já atua e depois se expandindo para os demais. A interoperabilidade com outros atores do ecossistema de pagamentos e articulações com governos locais são medidas adicionais para dar escala ao uso das moedas complementares digitais no combate à crise do coronavírus.

Resumen Los programas de ingresos básicos se han utilizado en todo el mundo como una herramienta para mitigar los efectos adversos de la crisis de COVID-19. En Brasil, la implementación de iniciativas federales de ingresos básicos de emergencia enfrenta un doble desafío: la logística de distribución de dinero y los criterios de elegibilidad de los ciudadanos. Las iniciativas monetarias complementarias han existido en Brasil durante muchos años y están asociadas especialmente con bancos comunitarios, instituciones que operan a nivel local y tienen un conocimiento más profundo sobre las necesidades de los residentes. Este artículo examina el uso de monedas complementarias digitales para enfrentar los desafíos de distribución de ingresos. Presentamos el caso de la moneda complementaria digital Mumbuca E-Dinheiro adoptada por el municipio de Maricá (RJ) y discutimos cómo esta iniciativa permitió la distribución de ingresos de manera rápida y segura para mitigar los efectos de la pandemia de COVID-19 en Brasil. Sugerimos que, en el momento actual, los ingresos básicos de emergencia podrían pagarse a través de la plataforma E-Dinheiro, comenzando por los municipios en que esta plataforma ya opera y luego expandiéndose a los demás. La interoperabilidad con otros actores del ecosistema de pagos y los vínculos con los gobiernos locales son medidas adicionales para ampliar el uso de monedas complementarias digitales en la lucha contra la crisis del coronavirus.

Abstract Basic income programs have been used worldwide as a tool to mitigate the adverse effects of the COVID-19 pandemic. In Brazil, the implementation of federal emergency basic income initiatives faces a twofold challenge: money distribution logistics and eligibility criteria. This paper analyses the use of digital complementary currencies (DCC) to face these challenges. Complementary currencies have long existed in Brazil as part of community banks. The latter are institutions that operate at the local level and have better information regarding residents' needs. We present the case of Mumbuca E-Dinheiro, a DCC adopted by the municipality of Maricá (RJ), and discuss how this initiative has enabled quick and safe cash distribution aimed at mitigating the effects of the COVID-19 pandemic in Brazil. We suggest that, at present, basic emergency income could be distributed through the E-Dinheiro platform, starting with the municipalities in which it already operates and then expanding to others. Interoperability with other actors in the payment ecosystem and connections with local governments are additional actions to scale up the use of digital complementary currencies to combat the coronavirus crisis.

Evaluación de la calidad microbiológica de productos naturales procesados de uso medicinal comercializados en Quito, Ecuador / Evaluation of the microbiological quality of natural processed products for medicinal use marketed in Quito, Ecuador

RESUMEN Objetivos: Determinar la calidad microbiológica de una muestra de productos naturales procesados de uso medicinal de libre comercio en Quito, Ecuador. Materiales y métodos: 83 productos se sometieron a recuentos de microorganismos aerobios, mohos y levaduras por técnicas convencionales estandarizadas, de acuerdo a la Farmacopea de los Estados Unidos (USP, por sus siglas en inglés). Se identificaron los microorganismos presentes y se determinó su sensibilidad antimicrobiana usando el método de difusión en agar. Resultados: El 17,0% de los jarabes, el 27,0% de los productos tópicos y el 43,0% de los sólidos orales excedieron los límites especificados para el recuento total de microorganismos aerobios, mientras que el 33,0% de los jarabes, el 7,0% de los productos tópicos y el 36,0% de los sólidos orales excedieron el límite para mohos y levaduras. Los productos de uso ocular no pasaron la prueba de esterilidad. El género bacteriano más frecuentemente aislado fue Bacillus, seguido por Escherichia coli, Klebsiella y Enterobacter. Salmonella ni Staphylococcus aureus se encontraron en ningún producto, pero microorganismos potencialmente patógenos como Pseudomonas se aislaron en el 40,0% de los colirios. Enterobacter y Escherichia coli mostraron resistencia a múltiples compuestos y Pseudomonas no fue resistente a ningún antibiótico. Conclusiones: La calidad microbiológica de los productos examinados no fue adecuada. Se aislaron microorganismos potencialmente patógenos y resistentes a antibióticos. Estos productos podrían no ser aptos para su distribución y consumo, aun cuando muchos de ellos cuenten con registro sanitario. El control y regulación por los entes responsables es indispensable.

ABSTRACT Objectives: To determine the microbiological quality of samples from processed natural products used for medicinal purposes and marketed in Quito, Ecuador. Materials and methods: Aerobic microorganisms, molds and yeasts were counted by conventional standardized techniques, according to the United States Pharmacopoeia (USP), in samples from 83 products. The microorganisms found were identified and their antimicrobial sensitivity was determined using the agar diffusion method. Results: The total aerobic microorganism count exceeded the specified limits in 17.0% of syrups, 27.0% of topical products and 43.0% of oral solids; the molds and yeasts count exceeded the limit in 33.0% of syrups, 7.0% of topical products and 36.0% of oral solids. Products for eye use did not pass the sterility test. The most frequently isolated bacterial genus was Bacillus, followed by Escherichia coli, Klebsiella and Enterobacter. Salmonella and Staphylococcus aureus were not found in any product, but potentially pathogenic microorganisms such as Pseudomonas were isolated in 40.0% of the eye drops. Enterobacter and Escherichia coli showed resistance to multiple compounds and Pseudomonas was not resistant to any antibiotic. Conclusions: The microbiological quality of the products examined was not adequate. Potentially pathogenic and antibiotic resistant microorganisms were isolated from the samples. These products may not be suitable for distribution and consumption, even though many of them have sanitary registration. Control and regulation by the corresponding authorities is essential.

Randomized control trial of ultrasound-guided erector spinae block versus shoulder periarticular anesthetic infiltration for pain control after arthroscopic shoulder surgery: Study protocol clinical trial (SPIRIT compliant).

INTRODUCTION: Moderate to severe postoperative pain and associated opioid use may interfere with patients' well-being and course of recovery. Regional anesthetic techniques provide an opportunity for opioid sparing and improved patient outcomes. A new regional technique called the erector spinae plane (ESP) block has the potential to provide effective analgesia after shoulder arthroscopy with minimal risks and decreased opioid consumption. Our primary objective is to determine whether, in patients who undergo arthroscopic shoulder surgery, a preoperative ESP block reduces pain scores as compared to periarticular infiltration at the end of surgery. Additionally, we will also examine other factors such as opioid consumption, sensory block, adverse events, patient satisfaction, and persistent pain. METHODS: This is a 2-arm, single-center, parallel-design, double-blind randomized controlled trial of 60 patients undergoing arthroscopic shoulder surgery. Eligible patients will be recruited in the preoperative clinic. Using a computer-generated randomization, with a 1:1 allocation ratio, patients will be randomized to either the ESP or periarticular infiltration group. Patients will be followed in hospital in the postanesthesia care unit, at 24 hours, and at 1 month. The study with be analyzed as intention-to-treat. DISCUSSION: This study will inform an evidence-based choice in recommending ESP block for shoulder arthroscopy, as well as providing safety data. The merits of the study include its double dummy blinding to minimize observer bias, and its assessment of patient important outcomes, including pain scores, opioid consumption, and patient satisfaction. This study will also help provide an estimate of the incidence of side effects and complications of the ESP block. TRIAL REGISTRATION NUMBER: NCT03691922; Recruited Date of registration: October 2, 2018.

Metacognitive Octonion-Valued Neural Networks as They Relate to Time Series Analysis.

In this paper, a metacognitive octonion-valued neural network (Mc-OVNN) learning algorithm and its application to diverse time series prediction are presented. The Mc-OVNN is comprised of two components: the octonion-valued neural network that represents the cognitive component and the metacognitive component that serves to self-regulate the learning algorithm. At each epoch, the metacognitive component decides if, how, and when learning occurs. The algorithm deletes unneeded samples and only stores those that will be used. This decision is determined by the octonion magnitude and the seven phases. To evaluate the Mc-OVNN algorithm's performance, it is applied to five real-world forecasting problems: the power consumption of a home in Honolulu, HI, USA, Box and Jenkins J series, Euro to Algerian Dinar (DZ) real-time conversion rates, the Mackey-Glass equation, and Europe Brent oil price prediction in a time series. When comparing the Mc-OVNN to other relevant techniques, Mc-OVNN displays its capability for efficient time series prediction. The real-time evaluation of the proposed algorithm is presented using the power consumption of a home in Boumerdès, Algeria, as a case study.

Potencial impacto financeiro às famílias na adoção das recomendações do Guia Alimentar para a População Brasileira / Potential financial impact on families in adopting the Brazilian Dietary Guidelines

Introdução: A adesão de um padrão alimentar não saudável pela população depende não só das características individuais (como psicológicas e sociais), mas também de características ambientais, que envolvem desde a acessibilidade ao local de compra e a disponibilidade do alimento, ate a exposição desse alimento nas mídias, e principalmente, suas políticas de preço. Considerando esse padrão não saudável como o principal determinante da epidemia de obesidade e de doenças crônicas não transmissíveis, o atual Guia Alimentar para a População Brasileira recomenda priorizar o consumo de alimentos frescos (não processados ou minimamente processados) e evitar alimentos ultraprocessados do cotidiano da população. Entretanto, ainda não está claro se o cenário econômico brasileiro favorece essas recomendações e a adoção de uma dieta saudável. Objetivo: Analisar os aspectos econômicos relacionados à adoção das recomendações do Guia Alimentar para a População Brasileira. Metodologia: Trata-se de um trabalho ecológico com delineamento misto, envolvendo estudo de série temporal e estudos transversais. Dados da Pesquisa de Orçamentos Familiares (POF 2008/09) e do Sistema Nacional de Índices de Preços ao Consumidor (SNIPC), além do sistema de classificação de alimentos NOVA utilizado no Guia Alimentar para a População Brasileira, foram utilizados. No manuscrito 01, dietas isoenergéticas (2.000 kcal) foram otimizadas por modelos de programação linear no intuito de analisar o impacto econômico das recomendações do Guia no custo atual da dieta. Os modelos foram identificados não só ao atender as recomendações do Guia Alimentar (considerando a participação dos grupos alimentares) e preservar ao máximo a composição alimentar atual, mas também ao respeitar as restrições nutricionais (baseadas em recomendações internacionais) e os limites de aceitação alimentar na população. O impacto do Guia Alimentar foi analisado comparando-se o custo das dietas otimizadas com o da dieta atual, para a população total e de acordo com o nível de renda. No manuscrito 02, um índice de inadequação da composição dietética (IICD) foi calculado no intuito de analisar a influência do preço dos alimentos sobre a composição alimentar da dieta dos brasileiros. O IACD foi calculado a partir da participação (%) dos grupos de alimentos classificados no Guia, indicando a diferença na composição alimentar da dieta atual e da dieta recomendada (esta identificada no manuscrito 01). A influência do preço dos alimentos no IICD foi analisada por meio do modelo de regressão log-log. O modelo final foi ajustado por renda (R$) e características sociodemográficas. Todos os modelos foram desenvolvidos para a população total e de acordo com o nível de renda. No manuscrito 03, a série de preço real (R$/kg) dos alimentos mais consumidos no país (n=102) foi calculada no intuito de analisar a mudança do preço de grupos alimentares ao longo do tempo no Brasil. Dados sobre preço de alimentos e bebidas da POF 2008/09 foram utilizados para calcular o preço real ao longo do tempo (de janeiro de 1995 até dezembro de 2017), usando a variação mensal dos preços do SNIPC. O preço mensal médio de cada grupo e subgrupo alimentar foram calculados considerando a quantidade adquirida de cada produto. Modelos polinomiais fracionários foram empregados para sintetizar as mudanças dos preços, e para estimar o preço de cada grupo e subgrupo até dezembro de 2030. Resultados: No manuscrito 01, o custo atual da dieta foi de R$3,37, menor entre as famílias de baixa renda (R$2,62) e maior entre as famílias de alta renda (R$4,17). Independentemente do nível de renda familiar, o custo da dieta e a parcela do orçamento alimentar foram diminuindo de forma gradativa ao atender as recomendações do Guia. Ainda assim, as famílias de baixa renda comprometem o orçamento duas vezes mais que as famílias de alta renda (20,20% vs 7,96%). No manuscrito 02, alimentos ultraprocessados responderam por 18,3% da dieta atual, enquanto alimentos não processados e minimamente processados responderam por pouco menos da metade das calorias. A otimização sugere valores para esses grupos de 9,1% e 69,4%, respectivamente, na dieta recomendada. Um aumento de 1,00% no preço de alimentos não processados ou minimamente processados aumentou o IICD em 0,76% (dieta menos saudável), enquanto um aumento de 1,00% no preço de alimentos ultraprocessados diminuiu o IICD em 0,70% (dieta saudável). A associação inversa entre preço de alimentos ultraprocessados e IICD permaneceu significativa apenas entre os estratos de baixa renda (-1,11%; p <0,05). No manuscrito 03, o grupo de alimentos ultraprocessados foi o mais caro (R$6,51/Kg), seguido pelos grupos de alimentos processados (R$6,44/Kg), e de alimentos não processados ou minimamente processados e ingredientes culinários processados (R$3,45/Kg) em 1995. Desde o início dos anos 2000, o preço dos alimentos ultraprocessados passou por sucessivas reduções, ficando mais baratos que os alimentos processados e reduzindo a distância entre eles e o preço do outro grupo. As previsões indicaram que alimentos não saudáveis se tornarão mais baratos que alimentos saudáveis em 2026. Conclusão: A adoção de práticas alimentares mais saudáveis ainda pode ser realizada com o mesmo ou menor orçamento da dieta atual. Entretanto, se nada for feito, o preço dos alimentos no Brasil mudarão desfavoravelmente considerando as recomendações do Guia Alimentar para a População Brasileira. A tributação de alimentos ultraprocessados e subsídios para alimentos não processados ou minimamente processados são alternativas para favorecer a adoção das recomendações do Guia Alimentar e melhorar a composição da dieta dos brasileiros.

Introduction: Adherence to an unhealthy dietary pattern by the population depends not only on individual characteristics (such as psychological and social), but also on environmental characteristics, which range from accessibility to the place of purchase and availability of food, to the exposure of this food in the media, and mainly, its price policies. Considering this unhealthy pattern as the main determinant of the obesity epidemic and non-communicable diseases, the current Brazilian Dietary Guidelines recommends prioritizing the consumption of fresh foods (unprocessed or minimally processed) and avoiding ultra-processed foods from the population's daily life. However, it is still unclear whether the Brazilian economic scenario favors these recommendations and the adoption of a healthy diet. Objective: To analyze the economic aspect related to the adoption of the Brazilian Dietary Guidelines. Methodology: It is an ecological work with a mixed design, involving a time series study and cross-sectional studies. Data from the Household Budget Survey (2008/09 HBS) and from the National System of Consumer Price Indexes (NSCPI), besides that NOVA food classification system used in the Brazilian Dietary Guidelines, were used. In manuscript 01, isoenergetic diets (2,000 kcal) were optimized by linear programming models in order to analyze the economic impact of the Brazilian Dietary Guidelines on current diet cost. The models were identified according to Brazilian Dietary Guidelines (considering the share (%) of food groups) and in order to preserve current diet, beside that to respect nutritional constrains (based on international recommendations) and food acceptance limits (obtained direct in the studied population). The impact of the Brazilian Dietary Guidelines was analyzed by comparing the cost of optimized diets with that of the current diet, for the total population and according to income level. In manuscript 02, a Dietary Composition Inadequacy Index (DCII) was calculated in order to analyze the influence of food prices on the dietary composition from Brazilians. The DCII was calculated from the share (%) of the food groups according to NOVA, indicating the difference in the food composition of the current diet and the recommended diet (this identified in manuscript 01). The influence of food prices on the DCII was analyzed using the log-log regression model. The final model was adjusted by income (R$) and sociodemographic characteristics. All models were developed for the total population and according to income level. In manuscript 03, the series of real prices (R$/kg) of the most consumed foods in the country (n = 102) was calculated in order to measure change in price of food groups over time in Brazil. Data on price of foods and beverages from 2008/09 HBS were used to calculate real price over time (from January 1995 to December 2017), using the monthly variation in prices from NSCPI. The average monthly price of each group and subgroup were calculated considering the quantity purchased of each product. Fractional polynomial models were used to synthesize price changes, and to estimate the price of each group and subgroup by December 2030. Results: In manuscript 01, current diet cost was R$3.37, lower among low-income families (R$2.62) and higher among high-income families (R$4.17). Regardless of income, diet cost and budget compromise decreased when approaching the Guidelines. Even so, the low-income families compromised the budget twice as much as high-income families (20.20% vs 7.96%). In manuscript 02, ultra-processed foods responded for 18.3% of the current diet, while unprocessed and minimally processed foods responded for slightly less than half of the calories. The optimization suggests values for these groups of 9.1% and 69.4%, respectively, in the recommended diet. A 1.00% increase in the price of unprocessed or minimally processed food increased the DCII by 0.76% (less healthy diet), while a 1.00% increase in the price of ultra-processed food decreased the DCII by 0.70 % (healthy diet). The inverse association between the price of ultra-processed foods and DCII remained significant only among the low-income strata (-1.11%; p <0.05). In manuscript 03, the group of ultra-processed foods was the most expensive (R$6.51/Kg), followed by the groups of processed foods (R$6.44/Kg), and of unprocessed or minimally processed foods and processed culinary ingredients (R$3.45/kg) in 1995. Since the early 2000s, the price of ultra-processed foods underwent successive reductions, becoming cheaper than processed foods and reducing the distance between it and the price of the other group. Predictions indicated that unhealthy foods will become cheaper than healthy foods in 2026. Conclusion: The adoption of healthier eating practices can still be performed with the same or lower budget than the current diet. However, if nothing is done, the food prices in Brazil will change unfavorably considering the Brazilian Dietary Guidelines recommendations. Taxation of ultra-processed foods and subsidies for unprocessed or minimally processed foods are alternatives to favor the adoption of the Brazilian Dietary Guideline and to improve the dietary composition of the Brazilians.

Budget Impact of Treatment-Free Remission in Treating Chronic-Phase Philadelphia-Positive Chronic Myeloid Leukemia in Lebanon.

PURPOSE: Chronic myeloid leukemia (CML) ranks second in terms of disease-related health care expenditures at the Lebanese Ministry of Public Health (MoPH) after breast cancer. With the introduction of tyrosine kinase inhibitors (TKIs), survival of patients with CML has dramatically improved and approached that of the normal population. In recent years, several studies demonstrated that patients who achieve a deep molecular response while receiving TKI therapy could safely attempt treatment-free remission (TFR), the new treatment goal in patients with CML. The objective is to estimate the budget impact of TFR at the MoPH. METHODS: Analyses were done on 162 patients with CML receiving imatinib, nilotinib, or dasatinib, as first-line or second-line therapy, over a 4-year time horizon using MoPH drug pricing. The model assumed that patients could attempt TFR after 36 months of TKI therapy, where the last 24 months were at stable molecular response as per MoPH and National Comprehensive Cancer Network guidelines. Duration of TFR was based on European Stop Kinase Inhibitor treatment-free survival curve. RESULTS: Out of the 162 patients, 83 were eligible to attempt TFR, 36 patients were not eligible, 32 patients were lost to follow-up, two patients died as a result of CML progression, and five died as a result of other causes. The total cost of CML treatment with TFR from the time of analysis and over 4 years can be reduced by more than 7 million US dollars (57%). CONCLUSION: The model can be used to inform health care decision makers on the importance of TFR and the potential savings.

Effect of rumen-protected branched-chain amino acid supplementation on production- and energy-related metabolites during the first 35 days in milk in Holstein dairy cows.

Essential AA are critical for multiple physiological processes. Branched-chain AA (BCAA) supplementation has beneficial effects on body weight, lipogenesis, and insulin resistance in several species. The BCAA are used for milk and body protein synthesis as well as being oxidized by the tricarboxylic acid cycle to produce ATP during catabolic states. The objective was to evaluate the effect of rumen-protected BCAA (375 g of 27% l-Leu, 85 g of 48% l-Ile, and 91 g of 67% l-Val) with or without propylene glycol (PG) oral administration on milk production, dry matter intake, nonesterified fatty acids, ß-hydroxybutyrate, and plasma urea nitrogen during the first 35 d in milk (DIM) in dairy cattle. Multiparous Holstein cows were enrolled in blocks of three 28 d before expected calving and assigned randomly to either the control or 1 of 2 treatments. The control (n = 26) received 200 g/d of dry molasses, the BCAA treatment (n = 23) received BCAA mixed with 200 g/d of dry molasses from calving until 35 DIM, and the BCAA plus PG (BCAAPG) treatment (n = 25) received BCAA mixed with 200 g/d of dry molasses from calving until 35 DIM plus 300 mL of PG once daily from calving until 7 DIM. Postpartum, dry matter intake least squares means (LSM; 95% confidence interval) were 20.7 (19.9, 21.7), 21.3 (20.4, 22.3), and 21.9 (20.9, 22.8) kg for control, BCAA, and BCAAPG, respectively. Milk yield (1-35 DIM) LSM were 41.7 (39.4, 44.0), 42.7 (40.3, 45.0), and 43.7 (41.4, 46.0) kg for control, BCAA, and BCAAPG, respectively. Energy-corrected milk LSM were 50.3 (46.8, 53.7), 52.4 (48.9, 55.8), and 52.9 (49.5, 56.4) kg for control, BCAA, and BCAAPG, respectively. Milk urea nitrogen LSM in milk for control, BCAA, and BCAAPG were 8.60 (8.02, 9.22), 9.70 (9.01, 10.45), and 9.75 (9.08, 10.47) mg/dL. Plasma urea nitrogen concentrations LSM for control, BCAA, and BCAAPG were 8.3 (7.7, 8.9), 10.1 (9.4, 10.9), and 9.6 (9.4, 10.3) mg/dL, respectively. The numbers of plasma samples classified as hyperketonemia were 77, 44, and 57 in control, BCAA, and BCAAPG, respectively. The BCAA supplementation increased plasma urea nitrogen and milk urea nitrogen, free valine concentration in plasma, and decreased hyperketonemia events during the postpartum period.

Cuidados paliativos domiciliares: revisão integrativa / Home palliative care: integrative review

Objective:To analyze national and international scientific productions that present daily experiences of care provided by caregivers and health professionals in home palliative care. Method:This is an integrative review of Lilacs, CINAHL, PubMed, IBECS, BDENF and ColecionaSUS databases of articles published between January 2005 and March 2019. The final sample of articles analyzed was composed of 42 articles. Results:The studies evidenced feelings of family caregivers such as fear, anguish, overload and gratitude in the daily care of the sick person; the main difficulties experienced relate to access to support services, the buying of medicines by care providers and the use of strategies for the effectiveness of home palliative care. Conclusion:The analysis showed that there is a need for the construction of comprehensive care for patients and caregivers, the production of evidence about the professional practices provided to this public, better organization of the support network and access to medicines.

Objetivo: Analisar produções científicas nacionais e internacionais que apresentam vivências do cotidiano de cuidados prestados pelos cuidadores e profissionais de saúde nos cuidados paliativos domiciliares. Método:Trata-se de uma revisão integrativa nas bases de dados Lilacs, CINAHL, PubMed, IBECS, BDENF e ColecionaSUS de artigos publicados entre janeiro de 2005 a março de 2019. A amostra final de artigos analisados foi composta de42 artigos. Resultados:Os estudos evidenciaramsentimentosdos cuidadores de familiares como o medo, angústia, sobrecarga e gratidão no cotidiano de cuidados ao ente adoecido;as principais dificuldadesvivenciadas referem-se ao acesso a serviços de apoio,à aquisição de medicamentos pelos prestadores de assistência bem como ao uso de estratégias para a eficácia dos cuidados paliativos domiciliares.Conclusão:A análise evidenciou que há necessidade de construção de cuidado integral a pacientes e cuidadores, produção de evidências sobre as práticas profissionais dispensadas a este público, melhor organização da rede de apoio e acesso a medicamentos.

A breakthrough in the artificial cultivation of Chinese cordyceps on a large-scale and its impact on science, the economy, and industry.

Chinese cordyceps, an entity of the Chinese caterpillar fungus (Ophiocordyceps sinensis, syn. Cordyceps sinensis) that parasitizes ghost moth larvae, is one of the best known traditional Chinese medicines and is found exclusively on the Tibetan Plateau with limited natural resources. Although the fungus O. sinensis can grow on artificial substrates and the ghost moth has been successfully reared, the large-scale artificial cultivation of Chinese cordyceps has only recently been accomplished after several decades of efforts and attempts. In this article, research progress related to this breakthrough from living habitats, the life history of the fungus, its host insect, fungal isolation and culture, host larvae rearing, infection cycle of the fungus to the host, primordium induction, and fruiting body development have been reviewed. An understanding of the basic biology of O. sinensis, its host insect and the simulation of the Tibetan alpine environment resulted in the success of artificial cultivation on a large scale. Practical workshop production has reached annual yields of 2.5, 5, and 10 tons in 2014, 2015, and 2016, respectively. There was no difference in the chemical components detected between the cultivated and natural Chinese cordyceps. However, the artificial cultivation system can be controlled to avoid heavy metal contamination and results in high-quality products. Although omics studies, including genomic, transcriptomic, proteomic, and metabolomic studies, have helped to understand the biology of the fungus, the success of the artificial cultivation of the Chinese cordyceps is clearly a milestone and provides the possibility for research on the in-depth mechanisms of the interaction between the fungus and host insects and their adaptation to the harsh habitats. This cultivation will not only result in a large industry to alleviate the pressure of human demand but also protect the limited natural resources for sustainable utilization.

Investigation and application of Dendrobium resources in Qinba Mountains with a discussion on industrial poverty alleviation model / 中国中药杂志

The Dendrobium species are rare and endangered medicinal plants, and it is difficult to investigate their wild resources with conventional methods because of typical epiphytic herbaceous. We explored Dendrobium resources(include culture resource) of Qinba Mountains and the boundary Mountain area in Hubei, Chongqing using the methods of literatures and field investigation, and found that the cultural base of Dendrobium were profound in Qinba Mountains region. Furthermore, its germplasm resources of Dendrobium were established for the first time in Wanzhou Luotian town. In case the advantages of local rock resources and poverty alleviation demand, we have actively carried out the cultivating mode of Dendrobium which grow on rock, and the poverty alleviation model of local characteristic Dendrobium industry were established preliminarily. Our application case can provide reference for the mining and transformation of traditional Chinese medicine resources census results.

Research on competitiveness of traditional Chinese medicine industry's international trade based on diamond theory / 中国中药杂志

China has a long history of the international trade of traditional Chinese medicine(TCM).And the export products mainly composed of Chinese herbal medicine and its extracts with Chinese patent herbal medicine and health care products as complementary items.The international trade of TCM faces problems of structural disequilibrium in export products and trade barriers.In this study,we used Michael Porter's diamond model to analyze the international competitiveness of TCM industry.We found that TCM industry in China was rich in production factors and broad in market demands,but lack of the related and supporting industries.In addition,compared with the herbal medicine manufacturers in European,American and Japanese,enterprises in China were weaker in the strategy making,market positioning and industry competing.The development of the international market of herbal medicine,the arrival of the aging society,and the introduced policies of the TCM,provide great opportunities for TCM industry' s development.In order to improve the competitiveness of the TCM industry,we propose to increase the international recognition of TCM by developing clinical study,cope with international trade barrier by strengthen international standardization research,and improve the competitiveness of TCM industry by economies of scale formed by the accumulation of the pharmaceutical industry.

Decision-making experiences of patients with end-stage kidney disease (ESKD) regarding treatment in Ghana: a qualitative study.

BACKGROUND: This is the first qualitative study to explore patient decision-making regarding end-stage kidney disease (ESKD) treatment in sub-Saharan Africa. The study addresses an important gap in the literature concerning choice and decision-making in an international context. METHODS: The study employed a qualitative research design, using grounded theory methodology. In-depth interviews were conducted with twenty-two adult patients with ESKD in 3 clinical settings in Ghana. Data analysis involved coding and a constant comparative approach to generate key themes. Ethical approval was gained from relevant ethics committees both in Ghana and the United Kingdom. RESULTS: Four main factors (personal, financial, healthcare system, and support network) were identified to influence patient decision-making regarding ESKD treatment in Ghana. Treatment was initiated for various reasons, including, initially, the urgent need to avoid premature death. Many approached their condition hoping for a cure and did not always understand the chronic nature of their condition. Financial and geographical inaccessibility of renal replacement therapy (RRT), as well as a relative lack of biomedical treatment choices, made decision making daunting for the individual with ESKD in Ghana. The subject of death or conservative management was not openly discussed. Rather patients did everything possible to seek alternative forms of treatment, including the simultaneous use of other non-RRT and traditional or faith-based healing approaches. CONCLUSIONS: Whilst similarities exist, this study illuminates stark cultural and contextual differences which make decision-making on ESKD treatment a daunting experience for the individual with ESKD in Ghana - as compared to those in high-income countries. The challenges associated with ESKD management in Ghana calls for meticulous efforts at primary prevention of the disease, including interventions directed at effective management of diabetes mellitus, hypertension and other chronic kidney disease (CKD) precursor conditions. Enhancing information provision would promote informed decision making, particularly within the initial stages of patient decision-making.