Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.

Influence of agro-ecological production areas on antioxidant activity, reducing sugar content, and selected phytonutrients of orange-fleshed sweet potato cultivars

Sweet potato is an important staple, and it is mainly known for its contribution of β-carotene in human diet. The effects of cultivar and habitat on this pigment and other nutritional characteristics of the crop still require investigation. In this study, three locally bred cultivars of sweet potato, two of which are orange-fleshed, were grown in three different agro-ecological areas to determine soluble sugar content, β-carotene, and total antioxidants of roots. In addition antioxidant activity, total carotenoids, and chlorophyll content were determined in edible leaves. Reducing sugars, β-carotene, total antioxidants capacity, total carotenoids, and chlorophyll content were significantly affected by environmental conditions. The location at lower altitude and closer to the coastline showed high evapotranspiration, thus reducing sugar content, antioxidant activity, and phytonutrients in both storage roots and leaves. Absence of water stress in agro-ecological locations further inland and at higher altitudes was associated with an increase in these compounds. Free radical scavenging activity of DPPH was higher in the storage roots (610.49 µmoles TE/100g) than in the leaves (426.06 µmoles TE/100g); nevertheless, opposite results were found for the ferric ion reducing activity (FRAP). The deep orange-fleshed cultivar A45 contained high β-carotene (15 mg/100g), which is enough to meet RDA for vitamin A. There is evidence of agro-ecological effect on sweet potato nutritional value.

Glomerulonefrite aguda após infecção de vias aéreas superiores ou pele: análise descritiva de 82 pacientes entre 14 e 64 anos de idade

INTRODUÇÃO: A glomerulonefrite aguda (GNA) após infecção de vias aéreas superiores ou pele é uma doença renal causada geralmente por cepas estreptocócicas nefritogênicas, podendo cursar com quadro súbito de hematúria macroscópica, hipertensão arterial, edema e, ocasionalmente, insuficiência renal aguda, sendo comum na infância e pouco incidente em adultos e indivíduos mais jovens. OBJETIVO: Analisar, de forma descritiva, os dados da apresentação inicial da GNA após infecção de vias aéreas superiores ou pele em pacientes com mais de 14 anos de idade, com ênfase em seus aspectos epidemiológicos e clínicos. PACIENTES E MÉTODOS: Foram analisados os dados clínicos de 82 pacientes, atendidos em nosso Serviço no período de 1972 a 2001, distribuídos em três grupos etários: grupo 1, com indivíduos entre 14 e 20 anos (n = 52); grupo 2, entre 21 e 30 anos (n = 19); e grupo 3, com idade > 31 anos (n = 11). RESULTADOS: Houve um predomínio do quadro entre pacientes mais jovens (grupo 1), do sexo masculino e da cor branca, precedido, principalmente, por infecção de pele, manifestando-se mais comumente por edema de membros inferiores e/ou face. Em alguns casos, até com síndrome nefrótica, e hipertensão arterial, sobretudo nos adultos com mais de 30 anos (grupo 3), sendo menos frequente o achado de hematúria macroscópica e, raramente, de insuficiência renal aguda. CONCLUSÃO: Nossos achados ressaltam a importância de se estudar a GNA após infecção de vias aéreas superiores ou pele em indivíduos mais jovens e adultos, procurando melhor caracterizar seus aspectos clínicos, sobretudo por se tratar de um grupo de pacientes no qual a doença é menos incidente.

The geographic dynamics of industry employment in Brazilian metropolitan areas: lessons for São Paulo

ABSTRACTWe discuss historic trends in large metropolitan areas in Brazil showing that manufacturing has decreased its share in the country but the movement was, in general, more intense in large metropolitan areas and particularly in the São Paulo Metropolitan Area (SPMA). This movement was more intense in the 1980s and in the first half of the 1990s. From mid 1990s up to the end of the 2000s, the manufacturing share trend became flat. We speculate that the first period reflects the exhaustion of the process of import substitution that took place in the previous three decades (1950 to 1980). The second period, from 1993 to 2009, is representative of a new model of growth and the evidence that manufacturing share became flat is reinforcing the idea of a new period in terms of manufacturing employment. While concentration has risen from 1996 to 2005, it decreased again in the second half of the first decade of the 2000s. The SPMA reinvented itself very quickly from late 1970s to mid-2000s.