Predictors of incorrectness in antimicrobial prescription in the Bauru State Hospital (Bauru city, São Paulo State, Brazil)

The inappropriate use of antimicrobials in hospitals presents a negative impact on patient outcome and is associated with the emergence and spread of multidrug-resistant microorganisms. Antimicrobial stewardship programs (ASPs) have been instituted in order to improve the quality of prescriptions in hospitals. In this setting, the identification of patterns of inappropriate antimicrobial prescription is a valuable tool that allows ASPs to identify priorities for directing educative/restrictive policies. With this purpose, a study was conducted in the Bauru State Hospital, a teaching hospital with 285 beds affiliated to the Botucatu Medical School, São Paulo State University. The hospital maintains an active ASP since it was opened, in 2002. We selected 25% of the requests for parenteral antimicrobials (RPAs) from 2005 for analysis. Prescriptions for prophylactic purposes were excluded. All other RPAs were classified according to a modified Kunin and Jones categories. Univariate and multivariable analyses were performed to identify predictors of general inappropriateness and of specific prescription errors. Prescriptions classified as "appropriate'' or "probably appropriate" were selected as controls in all stages of the study. Among 963 RPAs included in our study, 34.6% were inappropriate. General predictors of inappropriateness were: prescription on weekends/holidays (OR = 1.67, 95% CI = 1.20-2.28, p = 0.002), patient from intensive care unit (OR = 1.57, 95% CI = 1.11-2.23, p = 0.01), peritoneal (OR = 2.15, 95% CI = 1.27-3.65, p = 0.004) or urinary tract infection (OR = 1.89, 95% CI = 1.25-2.87, p = 0.002), combined therapy with two or more antimicrobials (OR = 1.72, 95% CI = 1.15-2.57, p = 0.008) and prescriptions including penicillin (OR = 2.12, 95% CI = 1.39-3.25, p = 0.001) or first-generation cephalosporins (OR = 1.74, 95% CI = 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR = 0.34, 95% CI = 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR = 0.04, 95% CI = 0.01-0.26, p = 0.001) and requests for agents with insufficient spectrum (OR = 0.14, 95% CI = 0.03-0.30, p = 0.01). In conclusion, the analysis of factors predictive of inappropriateness in antimicrobial prescription allowed us to identify issues requiring intervention. Also, it provided a positive feedback of the ASP efficacy, demonstrating the importance of previous consultation with an ID specialist to assure the quality of antimicrobial prescriptions.

Reductions in the Prevalence and Incidence of Geohelminth Infections following a City-wide Sanitation Program in a Brazilian Urban Centre

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The use of shallow seismic reflection technique in near surface exploration of urban sites: An evaluation in the city of SãO Paulo, Brazil

In order to evaluate the use of shallow seismic technique to delineate geological and geotechnical features up to 40 meters depth in noisy urban areas covered with asphalt pavement, five survey lines were conducted in the metropolitan area of São Paulo City. The data were acquired using a 24-bit, 24-channel seismograph, 30 and 100 Hz geophones and a sledgehammer-plate system as seismic source. Seismic reflection data were recorded using a CMP (common mid point) acquisition method. The processing routine consisted of: prestack band-pass filtering (90-250 Hz); automatic gain control (AGC); muting (digital zeroin) of dead/noisy traces, ground roll, air-wave and refracted-wave; CMP sorting; velocity analyses; normal move-out corrections; residual static corrections; f-k filtering; CMP stacking. The near surface is geologically characterized by unconsolidated fill materials and Quaternary sediments with organic material overlying Tertiary sediments with the water table 2 to 5 m below the surface. The basement is composed of granite and gneiss. Reflections were observed from 40 milliseconds to 65 ms two-way traveltime and were related to the silt clay layer and fine sand layer contact of the Tertiary sediments and to the weathered basement. The CMP seismic-reflection technique has been shown to be useful for mapping the sedimentary layers and the bedrock of the São Paulo sedimentary basin for the purposes of shallow investigations related to engineering problems. In spite of the strong cultural noise observed in these urban areas and problems with planting geophones we verified that, with the proper equipment, field parameters and particularly great care in data collection and processing, we can overcome the adverse field conditions and to image reflections from layers as shallow as 20 meters.

Diurnal evolution of solar radiation at the surface in the city of São Paulo: Seasonal variation and modeling

Seasonal variations in the diurnal evolution of the global, diffuse and direct solar radiation at the surface, the clearness index, diffuse fraction and direct fraction are described in detail for the City of Sao Paulo, Brazil. The description is based on measurements of global and diffuse solar radiation carried out over 5.25 years. The diffuse component was measured with a shadow-band device. The annual evolution of the amplitude of the diurnal cycle of all radiometric parameters indicates a seasonal pattern with two distinct periods: autumn-winter and spring-summer. About 10% of the observed period was characterized by clear sky days. This seasonal variation is determined by a larger incidence of clear sky days in the autumn-winter period. Reductions of up to 10% in hourly and daily values of global radiation were observed in conjunction with an increase in particulate matter concentration on clear sky days. The pollution effect may be responsible for the discrepancy, of 16%, found between local and more regional estimates of global solar radiation in Sao Paulo. The diurnal evolution of hourly values of monthly-averaged global and diffuse solar radiation were successfully estimated by the empirical expressions derived here. Daily values of monthly-averaged global solar radiation were satisfactorily estimated using the Angstrom expression.

Assessment of the diet of 0- to 6-year-old children in municipal schools in a Brazilian city

Diet control is one of the important factors in the prevention of dental caries because food functions as substratum for fermentation and, consequently, for the formation of the organic acids that demineralize the tooth surface. This study aims to descriptively assess school diet and the associated caries-preventive methods applied to children in all municipal nursery schools of a Brazilian city (Aragatuba/SP). For this, a questionnaire with open and closed questions was used. The results showed that all schools serve school meal, which is composed mainly of sugar, carbohydrates, and proteins. The students enjoy the meal very much because for most of them, the meal served at school is the only source of food. It was observed that 90% of the schools offer other kinds of food besides the main school meal. The snacks served such as cakes, white hominy, and milk fudge are composed of sweet and highly cariogenic foods. It was also verified that in 13.30% of the schools, the daily supervised dental hygiene, an important procedure that should not be neglected, is not carried out. This procedure introduces the children to healthy habits that are added to those acquired in the family environment. It was concluded that the school diet is potentially cariogenic and, in association with the lack of daily dental hygiene, this potential may become even higher.

Diversity of vascular plants growing on walls of a Brazilian city

City walls are very specialized environments, conditioned by human activities. There is little information about plants that invade human-made habitats, and no study done in Brazil with plants growing up on walls. The aim of the present study was to survey the wall vascular flora of a Brazilian city, comparing the diversity found in its downtown and neighborhoods. Fieldwork was done in Jundiaí, São Paulo State, where data was collected in downtown and in five neighborhoods. In each place, three transects of 1 km were established and every plant individual was registered. Twenty-eight species were identified, all of them on the downtown transect and most also on the neighborhood transects. Five species were the most frequent, although none were dominant. The diversity indicies of the six transects were not significantly different, with an overall diversity of H′ = 2.93. © Springer Science + Business Media, Inc. 2006.

Serological profile of anti-Toxoplasma gondii antibodies in apparently healthy dogs of the city of Botucatu, São Paulo state, Brazil

Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, a coccidian protozoan of worldwide distribution. The seroprevalence in canine population can be an alternative for measuring T. gondii urban spreading. A total of 780 blood samples from dogs were collected, during the yearly anti-rabies campaign, carried out by the Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Husbandry (FMVZ), São Paulo State University, UNESP, together with the county health authorities, in August 1999. Using Indirect Fluorescent Antibody Test (IFAT) for detecting antibodies anti-T. gondii in the sera samples, we observed that 258 dogs (33.1%) were positive. The associations between the serological results and the epidemiological variables were studied. Statistically significant differences were not found regarding sex (32.2% male and 34.3% female reactors). Dogs without a defined breed showed seropositivity statistically higher than the pedigreed group. The occurrence of infection was considered higher with age.

Fluoride concentrations in industrialized beverages consumed by children in the City of Bauru, Brazil

The increasing consumption of juices, soft drinks and teas among children has increased significantly fluoride ingestion at the age range of risk for development of dental fluorosis. Objective: The purpose of this study was to evaluate fluoride concentrations in some brands of industrialized beverages consumed by children in the city of Bauru, SP, Brazil. Material and Methods: 98 brands of beverages were analyzed, divided into 3 lots, comprising 36, 32 and 30 brands, respectively, for the first, second and third lots. Fluoride concentrations were determined by HMDS-facilitated diffusion, using a fluoride ion-specific electrode (Orion 9409). Results: Fluoride concentrations ranged between 0.04 and 1.76 μg F/mL. It was observed a wide variation in fluoride concentrations among the different brands, as well as the different lots of the same brand. There was no information on fluoride concentrations on the labels of any product. Conclusions: Some of the products analyzed could contribute significantly to the total fluoride intake and, thus, be important risk factors for development of dental fluorosis, which indicates the need of controlling the production of these beverages with respect to fluoride concentration.

Consumption of bottled water by children in the city of Bauru, State of São Paulo, Brazil - A brief communication

Objectives: To determine the consumption of bottled water by children in the city of Bauru, State of São Paulo, Brazil. Methods: A stratified sample of the 17 areas established by the city plan was used to identify a total of 1,000 homes for visitation. Information was collected using a questionnaire concerning the type of water consumed and population demographics. Results: Overall, around 30 percent of all residences used bottled water. Among all households where bottled water was consumed, about 26 percent had children residing. For those with children and bottled water, 81 percent reported to use bottled water for the preparation of the children's foods and beverages. Conclusions: An important percentage of children consume bottled water in the city of Bauru, State of São Paulo, Brazil. Considering previous studies showing that fluoride concentrations vary in bottled water, public health measures should be implemented in order to guarantee adequate levels of fluoride in commercialized water. © 2007, American Association of Public Health Dentistry.

Attributable fraction of work accidents related to occupational noise exposure in a Southeastern city of Brazil

Noise is the most frequent type of occupational exposure and can lead to both auditory and extra-auditory dysfunction as well as increasing the risk of work accidents. The purpose of this study was to estimate the attributable fraction of work accidents related to occupational noise exposure in a medium-sized city in Southeast Brazil. In this hospital-based case-control study, including 600 cases and 822 controls, the odds ratio of work accidents (controlled for several covariables) was obtained classifying occupational noise exposure into four levels and determining the prevalence at each level. Based on these data, the calculated attributable fraction was 0.3041 (95%CI: 0.2341-0.3676), i.e., 30% of work accidents in the study area were statistically associated with occupational noise exposure. The authors discuss the causes of this association and the implications for the prevention of work accidents.

Absence motivated by illness: A non-concurrent prospective study of physical education teachers in the municipal education system of the city of Campinas, São Paulo, Brazil

The object of this investigation was to identify and analize aspects of the health status related to absenteism in physical education teachers in the municipal education system of the city of Campinas, Brazil, as related to the medical leave program. The non-concurrent prospective study was accomplished by means of a comparison with teachers who work only in the classroom, refering to a three year period. In the variables of greatest interest, the Pearson non-parametric chi-square (X2) statistical test was adopted. Calculations of relative risk and level of confidence were made using the Epi-info computer program. Significant differences were observed in the following diagnostic groups favoring the not exposed group: i) Supplementary Classification of factors that exercise influence over the health status and access to health services and ii) Digestive system illness; while the physical education teachers showed a significant difference in: i) diseases of the musculoskeletal and connective tissue system and ii) Injuries and poisoing. Possible explications for some of the adverse effects as well as the protective ones that were observed include physical activity as a way of life along with being a physical education teacher and on the other side, peculiar behavior of epidemiological descriptive characteristics, like sex and age, within the socio-economic context of the country. © Copyright Moreira Jr. Editora.