138 resultados para Community Medicine


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AbstractINTRODUCTION: This study evaluated the effects of cattle removal on the Culicidae mosquito community structure in a tropical dry forest in Brazil.METHODS: Culicidae were collected during dry and wet seasons in cattle presence and absence between August 2008 and October 2010 and assessed using multivariate statistical models.RESULTS: Cattle removal did not significantly alter Culicidae species richness and abundance. However, alterations were noted in Culicidae community composition.CONCLUSIONS: This is the first study to evaluate the impact of cattle removal on Culicidae community structure in Brazil and demonstrates the importance of assessing ecological parameters such as community species composition.

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ABSTRACTINTRODUCTION:Although deaf people are exposed to hepatitis B and C risk factors, epidemiological studies regarding these diseases in deaf people are lacking.METHODS:After watching an explanatory digital versatile disc (DVD) in Brazilian Sign Language, 88 deaf people were interviewed and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), and hepatitis C virus antibody (anti-HCV).RESULTS:The prevalence of hepatitis B markers was 8%; they were associated with incarceration and being born outside the State of São Paulo. No cases of hepatitis C were identified.CONCLUSIONS:Participants showed a substantial lack of knowledge regarding viral hepatitis, indicating a need for public policies that consider linguistic and cultural profiles.

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Abstract INTRODUCTION: This study investigated the knowledge of users of primary healthcare services living in Ribeirão Preto, Brazil, about dengue and its vector. METHODS: A cross-sectional survey of 605 people was conducted following a major dengue outbreak in 2013. RESULTS: Participants with higher levels of education were more likely to identify correctly the vector of the disease. CONCLUSIONS: The results emphasize the relevance of health education programs, the continuous promotion of educational campaigns in the media, the role of the television as a source of information, and the importance of motivating the population to control the vector.

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Abstract: INTRODUCTION We investigated the association between demographic and behavioral factors and non-adherence to antimalarial therapy. METHODS A demographic questionnaire and 5-item self-reported questionnaire regarding non-adherence were completed by 135 patients after treatment for Plasmodium vivax. RESULTS Treatment interruption, but not demographic factors, was significantly associated with non-adherence to therapy. The likelihood of non-adherence was 5.16 times higher when the patients felt better than when they felt worse. The relative risk of parasitic resurgence was 3.04 times higher in non-adherent patients. CONCLUSIONS Treatment interruption is significantly associated with treatment adherence.

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PURPOSE: The Internet expands the range and flexibility of teaching options and enhances the ability to process the ever-increasing volume of medical knowledge. The aim of this study is to describe and discuss our experience with transforming a traditional medical training course into an Internet-based course. METHOD: Sixty-nine students were enrolled for a one-month course. They answered pre- and post-course questionnaires and took a multiple-choice test to evaluate the acquired knowledge. RESULTS: Students reported that the primary value for them of this Internet-based course was that they could choose the time of their class attendance (67%). The vast majority (94%) had a private computer and were used to visiting the Internet (75%) before the course. During the course, visits were mainly during the weekends (35%) and on the last week before the test (29%). Thirty-one percent reported that they could learn by reading only from the computer screen, without the necessity of printed material. Students were satisfied with this teaching method as evidenced by the 89% who reported enjoying the experience and the 88% who said they would enroll for another course via the Internet. The most positive aspect was freedom of scheduling, and the most negative was the lack of personal contact with the teacher. From the 80 multiple-choice questions, the mean of correct answers was 45.5, and of incorrect, 34.5. CONCLUSIONS: This study demonstrates that students can successfully learn with distance learning. It provides useful information for developing other Internet-based courses. The importance of this new tool for education in a large country like Brazil seems clear.

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OBJECTIVE: To identify social characteristics and expectations of individuals seen during a community project for the treatment of senile cataracts. Expected results from their eye surgery and its consequences to their quality of life were studied as well. METHODOLOGY: Cataract patients (visual acuity equal to or lower than 0.2 in the more superior eye) aged 50 years or over, were surveyed by means of interviews held during their visit at the Cataract Project in São Paulo city, State of São Paulo, Brazil, in 1999. RESULTS: The sample was composed of 331 subjects of low socioeconomic level ranging in age from 50 to 97 years (average = 71.8 years). Expectation of total recovery from the cataract condition by means of surgery was declared by 80.0% of the respondents, with no significant differences between male and female subjects (P < 0.1723). Hope to resume manual activities was expressed by 59.8%. CONCLUSION: A predominance of expectations of resuming normal activity and achieving a better quality of life after cataract surgery were identified.

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OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP), a teaching and tertiary hospital, were eligible to participate in the study. PATIENTS: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports. MAIN OUTCOME MEASURES: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates. RESULTS: A total of 126 patients were studied. Eighty-seven patients (69%) received antimicrobials on the day of study, 72 (57%) for treatment, and 15 (12%) for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%), non- intensive care unit nosocomial infection in 24 (33.3%), and intensive care unit-acquired infection in 22 patients (30.6%). Eleven patients (15.3%) had no defined type. The most frequently reported infections were respiratory (58.5%). The most frequently isolated bacteria were Enterobacteriaceae (33.8%), Pseudomonas aeruginosa (26.4%), and Staphylococcus aureus (16.9%; [100% resistant to methicillin]). Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age > 60 years (p = 0.007), use of a nasogastric tube (p = 0.017), and postoperative status (p = 0.017). At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p=0.088). CONCLUSION: The rate of nosocomial infection is high in intensive care unit patients, especially for respiratory infections. The predominant bacteria were Enterobacteriaceae, Pseudomonas aeruginosa, and Staphylococcus aureus (resistant organisms). Factors such as nasogastric intubation, postoperative status, and age ³60 years were significantly associated with infection. This study documents the clinical impression that prevalence rates of intensive care unit-acquired infections are high and suggests that preventive measures are important for reducing the occurrence of infection in critically ill patients.

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OBJECTIVE: To evaluate the recent scientific research progress on homeopathy. METHODOLOGY: Homeopathy was evaluated in terms of its clinical research; in vitro research, and physical foundations. The Medline database was the main reference source for the present research, concerning data of approximately the last 10 years. Secondary references (not available in this database) were obtained by means of direct requests to authors listed in the primary references. RESULTS: Clinical studies and in vitro research indicate the inefficacy of homeopathy. Some few studies with positive results are questionable because of problems with the quality and lack of appropriate experimental controls in these studies. The most recent meta-analyses on the topic yielded negative results. One of the few previous meta-analyses with positive results had serious publication bias problems, and its results were later substantially reconsidered by the main authors. The sparse in vitro homeopathic research with positive results has not been replicated by independent researchers, had serious methodological flaws, or when replicated, did not confirm the initial positive results. A plausible mechanism for homeopathic action is still nonexistent, and its formulation, by now, seems highly unlikely. CONCLUSIONS: As a result of the recent scientific research on homeopathy, it can be concluded that ample evidence exists to show that the homeopathic therapy is not scientifically justifiable.

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The herb community of tropical forests is very little known, with few studies addressing its structure quantitatively. Even with this scarce body of information, it is clear that the ground herbs are a rich group, comprising 14 to 40% of the species found in total species counts in tropical forests. The present study had the objective of increasing the knowledge about the structure and composition of the ground-herb community and to compare the sites for which there are similar studies. The study was conducted in a tropical non-inundated and evergreen forest 90 km north of Manaus, AM. Ground herbs were surveyed in 22 transects of 40 m², distributed in five plots of 4 ha. The inventoried community was composed of 35 species, distributed in 24 genera and 18 families. Angiosperms were represented by 8 families and Pteridophytes by 10 families. Marantaceae (12 sp) and Cyperaceae (4 sp) were the richest families. Marantaceae and Poaceae were the families with greatest abundance and cover. Marantaceae, Poaceae, Heliconiaceae and Pteridophytes summed 96% of total herb cover, and therefore were responsible for almost all the cover of the community. The 10 most important species had 83.7% of the individuals. In general, the most abundant species were also the most frequent. Richness per transect varied from 7 to 19 species, and abundance varied from 30 to 114 individuals. The community structure was quite similar to 3 other sites in South America and one site in Asia.

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Mansonella ozzardi is transmitted by two dipterian families, Ceratopogonidae (midges) and Simuliidae (black flies). In Brazil, black flies are vectors for this filariasis until now. In this paper, we determined the seasonality, parity capacity and parasitic infection rate of Cerqueirellum argentiscutum. The work was carried out in the Porto Japão community, Lower Solimões River, Amazonas, Brazil. Results show that the black flies were more abundant during the rainy season (from December to May). The number of parous flies was higher in every sampling during the course of year. Monthly Biting Rate (MBR1 123742.00, MBR2 86701.50) was high, although Parasitic Infection Rate (PIR1 0.06, PIR2 0.08) and Annual Transmission Potential (ATP 7.25) were low in numbers.

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The colonization process and successional patterns of a periphytic algal community were evaluated in a Amazonian Viveiro Lake (Rio Branco, Acre, Brazil). Sampling was performed over a period of 35 days; at four-day intervals for 20 days, and then at five-day intervals. Water sampling for physical, chemical and biological analyses was done during the dry and rainy season. Glass slides were used as artificial substrates for periphyton colonization. The structural community was evaluated through population density, algae class, diversity indices and descriptive species. Species richness, diversity and evenness increased as succession progressed. While density of Bacillariophyceae, Euglenophyceae and Zygnemaphyceae increased with succession, Cyanobacteria remained dominant. Synechocystis aquatilis, Synechocystis diplococcus and Navicula pseudolanceolata were the main descriptive species in both the dry and rainy season. Cymbela tumida, Frustulia rhomboides, Trachelomonas lacustris and Closterium acicularis was correlated with an increase in hydrologic level during the rainy season. Conversely, the density of Chlamydomonas sp., Chroomonas nordstedtii, Trachelomonas volvocinopsis, Trachelomonas volvocina and Synechococcus linearis was correlated with an increase in water transparency during the dry season. In general, the periphytic algal community showed high diversity and species richness independent of season. Season also had little influence on representation of algae class and main descriptive species. However, successional patterns varied by season, and changes in hydrologic levels acted directly on the succession path of periphytic algae. More research on periphyton dynamics is needed to improve our understanding of tropical lake ecosystems, especially in Amazonian.

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Palms show clear niche segregation patterns along topographic gradients in tropical forests, with some species associated to terra firme and others to seasonally flooded areas. The aim of this study was to quantitatively describe the fine-scale spatial variation within a palm community, tracking the changes in species' abundance along environmental gradients associated with a perennial stream the eastern Amazon. The study of palm communities was based on 60 forest plots in which all adult palms were counted. We found a total of 566 palms in a community containing 11 species. Furthermore, we found a significant separation in the palm community between seasonally-flooded and terra firme forests. We found a gradient with various densities of the three most abundant palm species within the first 100 m away from the flooded area. Other species were located exclusively in the terra firme forest. The abundance of the six most common species were distributed in relation to humidity gradients from floodplains to terra firme, with palm distribution from the most flood-tolerant to the least flood-tolerant palm species as follows: Euterpe oleracea, Attalea phalerata and Socratea exorrhiza (species with floodplain affinity), Astrocaryum gynacanthum, Astrocaryum aculeatum, Attalea maripa (species with terra firme affinity)