Comparative evaluation of underlying causes of death processed by the Automated Classification of Medical Entities and the Underlying Cause of Death Selection Systems

INTRODUCTION: The correct identification of the underlying cause of death and its precise assignment to a code from the International Classification of Diseases are important issues to achieve accurate and universally comparable mortality statistics These factors, among other ones, led to the development of computer software programs in order to automatically identify the underlying cause of death. OBJECTIVE: This work was conceived to compare the underlying causes of death processed respectively by the Automated Classification of Medical Entities (ACME) and the "Sistema de Seleção de Causa Básica de Morte" (SCB) programs. MATERIAL AND METHOD: The comparative evaluation of the underlying causes of death processed respectively by ACME and SCB systems was performed using the input data file for the ACME system that included deaths which occurred in the State of S. Paulo from June to December 1993, totalling 129,104 records of the corresponding death certificates. The differences between underlying causes selected by ACME and SCB systems verified in the month of June, when considered as SCB errors, were used to correct and improve SCB processing logic and its decision tables. RESULTS: The processing of the underlying causes of death by the ACME and SCB systems resulted in 3,278 differences, that were analysed and ascribed to lack of answer to dialogue boxes during processing, to deaths due to human immunodeficiency virus [HIV] disease for which there was no specific provision in any of the systems, to coding and/or keying errors and to actual problems. The detailed analysis of these latter disclosed that the majority of the underlying causes of death processed by the SCB system were correct and that different interpretations were given to the mortality coding rules by each system, that some particular problems could not be explained with the available documentation and that a smaller proportion of problems were identified as SCB errors. CONCLUSION: These results, disclosing a very low and insignificant number of actual problems, guarantees the use of the version of the SCB system for the Ninth Revision of the International Classification of Diseases and assures the continuity of the work which is being undertaken for the Tenth Revision version.

Can varying the number of teams in a shift schedule constitute a preventive strategy?

OBJECTIVE: The study examines the implications for shiftworkers of applying different numbers of teams in the organization of shiftwork. METHODS: The participating operators came from five different companies applying continuous shift rotation systems. The companies shared the same product organization and a common corporate culture belonging to the same multinational company. Each company had a shift system consisting of four, five or six teams, with the proportion of shifts outside day work decreasing as the number of teams increased. Questionnaire and documentary data were used as data sources. RESULTS: Operators in systems with additional teams had more daywork but also more irregular working hours due to both overtime and schedule changes. Operators using six teams used fewer social compensation strategies. Operators in four teams were most satisfied with their work hours. Satisfaction with the time available for various social activities outside work varied inconsistently between the groups. CONCLUSIONS: In rotating systems the application of more teams reduces the number of shifts outside day work. This apparent improvement for shiftworkers was counteracted by a concomitant irregularity produced by greater organizational requirements for flexibility. The balance of this interaction was found to have a critical impact on employees.

Social protection systems in vulnerable families: their importance for the public health

OBJECTIVE To analyze the effectiveness of the Chilean System of Childhood Welfare in transferring benefits to socially vulnerable families. METHODS A cross-sectional study with a sample of 132 families from the Metropolitan Region, Chile, stratified according to degree of social vulnerability, between September 2011 and January 2012. Semi-structured interviews were conducted with mothers of the studied families in public health facilities or their households. The variables studied were family structure, psychosocial risk in the family context and integrated benefits from the welfare system in families that fulfill the necessary requirements for transfer of benefits. Descriptive statistics to measure location and dispersion were calculated. A binary logistic regression, which accounts for the sample size of the study, was carried out. RESULTS The groups were homogenous regarding family size, the presence of biological father in the household, the number of relatives living in the same dwelling, income generation capacity and the rate of dependency and psychosocial risk (p ≥ 0.05). The transfer of benefits was low in all three groups of the sample (≤ 23.0%). The benefit with the best coverage in the system was the Single Family Subsidy, whose transfer was associated with the size of the family, the presence of relatives in the dwelling, the absence of the father in the household, a high rate of dependency and a high income generation capacity (p ≤ 0.10). CONCLUSIONS The effectiveness of benefit transfer was poor, especially in families that were extremely socially vulnerable. Further explanatory studies of benefit transfers to the vulnerable population, of differing intensity and duration, are required in order to reduce health disparities and inequalities.

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil. METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness. RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients. CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

New delivery systems for amphotericin B applied to the improvement of leishmaniasis treatment

Leishmaniasis is one of the six major tropical diseases targeted by the World Health Organization. It is a life-threatening disease of medical, social and economic importance in endemic areas. No vaccine is yet available for human use, and chemotherapy presents several problems. Pentavalent antimonials have been the drugs of choice to treat the disease for more than six decades; however, they exhibit high toxicity and are not indicated for children, for pregnant or breastfeeding women or for chronically ill patients. Amphotericin B (AmpB) is a second-line drug, and although it has been increasingly used to treat visceral leishmaniasis (VL), its clinical use has been hampered due to its high toxicity. This review focuses on the development and in vivo usage of new delivery systems for AmpB that aim to decrease its toxicity without altering its therapeutic efficacy. These new formulations, when adjusted with regard to their production costs, may be considered new drug delivery systems that promise to improve the treatment of leishmaniasis, by reducing the side effects and the number of doses while permitting a satisfactory cost-benefit ratio.

Molecular Epidemiologic Typing Systems of Bacterial Pathogens: Current Issues and Perpectives

The epidemiologic typing of bacterial pathogens can be applied to answer a number of different questions: in case of outbreak, what is the extent and mode of transmission of epidemic clone(s )? In case of long-term surveillance, what is the prevalence over time and the geographic spread of epidemic and endemic clones in the population? A number of molecular typing methods can be used to classify bacteria based on genomic diversity into groups of closely-related isolates (presumed to arise from a common ancestor in the same chain of transmission) and divergent, epidemiologically-unrelated isolates (arising from independent sources of infection). Ribotyping, IS-RFLP fingerprinting, macrorestriction analysis of chromosomal DNA and PCR-fingerprinting using arbitrary sequence or repeat element primers are useful methods for outbreak investigations and regional surveillance. Library typing systems based on multilocus sequence-based analysis and strain-specific probe hybridization schemes are in development for the international surveillance of major pathogens like Mycobacterium tuberculosis. Accurate epidemiological interpretation of data obtained with molecular typing systems still requires additional research on the evolution rate of polymorphic loci in bacterial pathogens.

Soybean response to starter nitrogen and Bradyrhizobium inoculation on a Cerrado oxisol under no-tillage and conventional tillage systems

In Brazil, Bradyrhizobium inoculation has successfully replaced the use of N fertilizer on soybean [Glycine max (L) Merr.] crops. However, with the expansion of no-tillage cropping systems in the Cerrados region, the idea that it is necessary to use small N rates at the sowing to overcome problems related with N immobilization has become widespread, mainly when soybean is cultivated after a non-legume crop. In this study we examined soybean response to small rates of N fertilizer under no-tillage (NT) and conventional tillage (CT) systems. Four experiments (a completely randomized block with five replicates) were carried out in a red yellow oxisol, during the periods of 1998/1999 and 1999/ 2000, under NT and CT. The treatments consisted of four urea rates (0, 20, 30 and 40 kg ha-1 N). All treatments were inoculated with Bradyrhizobium japonicum strains SEMIA 5080 and SEMIA 5079, in the proportion 1 kg of peat inoculant (1,5 x 10(9) cells g-1) per 50 kg of seeds. In both experiments, soybean was cultivated after corn and the N fertilizer was band applied at sowing. In all experiments, N rates promoted reductions of up to 50 % in the nodule number at 15 days after the emergence. Regardless of the management system, these reductions disappeared at the flowering stage and there was no effect of N rates on either the number and dry weight of nodules or on soybean yields. Therefore, in the Brazilian Cerrados, when an efficient symbiosis is established, it is not necessary to apply starter N rates on soybean, even when cultivated under notillage systems.

Maize response to nitrogen fertilization timing in two tillage systems in a soil with high organic matter content

No-tillage systems, associated to black oat as preceding cover crop, have been increasingly adopted. This has motivated anticipated maize nitrogen fertilization, transferring it from the side-dress system at the stage when plants have five to six expanded leaves to when the preceding cover crop is eliminated or to maize sowing. This study was conducted to evaluate the effects of soil tillage system and timing of N fertilization on maize grain yield and agronomic efficiency of N applied to a soil with high organic matter content. A three-year field experiment was conducted in Lages, state of Santa Catarina, from 1999 onwards. Treatments were set up in a split plot arrangement. Two soil tillage systems were tested in the main plots: conventional tillage (CT) and no-tillage (NT). Six N management systems were assessed in the split-plots: S1 - control, without N application; S2 - all N (100 kg ha-1) applied at oat desiccation; S3 - all N applied at maize sowing; S4 - all N side-dressed when maize had five expanded leaves (V5 growth stage); S5 - 1/3 of N rate applied at maize sowing and 2/3 at V5; S6 - 2/3 of nitrogen rate applied at maize sowing and 1/3 at V5. Maize response to the time and form of splitting N was not affected by the soil tillage system. Grain yield ranged from 6.0 to 11.8 t ha-1. The anticipation of N application (S2 and S3) decreased grain yield in two of three years. In the rainiest early spring season (2000/2001) of the experiment, S4 promoted an yield advantage of 2.2 t ha-1 over S2 and S3. Application of total N rate before or at sowing decreased the number of kernels produced per ear in 2000/2001 and 2001/2002 and the number of ears produced per area in 2001/2002, resulting in reduced grain yield. The agronomic efficiency of applied N (kg grain increase/kg of N applied) ranged from 13.9 to 38.8 and was always higher in the S4 than in the S2 and S3 N systems. Short-term N immobilization did not reduce grain yield when no N was applied before or at maize sowing in a soil with high organic matter content, regardless of the soil tillage system.

Pedotransfer functions to estimate proctor test parameters under different tillage systems

The Proctor test is time-consuming and requires sampling of several kilograms of soil. Proctor test parameters were predicted in Mollisols, Entisols and Vertisols of the Pampean region of Argentina under different management systems. They were estimated from a minimum number of readily available soil properties (soil texture, total organic C) and management (training data set; n = 73). The results were used to generate a soil compaction susceptibility model, which was subsequently validated using a second group of independent data (test data set; n = 24). Soil maximum bulk density was estimated as follows: Maximum bulk density (Mg m-3) = 1.4756 - 0.00599 total organic C (g kg-1) + 0.0000275 sand (g kg-1) + 0.0539 management. Management was equal to 0 for uncropped and untilled soils and 1 for conventionally tilled soils. The established models predicted the Proctor test parameters reasonably well, based on readily available soil properties. Tillage systems induced changes in the maximum bulk density regardless of total organic matter content or soil texture. The lower maximum apparent bulk density values under no-tillage require a revision of the relative compaction thresholds for different no-tillage crops.

Effects of tillage systems on physical properties of a cohesive yellow argisol in the northern state of Espírito Santo, Brazil

Tillage systems are a key element of the technology of crop production, both with a view to crop yield and from the perspective of soil conservation and sustainability of the production system. The aim of this paper was to evaluate the effects of five tillage systems on the physical properties of a cohesive Yellow Argisol. The experiment was installed in the field on January 21, 2011 and lasted 260 days, in an area previously used as pasture with Brachiaria grass without liming or fertilization, but irrigated by a low pressure spray system. The treatments, in five replications and in a randomized block design, consisted of: 1) disk plow (twice) + disk harrow + ridge-furrow tillage (raising a ridge along the planting row), 135 days after transplanting (DP + RID); 2) disk plow (twice) + disk harrow (DP no RID); 3) subsoiler (SB); 4) disk plow (twice) + disk harrow + scarification with three shanks along the plant row (DP + SPR); and 5) disk plow (twice) + disk harrow + scarification with three shanks in the total area (DP + STA). In all tillage systems, furrows were mechanically opened for the papaya plants. After the treatments, the mechanical resistance to penetration was determined, followed by soil moisture, mean weight diameter (MWD), geometric mean diameter (GMD), bulk density (BD), macroporosity (Ma), microporosity (Mi), and number of fruits per plant. There were differences in penetration resistance (PR) between treatments. The subsoiler was more effective to decrease RP to a distance of 0.35 m from the plants, perpendicular to the plant row. The scarifier resulted in a lower PR than DP or SB, even at the depth of 0.40 m, and it was more effective at greater distances perpendicular to the plant. All tillage systems induced a PR between 2.0 and 3.0 MPa at the depth with the highest concentration of papaya tree roots (0-0.25 m), improving the physical conditions to this depth. There was no statistical difference among the treatments for BD, Ma, Mi, MWD, and GMD at a depth of 0.20 m. The disk plow changed the physical properties of the soil most intensely to a depth of 0.20 m. The use of scarification, reduced tillage with a forest subsoiler, or ridge-furrow tillage did not improve the physical properties in the rhizosphere. Reduced tillage with a forest subsoiler resulted in a lower number of fruits per plant than all other treatments, which did not differ from each other.

Iron oxides and quality of organic matter in sugarcane harvesting systems

Improvements in working conditions, sustainable production, and competitiveness have led to substantial changes in sugarcane harvesting systems. Such changes have altered a number of soil properties, including iron oxides and organic matter, as well as some chemical properties, such as the maximum P adsorption capacity of the soil. The aim of this study was to characterize the relationship between iron oxides and the quality of organic matter in sugarcane harvesting systems. For that purpose, two 1 ha plots in mechanically and manually harvested fields were used to obtain soil samples from the 0.00-0.25 m soil layer at 126 different points. The mineralogical, chemical, and physical results were subjected to descriptive statistical analyses, such as the mean comparison test, as well as to multivariate statistical and principal component analyses. Multivariate tests allowed soil properties to be classified in two different groups according to the harvesting method: manual harvest with the burning of residual cane, and mechanical harvest without burning. The mechanical harvesting system was found to enhance pedoenvironmental conditions, leading to changes in the crystallinity of iron oxides, an increase in the humification of organic matter, and a relative decrease in phosphorus adsorption in this area compared to the manual harvesting system.

Decomposition of Arachis pintoi and Hyparrhenia rufa litters in monoculture and intercropped systems under lowland soil

Tropical grasslands under lowland soils are generally underutilized and the litter of forage legumes may be used to recover these degraded pastures. The objective of this work was to study the dynamics of litter decomposition of Arachis pintoi (pinto peanut), Hyparrhenia rufa (thatching grass) and a mixture of both species in a lowland soil. These treatments were analyzed in three areas: grass monoculture, legume monoculture and legume intercropped with the grass during the dry and wet seasons. Litter bags containing the legume, grass or a mixture of both species were incubated to estimate the decomposition rate and microorganism colonization. Decomposition constants (K) and litter half-lives (T1/2) were estimated by an exponential model whereas number of microorganisms in specific media were determined by plate dilution. The decomposition rate, release of nutrients and microorganisms number, especially bacteria, increased when pinto peanut was added to thatching grass, influenced by favorable lignin/N and C/N ratios in legume litter. When pinto peanut litter was incubated in the grass plots, 50% N and P was released within about 135 days in the dry season and in the wet season, the equivalent release occurred within 20 days. These results indicate that A. pintoi has a great potential for nutrient recycling via litter and can be used to recover degraded areas.

Phyllochron estimation in intercropped strawberry and monocrop systems in a protected environment

The phyllochron is defined as the time required for the appearance of successive leaves on a plant; this characterises plant growth, development and adaptation to the environment. To check the growth and adaptation in cultivars of strawberry grown intercropped with fig trees, it was estimated the phyllochron in these production systems and in the monocrop. The experiment was conducted in greenhouses at the University of Passo Fundo (28º15'41'' S, 52º24'45'' W and 709 m) from June 8th to September 4th, 2009; this comprised the period of transplant until the 2nd flowering. The cultivars Aromas, Camino Real, Albion, Camarosa and Ventana, which seedlings were originated from the Agrícola LLahuen Nursery in Chile, as well as Festival, Camino Real and Earlibrite, originated from the Viansa S.A. Nursery in Argentina, were grown in white polyethylene bags filled with commercial substrate (Tecnomax®) and evaluated. The treatments were arranged in a randomised block design and four replicates were performed. A linear regression was realized between the leaf number (LN) in the main crown and the accumulated thermal time (ATT). The phyllochron (degree-day leaf-1) was estimated as the inverse of the angular coefficient of the linear regression. The data were submitted to ANOVA, and when significance was observed, the means were compared using the Tukey test (p < 0.05). The mean and standard deviation of phyllochrons of strawberry cultivars intercropped with fig trees varied from 149.35ºC day leaf-1 ± 31.29 in the Albion cultivar to 86.34ºC day leaf-1 ± 34.74 in the Ventana cultivar. Significant differences were observed among cultivars produced in a soilless environment with higher values recorded for Albion (199.96ºC day leaf-1 ± 29.7), which required more degree-days to produce a leaf, while cv. Ventana (85.76ºC day leaf-1 ± 11.51) exhibited a lower phyllochron mean value. Based on these results, Albion requires more degree-days to issue a leaf as compared to cv. Ventana. It was conclude that strawberry cultivars can be grown intercropped with fig trees (cv. Roxo de Valinhos).

Effect of different substrates in aquaponic lettuce production associated with intensive tilapia farming with water recirculation systems

ABSTRACT The integration of fish farming in intensive system and plant production, called "aquaponics" is practiced successfully in countries like the USA, Australia and Europe. In Brazil, this integration has attracted the attention of researchers and producers. In this context, the aim of this study was to evaluate the effect of two substrates (crushed stone number 3, CS III and flexible polyurethane foam, FPF) on the production of aquaponic lettuce, moreover, to show that the residual water from intensive tilapia production provides sufficient qualitative characteristics for competitive production of lettuce without adding commercial fertilizers. The treatment in which FPF was used provided higher concentrations of macro and micronutrients in the shoots, higher production of fresh matter of shoots (95.48 g plant-1) and a larger number of leaves (14.90) relative to CS III. These results were attributed to the lower post-transplanting stress and the higher water retention time provided by the FPF. The residual water from tilapia intensive farming can provide sufficient nutrients for the production of lettuce, making the supplementary fertilization with commercial products unnecessary. Thus, the FPF presents the most suitable conditions to be used as substrate in aquaponics system with recirculation of the residual water from the intensive tilapia farming.

Health management practices and disease prevalence in dairy sheep systems in Argentina

A cross-sectional survey of 19 dairy sheep farms in Argentina was carried out with the purpose to know farm management, health practices, and occurrence and mortality of diseases. The survey comprised 40% of all sheep milking farms in Argentina. A questionnaire was conducted by way of personal interviews with sheep owners during farm visits. The proportions of farms reporting routine vaccination for clostridial diseases, contagious ecthyma, pneumonia and mineral and vitamin parenteral administration were 63%, 47.3%, 16.6% and 42.1% respectively. Regular treatment against lice was used in 37.5% of the farms, and 89.5% o the farmers treated against gastrointestinal nematodes (GIN). The mean number of GIN drenches per farm was 2.26±1.78 annually. In 68.4% of the milking flocks the California Mastitis Test was regularly done and 55.6% of the farmer managers had sampled their flocks once a year for Brucella ovis antibodies. During the pre-mating period respectively 68.4% and 50% of farmers clinically examined their rams and ewe for general health and teeth condition. The udders of ewes were frequently inspected at the start of each milking period. The most important parasite problems noticed were GIN (reported by 57.9% of farmers), lice (57.9%) and scabies (10.5%) and the most frequent infectious diseases were ecthyma (73.7%), pneumonia and other respiratory problems (57.9%), clinical mastitis (55.6%), clostridial diseases (36.9%) and foot lameness (35.2%). Photosensitivity (47.4%) and ruminal acidosis (42.1%) were reported as other frequent toxic or metabolic disorders. Owners mentioned that the mean lifespan or milk productive time per ewe was 4.5±1.4 years. Perinatal lamb mortality was 8.5% and the total flock mortality rates, above the first 24 h of life was 6.9%. The high rates of lamb mortality during the pre-weaning (10.3%) and post-weaning (5.9%) periods indicate that this problem, as well as the most prevalent diseases, should be the subject of further studies.