Reorganization of secondary and tertiary health care levels: impact on the outcomes of oral cancer screening in the São Paulo State, Brazil

This study presents the strategies for prevention and early detection of oral cancer by means of screening in the elderly population of São Paulo, the richest and the most populous state of Brazil. This research was a retrospective longitudinal study based on the analysis of secondary data. The variables - number of participating cities, coverage of screening, and number of suspicious and confirmed cases of oral cancer - were divided into two periods: 2001-2004 and 2005-2008. Data were analyzed statistically by the chi-square test at 5% significance level. The implementation of a nationwide public oral health policy in 2004 and the reorganization of the secondary and tertiary health care were evaluated as mediator factors able to interfere in the achieved outcomes. From 2001 to 2008, 2,229,273 oral examinations were performed. There was an addition of 205 participating cities by the end of the studied period (p<0.0001). The coverage of oral cancer screening increased from 4.1% to 16% (p<0.0001). There was a decrease in the number of suspicious lesions (from 9% in 2005 to 5% in 2008) (p<0.0001) and in the rate of confirmed oral cancer cases per 100,000 examinations (from 20.89 in 2001 to 10.40 in 2008) (p<0.0001). After 8 years of screening, there was a decrease in the number of suspicious lesions and confirmed cases of oral cancer in the population. The reorganization of secondary and tertiary health care levels of oral care seems to have contributed to modify these numbers, having a positive impact on the outcomes of oral cancer screening in the São Paulo State.

Larvacean (Chordata, Tunicata) abundance and inferred secondary production off southeastern Brazil

We studied the temporal and vertical variability in larvacean abundance and secondary production on a fixed station off southeast Brazil, from January 2007 to December 2008. Larvacean biomass was derived from length weight regressions, and growth rates were estimated from an empirical model. We identified eleven larvacean species. Oikopleura longicauda occurred throughout the studied period and was the most abundant species, followed by Oikopleura fusiformis. Fritillaria haplostoma, O. fusiformis and O. longicauda were found mainly above the thermocline, whereas Oikopleura dioica and Fritillaria pellucida preferred bottom layers. Higher abundance and biomass were observed in warmer months, when the water column was stratified as a result of the bottom intrusions of the cold and nutrient-rich South Atlantic Central Water. Secondary production mirrored the biomass seasonal pattern. Larvacean biomass equaled to less than 10% of copepod biomass during the same period, but larvacean production comprised on average 77% that of copepods, whereas the production of discarded houses and fecal pellets comprised up to 2800% of larvaceans secondary production. This confirms the potential significance of larvaceans in the carbon flux in tropical and subtropical coastal regions. (C) 2011 Elsevier Ltd. All rights reserved.

Burden of care and its impact on health-related quality of life of caregivers of individuals with spinal cord injury

Objective: to analyze the impact and burden of care on the Health-Related Quality of Life (HRQOL) of caregivers of individuals with a spinal cord injury (SCI). Method: cross-sectional observational study carried out by reviewing medical records and applying questionnaires. The scale Short Form 36 (SF-36) was used to assess HRQOL and the Caregiver Burden Scale (CBScale) for care burden. Results were analyzed quantitatively. Most patients with SCIs were male, aged 35.4 years old on average, with a predominance of thoracic injuries followed by cervical injuries. Most caregivers were female aged 44.8 years old on average. Results: tetraplegia and secondary complications stand out among the clinical characteristics that contributed to greater care burden and worse HRQOL. Association between care burden with HRQOL revealed that the greater the burden the worse the HRQOL. Conclusion: Preventing care burden through strategies that prepare patients for hospital discharge, integrating the support network, and enabling access to health care services are interventions that could minimize the effects arising from care burden and contribute to improving HRQOL.

Exogenous influences on plant secondary metabolite levels

Plant secondary metabolites are a group of naturally occurring compound classes biosynthesized by differing biochemical pathways whose plant content and regulation is strongly susceptible to environmental influences and to potential herbal predators. Such abiotic and biotic factors might be specifically induced by means of various mechanisms, which create variation in the accumulation or biogenesis of secondary metabolites. Hence the dynamic aspect of bioactive compound synthesis and accumulation enables plants to communicate and react in order to overcome imminent threats. This contribution aims to review the most important mechanisms of various abiotic and biotic interactions, such as pathogenic microorganisms and herbivory, by which plants respond to exogenous influences, and will also report on time-scale variable influences on secondary metabolite profiles. Transmission of signals in plants commonly occurs by 'semiochemicals', which are comprised of terpenes, phenylpropanoids, benzenoids and other volatile compounds. Due to the important functions of volatile terpenes in communication processes of living organisms, as well as its emission susceptibility relative to exogenous influences, we also present different scenarios of concentration and emission variations. Toxic effects of plants vary depending on the level and type of secondary metabolites. In farming and cattle raising scenarios, the toxicity of plant secondary metabolites and respective concentration shifts may have severe consequences on livestock production and health, culminating in adverse effects on crop yields and/or their human consumers, or have an adverse economic impact. From a wider perspective, herbal medicines, agrochemicals or other natural products are also associated with variability in plant metabolite levels, which can impact the safety and reliable efficacy of these products. We also present typical examples of toxic plants which influence livestock production using Brazilian examples of toxicity of sapogenins and alkaloids on livestock to highlight the problem. (c) 2012 Elsevier B.V. All rights reserved.

On the impact of disproportional samples in credit scoring models: An application to a Brazilian bank data

Statistical methods have been widely employed to assess the capabilities of credit scoring classification models in order to reduce the risk of wrong decisions when granting credit facilities to clients. The predictive quality of a classification model can be evaluated based on measures such as sensitivity, specificity, predictive values, accuracy, correlation coefficients and information theoretical measures, such as relative entropy and mutual information. In this paper we analyze the performance of a naive logistic regression model (Hosmer & Lemeshow, 1989) and a logistic regression with state-dependent sample selection model (Cramer, 2004) applied to simulated data. Also, as a case study, the methodology is illustrated on a data set extracted from a Brazilian bank portfolio. Our simulation results so far revealed that there is no statistically significant difference in terms of predictive capacity between the naive logistic regression models and the logistic regression with state-dependent sample selection models. However, there is strong difference between the distributions of the estimated default probabilities from these two statistical modeling techniques, with the naive logistic regression models always underestimating such probabilities, particularly in the presence of balanced samples. (C) 2012 Elsevier Ltd. All rights reserved.

Pamidronate for the treatment of osteoporosis secondary to chronic cholestatic liver disease in Wistar rats

Osteoporosis is a major complication of chronic cholestatic liver disease (CCLD). We evaluated the efficacy of using disodium pamidronate (1.0 mg/kg body weight) for the prevention (Pr) or treatment (Tr) of cholestasis-induced osteoporosis in male Wistar rats: sham-operated (Sham = 12); bile duct-ligated (Bi = 15); bile duct-ligated animals previously treated with pamidronate before and 1 month after surgery (Pr = 9); bile duct-ligated animals treated with pamidronate 1 month after surgery (Tr = 9). Rats were sacrificed 8 weeks after surgery. Immunohistochemical expression of IGF-I and GH receptor was determined in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia and the right femur was used for biomechanical analysis. Bone material volume over tissue volume (BV/TV) was significantly affected by CCLD (Sham = 18.1 ± 3.2 vs Bi = 10.6 ± 2.2%) and pamidronate successfully increased bone volume. However, pamidronate administered in a preventive regimen presented no additional benefit on bone volume compared to secondary treatment (BV/TV: Pr = 39.4 ± 12.0; Tr = 41.2 ± 12.7%). Moreover, the force on the momentum of fracture was significantly reduced in Pr rats (Sham = 116.6 ± 23.0; Bi = 94.6 ± 33.8; Pr = 82.9 ± 22.8; Tr = 92.5 ± 29.5 N; P < 0.05, Sham vs Pr). Thus, CCLD had a significant impact on bone histomorphometric parameters and pamidronate was highly effective in increasing bone mass in CCLD; however, preventive therapy with pamidronate has no advantage regarding bone fragility.