Harmonização e classificação toxicológica de agrotóxicos em 1992 no Brasil e a necessidade de prever os impactos da futura implantação do GHS

Em 1992, o Brasil modificou seus critérios de classificação toxicológica de agrotóxicos adequando-os à recomendação de classificação de periculosidade da Organização Mundial da Saúde (OMS). Em 2002, o Sistema Globalmente Harmonizado de Classificação e Rotulagem de Produtos Químicos (GHS) foi adotado pela Organização das Nações Unidas. Em decorrência, a OMS está adequando ao GHS sua recomendação de classificação de agrotóxicos, o que também deverá ser feito pelo Brasil. Considerou-se oportuno estimar o impacto da alteração de critérios, ocorrida em 1992, na reclassificação toxicológica dos produtos comerciais que se encontravam registrados na ocasião. Encontrou-se que 58,6% do total dos agrotóxicos então registrados (74,9% das formulações líquidas e 31,0% das sólidas) podem ter sofrido reclassificação para classes toxicológicas consideradas de me-nor periculosidade, sofrendo mudanças na comunicação de riscos expressa na rotulagem. Isto pode ter ocasionado conseqüências negativas devido a confusões de interpretação pelos agricultores. Nos países que já dispõem de sistemas de classificação de periculosidade de agrotóxicos, como o Brasil, recomenda-se estimar, antes da implantação, os impactos das mudanças que poderão decorrer da adoção do GHS.

Tendências da internação e da mortalidade infantil por diarréia: Brasil, 1995 a 2005

OBJETIVO: Analisar a tendência das internações e da mortalidade por diarréia em crianças menores de um ano. MÉTODOS: Foi realizado um estudo ecológico de séries temporais entre 1995 e 2005, para o Brasil e para as capitais dos estados. Foram utilizados dados secundários do Ministério da Saúde, obtidos do Sistema de Informação Hospitalar e do Sistema de Informação sobre Mortalidade. Durante o período de estudo foram registradas 1.505.800 internações e 39.421 mortes por diarréia de crianças menores de um ano de idade. Para as análises das tendências da taxa de internação e de mortalidade foram utilizados modelos de regressão polinomial. RESULTADOS: Houve redução tanto nas internações por diarréia quanto na mortalidade infantil por diarréia no País e em 13 capitais. Oito capitais tiveram queda somente na mortalidade por diarréia, enquanto três apresentaram decréscimo somente nas taxas de internação por diarréia. Na análise conjunta dos indicadores de diarréia e dos indicadores gerais, observou-se que houve decréscimo em todas as séries históricas somente no Brasil e em quatro capitais. CONCLUSÕES: A redução nas taxas de internações e mortalidade por diarréia observada pelas séries temporais podem ser resultado das medidas de prevenção e controle empregadas

Harmonização e classificação de periculosidade de agrotóxicos: impactos na classificação toxicológica, Brasil, 1992

Em 1992 o Brasil modificou seus critérios de classificação toxicológica de agrotóxicos adequando-os à recomendação de classificação de periculosidade da Organização Mundial da Saúde (OMS). Em 2002, o Sistema Globalmente Harmonizado de Classificação e Rotulagem de Produtos Químicos (GHS) foi adotado pela Organização das Nações Unidas. Em decorrência, a OMS está adequando ao GHS sua recomendação de classificação de agrotóxicos, o que também deverá ser feito pelo Brasil. Considerou-se oportuno estimar o impacto da alteração de critérios, ocorrida em 1992, na reclassificação toxicológica dos produtos comerciais que se encontravam registrados na ocasião. Encontrou-se que 58,6% do total dos agrotóxicos então registrados (74,9% das formulações líquidas e 31,0% das sólidas) podem ter sofrido reclassificação para Classes Toxicológicas consideradas de menor periculosidade, sofrendo mudanças na comunicação de riscos expressa na rotulagem. Isto pode ter ocasionado conseqüências negativas devido à confusões de interpretação pelos agricultores. Nos países que já dispõem de sistemas de classificação de periculosidade de agrotóxicos, como o Brasil, recomenda-se estimar, antes da implantação, os impactos das mudanças que poderão decorrer da adoção do GHS

Inequalities in mortality of men by oral and pharyngeal cancer in Barcelona, Spain and Sao Paulo, Brazil, 1995-2003

Background: Large inequalities of mortality by most cancers in general, by mouth and pharynx cancer in particular, have been associated to behaviour and geopolitical factors. The assessment of socioeconomic covariates of cancer mortality may be relevant to a full comprehension of distal determinants of the disease, and to appraise opportune interventions. The objective of this study was to compare socioeconomic inequalities in male mortality by oral and pharyngeal cancer in two major cities of Europe and South America. Methods: The official system of information on mortality provided data on deaths in each city; general censuses informed population data. Age-adjusted death rates by oral and pharyngeal cancer for men were independently assessed for neighbourhoods of Barcelona, Spain, and Sao Paulo, Brazil, from 1995 to 2003. Uniform methodological criteria instructed the comparative assessment of magnitude, trends and spatial distribution of mortality. General linear models assessed ecologic correlations between death rates and socioeconomic indices (unemployment, schooling levels and the human development index) at the inner-city area level. Results obtained for each city were subsequently compared. Results: Mortality of men by oral and pharyngeal cancer ranked higher in Barcelona (9.45 yearly deaths per 100,000 male inhabitants) than in Spain and Europe as a whole; rates were on decrease. Sao Paulo presented a poorer profile, with higher magnitude (11.86) and stationary trend. The appraisal of ecologic correlations indicated an unequal and inequitably distributed burden of disease in both cities, with poorer areas tending to present higher mortality. Barcelona had a larger gradient of mortality than Sao Paulo, indicating a higher inequality of cancer deaths across its neighbourhoods. Conclusion: The quantitative monitoring of inequalities in health may contribute to the formulation of redistributive policies aimed at the concurrent promotion of wellbeing and social justice. The assessment of groups experiencing a higher burden of disease can instruct health services to provide additional resources for expanding preventive actions and facilities aimed at early diagnosis, standardized treatments and rehabilitation.

Inverse aerodynamic design applications using the MGM hybrid formulation

The well-known modified Garabedian-Mcfadden (MGM) method is an attractive alternative for aerodynamic inverse design, for its simplicity and effectiveness (P. Garabedian and G. Mcfadden, Design of supercritical swept wings, AIAA J. 20(3) (1982), 289-291; J.B. Malone, J. Vadyak, and L.N. Sankar, Inverse aerodynamic design method for aircraft components, J. Aircraft 24(2) (1987), 8-9; Santos, A hybrid optimization method for aerodynamic design of lifting surfaces, PhD Thesis, Georgia Institute of Technology, 1993). Owing to these characteristics, the method has been the subject of several authors over the years (G.S. Dulikravich and D.P. Baker, Aerodynamic shape inverse design using a Fourier series method, in AIAA paper 99-0185, AIAA Aerospace Sciences Meeting, Reno, NV, January 1999; D.H. Silva and L.N. Sankar, An inverse method for the design of transonic wings, in 1992 Aerospace Design Conference, No. 92-1025 in proceedings, AIAA, Irvine, CA, February 1992, 1-11; W. Bartelheimer, An Improved Integral Equation Method for the Design of Transonic Airfoils and Wings, AIAA Inc., 1995). More recently, a hybrid formulation and a multi-point algorithm were developed on the basis of the original MGM. This article discusses applications of those latest developments for airfoil and wing design. The test cases focus on wing-body aerodynamic interference and shock wave removal applications. The DLR-F6 geometry is picked as the baseline for the analysis.

The Genus Wolbachia

Numerous invertebrate species form long lasting symbioses with bacteria (Buchner, 1949; Buchner, 1965). One of the most common of these bacterial symbionts is Wolbachia pipientis, which has been estimated to infect anywhere from 15–75% of all insect species (Werren et al., 1995a; West et al., 1998; Jeyaprakash and Hoy, 2000; Werren and Windsor, 2000) as well as many species of arachnids, terrestrial crustaceans and filarial nematodes (O’Neill et al., 1997a; Bandi et al., 1998). In most arthropod associations, Wolbachia act as reproductive parasites manipulating the reproduction of their hosts to enhance their own vertical transmission. There appears to be little direct fitness cost to the infected host besides the costs arising from the reproductive manipulations. However instances have been reported where Wolbachia can be either deleterious (Min and Benzer, 1997; Bouchon et al., 1998) or beneficial (Girin and Boultreau, 1995; Stolk and Stouthamer, 1995; Wade and Chang, 1995; Vavre et al., 1999b; Dedeine et al., 2001) to their hosts. Wolbachia were first described as intracellular Rickettsia-like organisms (RLOs), infecting the gonad cells of the mosquito, Culex pipiens (Hertig and Wolbach, 1924), and were later named 'Wolbachia pipientis' (Hertig, 1936). It was not until the work of Yen and Barr (Yen and Barr, 1971; Yen and Barr, 1973) that Wolbachia were implicated in causing crossing incompatibilities between different mosquito populations (Laven, 1951; Ghelelovitch, 1952). When polymerase chain reaction (PCR) diagnostics for Wolbachia became available, it became clear that this agent was both extremely widespread and also responsible for a range of different reproductive phenotypes in the different hosts it infected (O’Neill et al., 1992; Rousset et al., 1992; Stouthamer et al., 1993). The most common of these are cytoplasmic incompatibility, inducing parthenogenesis, overriding host sex-determination, and male-killing (O’Neill et al., 1997a). As of the time of this writing, more than 450 different Wolbachia strains with unique gene sequences, different phenotypes, and infecting different hosts have been deposited in GenBank and the Wolbachia host database (http://www.wolbachia.sols. uq.edu.au).

Adaptation of sorghum: characterisation of genotypic flowering responses to temperature and photoperiod

Sorghum [Sorghum bicolor (L.) Moench] is an important cereal crop grown in a wide range of tropical and temperate environments. This study was conducted to characterise the photothermal flowering responses of sorghum genotypes and to examine relationships between photothermal characteristics and environment of origin in order to better understand the phenological basis of adaptation to environment in sorghum. Twenty-four germplasm accessions and one hybrid from 24 major sorghum-growing areas were grown in a wide range of environments varying in temperature and photoperiod in India, Kenya and Mall between 1992 and 1995. Times from sowing to flowering (f) were recorded, and the responsiveness of 1/f to temperature and photoperiod was quantified using photothermal models. Times from sowing to flowering were accurately predicted in a wide range of environments using a multiplicative rate photothermal model. Significant variation in the minimum time to flower (F-m) and photoperiod sensitivity (critical photoperiod, P-c, and photoperiod-sensitivity slope, P-s) was observed among the genotypes; in contrast there was little variation in base temperature (Tb) Adaptation of sorghum to the diverse environments in which it is grown was largely determined by photoperiod sensitivity and minimum time to flower; photoperiod sensitivity determines bread adaptation to latitude (daylength), while variation in the minimum time to flower determines specific adaptation within smaller ranges of latitude, e.g. within the humid and sub-humid tropics.

Who fails to complete tuberculosis treatment? Temporal trends and risk factors for treatment interruption in a community-based directly observed therapy programme in a rural district of South Africa

SETTING: Hlabisa Tuberculosis Programme, Hlabisa, South Africa. OBJECTIVE: To determine trends in and risk factors for interruption of tuberculosis treatment. METHODS: Data were extracted from the control programme database starting in 1991. Temporal trends in treatment interruption are described; independent risk factors for treatment interruption were determined with a multiple logistic regression model, and Kaplan-Meier survival curves for treatment interruption were constructed for patients treated in 1994-1995. RESULTS: Overall 629 of 3610 surviving patients (17%) failed to complete treatment; this proportion increased from 11% (n = 79) in 1991/1992 to 22% (n = 201) in 1996. Independent risk factors for treatment interruption were diagnosis between 1994-1996 compared with 1991-1393 (odds ratio [OR] 1.9, 95% confidence interval [CT] 1.6-2.4); human immunodeficiency virus (HIV) positivity compared with HIV negativity (OR 1.8, 95% CI 1.4-2.4); supervised by village clinic compared with community health worker (OR 1.9, 95% CI 1.4-2.6); and male versus female sex (OR 1.3, 95% CI 1.1-1.6). Few patients interrupted treatment during the first 2 weeks, and the treatment interruption rate thereafter was constant at 1% per 14 days. CONCLUSIONS: Frequency of treatment interruption from this programme has increased recently. The strongest risk factor was year of diagnosis, perhaps reflecting the impact of an increased caseload on programme performance. Ensuring adherence to therapy in communities with a high level of migration remains a challenge even within community-based directly observed therapy programmes.

Treads in opiate-related deaths in the United Kingdom and Australia, 1985-1995

This paper compares data on rates of opiate overdose mortality in the UK and Australia between 1985 and 1995. Data on rates of ICD 9-coded overdose mortality were obtained from the Office of National Statistics in the UK and from the Australian Bureau of Statistics mortality register. The proportion of all deaths attributed to opioid overdose increased in both countries between 1985 and 1995. The proportion of all deaths attributed to opioid overdose was substantially higher in Australia than in the UK, but methadone appeared to contribute to more opioid overdose deaths in the UK (50%) than in Australia (18%). Given deficiencies in the available data, the reasons for these differences between the two countries are uncertain but a plausible hypothesis is that the greater availability and ease of access to methadone maintenance in the UK contributes to both the lower rate of opioid overdose mortality and the greater apparent contribution that methadone makes to opioid overdose deaths in that country. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

Dental set-vice provision in private general practice for an insured population in New South Wales, Australia

Objective To determine patterns of dental set-vices provided to a cohort of the insured population 18 years and over, in private general practice in New South Wales, Australia. Basic research design A cohort study using the person-years method and Poisson regression for analysis. Setting Data were derived from claims records submitted by members of a health insurance fund (Government Employees Health Fund-GEHF) for rebates during the study period 1 January 1992-31 December 1995. Participants There were 133,467 members aged 18 years and over from New South Wales. Main outcome measures To determine, by age group, for those members who used private general practice and made a claim (referred to as 'patients') the annual number of visits, total number of services received per year and number of services received at a visit, Results The mean number of visits per patient was 2.4 per year with patients under 45 years making fewer visits than the 45-54 age group reference category. Mean number of services utilised per patient-year was 5.9, with services provided increasing from 3.5 for the 18-24-year-old group, reaching a plateau of approximately 6.2 for those aged 45 years or more. The number of services received per visit was 2.4 and there were no differences by age. Service mix was dominated by restorative (35%), diagnostic (27%), and preventive services (18%); with age specific variations observed. Conclusions Age was found to be an important determinant in the use of dental services, independent of membership duration and gender.

Change in the rate of shell deposition and shell microstructure in response to shell borers in the abalone Haliotis rubra

Gastropod shells consist of two crystal types of calcium carbonate, an outer, prismatic calcite layer and an inner nacreous layer made of aragonite. In cross-section, the nacre of the nacreous layer appears to have a regular brick-like microstructure composed of thin laminae of aragonite crystals, separated by very thin sheets of protein (Lutz and Rhoads, 1980; Nakahara, 1983). In abalone (Genus, Haliotis) and other gastropods, thin layers of non-lamellar pigmented material occur within the nacre and have been termed alternatively, fine lines, growth rings or growth lines (Shepherd et al., 1995). It has been suggested that these pigmented layers are small, prismatic, calcite layers (Shepherd and Avalos-Borja, 1997; Zaremba et al., 1996) but investigations using a Raman laser in Haliotis rubra show that they contain aragonite rather than calcite (Hawkes et al, 1996). Day and Fleming (1992) suggest that the occurrence of pigmented layers is correlated with regular exogenous cues such as reproduction or temperature changes and indeed in some species, pigmented layers in the shell can be used to age abalone (review: Shepherd and Triantafillos, 1997). However, McShane and Smith (1992) suggest that pigmented layers can occur irregularly and therefore may be unreliable indicators of age.

Impact of voluntary folate fortification on plasma homocysteine and serum folate in Australia from 1995 to 2001: a population based cohort study

Study objective: To investigate the effect of the voluntary folate fortification policy in Australia on serum folate and total plasma homocysteine (tHcy) concentrations. Design: Population based cohort study. Setting: Perth, Western Australia. Participants: Men and women aged 27 to 77 years (n = 468), who were originally randomly selected from the Perth electoral roll. The cohort was surveyed in 1995/96 before widespread introduction of folate fortification of a variety of foods, and followed up on two occasions, firstly in 1998/99 and again in 2001, when a moderate number of folate fortified foods were available. Subjects with abnormal serum creatinine concentrations at baseline were excluded from this analysis. Main results: Repeated measures analysis of variance was used to determine changes in serum folate and tHcy over the three surveys and to assess whether time trends were related to age, sex, MTHFR C677T genotype, or consumption of folate fortified foods. An increase (38%) in mean serum folate (p < 0.0005) and a decrease (21%) in mean tHcy (p < 0.0005) were seen after introduction of the voluntary folate fortification policy in Australia. Serum folate was consistently higher (p = 0.032) and tHcy was consistently lower (p = 0.001) in subjects who consumed at least one folate fortified food compared with subjects who did not consume any folate fortified foods in the previous week. The time related changes in serum folate and tHcy were affected only by intake of folate fortified foods (p < 0.0005) and not by any other measured variables including age, sex, or MTHFR genotype. Conclusion: Voluntary fortification of foods with folate in Australia has been followed by a substantial increase in serum folate and decrease in tHcy in the general population.

Falling incidence of amputations for peripheral occlusive arterial disease in western Australia between 1980 and 1992

Objectives: To assess temporal trends in the incidence of surgical procedures for peripheral occlusive arterial disease (POAD) and associated changes in outcome as measured by the rate of major lower limb amputations for POAD. Design: a retrospective descriptive population-based study was conducted of the geographically isolated population of Western Austrialia between 1980 and 1992. Methods: Vascular procedures with an accompanying diagnosis of POAD were identified in a computerised system of name-identified records of all discharges from hospital for the population. These procedures were detected using relevant codes from the International Classification of Disease and Procedures. Records of angioplasty and thrombolysis procedures were augmented by searches of hospital-based registers of invasive radiological procedures. The data for the remaining procedures were validated by a review of a random sample of medical records. Results: over the 13 years of the study, rates of major amputations fell significantly for in non-amputation vascular surgery for individuals under the age of 60. In addition, rather than an overall rise in surgery there was shift away from sympathectomy and thromboendarterectomy to angioplasty and bypass surgery. Furthermore, an increasing proportion of all major amputations had a prior attempt at arterial reconstruction. Conclusion: These observations suggest the decrease in major amputations for POAD may reflect a fall in the incidence of POAD, possibly aided by move effective surgery, rather than increased rates of vascular surgery.

Trends in stroke incidence, mortality and case fatality rates in Joinville, Brazil: 1995-2006

Background: Studying stroke rates in a whole community is a rational way to assess the quality of patient care and primary prevention. However, there are few studies of trends in stroke rates worldwide and none in Brazil. Objective: Established study methods were used to define the rates for first ever stroke in a defined population in Brazil compared with similar data obtained and published in 1995. Methods: All stroke cases occurring in the city of Joinville during 2005-2006 were prospectively ascertained. Crude incidence and mortality rates were determined, and age adjusted rates and 30 day case fatality were calculated and compared with the 1995 data. Results: Of the 1323 stroke cases registered, 759 were first ever strokes. The incidence rate per 100 000 was 105.4 (95% CI 98.0 to 113.2), mortality rate was 23.9 (95% CI 20.4 to 27.8) and the 30 day case fatality was 19.1%. Compared with the 1995 data, we found that the incidence had decreased by 27%, mortality decreased by 37% and the 30 day case fatality decreased by 28%. Conclusions: Using defined criteria we showed that in an industrial southern Brazilian city, stroke rates are similar to those from developed countries. A significant decrease in stroke rates over the past decade was also found, suggesting an improvement in primary prevention and inpatient care of stroke patients in Joinville.