Tuberculosis among health care workers in a Brazilian tertiary hospital emergency unit

The Brazilian emergency system is being reorganized as a hierarchy in the region of Ribeirao Preto, state of Sao Paulo. We found increased occupational risk for tuberculosis in this region tertiary reference center-a nurse technician (Incidence rate [IR] 526.3/100000 inhabitants) had a risk of tuberculosis 12.6 (95% confidence interval [CI], 2.57-37.23) greater than the city population (41.8/100000 inhabitants). The system reorganization will have to make the centers adequate to deal with this problem. (C) 2008 Elsevier Inc. All rights reserved.

Characteristics of a large population of patients with refractory epilepsy attending tertiary referral centers in Italy

P>The characteristics of 1,124 consecutive adults and children with refractory epilepsy attending 11 tertiary referral centers in Italy were investigated at enrollment into a prospective observational study. Among 933 adults (age 16-86 years), the most common syndromes were symptomatic (43.7%) and cryptogenic (39.0%) focal epilepsies, followed by idiopathic (8.1%) and cryptogenic/symptomatic generalized (6.2%) epilepsies. The most common syndrome among 191 children was symptomatic focal epilepsy (35.1%), followed by cryptogenic focal (18.8%), cryptogenic/symptomatic generalized (18.3%), undetermined whether focal or generalized (16.8%), and idiopathic generalized (7.3%). Primarily and secondarily generalized tonic-clonic seizures were reported in 27.8% of adults and 16.8% of children. The most commonly reported etiologies were mesial temporal sclerosis (8.0%) and disorders of cortical development (6.2%) in adults, and disorders of cortical development (14.7%) and nonprogressive encephalopathies (6.8%) in children. More than three-fourths of subjects in both age groups were on antiepileptic drug (AED) polytherapy.

Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil

Background. Patients with refractory epilepsy often have impaired quality of life (QOL) as a consequence of seizures and adverse effects of antiepileptic drugs. We assessed the impact of adverse effects on QOL and the utility of a structured instrument to help the physician manage adverse effects in patients with refractory epilepsy. Methods. Clinical characteristics, drug treatment and adverse effects were evaluated in 102 patients with refractory epilepsy at a single tertiary referral centre. The Adverse Events Profile (AEP) and Quality of Life in Epilepsy-31 (QOLIE-31) questionnaires were completed at baseline and after six months. At baseline, patients with a high burden of adverse effects (AEP scores >= 45) were randomized to an intervention or control group. AEP scores in the intervention group were available to the physician as an instrument to help to reduce adverse effects. Results. Ninety-five patients (93.1%) were on polytherapy. Sixty-six completed the questionnaires and, of these, 43 (65.1%) had a high AE burden and were randomized to the intervention and control group. QOLIE-31 scores were inversely correlated with AEP scores at both visits. Among randomized patients, AEP scores tended to decrease between the baseline and the final visit without significant differences between groups (intervention group: 54.1 +/- 6.1 vs 51.1 +/- 9.1; control group: 55.8 +/- 5.8 vs 50.5 +/- 12.2). QOLIE-31 scores did not change substantially between visits (intervention group: 45.9 +/- 17.4 vs 48.4 +/- 14; control group: 47.5 +/- 15.7 vs 45.2 +/- 18.9). Conclusion. A significant proportion of patients had a high toxicity burden which had an impact on their QOL. Reduction of over-treatment is a difficult challenge which cannot be addressed solely by providing a structured assessment of adverse effects, but requires a more comprehensive approach aimed at optimizing the many components of the management strategy.

Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department

Background Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed. Goal To evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method. Methods A group of patients in need of respiratory isolation were first identified-group I (2004; 29 patients; 44.1 +/- 3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year-group II (2007; 50 patients; 43.4 +/- 1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained. Results Implementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5 +/- 9.3 X 3.7 +/- 2.0; p = 0.0180) and from indication to effective respiratory isolation (13.3 +/- 3.0 X 2.94 +/- 1.06; p = 0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 X 75.4/100.000 patients; p < 0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p < 0.001 greater for 2007. Conclusion Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

Influence of curing protocol on selected properties of light-curing polymers: Degree of conversion, volume contraction, elastic modulus, and glass transition temperature

Objectives. The purpose of this study was to investigate the effect of light-curing protocol on degree of conversion (DC), volume contraction (C), elastic modulus (E), and glass transition temperature (T(g)) as measured on a model polymer. It was a further aim to correlate the measured values with each other. Methods. Different light-curing protocols were used in order to investigate the influence of energy density (ED), power density (PD), and mode of cure on the properties. The modes of cure were continuous, pulse-delay, and stepped irradiation. DC was measured by Raman micro-spectroscopy. C was determined by pycnometry and a density column. E was measured by a dynamic mechanical analyzer (DMA), and T(g) was measured by differential scanning calorimetry (DSC). Data were submitted to two-and three-way ANOVA, and linear regression analyses. Results. ED, PD, and mode of cure influenced DC, C, E, and T(g) of the polymer. A significant positive correlation was found between ED and DC (r = 0.58), ED and E (r = 0.51), and ED and T(g) (r = 0.44). Taken together, ED and PD were significantly related to DC and E. The regression coefficient was positive for ED and negative for PD. Significant positive correlations were detected between DC and C (r = 0.54), DC and E (r = 0.61), and DC and T(g) (r = 0.53). Comparisons between continuous and pulse-delay modes of cure showed significant influence of mode of cure: pulse-delay curing resulted in decreased DC, decreased C, and decreased T(g). Influence of mode of cure, when comparing continuous and step modes of cure, was more ambiguous. A complex relationship exists between curing protocol, microstructure of the resin and the investigated properties. The overall performance of a composite is thus indirectly affected by the curing protocol adopted, and the desired reduction of C may be in fact a consequence of the decrease in DC. (C) 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Oral health in transition: the case of Indigenous peoples from Brazil

The objective of this paper is to summarise epidemiological information about the distribution of dental caries among Indigenous peoples in Brazil. The authors also present a case study of a specific group of Xavante Indians, one of the most numerous of Brazil`s Indigenous peoples, describing how their oral health has deteriorated over recent decades, and showing how an oral health programme is attempting to reverse the present trend of increase in caries. The programme at Etenheritipa Xavante village incorporated three principal components: educational, preventive, and clinical. From the beginning, the programme included epidemiological record keeping for monitoring the level of caries in the population. Transversal studies of the condition of oral health among the Xavante of Etenheritipa were undertaken in 1999, 2004, and 2007. In the period from 2004 to 2007 the DMFS values in the 11-15 age cohort had a significant reduction in caries experience. The mean DMFS score fell from 4.95 in 2004 to 2.39 in 2007 (p<0.01). An increase in the percent of individuals who were free from caries was also noted: in 1999, 20% of adolescents 11-15 had no caries; in 2007, the proportion had risen to 47%. The Xavante case is a prime example of the transition in oral health that is taking place among the Indigenous peoples of the Americas, and it highlights the importance of oral health promotion through preventive measures such as access to fluoridation and basic care in reducing the inequality between Indians and non-Indians.

Climate perspective on the large-scale circulation associated with the transition of the first South Atlantic hurricane

The landfall of Cyclone Catarina on the Brazilian coast in March 2004 became known as the first documented hurricane in the South Atlantic Ocean, promoting a new view oil how large-scale features can contribute to tropical transition. The aim of this paper is to put the large-scale circulation associated with Catarina`s transition in climate perspective. This is discussed in the light of a robust pattern of spatial correlations between thermodynamic and dynamic variables of importance for hurricane formation. A discussion on how transition mechanisms respond to the present-day circulation is presented. These associations help in understanding why Catarina was formed in a region previously thought to be hurricane-free. Catarina developed over a large-scale area of thermodynamically favourable air/sea temperature contrast. This aspect explains the paradox that such a rare system developed when the sea surface temperature was slightly below average. But, although thermodynamics played an important role, it is apparent that Catarina would not have formed without the key dynamic interplay triggered by a high latitude blocking. The blocking was associated with an extreme positive phase of the Southern Annular Mode (SAM) both hemispherically and locally, and the nearby area where Catarina developed is found to be more cyclonic during the positive phase of the SAM. A conceptual model is developed and a `South Atlantic index` is introduced as a useful diagnostic of potential conditions leading to tropical transition in the area, where large-scale indices indicate trends towards more favourable atmospheric conditions for tropical cyclone formation. Copyright (c) 2008 Royal Meteorological Society

Cloud condensation nuclei from biomass burning during the Amazonian dry-to-wet transition season

Aircraft measurements of cloud condensation nuclei (CCN) during the Large-Scale Biosphere-Atmosphere Experiment in Amazonia (LBA) were conducted over the Southwestern Amazon region in September-October 2002, to emphasize the dry-to-wet transition season. The CCN concentrations were measured for values within the range 0.1-1.0% of supersaturation. The CCN concentration inside the boundary layer revealed a general decreasing trend during the transition from the end of the dry season to the onset of the wet season. Clean and polluted areas showed large differences. The differences were not so strong at high levels in the troposphere and there was evidence supporting the semi-direct aerosol effect in suppressing convection through the evaporation of clouds by aerosol absorption. The measurements also showed a diurnal cycle following biomass burning activity. Although biomass burning was the most important source of CCN, it was seen as a source of relatively efficient CCN, since the increase was significant only at high supersaturations.

Impact of biomass burning aerosol on the monsoon circulation transition over Amazonia

Ensemble simulations of a regional climate model (RegCM3) forced by aerosol radiative forcing suggest that biomass burning aerosols can work against the seasonal monsoon circulation transition, thus re-enforce the dry season rainfall pattern for Southern Amazonia. Strongly absorbing smoke aerosols warm and stabilize the lower troposphere within the smoke center in southern Amazonia (where aerosol optical depth >0.3). These changes increase the surface pressure in the smoke center, weaken the southward surface pressure gradient between northern and southern Amazonia, and consequently induce an anomalous moisture divergence in the smoke center and an anomalous convergence in northwestern Amazonia (5 degrees S-5 degrees N, 60 degrees W-70 degrees W). The increased atmospheric thermodynamic stability, surface pressure, and divergent flow in Southern Amazonia may inhibit synoptic cyclonic activities propagated from extratropical South America, and re-enforce winter-like synoptic cyclonic activities and rainfall in southeastern Brazil, Paraguay and northeastern Argentina. Citation: Zhang, Y., R. Fu, H. Yu, Y. Qian, R. Dickinson, M. A. F. Silva Dias, P. L. da Silva Dias, and K. Fernandes (2009), Impact of biomass burning aerosol on the monsoon circulation transition over Amazonia, Geophys. Res. Lett., 36, L10814, doi: 10.1029/2009GL037180.

The South American Monsoon System and the 1970s climate transition

The South American Monsoon System (SAMS) is characterised by intense convective activity and precipitation during austral summer. This study investigates changes in the onset, demise and duration of SAMS during 1948-2008. The results show a significant change in these characteristics in the early 1970s. Onset becomes steadily earlier from 1948 to early 1970s and has occurred earlier than 23-27 October after 1972-1973. Demise dates have remained later than 21-25 April after the mid-to-late 1970s. SAMS duration shows a statistical changepoint in the summer of 1971-1972 such that the mean duration was similar to 170 days (1948-1972) and 195 days (1972-1982). Vertically integrated moisture flux is used to diagnose changes in mean state and reveal statistically significant increases over South America after 1971-1972. Copyright. (C) 2010 Royal Meteorological Society

An analysis of the environmental energetics associated with the transition of the first South Atlantic hurricane

This study presents the first analysis of the energetics associated with a hybrid cyclone`s transition in the Southern Hemisphere, Hurricane Catarina ( March 2004). Catarina has earned a place in history as the first documented South Atlantic hurricane, but its unusual tropical transition is still poorly understood. Here we show that Catarina`s transition was preceded by marked environmental changes in the Lorenz energy cycle, with an abrupt shift from a baroclinic to a predominantly barotropic state. Such changes help to explain the unusual vortex`s growth until its transition was completed. Although the vortex`s energy flux is not explicitly calculated, a likely mechanism linking the environmental energetics with Catarina is the extraction of eddy kinetic energy from horizontal momentum and heat transfers within the through component of the blocking. The results advance the understanding of this rare event and suggest that the technique has a great potential to study transitioning systems in general.

Transition redshift: new kinematic constraints from supernovae

The transition redshift (deceleration/acceleration) is discussed by expanding the deceleration parameter to first order around its present value. A detailed study is carried out by considering two different parametrizations, q = q(0) + q(1)z and q = q(0) + q(1)z(1 + z)(-1), and the associated free parameters (q(0), q(1)) are constrained by three different supernovae (SNe) samples. A previous analysis by Riess et al. using the first expansion is slightly improved and confirmed in light of their recent data (Gold07 sample). However, by fitting the model with the Supernova Legacy Survey (SNLS) type Ia sample, we find that the best fit to the redshift transition is z(t) = 0.61, instead of z(t) = 0.46 as derived by the High-z Supernovae Search (HZSNS) team. This result based in the SNLS sample is also in good agreement with the sample of Davis et al., z(t) = 0.60(-0.11)(+0.28) (1 sigma). Such results are in line with some independent analyses and accommodate more easily the concordance flat model (Lambda CDM). For both parametrizations, the three SNe Ia samples considered favour recent acceleration and past deceleration with a high degree of statistical confidence level. All the kinematic results presented here depend neither on the validity of general relativity nor on the matter-energy contents of the Universe.

PLANETARY NEBULAE IN THE INNER MILKY WAY II: THE BULGE-DISK TRANSITION

In this work, a sample of planetary nebulae located in the inner-disk and bulge of the Galaxy is used in order to find the galactocentric distance which better separates these two populations, from the point of view of abundances. Statistical distance scales are used to study the distribution of abundances across the disk-bulge interface. A Kolmogorov-Smirnov test is used to find the distance at which the chemical properties of these regions better separate. The results of the statistical analysis indicate that, on the average, the inner population has lower abundances than the outer. Additionally, for the a-element abundances, the inner population does not follow the disk radial gradient towards the galactic center. Based on our results, we suggest a bulge-disk interface at 1.5 kpc, marking the transition between the bulge and inner-disk of the Galaxy as defined by the intermediate mass population.

Nutrition in Transition: Dietary Patterns of Rural Amazonian Women During a Period of Economic Change

Objectives: The goal of this study was to understand the relationship between economic change (wage labor, retirement, and the Bolsa Familia program) and dietary patterns in the rural Amazon and to determine the extent to which these changes followed the pattern of the nutrition transition. Methods: The study was longitudinal. The weighed-inventory method and economic interviews were used to collect data on dietary intake and household economics in a sample of 30 and 52 women in 2002 and 2009, respectively. Twenty of the women participated in both years and make-up the longitudinal sub-sample. Comparative statistics were used to identify changes in dietary patterns over time and multiple linear regressions were used to explore the relationship between economics, subsistence strategies, and diet. Results: There was a significant decline in kcal (P < 0.01) and carbohydrate (P < 0.01) but no change in protein intake over time in both the larger and smaller, longitudinal subsample. The percent of energy, carbohydrate, protein, and fat purchased increased in the larger and longitudinal samples (P <= 0.02) and there was an increase in refined carbohydrate and processed, fatty-meat consumption over time. The abandonment of manioc gardens was associated with increased dependence on purchased food (P = 0.03) while receipt of the Bolsa Familia was associated with increased protein intake and adequacy (P = 0.02). Conclusions: The dietary changes observed are only in partial agreement with predictions of the nutrition transition literature. The relationship between the economic and diet changes was shaped by the local context which should be considered when implementing CCT programs, like the Bolsa Familia. Am. J. Hum. Biol. 23:458-469, 2011. (C) 2011 Wiley-Liss, Inc.

A Bayesian model for estimating the malaria transition probabilities considering individuals lost to follow-up

It is known that patients may cease participating in a longitudinal study and become lost to follow-up. The objective of this article is to present a Bayesian model to estimate the malaria transition probabilities considering individuals lost to follow-up. We consider a homogeneous population, and it is assumed that the considered period of time is small enough to avoid two or more transitions from one state of health to another. The proposed model is based on a Gibbs sampling algorithm that uses information of lost to follow-up at the end of the longitudinal study. To simulate the unknown number of individuals with positive and negative states of malaria at the end of the study and lost to follow-up, two latent variables were introduced in the model. We used a real data set and a simulated data to illustrate the application of the methodology. The proposed model showed a good fit to these data sets, and the algorithm did not show problems of convergence or lack of identifiability. We conclude that the proposed model is a good alternative to estimate probabilities of transitions from one state of health to the other in studies with low adherence to follow-up.