Dialysis, time and death: comparisons of two consecutive decades among patients treated at the same Brazilian dialysis center

The survival of hemodialysis patients is likely to be influenced not only by well-known risk factors like age and comorbidity, but also by changes in dialysis technology and practices accumulated along time. We compared the survival curves, dialysis routines and some risk factors of two groups of patients admitted to a Brazilian maintenance hemodialysis program during two consecutive decades: March 1977 to December 1986 (group 1, N = 162) and January 1987 to June 1997 (group 2, N = 237). The median treatment time was 22 months (range 1-198). Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank method. The Cox proportional hazard regression model was used to investigate the more important variables associated with outcome. The most important changes in dialysis routine and in patient care during the total period of observation were the progressive increase in the dose of dialysis delivered, the prohibition of potassium-free dialysate, the use of bicarbonate as a buffer and the upgrading of the dialysis equipment. There were no significant differences between the survival curves of the two groups. Survival rates at 1, 5 and 10 years were 84, 53 and 29%, respectively, for group 1 and 77, 42 and 21% for group 2. Patients in group 1 were younger (45.5 ± 15.2 vs 55.2 ± 15.9 years, P<0.001) and had a lower prevalence of diabetes (11.1 vs 27.4%, P<0.001) and of cardiovascular disease (9.3 vs 20.7%, P<0.001). According to the Cox multivariate model, only age (hazard ratio (HR) 1.04, confidence interval (CI) 1.03-1.05, P<0.001) and diabetes (HR 2.55, CI 1.82-3.58, P<0.001) were independent predictors of mortality for the whole group. Patients of group 2 had a lower prevalence of sudden death (19.1 vs 9.7%, P<0.001). After adjusting for age, diabetes and other mortality risk factors, the risk of death was 17% lower in group 2, although this difference was not statistically significant. We conclude that the negative effects of advanced age and of higher frequency of comorbidity on the survival of group 2 patients were probably offset by improvements in patient care and in the quality and dose of dialysis delivered, so that the survival curves did not undergo significant changes along time.

The mental health of graduate students at the Federal University of São Paulo: a preliminary report

We present data regarding the care provided to graduate level health professionals at the mental health center of the Federal University of São Paulo. From September 1996 to September 2003, 146 graduate students (99 in the Master's degree program and 47 in the Doctoral program) were attended. This population was predominantly female (68.5%), with a mean (± SD) age of 28.6 ± 4.42 years, not married (71.9%). Most of the subjects were professionals who had not graduated from the Federal University (78.1%). The students who sought help for psychological and/or psychiatric problems were classified into two categories: situational-adaptive crises and psychopathological crises. The main diagnoses were depression and anxiety disorders (44%) causing 4.5% of the subjects to be temporarily suspended from their graduate studies; 19.2% reported that they had used psychotropic drugs within the previous month, and 47.9% referred to sleep disturbances. Suicidal tendencies were mentioned by 18% of those interviewed. Students with emotional disturbances and academic dysfunctions should be recognized at an early stage, and it is fundamental for them to have access to mental health programs that provide formal, structured and confidential care. Thus, it is important that professors and advisors in graduate programs build a warm and affective learning environment. If we consider the expressive growth in Brazilian scientific production resulting from the implementation of an extensive national system of graduate education, it is important to focus efforts on enhancing and upgrading the mental health care system.

Cassava wastewater (manipueira) treatment using a two-phase anaerobic biodigestor

A two-phase anaerobic biodigestor was employed in order to analyze methane production with different manipueira organic loading rates. The acidogenic phase was carried out in a batch process whereas the methanogenic in an up-flow anaerobic fixed bed reactor with continuous feeding. The organic loading rates varied from 0.33 up to 8.48g of Chemical Demand Oxygen (COD)/L.day. The highest content of methane, 80.9%, was obtained with organic loading rate of 0.33g and the lowest, 56.8%, with 8.48gCOD/L.d. The highest reduction of COD, 88.89%, was obtained with organic loading rate of 2.25g and the lowest, 54.95%, with 8.48gCOD/L.d. From these data it was possible to realize that anaerobic biodigestion can be managed in at least two ways, i.e., for energy production (methane) or for organic loading reduction. The organic loading rate should be calculated as part of the purpose of the treatment to be accomplished.

Applying life cycle management of colombian cocoa production

The present research aims to evaluate the usefulness of the application of Life Cycle Management in the agricultural sector focusing on the environmental and socio-economic aspects of decision making in the Colombian cocoa production. Such appraisal is based on the application of two methodological tools: Life Cycle Assessment, which considers environmental impacts throughout the life cycle of the cocoa production system, and Taguchi Loss Function, which measures the economic impact of a process' deviation from production targets. Results show that appropriate improvements in farming practices and supply consumption can enhance decision-making in the agricultural cocoa sector towards sustainability. In terms of agri-business purposes, such qualitative shift allows not only meeting consumer demands for environmentally friendly products, but also increasing the productivity and competitiveness of cocoa production, all of which has helped Life Cycle Management gain global acceptance. Since farmers have an important role in improving social and economic indicators at the national level, more attention should be paid to the upgrading of their cropping practices. Finally, one fundamental aspect of national cocoa production is the institutional and governmental support available for farmers in face of socio-economic or technological needs.

Use of densimetric table to improve the quality of commercial castor bean seeds

Castor bean fruits are already used for biodiesel production but obtaining quality seeds is still a challenge. Seed cleaning improves lot quality but little is known about the effects of upgrading castor bean seed lots on a densimetric table. The objective of this study was to evaluate the influence of cleaning castor bean seed lots on a densimetric table on their physical, physiological and sanitary characteristics. Two commercial lots of the AL Guarani 2002 cultivar, separated into five categories according to their classification on a densimetric table (uncleaned and low, low intermediate, high intermediate and high outlets), were evaluated. Tests for the yield, one-thousand seed weight, germination, seedling emergence, electrical conductivity and seed health were performed. The classification of castor bean seeds on a densimetric table significantly improved the physical, physiological and sanitary quality of commercial seed lots. The physiological response of the different classified lots varied according to their initial weight. Castor bean seeds separated on a densimetric table for the upper outlet showed a better physical, physiological and sanitary quality compared to those for the lower outlet.