An Educational international partnership responding to local needs: Process evaluation of the Brazil FAIMER Regional Institute

The Brazilian public health system requires competent professionals sensitive to the needs of the population. The Foundation for Advancement of International Medical Education and Research (FAIMER) provides a two-year faculty development programme for health professions educators, aiming to build leadership in education to improve health. A partnership with governmental initiatives and FAIMER was established for meeting these needs. This paper describes the initial process evaluation results of the Brazilian FAIMER Institute Fellowship (FAIMER BR). Methods: Data were analysed for the classes 2007-2010 regarding: application processes; innovation project themes; retrospective post-pre self-ratings of knowledge acquisition; and professional development portfolios. Results: Seventeen of 26 Brazilian states were represented among 98 Fellows, predominantly from public medical schools (75.5%) and schools awarded Ministry of Health grants to align education with public health services (89.8%). One-third (n = 32) of Fellows' innovation projects were related to these grants. Significant increases occurred in all topic subscales on self-report of knowledge acquisition (eff ect sizes, 1.21-2.77). In the follow up questionnaire, 63% of Fellows reported that their projects were incorporated into the curriculum or institutional policies. The majority reported that the programme deepened their knowledge (98%), provided new ideas about medical education (90%) and provided skills for conflict management (63%). One-half of the Fellows reported sustained benefits from the programme listserv and other communications, including breadth of expertise, establishment of research collaboration and receiving emotional support. Conclusion: Contributors to initial programme success included alignment of curriculum with governmental initiatives, curriculum design merging educational technology, leadership and management skills and central role of an innovation educational project responding to local needs.

Onset of sexual maturity and relative growth of the freshwater crab Trichodactylus fluviatilis (Trichodactyloidea) in south-eastern Brazil

The main purpose of this study was to provide an estimate for the onset of morphological sexual maturity in the freshwater crab Trichodactylus fluviatilis, from a population located in south-eastern Brazil, based on the relative growth relationships, as well as the characterization of ''handedness''. Monthly collections were carried out at night, from January 2006 to January 2007, in a small water body. In the laboratory, the crabs were sexed; the following body structures were measured and the estimate of onset of sexual maturity was given by the logistic function, as y a/(1\+becx), for 50% of the population to reach the adult phase (CW50carapace width). Right propodus length and abdomen width were the best-fit relationships to represent the onset of sexual maturity for males and females, respectively. Based on the logistic function, the onset of sexual maturity was estimated to occur at around 18mm CW for both sexes. The relative growth recorded for this species is consistent with the model for brachyuran crabs (Hartnoll RG. 1982, Growth. In: Bliss, DE, editor. The biology of Crustacea: embryology, morphology and genetics. New York: Academic Press. p. 111-196), except for the abdomen growth, which is likely to be an adaptive condition related to protection of the newly hatched young. © 2013 Taylor & Francis.

Differential occupation of habitat as a reproductive strategy of the blue crab Callinectes ornatus Ordway, 1968 (Crustacea: Decapoda)

The reproductive biology of a species includes factors beyond its sexual maturity, fecundity and reproductive period, and may extend to the differential distribution of individuals. The reproductive dynamics of the blue crab Callinectes ornatus was investigated through monthly collections over the course of 2 years in three bays on the southeastern coast of Brazil. For each bay, six transects were established, four of them parallel to the beach line (at depths of 5, 10, 15, and 20 m), one transect exposed to wave action, and another sheltered from waves. Females and males were classified according to the gonadal maturation stage, and were grouped as individuals with reproductive potential (mature gonads or breeding females) or not (rudimentary gonads or in development). Analyses using ordination techniques (PCA) and gradient analysis (CCA) showed that 82.13 % of environmental variations were explained by the transect arrangement, and these characteristics explained 86.70 % of the differential distribution of female crabs and 96.57 % of the distribution of males. These results indicate that females with reproductive potential were more abundant in deeper regions, while females with rudimentary or developed gonads were abundant in shallower habitats and areas sheltered from wave action. Thus, the distribution of C. ornatus in these bays was linked to their reproductive state, as part of the reproductive strategy of the population. © 2013 Senckenberg Gesellschaft für Naturforschung and Springer-Verlag Berlin Heidelberg.

Preliminary Overview of the Economies of Latin America and the Caribbean 1997

Incluye Bibliografía.

An assessment of the economic impact of climate change on the Agriculture, Health and Tourism sectors in Saint Lucia

This report analyses the agriculture, health and tourism sectors in Saint Lucia to assess the potential economic impacts of climate change on the sectors. The fundamental aim of this report is to assist with the development of strategies to deal with the potential impact of climate change in Saint Lucia. It also has the potential to provide essential input for identifying and preparing policies and strategies to help advance the Caribbean subregion closer to solving problems associated with climate change and attaining individual and regional sustainable development goals. Some of the key anticipated impacts of climate change for the Caribbean include elevated air and sea-surface temperatures, sea-level rise, possible changes in extreme events and a reduction in freshwater resources. The economic impact of climate change on the three sectors was estimated for the A2 and B2 IPCC scenarios until 2050. An evaluation of various adaptation strategies for each sector was also undertaken using standard evaluation techniques. The key subsectors in agriculture are expected to have mixed impacts under the A2 and B2 scenarios. Banana, fisheries and root crop outputs are expected to fall with climate change, but tree crop and vegetable production are expected to rise. In aggregate, in every decade up to 2050, these sub-sectors combined are expected to experience a gain under climate change with the highest gains under A2. By 2050, the cumulative gain under A2 is calculated as approximately US$389.35 million and approximately US$310.58 million under B2, which represents 17.93% and 14.30% of the 2008 GDP respectively. This result was unexpected and may well be attributed to the unavailability of annual data that would have informed a more robust assessment. Additionally, costs to the agriculture sector due to tropical cyclones were estimated to be $6.9 million and $6.2 million under the A2 and B2 scenarios, respectively. There are a number of possible adaptation strategies that can be employed by the agriculture sector. The most attractive adaptation options, based on the benefit-cost ratio are: (1) Designing and implementation of holistic water management plans (2) Establishment of systems of food storage and (3) Establishment of early warning systems. Government policy should focus on the development of these adaption options where they are not currently being pursued and strengthen those that have already been initiated, such as the mainstreaming of climate change issues in agricultural policy. The analysis of the health sector placed focus on gastroenteritis, schistosomiasis, ciguatera poisoning, meningococal meningitis, cardiovascular diseases, respiratory diseases and malnutrition. The results obtained for the A2 and B2 scenarios demonstrate the potential for climate change to add a substantial burden to the health system in the future, a factor that will further compound the country’s vulnerability to other anticipated impacts of climate change. Specifically, it was determined that the overall Value of Statistical Lives impacts were higher under the A2 scenario than the B2 scenario. A number of adaptation cost assumptions were employed to determine the damage cost estimates using benefit-cost analysis. The benefit-cost analysis suggests that expenditure on monitoring and information provision would be a highly efficient step in managing climate change and subsequent increases in disease incidence. Various locations in the world have developed forecasting systems for dengue fever and other vector-borne diseases that could be mirrored and implemented. Combining such macro-level policies with inexpensive micro-level behavioural changes may have the potential for pre-empting the re-establishment of dengue fever and other vector-borne epidemic cycles in Saint Lucia. Although temperature has the probability of generating significant excess mortality for cardiovascular and respiratory diseases, the power of temperature to increase mortality largely depends on the education of the population about the harmful effects of increasing temperatures and on the existing incidence of these two diseases. For these diseases it is also suggested that a mix of macro-level efforts and micro-level behavioural changes can be employed to relieve at least part of the threat that climate change poses to human health. The same principle applies for water and food-borne diseases, with the improvement of sanitation infrastructure complementing the strengthening of individual hygiene habits. The results regarding the tourism sector imply that the tourism climatic index was likely to experience a significant downward shift in Saint Lucia under the A2 as well as the B2 scenario, indicative of deterioration in the suitability of the island for tourism. It is estimated that this shift in tourism features could cost Saint Lucia about 5 times the 2009 GDP over a 40-year horizon. In addition to changes in climatic suitability for tourism, climate change is also likely to have important supply-side effects on species, ecosystems and landscapes. Two broad areas are: (1) coral reefs, due to their intimate link to tourism, and, (2) land loss, as most hotels tend to lie along the coastline. The damage related to coral reefs was estimated at US$3.4 billion (3.6 times GDP in 2009) under the A2 scenario and US$1.7 billion (1.6 times GDP in 2009) under the B2 scenario. The damage due to land loss arising from sea level rise was estimated at US$3.5 billion (3.7 times GDP) under the A2 scenario and US$3.2 billion (3.4 times GDP) under the B2 scenario. Given the potential for significant damage to the industry a large number of potential adaptation measures were considered. Out of these a short-list of 9 potential options were selected by applying 10 evaluation criteria. Using benefit-cost analyses 3 options with positive ratios were put forward: (1) increased recommended design speeds for new tourism-related structures; (2) enhanced reef monitoring systems to provide early warning alerts of bleaching events, and, (3) deployment of artificial reefs or other fish-aggregating devices. While these options had positive benefit-cost ratios, other options were also recommended based on their non-tangible benefits. These include the employment of an irrigation network that allows for the recycling of waste water, development of national evacuation and rescue plans, providing retraining for displaced tourism workers and the revision of policies related to financing national tourism offices to accommodate the new climate realities.

An assessment of the economic impact of climate change on the Agriculture Sector in Jamaica

The agricultural sector‟s contribution to GDP and to exports in Jamaica has been declining with the post-war development process that has led to the differentiation of the economy. In 2010, the sector contributed 5.8% of GDP, and 3% to the exports (of goods), but with 36% of employment, it continues to be a major employer. With a little less than half of the population living in rural communities, agricultural activities, and their linkages with other economic activities, continue to play an important role as a source of livelihoods, and by extension, the economic development of the country. Sugar cane cultivation has, with the exception of a couple of decades in the twentieth century when it was superseded by bananas, dominated the agricultural export sector for centuries as the source of the raw materials for the manufacture of sugar for export. In 2005, sugar cane itself accounted for 6.4% of the sector‟s contribution to GDP, and 52% of the contribution of agricultural exports to GDP. Production for the domestic market has long been the larger subsector, organized around the production of root crops, especially yams, vegetables and condiments. To analyse the potential impact of climate change on the agricultural sector, this study selected three important crops for detailed examination. In particular, the study selected sugar cane because of its overwhelming importance to the export subsector of agriculture, and yam and escallion for both their contribution to the domestic subsector as well as the preeminent role yams and escallion play in the economic activities of the communities in the hills of central Jamaica, and the plains of the southwest respectively. As with other studies in this project, the methodology adopted was to compare the estimated values of output on the SRES A2 and B2 Scenarios with the value of output on a “baseline” Business As Usual (BAU), and then estimate the net benefits of investment in the relevant to climate change for the selected crops. The A2 and B2 Scenarios were constructed by applying forecasts of changes in temperature and precipitation generated by INSMET from ECHAM inspired climate models. The BAU “baseline” was a linear projection of the historical trends of yields for each crop. Linear models of yields were estimated for each crop with particular attention to the influence of the two climate variables – temperature and precipitation. These models were then used to forecast yields up to 2050 (table1). These yields were then used to estimate the value of output of the selected crop, as well as the contribution to overall GDP, on each Scenario. The analysis suggested replanting sugar cane with heat resistant varieties, rehabilitating irrigation systems where they existed, and establishing technologically appropriate irrigation systems where they were not for the three selected crops.

The relative growth and sexual maturity of the freshwater crab Dilocarcinus pagei (Brachyura, Trichodactylidae) in the northwestern region of the state of São Paulo

The aim of the present study was to determine the size at sexual maturity in the freshwater crab Dilocarcinus pagei Stimpson, 1861, from a population located in Mendonça, state of São Paulo, Brazil. The crabs were sampled monthly (July 2005 to June 2007), at Barra Mansa reservoir. The specimens were captured manually or in sieves passed through the aquatic vegetation. The crabs were captured and separated by sex based on morphology of the pleon and on the number of pleopods. The following dimensions were measured: carapace width (CW); carapace length (CL); propodus length (PL); and abdomen width (AW). The morphological analysis of the gonads was used to identify and categorize individuals according to their stage of development. The morphological maturity was estimated based on the analysis of relative growth based on the allometric equation y = ax b. The gonadal maturity was based on the morphology of the gonads by the method CW50 which indicates the size at which 50% of the individuals in the population showed gonads morphologically mature to reproduction. The biometric relationships that best demonstrated the different patterns of growth for the juvenile and adult stages were CW vs. PL for males and CW vs. AW for females (p<0.001). Based on these relationships, the estimated value to morphological sexual maturity was 21.5 mm (CW) in males and 19.7 mm (CW) in females. The determination of the size at sexual maturity and the adjustment of the data based on the logistic curve (CW50) resulted in a size of 38.2 mm for males and 39.4 mm for females (CW). Based on the data obtained for sexual maturity for D. pagei, we can estimate a minimum size for capture of 40 mm (CW). This minimum size allows at least half of the population to reproduce and retains the juveniles and a portion of the adults in the population.

Reconstruction of the Environmental Quality Fuzzy Index

In the world stage, the environmental condition has been a big public policies issue. A clear understanding of the parameters that determine the state of the environment is essential for estimation of the quality of life of the population, not least since ecosystems are highly complex. Consequently, definition of public policies demands the use of evaluation tools that can combine and quantify information in a clear way. The use of indicators and indices that are able to translate the complexity of environmental conditions in cities into simpler terms has been increasingly effective in decision-making, since they assist in general evaluation of the situation in question, identification of priority actions and anticipation of future trends. In an attempt to evaluate the environmental conditions of the Brazilian city, Sorocaba, an Environmental Quality Fuzzy Index (IFQAmb) was proposed. In this work this methodology is improved. After reviewing the IFQAmb methodology, a number of changes in the index are proposed. Additional variables are suggested, derived from a State Environment Department program whose objective is to grant municipalities the title of Municipio Verde e Azul (Green and Blue City). In addition, a new rule base is being drafted to enable consideration of all possibilities, since in the existing version the use of specific criteria eliminates a significant number of rules. The changes seek to define with clarity and precision the conceptual aspects and structure of the IFQAmb, so that it can provide an even more effective evaluation of environmental performance, guiding future actions in order to improve the living conditions of the population of Sorocaba.

Integrative aspects of the relationship between stress and heart rate variability

The literature indicates stress as a response of the organism to a stimulation that requires enormous efforts to adapt to the changes in the environment and the body. When an individual is subjected to stress, the autonomic nervous system is triggered, the sympathetic pathway is activated, and the parasympathetic system is suppressed, which exerts several effects on the cardiovascular system and affects heart rate variability. This research aimed to conduct a literature review to find and analyze the studies that address clearly the implications of stress on heart rate variability. The methodology employed was an active search in the databases SciELO, PubMed and Lilacs. The results were five articles, most of which suggest a relationship between stress and heart rate variability. We observed that the majority of the studies indicated a strong association between stress and cardiac autonomic activity. The stress is present in the daily activities of the population, especially in labor. The subject is vast, however, were observed in the references the effects of stress on the body making it vulnerable to diseases. Thus, this information may contribute to the aid of preventive strategies against stress and diseases of the cardiovascular system.

BIRD CONTROL METHODS AND DEVICES--COMMENTS OF THE NATIONAL PEST CONTROL ASSOCIATION

It may be useful to review some of the considerations that go into recommendations concerning bird management. Later I will make some comments concerning specific methods and devices being used in or promoted for bird control work regardless of whether or not they are new. Members of the National Pest Control Association provide a variety of services, such as fumigation, termite control and general pest control which includes rodent control. There are eight such categories listed in our roster, but only one member in five provides every service listed. Bird control is a rather recent development and is the newest category of service to be listed in the NPCA roster where it appeared for the first time in 1959. As of September 1, 1966, 45% of our members' offices indicated that they were prepared to offer bird control service. Less than 40% did so in 1964. Why is it that more of our members do not declare themselves as ready to do bird control work? I believe the most common answer you would find is that bird control is not yet sufficiently established that they can provide a service comparable in quality to that which is provided against termites or cockroaches or rats. Our members simply do not want to jeopardize their reputation on methods that are not certain or are too complex. Others recognize the emotional reaction evidenced by much of the population concerning control of birds and do not want to become involved in work that might offend some of their clientele. Still others simply do not agree that birds are their responsibility.

Molecular Surveillance of the Newcastle Disease Virus in Domestic and Wild Birds on the North Eastern Coast and Amazon Biome of Brazil

Brazil is one of the world's largest countries with a rich diversity of wildlife, including resident and migratory wild birds, which may be natural reservoirs of the Newcastle disease virus (NDV). Because Brazil is a major global exporter of chicken meat, the emergence of such a disease may have a huge negative impact not only on the economy due to trade restrictions and embargoes, but also on the quality of life of the population. Samples were collected from 1,022 asymptomatic domestic and wild birds from the Brazilian coast and the Amazon region using tracheal/cloacal swabs and tested by RT-qPCR. The results showed 7 (0.7%) birds were positive for NDV. The positive samples were then isolated in embryonated chicken eggs and their matrix protein genes were partially sequenced, revealing a low-pathogenicity NDV. This study confirms the maintenance of the velogenic-NDV free status of Brazil.

Accuracy of Screening for Potentially Malignant Disorders of the Oral Mucosa by Dentists in Primary Care

Purpose: To examine the accuracy of a screening programme for potentially malignant disorders of the oral mucosa by visual inspection in primary health care. Materials and Methods: The study was based on secondary data from the Primary Care Information System maintained by seven units of family health in Sao Paulo City managed by a non-governmental agency. The reference population was composed of 15,072 residents 50 years old or more of both genders. The study population comprised 2,980 individuals. During screening in community settings, the oral mucosa was examined by trained dentists and distributed into two categories: (a) screen negative (b) screen positive. All participants underwent comprehensive clinical exams by a general dental practitioner supervised by a specialist. Individual records were grouped in a working dataset. Point and 95% confidence interval estimates were calculated regarding measures of sensitivity (Se), specificity (Sp) and positive and negative predictive values (PPV and NPV, respectively). Results: 18.0% of the population was considered screen positive. A total of 133 lesions (4.5%) were identified and 8 cases of oral cancer were confirmed, which corresponded to a prevalence rate of 27 cases in 10,000 people, a much higher rate than expected. The measures found were Se: 91.7% (85.3-95.6), Sp: 85.4% (84.1-86.7), PPV: 22.7% (19.3-26.5), NPV: 99.5% (99.2-99.8). The visual screen presented high accuracy. Conclusion: The test presented high sensibility and specificity values. From a public health point of view, the high accuracy levels showed the importance of oral health teams on family health strategy for more comprehensive primary care. Targeting risk groups and delegating the screening to community health agents may improve PPV and coverage.

In Vitro Evaluation of the Probiotic Potential of Bacteriocin Producer Lactobacillus sakei 1

Lactobacillus sakei 1 is a food isolate that produces a heat-stable antimicrobial peptide (sakacin 1, a class ha bacteriocin) inhibitory to the opportunistic pathogen Listeria monocytogenes. Bacterial isolates with antimicrobial activity may be useful for food biopreservation and also for developing probiotics. To evaluate the probiotic potential of L. sakei I, it was tested for (i) in vitro gastric resistance (with synthetic gastric juice adjusted to pH 2.0, 2.5, or 3.0); (ii) survival and bacteriocin production in the presence of bile salts and commercial prebiotics (inulin and oligofructose); (iii) adhesion to Caco-2 cells; and (iv) effect on the adhesion of L. monocytogenes to Caco-2 cells and invasion of these cells by the organism. The results showed that L. sakei I survival in gastric environment varied according to pH, with the maximum survival achieved at pH 3.0, despite a 4-log reduction of the population after 3 h. Regarding the bile salt tolerance and influence of prebiotics, it was observed that L. sakei 1 survival rates were similar (P > 0.05) for all de Man Rogosa Shame (MRS) broth formulations when tests were done after 4 h of incubation. However, after incubation for 24 h, the survival of L. sakei 1 in MRS broth was reduced by 1.8 log (P < 0.001), when glucose was replaced by either inulin or oligofructose (without Oxgall). L. sakei 1 was unable to deconjugate bile salts, and there was a significant decrease (1.4 log) of the L. sakei 1 population in regular MRS broth plus Oxgall (P < 0.05). In spite of this, tolerance levels of L. sakei 1 to bile salts were similar in regular MRS broth and in MRS broth with oligofructose. Lower bacteriocin production was observed in MRS broth when inulin (3,200 AU/ml) or oligofructose (2,400 AU/ml) was used instead of glucose (6,400 AU/ml). L. sakei I adhered to Caco-2 cells, and its cell-free pH-neutralized supernatant containing sakacin I led to a significant reduction of in vitro listerial invasion of human intestinal Caco-2 cells.

Prevalence of the metabolic syndrome using two proposed definitions in a Japanese-Brazilians community

Metabolic Syndrome (MetS) is associated with increased risk of morbi-mortality, thus the characterization of the population magnitude of this syndrome is critical for allocating health care. However, prevalence estimates of MetS in the same population could differ depending on the definition used. Therefore, we compared the prevalence of the MetS using definitions proposed by: National Cholesterol Education Panel Revised (NCEP) and International Diabetes Federation (IDF) 2009 in a Japanese-Brazilians community (131 individuals, age 57 ± 16 years, 1st and 2nd generation). All individuals went through a clinical and laboratorial evaluation for assessment of weigh, height, waist circumference, blood pressure, triglycerides, HDL-cholesterol and fasting plasma glucose. The prevalence of MetS was 26.7% (n = 35) and 37.4% (n = 49) under the NCEP and IDF definitions, respectively. Despite higher blood pressure measurements, waist circumference and serum triglyceride levels and lower HDL cholesterol levels (p < 0.01), individuals identified with MetS did not show increased blood glucose levels. IDF definition classified 14 individuals (10.7%) with MetS that were not classified under the NCEP and 35 individuals were identified with MetS by both criteria. We observed, in this group, more severe lipid disorders, compared to individuals identified only under the IDF definition, and the BMI and waist circumference (p = 0.01; p = 0.006, respectively) were lower. In conclusion, the IDF revised criteria, probably because of the ethnic specific values of waist circumference, was able to identify a larger number of individuals with MetS. However, our data suggesting that additional studies are necessary to define best MetS diagnostic criteria in this population.

Molecular surveillance of the Newcastle disease virus in domestic and wild birds on the North Eastern Coast and Amazon biome of Brazil

Brazil is one of the world's largest countries with a rich diversity of wildlife, including resident and migratory wild birds, which may be natural reservoirs of the Newcastle disease virus (NDV). Because Brazil is a major global exporter of chicken meat, the emergence of such a disease may have a huge negative impact not only on the economy due to trade restrictions and embargoes, but also on the quality of life of the population. Samples were collected from 1,022 asymptomatic domestic and wild birds from the Brazilian coast and the Amazon region using tracheal/cloacal swabs and tested by RT-qPCR. The results showed 7 (0.7%) birds were positive for NDV. The positive samples were then isolated in embryonated chicken eggs and their matrix protein genes were partially sequenced, revealing a low-pathogenicity NDV. This study confirms the maintenance of the velogenic-NDV free status of Brazil.