Chronic obstructive pulmonary disease in Brazil: mortality and hospitalization trends and rates, 1996-2008

SETTING: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death among adults in Brazil. OBJECTIVE: To evaluate the mortality and hospitalisation trends in Brazil caused by COPD during the period 1996-2008. DESIGN: We used the health official statistics system to obtain data about mortality (1996-2008) and morbidity (1998-2008) due to COPD and all respiratory diseases (tuberculosis: codes A15-16; lung cancer: code C34, and all diseases coded from J40 to 47 in the 10th Revision of the International Classification of Diseases) as the underlying cause, in persons aged 45-74 years. We used the Joinpoint Regression Program log-linear model using Poisson regression that creates a Monte Carlo permutation test to identify points where trend lines change significantly in magnitude/direction to verify peaks and trends. RESULTS: The annual per cent change in age-adjusted death rates due to COPD declined by 2.7% in men (95%CI -3.6 to -1.8) and -2.0% (95%CI -2.9 to -1.0) in women; and due to all respiratory causes it declined by -1.7% (95%CI 2.4 to -1.0) in men and -1.1% (95%CI -1.8 to -0.3) in women. Although hospitalisation rates for COPD are declining, the hospital admission fatality rate increased in both sexes. CONCLUSION: COPD is still a leading cause of mortality in Brazil despite the observed decline in the mortality/hospitalisation rates for both sexes.

Maternal diabetes affects cell proliferation in developing rat placenta

Placentation starts with the formation of a spheroidal trophoblastic shell surrounding the embryo, thus facilitating both implantation into the uterine stroma and contact with maternal blood. Although it is known that diabetes increases the placental size and weight, the mechanisms responsible for this alteration are still poorly understood. In mammals, cellular proliferation occurs in parallel to placental development and it is possible that diabetes induces abnormal uncontrolled cell proliferation in the placenta similar to that seen in other organs (e.g. retina). To test this hypothesis, the objective of this work was to determine cell proliferation in different regions of the placenta during its development in a diabetic rat model. Accordingly, diabetes was induced on day 2 of pregnancy in Wistar rats by a single injection of alloxan (40 mg/kg i.v.). Placentas were collected on days 14, 17, and 20 postcoitum. Immunoperoxidase was used to identify Ki67 nuclear antigen in placental sections. The number of proliferating cells was determined in the total placental area as well as in the labyrinth, spongiotrophoblast and giant trophoblast cell regions. During the course of pregnancy, the number of Ki67 positive cells decreased in both control and diabetic rat placentas. However, starting from day 17 of pregnancy, the number of Ki67 positive cells in the labyrinth and spongiotrophoblast regions was higher in diabetic rat placentas as compared to control. The present results demonstrate that placentas from the diabetic rat model have a significantly higher number of proliferating cells in specific regions of the placenta and at defined developmental stages. It is possible that this increased cell proliferation promotes thickness of the placental barrier consequently affecting the normal maternal-fetal exchanges.

Vulnerability to heat-related mortality in Latin America: A case-crossover study in Sao Paulo, Brazil, Santiago, Chile and Mexico City, Mexico

Background Factors affecting vulnerability to heat-related mortality are not well understood. Identifying susceptible populations is of particular importance given anticipated rising temperatures from climatic change. Methods We investigated heat-related mortality for three Latin American cities (Mexico City, Mexico; Sao Paulo, Brazil; Santiago, Chile) using a case-crossover approach for 754 291 deaths from 1998 to 2002. We considered lagged exposures, confounding by air pollution, cause of death and susceptibilities by educational attainment, age and sex. Results Same and previous day apparent temperature were most strongly associated with mortality risk. Effect estimates remained positive though lowered after adjustment for ozone or PM(10). Susceptibility increased with age in all cities. The increase in mortality risk for those >= 65 comparing the 95th and 75th percentiles of same-day apparent temperature was 2.69% (95% CI: -2.06 to 7.88%) for Santiago, 6.51% (95% CI: 3.57-9.52%) for Sao Paulo and 3.22% (95% CI: 0.93-5.57%) for Mexico City. Patterns of vulnerability by education and sex differed across communities. Effect estimates were higher for women than men in Mexico City, and higher for men elsewhere, although results by sex were not appreciably different for any city. In Sao Paulo, those with less education were more susceptible, whereas no distinct patterns by education were observed in the other cities. Conclusions Elevated temperatures are associated with mortality risk in these Latin American cities, with the strongest associations in So Paulo, the hottest city. The elderly are an important population for targeted prevention measures, but vulnerability by sex and education differed by city.

Mudanças no âmbito da testagem anti-HIV no Brasil entre 1998 e 2005

OBJETIVO: Analisar mudanças na realização de teste anti-HIV, as razões alegadas entre as pessoas que foram ou não testadas e o recebimento de aconselhamento. MÉTODOS: Estudos transversais conduzidos com homens e mulheres de 16 a 65 anos, com amostras representativas do Brasil urbano em 1998 (n=3.600) e 2005 (n=5.040). Características sociodemográficas, sexuais, reprodutivas e de experiências de vida e saúde foram consideradas na análise. A avaliação das possíveis diferenças nas distribuições das variáveis baseou-se nos testes qui-quadrado de Pearson e F design-based (±<5%). RESULTADOS: Em 1998, 20,2% dos entrevistados haviam realizado o teste e 33,6% em 2005. Foram testadas 60% das mulheres na faixa 25-34 anos, mas as que iniciaram a vida sexual antes dos 16 anos e reportaram quatro ou mais parceiros sexuais nos cinco anos anteriores à entrevista foram menos testadas. Não se observou aumento significativo da testagem entre homens, exceto para os de 55-65 anos, renda per capita entre 1-3 e 5-10 salários mínimos, aposentados, protestantes históricos e adeptos de cultos afro-brasileiros, moradores da região Norte/Nordeste e os que declararam parceria homo/bissexual ou não tiveram relações sexuais nos cinco anos anteriores à entrevista. Não aumentou a freqüência de testagem entre pessoas auto-avaliadas como sob alto risco para o HIV. Entre as mulheres, a freqüência de testagem pré-natal aumentou e a testagem por trabalho diminuiu entre os homens. Em 2005, metade dos testados não recebeu orientação antes ou após o teste. CONCLUSÕES: Houve expansão desigual na testagem, atingindo principalmente mulheres em idade reprodutiva, adultas e pessoas com melhores condições sociais. A testagem parece estar aumentando no País sem a devida atenção à decisão autônoma das pessoas e sem o provimento de maior e melhor oferta de aconselhamento

Air Pollution and Mortality in Latin America The Role of Education

Background: People with less education in Europe, Asia, and the United States are at higher risk of mortality associated with daily and longer-term air pollution exposure. We examined whether educational level modified associations between mortality and ambient particulate pollution (PM(10)) in Latin America, using several timescales. Methods: The study population included people who died during 1998-2002 in Mexico City, Mexico; Santiago, Chile; and Sao Paulo, Brazil. We fit city-specific robust Poisson regressions to daily deaths for nonexternal-cause mortality, and then stratified by age, sex, and educational attainment among adults older than age 21 years (none, some primary, some secondary, and high school degree or more). Predictor variables included a natural spline for temporal trend, linear PM(10) and apparent temperature at matching lags, and day-of-week indicators. We evaluated PM(10) for lags 0 and I day, and fit an unconstrained distributed lag model for cumulative 6-day effects. Results: The effects of a 10-mu g/m(3) increment in lag 1 PM(10) on all nonextemal-cause adult mortality were for Mexico City 0.39% (95% confidence interval = 0.131/-0.65%); Sao Paulo 1.04% (0.71%-1.38%); and for Santiago 0.61% (0.40%-0.83%. We found cumulative 6-day effects for adult mortality in Santiago (0.86% [0.48%-1.23%]) and Sao Paulo (1.38% [0.85%-1.91%]), but no consistent gradients by educational status. Conclusions: PM(10) had important short- and intermediate-term effects on mortality in these Latin American cities, but associations did not differ consistently by educational level.

Advertisement call, vocal activity, and geographic distribution of Brachycephalus hermogenesi (Giaretta and Sawaya, 1998) (Anura, Brachycephalidae)

Brachycephalus hermogenesi is an endemic leaf litter inhabitant of the Atlantic forest of southeastern Brazil, whose original distribution included a restricted area near the boundaries of the States of Sao Paulo and Rio de Janeiro. We were surprised to find out, while conducting herpetofaunal surveys at Estacao Biologica de Boraceia (EBB), that the background forest insect-like sound we have been searching for corresponded to calling individuals of the species. Males call during the day at high densities, hidden under the leaf litter. Individuals do not answer playback, seem to move very infrequently, and seem to ignore nearby calling activity. We gathered data on annual and daily vocal activity of the species at EBB, observing a total of 1,549 calls given by 31 focal individuals in November 2003 and 2005. The call varies from short single note calls to calls composed of groups of two to seven similar notes emitted at regular intervals. We also extend the known distribution of the species southward to the State of Sao Paulo.

Late Paleozoic-Early Triassic magmatism on the western margin of Gondwana: Collahuasi area, Northern Chile

The basement in the `Altiplano` high plateau of the Andes of northern Chile mostly consists of late Paleozoic to Early Triassic felsic igneous rocks (Collahuasi Group) that were emplaced and extruded along the western margin of the Gondwana supercontinent. This igneous Suite crops out in the Collalluasi area and forms the backbone of most of the high Andes from latitude 20 degrees to 22 degrees S. Rocks of the Collahuasi Group and correlative formations form art extensive belt of volcanic and subvolcanic rocks throughout the main Andes of Chile, the Frontal Cordillera of Argentina (Choiyoi Group or Choiyoi Granite-Rhyolite Province), and the Eastern Cordillera of Peru. Thirteen new SHRIMP U-Pb zircon ages from the Collahuasi area document a bimodal timing for magnatism, with a dominant peak at about 300 Ma and a less significant one at 244 Ma. Copper-Mo porphyry mineralization is related to the younger igneous event. Initial Hf isotopic ratios for the similar to 300 Ma zircons range from about -2 to +6 indicating that the magmas incorporated components with a significant crustal residence time. The 244 Ma magmas were derived from a less enriched source, with the initial HT values ranging from +2 to +6, suggestive of a mixture with a more depleted component. Limited whole rock (144)Nd/(143)Nd and (87)Sr/(86)Sr isotopic ratios further support the likelihood that the Collahuasi Group magmatism incorporated significant older crustal components, or at least a mixture of crustal sources with more and less evolved isotopic signatures. (C) 2007 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Tectonic implications of a paleomagnetic study of the Sarmiento Ophiolitic Complex, southern Chile

A paleomagnetic study was carried out on the Late Jurassic Sarmiento Ophiolitic Complex (SOC) exposed in the Magallanes fold and thrust belt in the southern Patagonian Andes (southern Chile). This complex, mainly consisting of a thick succession of pillow-lavas, sheeted dikes and gabbros, is a seafloor remnant of the Late Jurassic to Early Cretaceous Rocas Verdes basin that developed along the south-western margin of South America. Stepwise thermal and alternating field demagnetization permitted the isolation of a post-folding characteristic remanence, apparently carried by fine grain (SD?) magnetite, both in the pillow-lavas and dikes. The mean ""in situ"" direction for the SOC is Dec: 286.9 degrees, Inc: -58.5 degrees, alpha-95: 6.9 degrees, N: 11 (sites). Rock magnetic properties, petrography and whole-rock K-Ar ages in the same rocks are interpreted as evidence of correlation between remanence acquisition and a greenschist facies metamorphic overprint that must have occurred during latest stages or after closure and tectonic inversion of the basin in the Late Cretaceous. The mean remanence direction is anomalous relative to the expected Late Cretaceous direction from stable South America. Particularly, a declination anomaly over 50 degrees is suggestively similar to paleomagnetically interpreted counter clockwise rotations found in thrust slices of the Jurassic El Quemado Fm. located over 100 km north of the study area in Argentina. Nevertheless, a significant ccw rotation of the whole SOC is difficult to reconcile with geologic evidence and paleogeographic models that suggest a narrow back-arc basin sub-parallel to the continental margin. A rigid-body 30 degrees westward tilting of the SOC block around a horizontal axis trending NNW, is considered a much simpler explanation, being consistent with geologic evidence. This may have occurred as a consequence of inverse reactivation of old normal faults, which limit both the SOC exposures and the Cordillera Sarmiento to the East. The age of tilting is unknown but it must postdate remanence acquisition in the Late Cretaceous. Two major orogenic events of the southern Patagonian Andes, in the Eocene (ca. 42 Ma) and Middle Miocene (ca. 12 Ma), respectively, could have caused the proposed tilting. (C) 2008 Elsevier B.V. All rights reserved.

Prediction of the economic activity from the short and long-term interest rate differential: new evidences in Chile and the United States of America cases

The purpose of this work is to verify the stability of the relationship between real activity and interest rate spread. The test is based on Chen (1988) and Osorio and Galea (2006). The analysis is applied to Chile and the United States, from 1980 to 1999. In general, in both cases the relationship was statistically significant in early 80s, but a break point is found in both countries during that decades, suggesting that the relationship depends on the monetary rule follow by the Central Bank.