The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006]

Background: In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.Objective: To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.Methods: Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.Results: Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.Conclusions: This safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

A multidisciplinary program of preparation for childbirth and motherhood: maternal anxiety and perinatal outcomes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

An approach using Lagrangian/surrogate relaxation for lot-sizing with transportation costs

Neste trabalho estuda-se um problema de dimensionamento de lotes e distribuição que envolve além de custos de estoques, produção e preparação, custos de transportes para o armazém da empresa. Os custos logísticos estão associados aos contêineres necessários para empacotar os produtos produzidos. A empresa negocia um contrato de longo prazo onde um custo fixo por período é associado ao transporte dos itens, em contrapartida um limite de contêineres é disponibilizado com custo mais baixo que o custo padrão. Caso ocorra um aumento ocasional de demanda, novos contêineres podem ser utilizados, no entanto, seu custo é mais elevado. Um modelo matemático foi proposto na literatura e resolvido utilizando uma heurística Lagrangiana. No presente trabalho a resolução do problema por uma heurística Lagrangiana/surrogate é avaliada. Além disso, é considerada uma extensão do modelo da literatura adicionando restrições de capacidade e permitindo atraso no atendimento a demanda. Testes computacionais mostraram que a heurística Lagrangiana/surrogate é competitiva especialmente quando se têm restrições de capacidade apertada.

Mammal defaunation as surrogate of trophic cascades in a biodiversity hotspot

Preserving large tracts of natural habitats is essential to maintain biodiversity. Nevertheless, even large areas may still suffer from less visible impacts such as loss of ecological processes. Because mapping ecological processes over large scales is not practical, an alternative is to map surrogate species that are key for those processes. In this study, we chose four species of Neotropical large mammals (the largest apex predator: jaguar - Panthera onca; the largest herbivore: tapir - Tapirus terrestris; the largest seed predator: white-lipped peccary - Tayassu pecari; and the largest arboreal seed disperser: muriqui - Brachyteles spp.) in an ecosystem with an old history of human impact (the Atlantic Forest) to test whether areas with native forest still harbor ecological processes that may guarantee long-term ecosystem maintenance. We gathered 94 locations with recent presence of the four species to map current ranges and model suitable areas. Our results reveal that 96% of the remaining Atlantic Forest is depleted of at least one of the four surrogate species and 88% is completely depleted of all four surrogate species. We also found that only 16% is still environmentally suitable for all four, and 55% is completely unsuitable to all four of them. Our study highlights the importance of looking beyond land cover to fully depict intactness of natural areas, and suggests that ecosystems with a long history of human impact (such as the Atlantic Forest) may be suffering from ecological impacts not seen at a first glance. © 2013 Elsevier Ltd.

Heurística Surrogate para problema de carregamento de paletes dio produtor

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The mean corpuscular volume and hydroxyurea in brazilian patients with sickle cell anemia: a surrogate marker of compliance

The suppression of erythropoiesis by Hydroxyurea (HU) therapy is associated with increase in mean corpuscular volume, in addition to the increase in Hb F. Monitoring the mean corpuscular volume values and the presence of macrocytosis are effective tools of adherence to the treatment with HU in patients with sickle cell anemia. The aim of this study is to monitor the mean corpuscular volume values after starting treatment with HU to determine if macrocytosis can be used as a surrogate marker of compliance with therapy. We conducted a prospective cohort study over one year with measurements of blood counts and mean corpuscular volume after starting therapy with HU in 95 patients with sickle cell anemia who were regularly followed in our ambulatory outpatient unit. In one-year of successful use of HU the mean value of the mean corpuscular volume increased significantly. The Andersen and Gill model demonstrated that the increase of one unit of MCV implies a 5% reduction in the risk of visiting the emergency room. Monitoring mean corpuscular volume values after prescribing HU alerts the provider of noncompliance in order to counsel the patient in question for better adherence to the use of HU that could improve the quality of care and to reduce morbidity and the frequency of acute pain crises and associated healthcare costs.

Produção de sentidos sobre a maternidade: uma experiência no Programa Mãe Canguru

Este artigo analisa, sob a perspectiva da relação entre a família e instituições de saúde, os sentidos produzidos sobre a maternidade em um programa de saúde neonatal desenvolvido na rede pública - o Programa Mãe Canguru. A partir de entrevistas e observações feitas com usuárias durante sua participação no programa, buscamos apreender como as práticas discursivas e não discursivas sobre maternidade e maternagem, difundidas nesse processo, se articulam com as experiências concretas dessas mulheres para produzir novas configurações subjetivas. Na interpretação dos dados, realizada através de análise do discurso, os aspectos mais significativos das falas das entrevistadas foram agrupados em quatro núcleos de sentido: família e religião; o impacto do nascimento prematuro; desconfiança e resistência nas relações com instituições e profissionais de saúde; e a experiência com o Programa Mãe Canguru. Ao final, procurou-se identificar as principais estratégias e formas de singularização utilizadas por essas mulheres ao atribuírem sentidos ao papel materno.

A branch-and-price approach to p-median location problems

This paper describes a branch-and-price algorithm for the p-median location problem. The objective is to locate p facilities (medians) such as the sum of the distances from each demand point to its nearest facility is minimized. The traditional column generation process is compared with a stabilized approach that combines the column generation and Lagrangean/surrogate relaxation. The Lagrangean/surrogate multiplier modifies; the reduced cost criterion, providing the selection of new productive columns at the search tree. Computational experiments are conducted considering especially difficult instances to the traditional column generation and also with some large-scale instances. (C) 2004 Elsevier Ltd. All rights reserved.

Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The fish zonation of the Itanha,m river basin in the Atlantic Forest of southeast Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A simple method for estimating global DNA methylation using bisulfite PCR of repetitive DNA elements

We report a method for studying global DNA methylation based on using bisulfite treatment of DNA and simultaneous PCR of multiple DNA repetitive elements, such as Alu elements and long interspersed nucleotide elements (LINE). The PCR product, which represents a pool of approximately 15000 genomic loci, could be used for direct sequencing, selective restriction digestion or pyrosequencing, in order to quantitate DNA methylation. By restriction digestion or pyrosequencing, the assay was reproducible with a standard deviation of only 2% between assays. Using this method we found that almost two-thirds of the CpG methylation sites in Alu elements are mutated, but of the remaining methylation target sites, 87% were methylated. Due to the heavy methylation of repetitive elements, this assay was especially useful in detecting decreases in DNA methylation, and this assay was validated by examining cell lines treated with the methylation inhibitor 5-aza-2'deoxycytidine (DAC), where we found a 1-16% decrease in Alu element and 18-60% LINE methylation within 3 days of treatment. This method can be used as a surrogate marker of genome-wide methylation changes. In addition, it is less labor intensive and requires less DNA than previous methods of assessing global DNA methylation.

Um novo método para quantificar mercúrio orgânico (Hg orgânico) empregando a espectrometria de fluorescência atômica do vapor frio

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Abordagens complementares para problemas de p-medianas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Métodos de geração de colunas para problemas de atribuição

Este trabalho apresenta métodos de geração de colunas para dois importantes problemas de atribuição: o Problema Generalizado de Atribuição (PGA) e o Problema de Atribuição de Antenas a Comutadores (PAAC). O PGA é um dos mais representativos problemas de Otimização Combinatória e consiste em otimizar a atribuição de n tarefas a m agentes, de forma que cada tarefa seja atribuída a exatamente um agente e a capacidade de cada agente seja respeitada. O PAAC consiste em atribuir n antenas a m comutadores em uma rede de telefonia celular, de forma a minimizar os custos de cabeamento entre antenas e comutadores e os custos de transferência de chamadas entre comutadores. A abordagem tradicional de geração de colunas é comparada com as propostas neste trabalho, que utilizam a relaxação lagrangeana/surrogate. São apresentados testes computacionais que demonstram a efetividade dos algoritmos propostos.

Histórias de vida de mulheres HIV+ ativistas: mudanças e permanências

Nesses anos de seu reconhecimento, a aids tem obrigado a desnaturalizar questões sociais e culturais construídas historicamente e que são parte dos signos, das normas e dos códigos que balizam a estrutura e a organização da sociedade, impondo outros olhares e novas perspectivas para a complexidade de questões relacionadas aos gêneros, aos corpos e à cultura. Considerando essa conjuntura, esta pesquisa foi realizada com quatro mulheres HIV+ ativistas no movimento de aids com o objetivo de apreender suas concepções sobre a doença, os contextos de vulnerabilidade que possibilitaram sua infecção, suas vulnerabilidades à reinfecção e as mudanças e permanências nos campos afetivo-conjugal e da maternidade, a partir da experiência da doença e da militância.