The variability and predictors of quality of AIDS care services in Brazil

Background: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery.Methods: The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality.Results: The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities.Conclusion: The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).

High Prevalence of bla(CTX-M) Extended Spectrum Beta-Lactamase Genes in Klebsiella pneumoniae Isolates from a Tertiary Care Hospital: First report of bla(SHV-12), bla(SHV-31), bla(SHV-38), and bla(CTX-M-15) in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of antioxidant agents on bond strength of composite to bleached enamel with 38% hydrogen peroxide

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Características físicas e morfológicas de sêmen de touros jovens das raças Gir, Guzerá, Nelore (Bos taurus indicus) e Caracu (Bos taurus taurus)

Foram utilizados 38 tourinhos com idade inicial entre 426 e 462 dias e final entre 751 e 781 dias das raças Nelore, Guzerá, Gir e Caracu, subdivididos em sete grupos genéticos conforme o método de seleção, com o objetivo de comparar o desenvolvimento reprodutivo, avaliado pelas características físicas e morfológicas do sêmen (volume, aspecto, turbilhonamento, motilidade progressiva e vigor, morfologia e concentração espermáticas), em 11 colheitas com intervalos de 29 dias. Os touros dos grupos Nelore seleção (NeS, n=6), Nelore tradicional (NeT, n=9) e Caracu seleção (CaS, n=6), com 415, 430 e 419kg de peso, respectivamente, apresentaram diferenças em todas as características quando comparados com o Nelore controle (NeC, n=4), com 302kg de peso, na segunda colheita, e este foi o único a diferir dos outros seis grupamentos na décima primeira colheita (P<0,05). Foram registradas diferenças na motilidade progressiva média dos espermatozóides na terceira colheita entre o grupamento CaS (68,3%) e o Guzerá tradicional (GuT, n=5) (10,0%), assim como entre o CaS (76,7%) e o NeS (45,0%) na quarta colheita (P<0,05). Não foram registradas diferenças no total de defeitos de espermatozóides nas segunda e última colheitas. Com base na morfologia espermática pode-se concluir que os tourinhos dos grupos genéticos NeT, CaS, Gir Seleção (GiS, n=4), Guzerá Seleção (GuS, n=4), NeC, GuT e NeS alcançaram a maturidade sexual com idades de 547, 532, 578, 544, 547, 572 e 600 dias, e pesos corporais de 430, 440, 389, 420, 336, 451 e 438kg, respectivamente.

Penetration of 38% hydrogen peroxide into the pulp chamber in bovine and human teeth submitted to office bleach technique

This study evaluated the pulp chamber penetration of peroxide bleaching agent in human and bovine teeth after office bleach technique. All the teeth were sectioned 3 mm apical of the cement-enamel junction and were divided into 2 groups, A (70 third human molars) and B (70 bovine lateral incisors), that were subdivided into A1 and B1 restored by using composite resin, A2 and B2 by using glass ionomer cement, and A3 and B3 by using resin-modified glass ionomer cement; A4, A5, B4, and B5 were not restored. Acetate buffer was placed in the pulp chamber, and the bleaching agent was applied for 40 minutes as follows: A1-A4 and B1-B4, 38% hydrogen peroxide exposure and A5 and B5, immersion into distilled water. The buffer solution was transferred to a glass tube in which leuco crystal violet and horseradish peroxidase were added, producing a blue solution. The optical density of the blue solution was determined by spectrophotometer and converted into microgram equivalents of hydrogen peroxide. Data were submitted to analysis of variance and Dunnett, Kruskal-Wallis, and Tukey tests (5%). A higher level of hydrogen peroxide penetrated into the pulp chamber in resin-modified glass ionomer cements in bovine (0.79 +/- 0.61 mu g) and human (2.27 +/- 0.41 mu g) groups. The bleaching agent penetration into the pulp chamber was higher in human teeth for any experimental situation. The penetration of the hydrogen peroxide depends on restorative materials, and under the conditions of this study human teeth are more susceptible to penetration of bleaching agent into the pulp chamber than bovine teeth.

Carcass and meat quality traits of wild boar (Sus scrofa s. L.) with 2n=36 karyotype compared to those of phenotypically similar crossbreeds (2n=37 and 2n=38) raised under same farming conditions. 1. Carcass quantity and meat dressing

The aim of this study was to compare wild boar (chromosomal number 2n = 36) to phenotypically similar animals of 2n = 37 and 2n = 38 chromosomes (crossbreeds) with respect to live weight, carcass yield, meat yield, fat and weight of inner organs. All animals were born and raised on the same farm and slaughtered at 39 weeks. The final live weight of wild boar 2n = 36 was significantly lower (47.2 kg) as compared to crossbreeds (80.0 kg). Animals 2n = 36 had more carcass yields (65.5%) than 2n = 37 karyotype (64.9%) and 2n = 38 (64.4%). Wild boar had the highest yields for the cuts with bones and boneless cuts compared to crossbreeds. Therefore, variations in karyotype are accompanied by differences in some carcass quantitative traits, i.e., 2n = 36 grow and fatten slower than crossbreeds 2n = 37 and 2n = 38. (c) 2008 Elsevier Ltd. All rights reserved.

Penetração de peróxido de hidrogênio 38% no interior da câmara pulpar de dentes bovinos e humanos com ou sem restauração submetidos ao clareamento externo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Notas de la CEPAL Nº 38

Panorama regional Columna de opinión de José Luis Machinea: La Región en una fase de crecimiento: los retos para la política económica El sector externo Política macroeconómica El desempeño interno Dramática temporada de huracanes en el Caribe Apéndice estadístico Publicaciones recientes Calendario

ECLAC Notes Nº 38

Regional Overview Op- ed, José Luis Machinea: The Region in a Growth Phase: the Challenges to Economic Policy The External Sector Macroeconomic Policy Internal Performance Dramatic Hurrican Season in the Caribbean Statistical Appendix Recent titles Calendar