A systematic literature review on corporate sustainability: contributions, barriers, innovations and future possibilities.

This paper aims to understand the current research scenario through published studies on corporate sustainability, emphasizing the environmental approach. Methodologically, this research develops a systematic literature review based on papers published in the Web of Science database in the last ten years. As a result, there was an upward evolution of research on the searched topic, with one hundred fifteen publications in the last three years compared to one hundred six documents published in the previous seven years. It is also observed that studies published at the beginning of the time frame between 2011 and 2020 were more concerned with the adoption of corporate sustainability, while the most recent research focuses on new approaches and methodologies for its implementation. And, with regard to its implementation, one of the main barriers is the incorrect perception of senior managers that the results from corporate sustainability must be more linked to the economic than to the environmental and social spheres. As relevant aspects, this study observed that new technologies, currently led by the 5th generation mobile network (5G) and Fourth Industrial Revolution (Industry 4.0), can contribute to the insertion of corporate sustainability in the industrial context. It also noted that, despite being recent, COVID-19 was considered by several researchers as an event to be considered in terms of corporate sustainability.

Proteinuria in early referral to spectral domain optical coherence tomography for macular edema detection in type 2 diabetes individuals: results from the Brazilian diabetes study.

BACKGROUND: Measurement of retinal thickness by optical coherence tomography (OCT) shows higher diagnostic accuracy for diabetic macular edema (DME) than fundus photography alone. The expanding gap between the rising number of type 2 diabetes (T2D) individuals and the availability of OCT devices demands a targeted selection of individuals at higher risk of DME who would benefit the most from early referral. We sought to appraise if proteinuria should be considered in a targeted referral of T2D individuals to OCT examination. METHODS: This study was a cross-sectional analysis of 576 consecutive patients enrolled in the Brazilian Diabetes Study between June/2016 and December/2021 who underwent OCT exam and urinalysis to assess ME and proteinuria status, respectively. Differences in the prevalence of DME between proteinuria groups and across a range of diabetic retinopathy (DR) stages were evaluated. RESULTS: Among 1134 eyes included in this analysis, the prevalence of proteinuria was 22% and 18.2% of eyes had DME. Proteinuria was related to an increased prevalence of DME (13.2% vs 38.7% for control vs proteinuria, respectively; p < .001), with an OR of 4.08 [95% confidence interval (CI): 2.50-6.64, p < .001), after adjustment for covariates. Proteinuria was independently related to DME also among eyes with non-apparent DR [OR: 2.82; 95%CI: 1.34-5.93; p = .003] and non-proliferative DR (OR of 5.94, 95%CI 2.13-16.62, p < .001). Fundus photography spotted only half of the DME cases detected by OCT. CONCLUSION: In T2D individuals, early referral to OCT examination should be pursued for all individuals with concurrent proteinuria. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04949152.

Rationale and design of the Brazilian diabetes study: a prospective cohort of type 2 diabetes.

BACKGROUND: Optimal control of traditional risk factors only partially attenuates the exceeding cardiovascular mortality of individuals with diabetes. Employment of machine learning (ML) techniques aimed at the identification of novel features of risk prediction is a compelling target to tackle residual cardiovascular risk. The objective of this study is to identify clinical phenotypes of T2D which are more prone to developing cardiovascular disease. METHODS: The Brazilian Diabetes Study is a single-center, ongoing, prospective registry of T2D individuals. Eligible patients are 30 years old or older, with a confirmed T2D diagnosis. After an initial visit for the signature of the informed consent form and medical history registration, all volunteers undergo biochemical analysis, echocardiography, carotid ultrasound, ophthalmologist visit, dual x-ray absorptiometry, coronary artery calcium score, polyneuropathy assessment, advanced glycation end-products reader, and ambulatory blood pressure monitoring. A 5-year follow-up will be conducted by yearly phone interviews for endpoints disclosure. The primary endpoint is the difference between ML-based clinical phenotypes in the incidence of a composite of death, myocardial infarction, revascularization, and stroke. Since June/2016, 1030 patients (mean age: 57 years, diabetes duration of 9.7 years, 58% male) were enrolled in our study. The mean follow-up time was 3.7 years in October/2021. CONCLUSION: The BDS will be the first large population-based cohort dedicated to the identification of clinical phenotypes of T2D at higher risk of cardiovascular events. Data derived from this study will provide valuable information on risk estimation and prevention of cardiovascular and other diabetes-related events. CLINICALTRIALS.GOV IDENTIFIER: NCT04949152.

Dapagliflozin increases retinal thickness in type 2 diabetic patients as compared with glibenclamide: A randomized controlled trial.

AIM: In patients with type 2 diabetes mellitus (T2DM) a progressive thinning in the central retinal thickness (CRT) is mainly related to neuroretinal degeneration and occurs before the decline in visual acuity or capillary density. We investigated the change in CRT by optical coherence tomography (OCT) in T2DM patients after 12 weeks of treatment with dapagliflozin or glibenclamide. METHODS: Ninety-seven patients (57 ± 7 years) with T2DM and clinical or subclinical atherosclerosis were randomized 1:1 to dapagliflozin (10 mg/day) or glibenclamide (5 mg/day) on top of metformin XR 1.5 g/day. OCT was obtained in all patients enrolled in the study, both at the time of randomization and at the end of the study. RESULTS: Baseline and post-treatment values of fasting glucose and glycated hemoglobin were equivalent in the two arms. There was no difference in change in diabetic retinopathy status after therapy. The center subfield thickness changed by +2(6)µm in the dapagliflozin group and by -1(7) µm in the glibenclamide group (P = 0.001). CONCLUSION: A short-term treatment with dapagliflozin may increase CRT as compared with equivalent glycemic control with glibenclamide.

Assessment of dapagliflozin effect on diabetic endothelial dysfunction of brachial artery (ADDENDA-BHS2 trial): rationale, design, and baseline characteristics of a randomized controlled trial.

BACKGROUND: Endothelial dysfunction (ED) is a hallmark in type 2 diabetes mellitus (T2DM) that favor both atherogenesis and ischemia and reperfusion injury (IRI). Sodium-glucose-2 co-transporter inhibitors (SGLT2i) may hypothetically improve microvascular and macrovascular functions via a broad spectrum of mechanisms, being superior to traditional antidiabetic therapy such as sulfonylurea, even in subjects under equivalent glycemic control. Hence, the present clinical trial was designed to compare the effect of these two treatments on markers of arterial wall function and inflammation in T2DM patients as well as on the potential mediating parameters. METHOD AND RESULTS: ADDENDA-BHS2 is a prospective, single-center, active-controlled, open, randomized trial. Ninety-eight participants (40-70 years old) with HbA1c 7-9% were randomized (1:1, stratified by gender, BMI and HbA1c levels) to either dapagliflozin 10 mg/day or glibenclamide 5 mg/day on top of metformin. The primary endpoint was the change of flow-mediated dilation (FMD) after a 12-week period of treatment evaluated at rest and after IRI between dapagliflozin and glibenclamide arms. Secondary outcomes were defined as the difference between treatments regarding: plasma nitric oxide (NO) change after FMD, plasma isoprostane, plasma levels of vascular inflammatory markers and systemic inflammatory markers, plasma levels of adipokines, anthropometric measures, glucose control parameters, office and ambulatory BP control. Safety endpoints were defined as systolic and diastolic function assessed by echocardiography and retinopathy change. Serious adverse events were recorded. The study protocol was approved by the Independent Scientific Advisory Committee. CONCLUSION: The ADDENDA-BHS2 trial is an investigator-initiated clinical trial comparing the effect of dapagliflozin versus glibenclamide on several aspects of vascular function in high cardiovascular risk T2DM patients. Besides, a large clinical and biochemical phenotype assessment will be obtained for exploring potential mediations and associations.Trial registration Clinical trial registration: NCT02919345 (September, 2016).

Precarização do trabalho do agente comunitário de saúde: um desafio para a gestão do SUS / Precariousness of the work of the Community health: a challenge for SUS management

INTRODUÇÃO: A discussão do tema precarização do emprego exige que sejam consideradas algumas conexões que envolvem as relações de trabalho e poder. OBJETIVO: estudar as condições de trabalho do agente comunitário de saúde. MATERIAL E MÉTODO: estudo descritivo com abordagem predominantemente qualitativa e teve como foco as formas de inserção no trabalho dos agentes comunitários de saúde de duas áreas do Rio Grande do Norte. RESULTADOS: a discussão da contratação do agente comunitário de saúde é mais complexa no que aparenta, pois ela não é resultado de uma simples decisão do setor saúde em contratar desta ou de outra forma. CONCLUSÃO: as secretarias municipais de saúde convivem com uma situação entre o reconhecimento do papel e da importância do agente comunitário de saúde nos serviços municipais e sua incapacidade, ou falta de vontade, de vincular esse profissionais de forma permanente à instituição e, o que é pior, sua incapacidade de vinculá-lo por meio de um contrato de trabalho que lhe garanta direitos, como férias, licenças, décimo terceiro salário, aposentadoria.