Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo.METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care.RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician.CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.

Use of a condom in sex relations by HIV carriers

The frequency with which condoms are used in sex relations by subjects with HIV was determined by interviewing 132 individuals, 82 men and 50 women, most of them from São Paulo state and some from other regions of the country, all of them seen at an outpatient clinic of the School of Medicine in Botucatu. The women were younger, were of lower educational level and had poorer professional qualification than men. Also, a greater proportion of women were widowed, separated or divorced. We observed that 43.9% of men and 72% of women had been contaminated by the sexual route, but only 41.2% of the men and 31.8% of the women reported the use of a condom after the diagnosis of infection, with most men and women preferring sexual abstinence. The results enable the conclusion that there is still a need to continue to provide information about the use of condoms and to guarantee their free-of-charge distribution due to the low levels of education and professional qualification of the individuals studied. The data also suggest that campaigns for the dissemination of preventive measures should consider the social and cultural differences of infected women.

Science education and popularization of science in the biomedical area: its role for the future of science and of society

This paper presents the main subjects discussed in the round-table: "Educational Base for Biomedical Research", during the International Symposium on Biomedical Research in the 21st century; two main aspects will be focused: (1) the importance of popularizing science in order to stimulate comprehension of the scientific process and progress, their critical thinking, citizenship and social commitment, mainly in the biomedical area, considering the new advances of knowledge and the resulting technology; (2) the importance to stimulate genuine scientific vocation among young people, by giving them opportunity to early experience scientific environment, throught the hands of well prepared master in a humanistic atmosphere.

Development of assistive technology for the visually impaired: use of the male condom

The objectives were to develop and evaluate an assistive technology for the use of the male condom by visually impaired men. It was a technology development study with the participation of seven subjects. Three workshops were performed between April and May of 2010; they were all filmed and the statements of the participants were transcribed and analyzed by content. Three categories were established: Sexuality of the visually impaired; Utilization of the text, For avoiding STDs, condoms we will use, divided in two subcategories, Concept discussion and Text evaluation; and Construction of a simple penile prosthesis. The knowledge transmitted related to STD, the utilization of the condom on the penile prosthesis made by the subjects themselves, and the interaction during the workshops were effective factors for the study. In the context of sexual health, the necessity of developing works involving the visually impaired was noted, addressing sexually transmitted diseases and focusing on the use of the condom by this population.

INNOVATIVE USE OF A TABLET DEVICE TO DELIVER INSTRUCTION IN UNDERGRADUATE CHEMISTRY LECTURES

This report describes a simple, inexpensive and highly effective instructional model based on the use of a tablet device to enable the real-time projection of the instructor's digitally handwritten annotations to teach chemistry in undergraduate courses. The projection of digital handwriting allows the instructor to build, present and adapt the class contents in a dynamic fashion and to save anything that is annotated or displayed on the screen for subsequent sharing with students after each session. This method avoids the loss of continuity and information that often occurs when instructors switch between electronic slides and white/chalk board during lessons. Students acknowledged that this methodology allows them to follow the instructor's cognitive process and the progressive development of contents during lectures as the most valuable aspect of the implemented instructional model.

Use of medicinal plant in the manufacturing of energetic cookies

Many nutrients provide energy and regulate physiological processes linked to exercise. This work aimed at using medicinal plant in the manufacturing of energetic cookie. An evaluation of microbiological and physicochemical stability was made within 180 days of the fabrication of the product. Sensorial analysis was performed in all stages with untrained tasters. The results were statistically tested. The evaluation of ergogenic effect of the product used the maximum volume of oxygen index as a parameter through the cooper track test (12 minutes) with 7 voluntaries. The participants received the consent form. This study was approved by the local ethics committee (N° CAAE - 0009.0.313.000-08). It was observed good stability for physicochemical and microbiological parameters. As for sensorial analysis there was a predominance of scores 6 to 8, characterizing good acceptance. It was verified increase in VO2 max after the intake of the cookies with or without the medicinal plants. However, the product with the medicinal plants presented a bigger value, 35.47 VO2 max mL/(kg.min)-1. The fraction of carbohydrate and the presence of medicinal plants can be considered as nutritional ergogenic substances. The lipid fraction favor the energetic aspect of the product. The proposed product presented energetic and ergogenic effect.

The use of cashew apple residue as source of fiber in low fat hamburgers

The main purpose of this study was to produce hamburgers with partial substitution of the meat with cashew apple residue powder. The powder residue was obtained after the extraction of the pulp and dehydration in stove with air circulation. Three formulations of hamburgers with increasing concentration of the residue as well as a control sample were prepared. The formulated products with cashew apple residue powder presented lower humidity and proteins and 35% lipid reduction. However, there was an increase in carbohydrates and pH with the addition of the powder from the cashew apple residue. Some formulations showed an improvement of the final product yield. The total dietary fiber value was between 0 and 7.66%, with higher content of insoluble dietary fiber. The addition of up to 10.70% of the residue did not cause significant sensory changes in the flavor of the samples. The production of hamburgers with a partial substitution of cow meat with the cashew apple residue could be a feasible option since it resulted in product with high nutritional quality that is rich or have high dietary fiber content and is low in fat.

Use of the polymerase chain reaction for detection of Fusarium graminearum in bulgur wheat

The detection of mycotoxigenic fungi in foodstuff is important because their presence may indicate the possible associated mycotoxin contamination. Fusarium graminearum is a wheat pathogen and a producer of micotoxins. The polymerase chain reaction (PCR) has been employed for the specific identification of F. graminearum. However, this methodology has not been commonly used for detection of F. graminearum in food. Thus, the objective of the present study was to develop a molecular methodology to detect F. graminearum in commercial samples of bulgur wheat. Two methods were tested. In the first method, a sample of this cereal was contaminated with F. graminearum mycelia. The genomic DNA was extracted from this mixture and used in a F. graminearum specific PCR reaction. The F. graminearum species was detected only in samples that were heavily contaminated. In the second method, samples of bulgur wheat were inoculated on a solid medium, and isolates having F. graminearum culture characteristics were obtained. The DNA extracted from these isolates was tested in F. graminearum specific PCR reactions. An isolate obtained had its trichothecene genotype identified by PCR. The established methodology could be used in surveys of food contamination with F. graminearum.

Evaluation of the use of PetrifilmTM EB count plates for the enumeration of Enterobacteriaceae in poultry samples

A test that is rapid, simple, accurate, not expensive, gives rapid results, and is sensitive enough to detect low levels of microorganisms would be the most suitable for food industry routine laboratories, or even for a public health laboratories. A ready-to-use alternative, commercially available method is the PetrifilmTM EB method. The aim of this study was to evaluate whether there is a statistically significant difference between the conventional methods based on Violet Red Bile Glucose Agar and the alternative 3M TM Petrifilm (EB) method for the enumeration of Enterobacteriaceae in poultry carcasses. This study also assessed whether the alternative method showed ability to produce results that were directly proportional to the concentration of the target (approximately 270 colony-forming unit.mL-1). A total of 120 poultry carcasses samples showed a significant difference (p < 0.05) between the populations obtained by the two methods, and the conventional method showed low proportionality between the dilutions. On the other hand, the PetrifilmTM EB quantification system showed the capacity to produce results that are proportional to the concentration of the analyte in samples in the concentration range from 1 to 256 colony-forming unit.mL-1.

Use of simulated annealing in standardization and optimization of the acerola wine production

In this study, seven wine samples were prepared varying the amount of pulp of acerola fruits and the sugar content using the simulated annealing technique to obtain the optimal sensory qualities and cost for the wine produced. S. cerevisiae yeast was used in the fermentation process and the sensory attributes were evaluated using a hedonic scale. Acerola wines were classified as sweet, with 11°GL of alcohol concentration and with aroma, taste, and color characteristics of the acerola fruit. The simulated annealing experiments showed that the best conditions were found at mass ratio between 1/7.5-1/6 and total soluble solids between 28.6-29.0 °Brix, from which the sensory acceptance scores of 6.9, 6.8, and 8.8 were obtained for color, aroma, and flavor, respectively, with a production cost 43-45% lower than the cost of traditional wines commercialized in Brazil.

Use of starter cultures isolated from native microbiota of artisanal sausage in the production of Italian sausage

The most promising microorganisms for use as starter cultures are those isolated from the native microbiota of traditional fermented products. The aim of this study was to evaluate the use of lactic acid bacteria selected from the native microbiota of sausages produced by spontaneous fermentation as starter cultures for the production of sausage. Strains of Lactobacillus plantarum 503 and 341 have the potential for use as starter cultures in the manufacture of Italian sausage type. The population of lactic acid bacteria in sausages was >8 log CFU.g-1 during fermentation, which caused the pH to decrease to <4.5. This decrease in pH and the water activity of < 0.90 of sausages ensures the safety and preservation of this product. Sausages produced with these lactic cultures fulfill the requirements for microbiological quality and composition of Italian sausage type. Our results suggest the possibility of using these starter cultures for the production of sausages with peculiar characteristics that contribute to the identity of the product.

Assessing the use of frozen pork meat in the manufacture of cooked ham

This study aimed to evaluate the effects of slow (–18 °C) and fast freezing (liquid nitrogen) of pork meat, and the use of exudate released upon thawing, on the physicochemical, color, rheological, microbiological, histological, and sensory characteristics of cooked ham. The meat samples were frozen at –18 °C and thawed after 22 weeks for the production of cooked ham. No significant difference was observed regarding physicochemical, color and microbiological parameters or in sensory acceptance. The hardness and chewiness parameters showed significant differences when compared to the control sample (ham made from chilled meat). Light microscopy of cooked ham samples showed that changes in the tissues were caused by freezing and thawing the meat. The effect of exudate was significant on the sodium content and compression force parameters, but this difference was not perceived in the sensory analysis, confirming that frozen pork meat can be used to produce cooked ham without loss of quality.