Cervical cancer screening coverage in a high-incidence region

OBJECTIVE To analyze the coverage of a cervical cancer screening program in a city with a high incidence of the disease in addition to the factors associated with non-adherence to the current preventive program.METHODS A cross-sectional study based on household surveys was conducted. The sample was composed of women between 25 and 59 years of age of the city of Boa Vista, RR, Northern Brazil who were covered by the cervical cancer screening program. The cluster sampling method was used. The dependent variable was participation in a women’s health program, defined as undergoing at least one Pap smear in the 36 months prior to the interview; the explanatory variables were extracted from individual data. A generalized linear model was used.RESULTS 603 women were analyzed, with an mean age of 38.2 years (SD = 10.2). Five hundred and seventeen women underwent the screening test, and the prevalence of adherence in the last three years was up to 85.7% (95%CI 82.5;88.5). A high per capita household income and recent medical consultation were associated with the lower rate of not being tested in multivariate analysis. Disease ignorance, causes, and prevention methods were correlated with chances of non-adherence to the screening system; 20.0% of the women were reported to have undergone opportunistic and non-routine screening.CONCLUSIONS The informed level of coverage is high, exceeding the level recommended for the control of cervical cancer. The preventive program appears to be opportunistic in nature, particularly for the most vulnerable women (with low income and little information on the disease). Studies on the diagnostic quality of cervicovaginal cytology and therapeutic schedules for positive cases are necessary for understanding the barriers to the control of cervical cancer.

Forty years of visceral leishmaniasis in the State of Piaui: a review

Visceral leishmaniasis (VL) has been known to occur in the state of Piauí since 1934. The typically rural disease began to appear in urban areas over time, being concentrated mainly in Teresina, the capital of Piauí. Teresina was also affected by the first urban epidemic of VL in Brazil. Over 1,000 cases of the disease were reported during urbanization (1981-1986). Human population growth and migration led to land occupation on the outskirts of Teresina. These factors have contributed to vector proliferation, increasing the incidence of VL. At present, the incidence of human and canine disease is quite high and uncontrolled in Piauí. It seems that some measures, such as the elimination of seropositive dogs, failed to significantly reduce the number of new VL cases in Teresina. Despite previously conducted studies, little is known about VL epidemiology in urban areas. The aim of this review is to reveal the situation of VL in Teresina during the last 40 years, focusing on the major factors that may contribute to the high incidence and persistence of VL infection.

Friedreich's ataxia: clinical and molecular study of 25 Brazilian cases

INTRODUCTION: Friedreich's ataxia is a neurodegenerative disorder whose clinical diagnostic criteria for typical cases basically include: a) early age of onset (< 20 or 25 years), b) autosomal recessive inheritance, c) progressive ataxia of limbs and gait, and d) absence of lower limb tendon reflexes. METHODS: We studied the frequency and the size of expanded GAA and their influence on neurologic findings, age at onset, and disease progression in 25 Brazilian patients with clinical diagnosis of Friedreich's ataxia - 19 typical and 6 atypical - using a long-range PCR test. RESULTS: Abnormalities in cerebellar signs, in electrocardiography, and pes cavus occurred more frequently in typical cases; however, plantar response and speech were more frequently normal in this group when the both typical and atypical cases were compared. Homozygous GAA expansion repeats were detected in 17 cases (68%) - all typical cases. In 8 patients (32%) (6 atypical and 2 typical), no expansion was observed, ruling out the diagnosis of Friedreich's ataxia. In cases with GAA expansions, foot deformity, cardiac abnormalities, and some neurologic findings occurred more frequently; however, abnormalities in cranial nerves and in tomographic findings were detected less frequently than in patients without GAA expansions. DISCUSSION: Molecular analysis was imperative for the diagnosis of Friedreich's ataxia, not only for typical cases but also for atypical ones. There was no genotype-phenotype correlation. Diagnosis based only on clinical findings is limited; however, it aids in better screening for suspected cases that should be tested. Evaluation for vitamin E deficiency is recommended, especially in cases without GAA expansion.

Vegetational changes during the last millennium inferred from a palynological record from the Bananal Island, Tocantins, Brazil

The Bananal Island is regarded the largest fluvial island in the world, bounded by Araguaia and Javaés rivers, being located in southwest of Tocantins. The objectives of this work were to provide information about the vegetational changes that occurred at the Bananal Island, in order to contribute to the understanding the dynamics of past and current savanna and areas of ecotones with forests. Thus, a sedimentary core collected from a small lake at the Bananal Island plain was submitted to pollen and radiocarbon dating analyses. The results showed that the last millennium was dominated by forest reflecting a wet climate. At the beginning of the record (920-770 yr cal BP) the wet climate and high rainfall produced flooding during long rainy seasons that maintained the Javaés River connected to the studied lake, and hence, this environment was marked by the presence of a homogenous forest rich in Moraceae/Urticaceae, due to flooded soils occurrence. During the following period (770-304 yr cal BP) the reduced rainfall and shortening of the rainy seasons isolated the lake from the Javaés River for long periods, which caused a diversification of the forest and gave rise to the appearance of the components of floodplain forest and marsh vegetation adapted to waterlogged soils. Since 304 years cal BP to the present day this environment remained dominated by this diverse forest and the lacustrine conditions were also similar to previous phase, with a slight increase of moisture in the last 84 years that caused the increase of Piranhea.

Trends in mortality due to ischemic heart disease in the municipality of Goiania, Brazil, during the years between 1980 and 1994

OBJECTIVE: To analyze the trends of specific, standardized coefficients of mortality due to ischemic heart disease according to sex and age during the years 1980 and 1994 in the municipality of Goiania, GO, Brazil. METHODS: Data on deaths were retrieved from the Information on Mortality System of the Ministry of Health; population data were obtained from the Foundation of the Brazilian Institute for Geography and Statistics (IBGE). The trends of the specific coefficients were analyzed by triennia of the historical series, including individuals of both sexes from 25 years of age on, partitioned into 6 age groups of ten years intervals. The population data corresponding to the year 1980 were used as the standard for the calculation of each age group coefficient. Analyses were carried out by straight linear regression. RESULTS: Coefficients were greater for males in each triennium of the series and increased with age in both sexes. The study of the trends of the specific age coefficients of both sexes revealed a stable pattern of evolution up to the age of 65-74 years (P>0.05). From 75 years on, a clear-cut decline in mortality due to ischemic heart disease was shown by both sexes. The standardized coefficients also showed a significant decline (p<=0.05). CONCLUSION: The municipality of Goiânia is at present in a stage of epidemiological transition similar to that of developed countries, even though the observed decline is predominantly influenced by the mortality of older individuals (75 years of age or older).

The Potential for Dispersal of Onchocerciasis in Ecuador in Relation to the Distribution of the Vector Simulium exiguum (Diptera:Simuliidae)

The future dispersal of onchocerciasis in Ecuador is dependent on the distribution of cytotypes of the vector species complex Simulium exiguum. Over the last 14 years, collections of larvae have been made from over 25 rivers, between 80-1600 m altitude, from various sites on both sides of the Andes. Analysis of larval polytene chromosomes was used to determine the distributions of each cytotype. On the western side of the Andes, the Cayapa cytotype (the only cytotype directly incriminated as a vector) has a distribution from Santo Domingo de los Colorados northwards. The Quevedo and Bucay cytotypes occur from Santo Domingo de los Colorados southwards. On the eastern side of the Andes, the Aguarico cytotype occurs in the Rio Aguarico and a new cytotype is present in the tributaries of the Rio Napo. Whether the disease will spread south of Santo Domingo and on the eastern side of the Andes depends on vector capacity of the cytotypes and the dispersal patterns of individuals infected with onchocerciasis. At present the Aguarico, Bucay and Quevedo cytotypes are known to be efficient hosts, but their biting preferences and biting densities have not yet been evaluated

Implications, large and small, from chemical education research for the teaching of chemistry

Research studies in chemical education pose a communication problem for chemists. Unlike the findings from other specializations in chemistry the findings in chemical education tend to be reported in education journals that are not readily accessible to most chemists or chemistry teachers. This lecture is an attempt to remedy this gap in communication. Research studies fall into three broad categories. (i) issues related to the content of chemistry itself, that is, What content to teach? And What meaning of each topic is to be conveyed? (ii) issues related to how chemical content is taught, such as, the role of lectures, practical work, particular pedagogies, etc. and (iii) issues related to its learning, that is, learning of concepts, conceptual change, motivation, etc. Findings in each of these categories of research over the last twenty years have drawn attention to opportunities for improving the quality of chemical education in each of the levels of formal education where chemistry is taught. Sometimes the research findings seem small since they, in fact, merely diagnose the actual problem in teaching and learning. At other times, the research findings are large because they provide a solution to these problems. What remains to be done is to disseminate the findings so that appropriate teaching occurs more widely, with its consequent gains in the quality of learning. Research findings, of these small and large types will be used to illustrate the potential of research to make the practice of chemical education more effective.

Células a combustível de baixa potência para aplicações estacionárias

A paradigmatic shift in developing fuel cell for stationary applications has been occurring in the last ten years. Previously, 100 kW class to a few MW class power plants were preferred but recently, the development has drifted towards units of only a few kW. The motivation is the present market situation, which favors disperse residential electric power generation from natural or liquefied gas. Membrane-type fuel cells are very promising for this application, due to their present state of development in the automobile industry. More recently, small ceramic fuel cells (SOFC) has also been found to be adequate for this application. Considering a family of 4 members, 1 kW (electric) units seem to be optimal for individual residences. This presentation discusses briefly the Brazilian scenario with respect to these units.

Produtos naturais: atualidade, desafios e perspectivas

This article offers an overview on the historical facts and the recent state of art of Chemistry of Natural Products which, in the course of 25 years of SBQ, have led to the present development of this area in Brazil. In addition, this article deals with the last trends on Natural Products in Brazil and also in developed countries.

Steroid-resistant idiopathic nephrotic syndrome in children: long-term follow-up and risk factors for end-stage renal disease

INTRODUTION: Steroid resistant idiopathic nephrotic syndrome (SRINS) in children is one of the leading causes of progression to chronic kidney disease stage V (CKD V)/end stage renal disease (ESRD). OBJECTIVE: The aim of this retrospective study is to evaluate the efficacy of immunosuppressive drugs (IS) and to identify risk factors for progression to ESRD in this population. METHODS: Clinical and biochemical variables at presentation, early or late steroid resistance, histological pattern and response to cyclosporine A (CsA) and cyclophosfamide (CP) were reviewed in 136 children with SRINS. The analyzed outcome was the progression to ESRD. Univariate as well as multivariate Cox-regression analysis were performed. RESULTS: Median age at onset was 5.54 years (0.67-17.22) and median follow up time was 6.1 years (0.25-30.83). Early steroid-resistance was observed in 114 patients and late resistance in 22. Resistance to CP and CsA was 62.9% and 35% respectively. At last follow-up 57 patients reached ESRD. The renal survival rate was 71.5%, 58.4%, 55.3%, 35.6% and 28.5% at 5, 10, 15, 20 and 25 years respectively. Univariate analysis demonstrated that older age at onset, early steroid-resistance, hematuria, hypertension, focal segmental glomerulosclerosis (FSGS), and resistance to IS were risk factors for ESRD. The Cox proportional-hazards regression identified CsAresistance and FSGS as the only predictors for ESRD. CONCLUSION: Our findings showed that CsA-resistance and FSGS were risk factors for ESRD.

International thought in the Lula era

In the last fifty years, Brazil began a rapid process of structural transformation, following the first stage of industrial development in the 1930s. Currently the country integrates the small group of countries which evolved from an initial peripheral and subordinate insertion dating back to the nineteenth century, part of the most dynamic segment of the semiperiphery. But this category, intermediate between the "maturity" and "backwardness", according Modernization theorists, or between the "center" and "periphery", as theorists of the Dependence defend, has undergone a process of overcoming considerable positive progress in the direction of the group of states that dominate the current world system. In this way, during the years 2003-2010, foreign policy, along with the formulation of a new regionalism as a strategy of global integration and a new ideal model of State, has been a key factor

Brazilian foreign policy under President Lula (2003-2010): an overview

Foreign Minister of Brazil since 2003, Ambassador Celso Amorim outlines the main guidelines and accomplishments of Brazil's foreign policy under President Luiz Inácio Lula da Silva. The article provides a full-fledged, although not exhaustive, narrative of a number of diplomatic initiatives championed by Brazil over the last eight years: from the gathering of the group of developing countries in a World Trade Organization (WTO) meeting in Cancun to the negotiations that led to the Declaration of Tehran, as well as the challenges the country has been facing as its international weight grows.

Climate governance in an international system under conservative hegemony: the role of major powers

In the last five years, climate change has been established as a central civilizational driver of our time. As a result of this development, the most diversified social processes - as well as the fields of science which study them - have had their dynamics altered. In International Relations, this double challenge could be explained as follows: 1) in empirical terms, climate change imposes a deepening of cooperation levels on the international community, considering the global common character of the atmosphere; and 2) to International Relations as a discipline, climate change demands from the scientific community a conceptual review of the categories designed to approach the development of global climate governance. The goal of this article is to discuss in both conceptual and empirical terms the structure of global climate change governance, through an exploratory research, aiming at identifying the key elements that allow understanding its dynamics. To do so, we rely on the concept of climate powers. This discussion is grounded in the following framework: we now live in an international system under conservative hegemony that is unable to properly respond to the problems of interdependence, among which - and mainly -, the climate issue.

Between system maker and privileges taker: the role of China in the Greater Mekong Sub-region

Utilizing China's leadership projects in the Great Mekong Sub-Region (GMS) as a case study, this paper aims to investigate whether China qualifies as an international leader. This work argues that its geographic position and economic rise allow China to be a "system maker and privilege taker," which is a dual role forming in economic-political relations in the GMS in the last ten years. China is among major driving forces to set up an economic zone in GMS. Growing Chinese regional power is intimately related to the creation of various hubs connecting regional transportation, communication and energy systems that foster the economic development of this region. However, China also proves dark sides of rising powers which take advantage of their privileges to gain benefits. As a "system maker" with its own position and capability, China has notably benefited from building hydropower systems. More importantly, while China is pursuing its benefits and privileges, its hydropower projects have caused some negative effects for the ecosystem in the region. The inflation of dam constructions in both China and GMS countries is raising concerns about using natural resources of the Mekong River. Our concluding part addresses the pressing need to start a serious discussion on the balance between national interests and regional solidarity within the formulation of Chinese foreign policy in GMS.

Peaceful rise and the limits of Chinese exceptionalism

Throughout the last thirty years of opening to the world Beijing has stressed that its rise will be peaceful and that, from a strategic point of view, China is exceptional. There are many challenges facing Beijing's response to the US rebalancing to the Asia-Pacific, but we consider that the ones with greater impact are, in point of fact, of a domestic nature and constitute limits to Chinese exceptionalism.