Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas' disease

A century after its discovery, Chagas' disease still represents a major public health challenge in Latin America. Moreover, because of growing population movements, an increasing number of cases of imported Chagas' disease have now been detected in non-endemic areas, such as North America and some European countries. This parasitic zoonosis, caused by Trypanosoma cruzi, is transmitted to humans by infected Triatominae insects, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to fetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40-50% of patients develop progressive cardiomyopathy and/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary and tertiary prevention of Chagas' disease have been attempted. While control of both vectorial and blood transfusion transmission of T cruzi (primary prevention) has been successful in many regions of Latin America, early detection and aetiological treatment of asymptomatic subjects with Chagas' disease (secondary prevention) have been largely underutilised. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intention of preventing or delaying complications of the disease (tertiary prevention). In this review we discuss in detail each of these issues.

Information Society, Teaching, and Learning: Education Reforms in Brazil

This article examines the subject matter of learning within the context of information society, through an inquiry concerning both the reforms in education adopted in Brazil in the last thirty years and their results. It provides a revision on the explanations of school failure based on assumptions of learning problems due to cognitive and linguistic deficits. From the guidelines related with written school forms as well as the constant cultural oppression accomplished inside the school, the article claims the necessity of changing the psychological and pedagogic views that, under the label of democratic practices, determine school institutions and its daily life, by means of instrumental relations with knowledge that disregard the reading practices which are congenial to popular culture.

Distance Education in Another Register: Uses and Appropriation of Technologies in Teacher Education

The article explores the relationships between distance education, information and communication technologies and teacher education. Its focus is on the interactive media and its uses in an in-service teacher education program, in Brazil, and on the ways the teachers used the technologies doing their own appropriateness. It departs from the presuppositions of the society of knowledge, that is, the close relationships between new technologies, continuing professional development and social inclusion, arguing that this paradigm is an ideological discourse. The article shows how the teachers have used the technologies in creative ways, calling the attention to the importance of this teachers` abilities as a basic skill to facing the challenges of the society of knowledge itself.

Teacher strikes in Brazil and its representations: ""orderly disciplined class"" and ""education workers"" (Sao Paulo, 1963-1979)

This article analyses the teacher strikes that took place in the state of Sao Paulo ( Brazil). These strikes produced new representations of the profession and gave a particular visibility to its interest aggregation processes. These same strikes appeared as major incentives for the organisation of teachers in Brazil. The October 1963 strike - about six months before the military coup of 1964 - was the first to mobilise the whole of the teaching profession of the Sao Paulo state: primary and secondary education, public and private schools were all involved. The two other strikes, organised by teachers in the public schools in 1978 and 1979, took place under the dictatorship. As such, they had a particular significance in the process of recovering civil liberties in the final stages of the military regime in the 1980s. This article is based on an analysis of the front-page covering of these teacher strikes by the two major journals of the state, O Estado de S. Paulo and Folha de S. Paulo. With Chartier`s concept collective representations in mind, this approach allows us to grasp how large-circulation journals diffuse images of the profession and its organisational configurations. These press pictures are analysed by dint of the analytical frame Roland Barthes advanced in the 1960s, i.e. by reading their denoted, connoted and symbolic messages.

Emerging Issues Concerning the Education of Speech and Language Pathologists and Audiologists in Brazil and South America

Diversity is one of the major characteristics of Brazil and all South America. This paper presents an overview of the current situation of the education of speech and language pathologists (SLP) and audiologists in Brazil and in several other countries of South America. This paper also discusses the main challenges shared by these countries. The discussion is focused on the mutual interferences between education and the areas of professional practice, cultural diversity and continued education. There are many emerging issues about the education of SLP and audiologists in South America. The suggested conclusion is that, despite the many differences, the South American SLP and audiologists` education would benefit from joint efforts and collaborative experiences. Copyright (C) 2010 S. Karger AG, Basel

Epidemiology of leisure, transportation, occupational, and household physical activity: prevalence and associated factors

Background: To estimate the prevalence of and identify factors associated with physical activity in leisure, transportation, occupational, and household settings. Methods: This was a cross-sectional study aimed at investigating living and health conditions among the population of São Paulo, Brazil. Data on 1318 adults aged 18 to 65 years were used. To assess physical activity, the long version of the International Physical Activity Questionnaire was applied. Multivariate analysis was conducted using a hierarchical model. Results: The greatest prevalence of insufficient activity related to transportation (91.7%), followed by leisure (77.5%), occupational (68.9%), and household settings (56.7%). The variables associated with insufficient levels of physical activity in leisure were female sex, older age, low education level, nonwhite skin color, smoking, and self-reported poor health; in occupational settings were female sex, white skin color, high education level, self-reported poor health, nonsmoking, and obesity; in transportation settings were female sex; and in household settings, with male sex, separated, or widowed status and high education level. Conclusion: Physical activity in transportation and leisure settings should be encouraged. This study will serve as a reference point in monitoring different types of physical activities and implementing public physical activity policies in developing countries

Factors associated with sexual initiation and condom use among adolescents on Santiago Island, Cape Verde, West Africa

Foram analisados fatores associados ao início da vida sexual de adolescentes na Ilha de Santiago, Cabo Verde, segundo sexo. Estudo realizado com amostra probabilística e representativa de 768 adolescentes, age 13-17 anos, de escolas secundárias públicas da Ilha de Santiago em 2007. A associação foi testada pelo teste de proporção, qui-quadrado de Pearson ou Fisher e regressão logística. Nos rapazes, os fatores associados ao início da vida sexual foram: idade maior que 14 anos, ser católico e consumo de bebidas alcoólicas. Para meninas: escolaridade maior que nove anos e ter parceiro afetivo-sexual. Ao contrário de outros contextos da África Subsaariana, foram constatadas taxas elevadas de uso de preservativo por adolescentes no início da vida sexual. Os adolescentes podem iniciar a vida sexual de maneira mais segura se tiverem informação, educação sexual e acesso a métodos de prevenção à gravidez e às DST. Este artigo oferece elementos para a reflexão sobre o delineamento de políticas de redução da vulnerabilidade dos jovens às DST/AIDS e sobre os limites e desafios da promoção do uso do preservativo e educação sexual, focando as relações desiguais de gênero

Epidemiology of Leisure, Transportation, Occupational, and Household Physical Activity: Prevalence and Associated Factors

Background: To estimate the prevalence of and identify factors associated with physical activity in leisure, transportation, occupational, and household settings. Methods: This was a cross-sectional study aimed at investigating living and health conditions among the population of So Paulo, Brazil. Data on 1318 adults aged 18 to 65 years were used. To assess physical activity, the long version of the International Physical Activity Questionnaire was applied. Multivariate analysis was conducted using a hierarchical model. Results: The greatest prevalence of insufficient activity related to transportation (91.7%), followed by leisure (77.5%), occupational (68.9%), and household settings (56.7%). The variables associated with insufficient levels of physical activity in leisure were female sex, older age, low education level, nonwhite skin color, smoking, and self-reported poor health; in occupational settings were female sex, white skin color, high education level, self-reported poor health, nonsmoking, and obesity; in transportation settings were female sex; and in household settings, with male sex, separated, or widowed status and high education level. Conclusion: Physical activity in transportation and leisure settings should be encouraged. This study will serve as a reference point in monitoring different types of physical activities and implementing public physical activity policies in developing countries.

Health services performance for TB treatment in Brazil: a cross-sectional study

Background: Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions. Methods: This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaborai (ITA), Ribeirao Preto (RP) and Sao Jose do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the Primary Care Assessment Tool adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites. Results: ""Access to treatment"" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. ""Bond"" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. ""Range of services"" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. ""Coordination"" was evaluated as satisfactory in all cities. ""Family focus"" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP. Conclusions: Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.

Strange and multistrange particle production in Au plus Au collisions at root s(NN)=62.4 GeV

We present results on strange and multistrange particle production in Au + Au collisions at root s(NN) = 62.4 GeV as measured with the STAR detector at RHIC. Midrapidity transverse momentum spectra and integrated yields of K(S)(0), Lambda, Xi, and Omega and their antiparticles are presented for different centrality classes. The particle yields and ratios follow a smooth energy dependence. Chemical freeze-out parameters, temperature, baryon chemical potential, and strangeness saturation factor obtained from the particle yields are presented. Intermediate transverse momentum (p(T)) phenomena are discussed based on the ratio of the measured baryon-to-meson spectra and nuclear modification factor. The centrality dependence of various measurements presented show a similar behavior as seen in Au + Au collisions at root s(NN) = 200 GeV.

Parton energy loss in heavy-ion collisions via direct-photon and charged-particle azimuthal correlations

Charged-particle spectra associated with direct photon (gamma(dir)) and pi(0) are measured in p + p and Au + Au collisions at center-of-mass energy root(S)(NN) = 200 GeV with the STAR detector at the Relativistic Heavy Ion Collider. A shower-shape analysis is used to partially discriminate between gamma(dir) and pi(0). Assuming no associated charged particles in the gamma(dir) direction ( near side) and small contribution from fragmentation photons (gamma(frag)), the associated charged-particle yields opposite to gamma(dir) (away side) are extracted. In central Au + Au collisions, the charged-particle yields at midrapidity (vertical bar eta vertical bar < 1) and high transverse momentum (3 < (assoc)(PT) < 16 GeV/c) associated with gamma(dir) and pi(0) (vertical bar eta vertical bar < 0.9, 8 < (trig)(PT) < 16 GeV/c) are suppressed by a factor of 3-5 compared with p + p collisions. The observed suppression of the associated charged particles is similar for gamma(dir) and pi(0) and independent of the gamma(dir) energy within uncertainties. These measurements indicate that, in the kinematic range covered and within our current experimental uncertainties, the parton energy loss shows no sensitivity to the parton initial energy, path length, or color charge.

Balance functions from Au+Au, d+Au, and p+p collisions at root s(NN)=200 GeV

Balance functions have been measured for charged-particle pairs, identified charged-pion pairs, and identified charged-kaon pairs in Au + Au, d + Au, and p + p collisions at root s(NN) = 200 GeV at the Relativistic Heavy Ion Collider using the STAR detector. These balance functions are presented in terms of relative pseudorapidity, Delta eta, relative rapidity, Delta y, relative azimuthal angle, Delta phi, and invariant relative momentum, q(inv). For charged-particle pairs, the width of the balance function in terms of Delta eta scales smoothly with the number of participating nucleons, while HIJING and UrQMD model calculations show no dependence on centrality or system size. For charged-particle and charged-pion pairs, the balance functions widths in terms of Delta eta and Delta y are narrower in central Au + Au collisions than in peripheral collisions. The width for central collisions is consistent with thermal blast-wave models where the balancing charges are highly correlated in coordinate space at breakup. This strong correlation might be explained by either delayed hadronization or limited diffusion during the reaction. Furthermore, the narrowing trend is consistent with the lower kinetic temperatures inherent to more central collisions. In contrast, the width of the balance function for charged-kaon pairs in terms of Delta y shows little centrality dependence, which may signal a different production mechanism for kaons. The widths of the balance functions for charged pions and kaons in terms of q(inv) narrow in central collisions compared to peripheral collisions, which may be driven by the change in the kinetic temperature.

Spectra of identified high-p(T) pi(+/-) and p((p)over-bar ) in Cu + Cu collisions at root s(NN)=200 GeV

We report new results on identified (anti) proton and charged pion spectra at large transverse momenta (3 < p(T) < 10 GeV/c) from Cu + Cu collisions at root s(NN) = 200 GeV using the STAR detector at the Relativistic Heavy Ion Collider (RHIC). This study explores the system size dependence of two novel features observed at RHIC with heavy ions: the hadron suppression at high-p(T) and the anomalous baryon to meson enhancement at intermediate transverse momenta. Both phenomena could be attributed to the creation of a new form of QCD matter. The results presented here bridge the system size gap between the available pp and Au + Au data, and allow for a detailed exploration of the onset of the novel features. Comparative analysis of all available 200 GeV data indicates that the system size is a major factor determining both the magnitude of the hadron spectra suppression at large transverse momenta and the relative baryon to meson enhancement.

Charged and strange hadron elliptic flow in Cu plus Cu collisions at root s(NN)=62.4 and 200 GeV

We present the results of an elliptic flow, v(2), analysis of Cu + Cu collisions recorded with the solenoidal tracker detector (STAR) at the BNL Relativistic Heavy Ion Collider at root s(NN) = 62.4 and 200 GeV. Elliptic flow as a function of transverse momentum, v(2)(p(T)), is reported for different collision centralities for charged hadrons h(+/-) and strangeness-ontaining hadrons K(S)(0), Lambda, Xi, and phi in the midrapidity region vertical bar eta vertical bar < 1.0. Significant reduction in systematic uncertainty of the measurement due to nonflow effects has been achieved by correlating particles at midrapidity, vertical bar eta vertical bar < 1.0, with those at forward rapidity, 2.5 < vertical bar eta vertical bar < 4.0. We also present azimuthal correlations in p + p collisions at root s = 200 GeV to help in estimating nonflow effects. To study the system-size dependence of elliptic flow, we present a detailed comparison with previously published results from Au + Au collisions at root s(NN) = 200 GeV. We observe that v(2)(p(T)) of strange hadrons has similar scaling properties as were first observed in Au + Au collisions, that is, (i) at low transverse momenta, p(T) < 2 GeV/c, v(2) scales with transverse kinetic energy, m(T) - m, and (ii) at intermediate p(T), 2 < p(T) < 4 GeV/c, it scales with the number of constituent quarks, n(q.) We have found that ideal hydrodynamic calculations fail to reproduce the centrality dependence of v(2)(p(T)) for K(S)(0) and Lambda. Eccentricity scaled v(2) values, v(2)/epsilon, are larger in more central collisions, suggesting stronger collective flow develops in more central collisions. The comparison with Au + Au collisions, which go further in density, shows that v(2)/epsilon depends on the system size, that is, the number of participants N(part). This indicates that the ideal hydrodynamic limit is not reached in Cu + Cu collisions, presumably because the assumption of thermalization is not attained.

Longitudinal double-spin asymmetry and cross section for inclusive neutral pion production at midrapidity in polarized proton collisions at s=200 GeV

We report a measurement of the longitudinal double-spin asymmetry A(LL) and the differential cross section for inclusive pi(0) production at midrapidity in polarized proton collisions at s=200 GeV. The cross section was measured over a transverse momentum range of 1 < p(T)< 17 GeV/c and found to be in good agreement with a next-to-leading order perturbative QCD calculation. The longitudinal double-spin asymmetry was measured in the range of 3.7 < p(T)< 11 GeV/c and excludes a maximal positive gluon polarization in the proton. The mean transverse momentum fraction of pi(0)'s in their parent jets was found to be around 0.7 for electromagnetically triggered events.