Surveillance Programme for Healthcare Associated Infections in the State of São Paulo, Brazil. Implementation and the first three years' results

Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Inequalities in access to education and healthcare

The burden of disease is borne by those who suffer as patients but also by society at large, including health service providers. That burden is felt most severely in parts of the world where there is no infrastructure, or foreseeable prospects of any, to change the status quo without external support. Poverty, disease and inequality pervade all the activities of daily living in low-income regions and are inextricably linked. External interventions may not be the most appropriate way to impact on this positively in all circumstances, but targeted programmes to build social capital, within and by countries, are more likely to be sustainable. By these means, basic oral healthcare, underpinned by the primary healthcare approach, can be delivered to more equitably address needs and demands. Education is fundamental to building knowledge-based economies but is often lacking in such regions even at primary and secondary level. Provision of private education at tertiary level may also introduce its own inequities. Access to distance learning and community-based practice opens opportunities and is more likely to encourage graduates to work in similar areas. Recruitment of faculty from minority groups provides role models for students from similar backgrounds but all faculty staff must be involved in supporting and mentoring students from marginalized groups to ensure their retention. The developed world has to act responsibly in two crucial areas: first, not to exacerbate the shortage of skilled educators and healthcare workers in emerging economies by recruiting their staff; second, they must offer educational opportunities at an economic rate. Governments need to lead on developing initiatives to attract, support and retain a competent workforce.

Subgingival utilization of a 1% chlorhexidine collagen gel for the treatment of periodontal pockets. A clinical and microbiological study.

This study evaluates the effect of subgingival irrigation with a 1% chlorhexidine collagen gel in periodontal pockets as an adjunct procedure to scaling and root planing (SRP). Thirty-seven sites with probing depth (PD) of 5-7 mm and BANA positive in 6 patients with chronic periodontal disease were selected. Sites were assigned to different treatment groups consisting of SRP only (group 1), SRP + irrigation with collagen gel (group 2), or SRP + irrigation with collagen gel containing 1% chlorhexidine (group 3). Subgingival irrigation was performed after initial SRP and at 7, 14 and 21 days. Clinical measurements including PD, plaque index (PI), gingival index (GI), gingival recession (GI), bleeding on probing (BOP) and clinical attachment level (CAL) were performed at the selected sites at baseline, 60 and 90 days and the BANA test was performed on plaque samples from the same sites at baseline and 90 days. There was an improvement in clinical parameters in all groups with a significantly greater decrease in GI and bleeding in the chlorhexidine group. There was a greater reduction of BANA positive sites in groups 2 and 3. The authors concluded that 1% chlorhexidine collagen gel is a promising adjunct to SRP in the treatment of adult periodontitis.

Genetic diversity in Colletotrichum gloeosporioides from Stylosanthes spp. at Centers of origin and utilization

Using molecular markers, this work compares the genetic diversity in Colletotrichum gloeosporioides infecting species of the tropical forage legume Stylosanthes at the center of origin in Brazil and Colombia with that of Australia, China, and India, where Srylosanthes spp. have been introduced for commercial use. There was extensive diversity in the pathogen population from Brazil, Colombia, China, and India. The Australian pathogen population was least diverse probably due to its geographical isolation and effective quarantine. The extensive diversity in China and India means that threats from exotic pathogen races to Stylosanthes pastures can potentially come from countries outside the South American center of origin. In Brazil and India, both with native Stylosanthes populations, a high level of genetic differentiation in the pathogen population was associated with sites where native or naturalized host population was widely distributed. There was limited genetic diversity at germplasm evaluation sites, with a large proportion of isolates having identical haplotypes. This contrasts recent pathogenicity results for 78 of the Brazilian isolates that show hot spots of complex races are more common around research stations where host germplasm are tested, but few are found at sites containing wild host populations. For a pathogen in which the same races arise convergently from different genetic backgrounds, this study highlights the importance of using both virulence and selectively neutral markers to understand pathogen population structure.

Modeling metabolizable energy utilization in broiler breeder pullets

The objective of this study was to determine models for ME requirements for broiler breeder pullets using the factorial method. The influence of the temperature on maintenance ME requirements was determined by experiments conducted in three environmental rooms with temperature kept constant at 15, 22, and 30°C, using the comparative slaughter technique. The energy requirements for weight gain were determined based on the body energy content and efficiency of energy utilization for weight gain. Two ME requirement models for each age were developed using the coefficients for maintenance and weight gain. The models for 3 to 8 wk were ME = W 0.75 (186.52 - 1.94T) + 2.47WG, and ME = W 0.75 (174 - 1.88T) + 2.83WG; for 9 to 14 wk, ME = W 0.75 (186.52 - 1.94T) + 2.69WG, and ME = W 0.75 (174 - 1.88T) + 2.50WG; and 15 to 20 wk, ME = W 0.75 (186.52 - 1.94T) + 2.76WG, and ME = W 0.75 (174 - 1.88T) + 3.24WG. In these equations, W is BW (kg), T is temperature (°C), and WG is daily weight gain (g). These models were compared to the breeder's recommendations in a feeding trial from 5 to 20 wk of age. Models 1 and 2 provided energy intakes that promoted BW smaller than the breeder's recommendation. However, all breeder pullets had weights above the standard recommendation. Model 2 gave the smallest ME intake and BW close to the standard recommendation and provided the best prediction of ME requirements.

Utilization of fish protein hydrolysate in prepared diets for pacu, Piaractus mesopotamicus, larvae

Growth and survival rates of pacu, Piaractus mesopotamicus, larvae fed prepared diets containing different animal protein sources were evaluated. Four diets with the same level of crude protein (CP) (36%) and calories (4.02 kcal gross energy/g of diet) were fed to the larvae. Diets were formulated to contain one of four protein sources: (1) fish meal (FM), (2) tilapia residue silage (TS), (3) protein hydrolysate from tilapia residue (HT), and (4) eviscerated tilapia residue (HET). Larvae were fed Artemia nauplii for six days, prior to the start of the study, and the prepared diet was supplied from day 7 until the study concluded. Variance analysis showed no significant differences (P > 0.05) for survival rates and larval final lengths among treatments. However, final average weights were significantly different (P < 0.05 for larvae fed FM and HT. Average survival rates were relatively high and ranged from 68.1% to 73.9%. After the live food was replaced by prepared diets, no larval growth was observed for any treatment. Fish protein hydrolysate (HT and HET) and fish silage showed potential to be used as ingredients in the diet of pacu larvae. However, hydrolysate inclusion levels, processing methods to minimize nutrient lixiviation, and the best moment to replace live food with an inert diet (weaning) need further investigation. © 2003 by The Haworth Press, Inc. All rights reserved.

Water-soluble extract of Coleus barbatus modulates weight gain, energy utilization and lipid metabolism in secondary biliary cirrhosis: an experimental study in young rats.

PURPOSE: To test if a water extract of Coleus barbatus (WEB) has any effect on weight gain, food energy utilization and lipid metabolism in young rats with obstructive cholestasis. METHODS: Forty 21 day old (P21) Wistar rats, in groups of 10, were submitted to one of the following treatments: a sham operation with daily water or WEB administration, double ligature and resection of the bile duct with daily water or WEB administration. At P49 they were submitted for euthanasia when the following were determined: ingested feed (IF), energy utilization (EU) and weight gain (WG) from P29 to P49, together with total serum cholesterol (TC) and triacylglycerol (TG) concentrations, liver wet weight (LWW) and fat content (LFC). Two Way ANOVA and the S.N.K. test for paired comparisons were employed to study the effects of cholestasis and those of WEB and their interactions (p < or = 0.05). RESULTS: Cholestasis, independently of WEB, and WEB, independently of cholestasis both reduced IF, EU, and WG but there was no significant interaction between the two factors. Cholestasis, independently of WEB, increased LWW, LFC, the TC and TG The WEB, independently of cholestasis, reduced these values, and there was a significant interaction between the two factors; such that these effects were more accentuated in animals with cholestasis. CONCLUSION: The WEB reduced IF, WG, and EU, both in the presence and absence of cholestasis in the same proportion. It also partially inhibited the increase in LWW, LFC, TC and TG caused by cholestasis.

Modeling energy utilization and growth parameter description for broiler chickens

Two experiments were conducted to develop and evaluate a model to estimate ME requirements and determine Gompertz growth parameters for broilers. The first experiment was conducted to determine maintenance energy requirements and the efficiencies of energy utilization for fat and protein deposition. Maintenance ME (ME m) requirements were estimated to be 157.8, 112.1, and 127.2 kcal of ME/kg 0.75 per day for broilers at 13, 23, and 32°C, respectively. Environmental temperature (T) had a quadratic effect on maintenance requirements (ME m = 307.87 - 15.63T + 0.3105T 2; r 2= 0.93). Energy requirements for fat and protein deposition were estimated to be 13.52 and 12.59 kcal of ME/g, respectively. Based on these coefficients, a model was developed to calculate daily ME requirements: ME = BW 0.75 (307.87 - 15.63T + 0.3105 T 2) + 13.52 G f + 12.59 G p. This model considers live BW, the effects of environmental temperature, and fractional fat (G f) and protein (G p) deposition. The second experiment was carried out to estimate the growth parameters of Ross broilers and to collect data to evaluate the ME requirement model proposed. Live BW, empty feather-free carcass, weight of the feathers, and carcass chemical compositions were analyzed until 16 wk of age. Parameters of Gompertz curves for each component were estimated. Males had higher growth potential and higher capacity to deposit nutrients than females, except for fat deposition. Data of BW and body composition collected in this experiment were fitted into the energy model proposed herein and the equations described by Emmans (1989) and Chwalibog (1991). The daily ME requirements estimated by the model determined in this study were closer to the ME intake observed in this trial compared with other models. ©2005 Poultry Science Association, Inc.

Utilization of shells of the snail Achatina fúlica Bowdich, 1822 (Mollusca, Gastropoda) by the hermit crab Clibanarius vittatus (Bosc, 1802) (Decapoda, Anomura) in the São Vicente Estuary, São Paulo, Brazil

Hermit crabs depend on mollusc shells for housing. In this study, an unusual resource is reported for a hermit crab that usually inhabits marine gastropod shells. During a field study conducted from May 2001 to April 2003 in an estuarine area in São Vicente, state of São Paulo, Brazil, 21 individuals of Clibanarius vittatus (Bosc, 1802) were found inhabiting the shells of the terrestrial gastropod Achatina fullea Bowdich, 1822. A. fúlica occurs in nearshore grass patches, where occasional contact with sea water kills them, and their shells then become available to the hermit crabs.

Utilization of different methodologies for the characterization of Hb Hasharon heterozygotes

Hb Hasharon has an electrophoretic mobility similar to that of Hb S in cellulose acetate and a mobility between Hb S and C at acid pH. In high-performance liquid chromatography, Hb Hasharon shows a distinct chromatographic profile and retention time. The origin of this variant is a mutation in codon 47 (GAC → CAC) of the α2-globin gene, resulting in the replacement of asparagine by histidine during the translation process. Ten blood samples from individuals suspected of being Hb Hasharon carriers were analyzed. In addition to classic laboratory tests and high-performance liquid chromatography, molecular analysis by polymerase chain reaction with restriction fragment length polymorphism designed in the laboratory was performed to confirm this mutation. The study of these cases showed that a combination of classical and molecular methodologies is necessary in the diagnosis of hemoglobinopathies for a correct hemoglobin mutant identification. The accurate identification of hemoglobin variants is essential for genetic counseling and choice of therapy. ©FUNPEC-RP.

Dietary energy requirement of piracanjuba fingerlings, Brycon orbignyanus, and relative utilization of dietary carbohydrate and lipid

Ten isonitrogenous casein-gelatin-based diets were formulated to contain five estimated metabolizable energy concentrations (10.92, 12.29, 13.63, 14.82 and 16.16 kJ g -1) at two carbohydrate-to-lipid ratios (CHO : L, 5.3 and 12.8, g : g) in a 5 × 2 factorial arrangement. Each diet was assigned to triplicate groups of 11 piracanjuba fingerlings (5.25 ± 0.14 g) and fed to apparent satiation twice a day for 90 days. Higher daily weight gain was obtained by fish fed the 13.63 kJ g -1 diets for both CHO : L ratios. There was a significant reduction of feed consumption when dietary energy concentration increased above 13.63 kJ g -1. Feed conversion ratio and apparent net energy retention improved as dietary energy increased. Apparent net protein retention tended to be lower in the highest and lowest dietary energy concentrations. The results suggest that dietary lipid energy was more efficiently utilized by piracanjuba fingerlings than carbohydrate energy. Body composition and hepatosomatic index (HSI) were not influenced by dietary CHO : L ratio. However, an increase in dietary energy concentration beyond 13.63 kJ g -1 resulted in a significant increment in lipid deposition, while body moisture and HSI decreased. Our findings indicate that at 300 g kg -1 dietary crude protein, a CHO : L ratio of 5.3 is recommended for piracanjuba, and the required energy is either 13.63 kJ g -1 if raised for aquaculture or 14.82 kJ g -1 if destined to stock enhancement. © 2006 Blackwell Publishing Ltd.

Study of utilization of petrol engine equipped with exhaust gas recirculation (EGR) and catalytic converter to reduce consumption and NOx emission

Study of consumption rate and gaseous pollutant emission from engine tests simulating real work conditions, using spark point manually controlled and exhaust gas recirculation (EGR) in diverse proportion levels. The objective of this work is to re-examine the potential of the EGR conception, a well-known method of combustion control, employed together electronic fuel injection and three-way catalytic converter closed-loop control at a spark ignition engine, verifying the performance characteristics and technical availability of this conception to improve pollution control, fuel economy at low torque drive condition and to improve the engine exhaust components useful life. The pollutant emissions and consumption levels under operational conditions simulations were analysed and compared with the expected by concerning theory and real tests performed by EGR equipped engines by factory. Copyright © 2006 Society of Automotive Engineers, Inc.

Spatial distribution and shell utilization in three sympatric hermit crabs at non-consolidated sublittoral of estuarine-bay complex in São Vicente, São Paulo, Brazil

The objective of the present study was to characterize the spatial distribution and shell utilization of three hermit crab species in the estuarine-bay complex of São Vicente, São Paulo State, Brazil. Monthly samples were done throughout two years, in the non-consolidated sub-littoral at the estuarine-bay complex. The environmental factors, such as temperature, salinity and depth, were measured every month. The three hermit crab species, Clibanarius vittatus, Loxopagurus loxochelis and Isocheles sawayai, were captured utilizing shells from six gastropods species; 92.7% of the hermit crabs utilized Stramonita haemastoma. The results suggest a strong correlation between hermit crabs spatial distribution and salinity, which was considered the main environmental factor limiting their distribution in the estuary. I. sawayai was the only species present in all transects sampled; C. vittatus was captured only in regions with low salinity and L. loxochelis occurred only in high salinity waters.

Utilization of neuromuscular electrical stimulation in the acute phase of ankle immobilization at 90°: Study in rats

Objective: To evaluate the skeletal muscle glycogen content and plasmatic concentration of interleukin -6 (IL-6), interleukin-4 (IL-4), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) in rats submitted to electrical stimulation sessions during the first three days of ankle immobilization at the position of 90°. Methods: Albinomale Wistar rats(3-4 months) were maintained in vivarium. conditions with food and water ad libitum, Submitted to 12 h photoperiodic cycles of light/dark, and distributed into 7 experimental groups (n = 6): control(C), immobilized 1 day(I1) immobilized 1 day and electrically stimulated(IE1) immobilized 2 days(12), immobilized 2 days and electrically stimulated(IE2), immobilized 3 days(13) and immobilized 3 days and electrically stimulated(IE3). Groups I utilized an acrylic resin orthesis model and groups electrically stimulated (IE) utilized the orthesis and a session of electrotherapy by a Dualpex 961 (biphasic quadratic pulse, 10 Hz, 0.4 ms, 5.0 mA, one 20 min session a day). After the experimental period, the rats were anesthetized with pentobarbital sodium(40 mg/kg) and a blood sample was colleted to evaluate the plasmatic concentration of interleukins by means of the radioimmunoassay method. The soleus and the white portion of the gastrocnemius muscle were colleted for glycogen reserves analysis(GLY). Other groups of rats were used to apply the glucose tolerance test(GTT) and insulin tolerance test(ITT). For statistical analysis, the Kolmogorov-Smirnov normality test followed by ANOVA and the Tukey tests were utilized, with a critical level established at 5%. Results: In ITT test, groups IE enhanced the skeletal muscle glucose uptake, but no changes were observed in GTT after the therapy session, which indicates that electrical stimulation is a sensibilizing method to augment skeletal muscle glucose uptake. The GLY reserves were reduced in I groups, which indicate that disuse altered insulin sensitivity and compromised energetic homeostasis. However. the IE groups displayed an augment in GLY content, suggesting that electrical stimulation restores the enzymatic pathways altered by immobilization. The improvement in GLY was accompanied by an elevation of the plasmatic concentration of IL-6 and TNF-α, showing the participation of these interleukins in the control of metabolic profile. Plasmatic concentrations of IL-10 were elevated only after 3 days of IE while IL-4 did not display any modifications. Conclusion: The results suggest that neuromuscular electricaf stimulation is an important toot in the maintenance of energetic, conditions of musculature submitted to immobilization, and presents multifactor mechanisms linked to interleukins action that converge to maintain the energetic equilibrium of the tissue in disuse.