Intellectuals in a Network A New Generation Faces the Challenges of Development

Brazilian social thought draws on the inspiration of past masters the common denominator of whose work is probably a deep humanism. Confronting the challenges of a fluid, ever-changing reality is now a matter of survival. The idea of climate change has made the environment, long relegated to second place, a matter of much wider interest and concern. The other great problem is poverty, and here, while there have been undeniable advances, much remains to be done. The main challenge is producing forms of social organization that will allow ordinary citizens to have an impact on what really matters. Developing policy in these areas has engaged the efforts of a wide range of experts from a variety of fields. Whereas university-educated intellectuals once formed an intelligentsia, today they are engaged in practical politics and much more often function as agents who link social actors together than as mere elaborators of theories.

Toxic and essential elements in blood from delivering women in selected areas of Sao Paulo State, Brazil

This study was designed to evaluate the degree of environmental contamination and possible exposure of pregnant women to toxic elements in seven selected areas of Sao Paulo State, Brazil. The overall median concentration of Mo in maternal blood was 0.53 mu g L(-1), highly significant differences found between sites (p < 0.0001). Cd was found to be low overall - 0.09 mu g L(-1) (0.01-0.58 mu g L(-1)) - with mothers from the Coastal and Rural 1 sites having the highest levels (p < 0.016). Median Hg concentration was 0.60 mu g L (1) (0.06 mu g L (1)-4.35 mu g L (1)); median Pb level was 16.2 mu g L (1) (3.5-57.7 mu g L(-1)) and no differences between sites were observed for both metals. Median Mn level was 16.7 mu g L(-1) (7.0-39.7 mu g L(-1)), being highest in Urban 2 site (p < 0.016). Concentrations of maternal Co were found to range between 0.06 mu g L(-1) and 1.1 mu g L(-1) (median 0.25 mu g L(-1)) and As level was 0.60 mu g L(-1) (0.10-3.8 mu g L(-1)) overall, with no statistical significance between sites for Co and As. Median Se concentrations were found to be 64 mg L(-1) (36-233 mu g L(-1)), with the highest median levels found in Urban 3 site; site differences were statistically significant (p < 0.0001). Correlation for each element (between paired maternal and cord blood) was measured only in Rural site 1; significant correlation was shown for Hg, Pb, Mn and Co (p < 0.05). These findings may be interpreted as indicating low environmental contamination in Sao Paulo State, Brazil. These findings could also indicate that pregnant women have little or no contact with pollutants, possibly due to awareness campaigns carried out by public health practitioners.

Postural changes in women with chronic pelvic pain: a case control study

Background: Chronic pelvic pain (CPP) is a lower abdominal pain lasting at least 6 months, occurring continuously or intermittently and not associated exclusively with menstruation or intercourse. Although the musculoskeletal system has been found to be involved in CPP, few studies have assessed the contribution of posture in women with CPP. We aimed to determine if the frequency of postural changes was higher in women with CPP than healthy subjects. Methods: A case-control study included 108 women with CPP of more than 6 months' duration (CPP group) who consecutively attended at the Hospital of the University of Sao Paulo and 48 healthy female volunteers (control group). Postural assessment was noninvasive and performed in the standing position, with the reference points of Kendall used as normal parameters. Factors associated with CPP were assessed by logistic regression analysis. Results: Logistic regression showed that the independent factors associated with CPP were postural changes in the cervical spine (OR 4.1; 95% CI 1.6-10.7; p < 0.01) and scapulae (OR 2.9; 95% CI 1.1-7.6; p < 0.05). Conclusion: Musculoskeletal changes were associated with CPP in 34% of women. These findings suggest that a more detailed assessment of women with CPP is necessary for better diagnosis and for more effective treatment.

Nutrient intakes related to osteoporotic fractures in men and women - The Brazilian Osteoporosis Study (BRAZOS)

Background: Adequate nutrition plays an important role in bone mass accrual and maintenance and has been demonstrated as a significant tool for the prevention of fractures in individuals with osteoporosis. Objective: The aim of the present study was to evaluate bone health-related nutrients intake and its association with osteoporotic fractures in a representative sample of 2344 individuals aged 40 years or older in Brazil. Methods: In a transversal population-based study, a total of 2420 individuals over 40 years old were evaluated from March to April 2006. Participants were men and women from all socioeconomic classes and education levels living around the Brazilian territory Individuals responded a questionnaire including self reported fractures as well a 24-hour food recall. Nutrient intakes were evaluated by Nutrition Data System for Research software (NDSR, University of Minnesota, 2007). Low trauma fracture was defined as that resulting of a fall from standing height or less. Nutrient intakes adequacies were performed by using the DRI's proposed values. Statistical analysis comprises Oneway ANCOVA adjusted by age and use of nutritional supplements and multiple logistic regression. SAS software was used for statistical analysis. Results: Fractures was reported by 13% of men and 15% of women. Women with fractures presented significantly higher calcium, phosphorus and magnesium intakes. However, in all regions and socio-economical levels mean intakes of bone related nutrients were below the recommended levels. It was demonstrated that for every 100 mg/phosphorus increase the risk of fractures by 9% (OR 1.09; IC95% 1.05-1.13, p < 0.001). Conclusion: The results demonstrated inadequacies in bone related nutrients in our population as well that an increase in phosphorus intake is related to bone fractures.

Attempted Suicide in Reproductive Age Women

In this study, we described the frequency of attempted suicide among women of reproductive age (10 to 49 years) in a General University Hospital in Ribeirao Preto, Brazil (conducted 2005). Relevant comorbidities associated with the suicide attempt were calculated. Secondary data were obtained through the hospital`s records where attempted suicides were reported. Findings revealed 132 attempted suicides; most women took a toxic substance or their own medication. Half of the women previously had attempted suicide. Depression was the most frequent psychiatric diagnosis on discharge from the hospital, specifically borderline personality disorder, personality disorders axis B and depression without association.

Body weight as an indicator of fat-free mass in active elderly women

Objective: Fat-free mass (FFM) reduction and the tendency for a reduction in surrounding fatty issue and increase in the middle are a natural consequence of growing old and should be studied in order to gain a better understanding of the aging process. This study set out to find the FFM differences between active elderly women in two age groups (60-69 and 70-80 years) and to determine which of the anthropometric measurements, body weight (BW), abdominal circumference (AC), or body mass index (BMI) are the best predictors of FFM variation within the group. Methods: Eighty-one (n = 81) active elderly women of the Third Age willingly signed up to participate in the research during the activities at the University of the Third Age (UTA) in Brazil. The research was approved by the Research Ethics Committee of the Faculty of Medical Sciences of the State University of Campinas (UNICAMP). Body weight (BW), height (H) and the BMI were measured according to the international standards. The AC was measured in centimetres at the H of the navel and body composition was ascertained using bioimpedance analysis. The SAS program was used to perform the statistical analysis of independent samples and parametric data. Results: The results showed FFM values with significant differences between the two groups, with the lowest values occurring among the women who were over 70 years of age. In the analysis, the Pearson`s Correlation Coefficient for each measured independent variable was ascertained, with the BW measurement showing the highest ratio (0.900). Conclusions: The BW measurement was regarded as reliable, low-cost and easy to use for monitoring FFM in elderly women who engage in physical activities. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Body composition and quality of life (QoL) of the elderly offered by the ""University Third Age`` (UTA) in Brazil

The investigation of the factors that interfere in the well-being of the elderly and their QoL can provide theoretical and methodological subsidies in structuring actions and policies in the health area, in order to fulfill the needs of that population. In this descriptive transversal study, body composition and QoL of elderly women at the UTA program in Piracicaba (Sao Paulo, Brazil) were verified. The participants were 81 women from UTA, and the general levels of physical activity were evaluated, as well as body weight (BW), height, and bodymass index (BMI). The waist circumference (WC) was measured at the level of the umbilical scar and the body composition by impedance (BIA 310e). QoL was verified by means of WHOQOL-Bref and statistical analysis developed with the SAS program. The decrease of weight, height, BMI, and fat-free mass (FFM) was observed among the several age groups, although with no significant difference. The average levels of the general QoL scores and physical, psychological and environmental domains decreased in higher age groups, but social domains showed the opposite result. This fact can be a particular characteristic of the UTA group, and factors the influence such behavior are yet to be studied. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Genic expression of the uterine leiomyoma in reproductive-aged women after treatment with goserelin

Objective: To identify the genes presenting different expression in uterine leiomyomas after goserelin treatment. Design: Retrospective analyses of tissue obtained in a prospective clinical study. Setting: School of Medicine of the University of Sao Paulo. Patient(s): 30 nulliparous black women aged 20 to 45 years with symptoms of uterine leiomyoma, uterine volume over 300 mL, and surgical indications for myomectomy. Intervention(s): Fifteen patients were given a monthly dose of 3.6 mg of goserelin over 3 months before surgery (group A), and 15 patients underwent surgery without any previous treatment (group B). Five random samples from each group were analyzed using the microarray technique with the Affymetrix platform (GeneChip Rat Genome 230 2.0 Array). Main Outcome Measure(s): Quantification of transcript expression levels of uterine fibroids in patients treated or not treated with goserelin. Result(s): Of the total of 47,000 sequences that were analyzed, representing approximately 38,500 human genes already characterized, we found a differential expression of 174 genes. Of these, 70 were up-regulated (33 genes with known function) and 104 were down-regulated (65 genes with known function) in samples from group A (treated) when compared with group B (nontreated). Conclusion(s): The genic expression of uterine leiomyomas changes in women who have had goserelin treatment when compared with nontreated patients. (Fertil Steril (R) 2010; 94: 1072-7. (C) 2010 by American Society for Reproductive Medicine.)

High serum follistatin levels in women with ovarian endometriosis

Follistatin is an activin-binding protein produced by several tissues, including endometrium and endometriotic implants. We aimed to quantify follistatin in patients with ovarian endometriosis and investigate its value as a diagnostic marker. Women undergoing laparoscopic excision of ovarian endometrioma (n = 52) or other benign ovarian cysts (n = 52) were studied, plus women with non-ovarian endometriosis (n = 11) and healthy controls (n = 27). Serum was collected from all subjects, and peritoneal and cystic fluid from a subset with endometrioma. Follistatin was measured by enzyme-linked immunosorbent assay. The diagnostic accuracy of follistatin to detect endometrioma was evaluated by receiver operating characteristic (ROC) curve and compared with cancer antigen (CA)-125. Serum follistatin was increased in women with ovarian endometrioma (2080 +/- 94 pg/ml) compared with controls (545 +/- 49 pg/ml, P < 0.001), other benign ovarian cysts (795 +/- 60 pg/ml, P < 0.001) or non-ovarian endometriosis (1271 +/- 115 pg/ml, P < 0.001). Cystic fluid showed a higher concentration of follistatin (9850 +/- 4461 pg/ml) than peritoneal fluid (1885 +/- 261 pg/ml, P < 0.001) and serum (P < 0.001). Follistatin levels detected 48/52 cases of endometrioma (92% sensitivity) at 1433 pg/ml cut-off, corresponding to 92% specificity. CA-125 detected only 44% of endometriomas with 90% specificity. ROC curve comparison showed follistatin was more accurate than CA-125 to discriminate women with endometrioma either from controls or women with other benign ovarian cysts (P < 0.0001). Serum follistatin is increased in women with endometriosis and allows clear distinction between endometrioma and other benign ovarian cysts. Follistatin has the sensitivity and specificity to become a useful clinical marker of ovarian endometrioma.

Longitudinal Follow-Up of Bipolar Disorder in Women With Premenstrual Exacerbation: Findings From STEP-BD

Objective: The impact of hormonal fluctuation during the menstrual cycle on the course of bipolar disorder is poorly understood. The authors determined the course of illness and time to relapse of bipolar disorder in prospectively followed women with premenstrual exacerbation. Method: Participants were 293 premenopause-age women with bipolar disorder who were followed prospectively for 1 year as part of the Systematic Treatment Enhancement Program for Bipolar Disorder. Frequency of mood episodes was compared between 191 women with premenstrual exacerbation (65.2%) and 102 women without. Among 129 women who were in recovered status at baseline, time to relapse was compared between 66 women with premenstrual exacerbation (51.2%) and 63 without. Results: During follow-up, the group with premenstrual exacerbation had more episodes (primarily depressive) than did the group without, but they were not more likely to meet criteria for rapid cycling during this period. In contrast, they were more likely to report rapid cycling retrospectively. Women with premenstrual exacerbation had a shorter time to relapse and were at greater risk for relapse, but this association was not significant after adjustment for retrospectively reported rapid cycling. Women with premenstrual exacerbation had more depressive and mood elevation symptoms overall. Conclusions: Women with bipolar disorder and premenstrual exacerbation have a worse course of illness, a shorter time to relapse, and greater symptom severity, but they are not more likely to meet criteria for rapid cycling. Premenstrual exacerbation may be a clinical marker predicting a more symptomatic and relapse-prone phenotype in reproductive-age women with bipolar disorder.

Obstetric Outcome in Pregnant Women on Long-term Dialysis: A Case Series

Background: Although still uncommon, pregnancy frequency in women on maintenance hemodialysis therapy has increased in the past 20 years. Most published reports suggest that intensified hemodialysis regimens result in better pregnancy outcomes. The small number of patients investigated in all reported series is the main limitation of the available studies. Study Design: Retrospective case series. Setting & Participants: Data for all pregnancies that occurred in 1988-2008 in women undergoing maintenance hemodialysis (52 pregnancies) at the Sao Paulo University Medical School (Sao Paulo, Brazil). Outcomes & Measurements: We analyzed maternal and fetal outcomes of 52 pregnancies, as well as their relationship with various clinical, laboratory, and hemodialysis parameters, such as pre-eclampsia, pregnancy before or after dialysis therapy, hemodialysis dose, polyhydramnios, anemia, and predialysis serum urea level. In addition, logistic regression models for a composite adverse fetal outcome (perinatal death or extremely premature delivery) and linear regression models for birth weight were built. Results: 87% overall rate of successful delivery, with a mean gestational age of 32.7 +/- 3.1 weeks. Pre-eclampsia was associated with a poor prognosis compared with pregnancies without pre-eclampsia: a successful delivery rate of 60% versus 92.9% (P = 0.02), extremely premature delivery rate of 77.8% versus 3.3% (P = 0.001), lower gestational age (P = 0.001), and birth weight (P = 0.001). Patients with an adverse composite fetal outcome had a higher frequency of pre-eclampsia (P = 0.001), lower frequency of polyhydramnios (P = 0.03), lower third-trimester hematocrit (P = 0.03), and higher predialysis serum urea level (P = 0.03). The same results were seen for birth weight. Limitations: Retrospective data analysis. The absence of creatinine clearance measurements did not allow evaluation of the impact of residual renal function on fetal outcome. Conclusions: Outcomes of pregnancy in women undergoing hemodialysis often are good. Preeclampsia, third-trimester hematocrit, polyhydramnios, and predialysis serum urea level are important variables associated with fetal outcome and birth weight. Am J Kidney Dis 56:77-85. (C) 2010 by the National Kidney Foundation, Inc.Inc

Women`s opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital

Objective: to describe women`s feelings about mode of birth. Design: exploratory descriptive design. Semi-structured interviews were conducted using a questionnaire that had been developed previously (categorical data and open-and closed-ended questions). Qualitative analysis of the results was performed through a context analysis technique. Setting: the largest public university hospital in Brazil. Participants: 48 women in their third trimester of pregnancy. Findings: most women expressed a preference for vaginal birth, as they perceived that they would have a faster recovery. Women who expressed a preference for caesarean section did so because of lack of pain during the birth and the need for tubal sterilisation. The majority of women considered it important to have experience with a mode of birth in order to choose a preference. Complications associated with maternal illness were very influential in the decision-making process. Key conclusions: these results provide a useful first step towards the identification of aspects of women`s feelings about modes of birth. Most women expressed a preference for vaginal birth. Further exploration of women`s feelings regarding parturition and the decision-making process is required. (C) 2008 Elsevier Ltd. All rights reserved.

HANDEDNESS INFLUENCES PASSIVE SHOULDER RANGE OF MOTION IN NONATHLETE ADULT WOMEN

Objective: The Purpose of this study was to determine whether handedness influences bilateral shoulder range of motion in nonathlete adult women. Methods: This was an observational Study. Shoulder range of motion (flexion, abduction, horizontal adduction, extension, external and internal rotation) was passively and bilaterally measured in 50 female, right-handed, and healthy university students, ranging from 20 to 29 years of age, who were not practicing repetitive activities with the upper limbs at the time Of this study. The assessment was performed with a universal goniometer, twice for each subject by the same examiner. irst and second measurements were correlated using the intraclass correlation coefficient, which was high for all movements and ranged from 0.80 to 0.97. The Student t test and Wilcoxon test were used to compare the range of motion between the dominant and nondominant shoulders and the mean differences between the 2 sides. The effect of size vias alpha = .05. Results: There is statistically significance difference between the 2 sides when the rotational range of motion is compared the dominant shoulder presented increased external rotation (mean, 4.74 degrees; 95% confidence interval, 1.61-7.87) and decreased internal rotation (mean, 3.52 degrees; 95% confidence interval, 1.64-5.4) compared to the opposite Shoulder. Conclusion: Dominance should be considered when shoulder rotation is evaluated even in nonathlete adult women. (J Manipulative Physiol Ther 2009;32:149-153)

Differentially expressed genes in eutopic and ectopic endometrium of women with endometriosis

Objective: To elucidate the potential mechanisms involved in the physiopathology of endometriosis. We analyzed the differential gene expression profiles of eutopic and ectopic tissues from women with endometriosis. Design: Prospective laboratory study. Setting: University hospital. Patient(s): Seventeen patients in whom endometriosis was diagnosed and 11 healthy fertile women. Intervention(s): Endometrial biopsy specimens from the endometrium of healthy women without endometriosis and from the eutopic and ectopic endometrium tissues of patients with endometriosis were obtained in the early proliferative phase of the menstrual cycle. Main Outcome Measure(s): Six paired samples of eutopic and ectopic tissue were analyzed by subtractive hybridization. To evaluate the expression of genes found by rapid subtraction hybridization methods, we measured CTGF, SPARC, MYC, MMP and IGFBP1 genes by real-time polymerase chain reaction in all samples. Result(s): This study identified 291 deregulated genes in the endometriotic lesions. Significant expression differences were obtained for SPARC, MYC, and IGFBP1 in the peritoneal lesions and for MMP3 in the ovarian endometriomas. Additionally, significant differences were obtained for SPARC and IGFBP1 between the peritoneal and ovarian lesions. No significant differences were found for the studied genes between the control and the eutopic endometrium. Conclusion(s): This study identified 291 genes with differential expression in endometriotic lesions. The deregulation of the SPARC, MYC, MMP3, and IGFBP1 genes may be responsible for the loss of cellular homeostasis in endometriotic lesions. (Fertil Steril(R) 2010;93:1750-73. (C) 2010 by American Society for Reproductive Medicine.)

Glycodelin expression in the endometrium of healthy women and in the eutopic and ectopic endometrium of women with endometriosis

Objective: To analyze the expression of the glycodelin gene to better understand the molecular environment of endometriotic lesions and to elucidate the potential mechanisms that underlie the complex physiopathology of endometriosis. Design: Prospective laboratory study. Setting: University hospital. Patient(s): Eleven healthy fertile women and 17 patients with endometriosis in the early proliferative phase of the menstrual cycle. Intervention(s): Endometrial biopsy specimens were obtained from the endometrium of healthy women without endometriosis (controls) and from eutopic and ectopic endometrium tissues (pelvic and ovarian endometriotic implants) of endometriosis patients. Main Outcome Measure(s): The glycodelin relative expression level by real-time polymerase chain reaction (PCR) analysis. Result(s): The glycodelin down-regulation found in the endometriotic lesions was 332.26 and 123.17-fold lower, respectively, when compared with the eutopic tissue and the control endometrium. Conclusion(s): Glycodelin may be one of the molecules that contributes to the loss of cellular homeostasis in endometriotic lesions. (Fertil Steril (R) 2009;91:1676-80. (C)2009 by American Society for Reproductive Medicine.)