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).

Virulence genes and plasmid profiles in Rhodococcus equi isolates from domestic pigs and wild boars (Sus scrofa) in Brazil

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

A snapshot of management practices and nutritional recommendations used by feedlot nutritionists in Brazil

Feedlot consulting nutritionists were invited to participate in a survey of feedlot nutritional and management practices in Brazil. Thirty-one nutritionists completed the survey on a Web site that was designed for collection of survey data. The survey consisted of 94 questions that included general information (n = 10); commodity information (n = 12); and questions about the use of coproducts (n = 5), roughage source and levels (n = 5), finishing diet adaptation methods (n = 7), supplements and micronutrients (n = 8), feed mixers (n = 6), feeding management (n = 3), cattle management and type of cattle fed (n = 16), formulation practices (n = 17), information resources used for nutritional recommendations (n = 2), and 2 additional questions. One final question addressed the primary challenges associated with applying nutritional recommendations in practice. The number of animals serviced yearly by each nutritionist averaged 121,682 (minimum = 2,000; maximum = 1,500,000; mode = 120,000; total = 3,163,750). Twenty-two respondents (71%) worked with feedlots that feed less than 5,000 animals/yr. Labor, along with availability and precision of equipment, seemed to be the main challenges for the nutritionists surveyed. Most of the nutritionists surveyed used TDN as the primary energy unit for formulation. More than 50% of the clients serviced by the 31 nutritionists did not manage feed bunks to control the quantity of feed offered per pen, and 36.6% fed cattle more than 4 times daily. The NRC (1996) and Journal of Animal Science were the most used sources of information by these nutritionists. Overall, general practices and nutritional recommendations provided by the 31 nutritionists surveyed were fairly consistent. Present data should aid in development of new research, future National Research Council models, and recommendations for Brazilian feeding systems in which Bos indicus cattle predominate.

Relationship between udder measurements and milk yield in Bergamasca ewes in Brazil

The present work aimed to evaluate udders of Bergamasca ewes and their correlation with milk yield in a mix system of milk yield. Seventy-seven ewes were fed with balanced concentrate starting 20 days before lambing until the end of the experiment. The lambs stayed with their mothers in pastures during the day and were separated at night. They returned to their mothers after the morning milking and were weaned at 45 days of age. Forty-eight hours after lambing, ewes were machine milked once daily at 7 am and the milk yield was recorded for a period of 60 days. Measurements of circumference, depth and width of the udder, and width and length of teats, at 30 and 60 days, were taken. A higher average daily yield of commercial milk was observed after lambs weaning (0.509 vs. 0.435 kg/ewe/day) than before. In the same way, the correlations between udder depth, circumference and width and milk yield were positive and significant only after weaning (0.74, 0.75 and 0.62, respectively). Udder measures had positive correlations with milk yield and can be used in programs of milk yield improvement. (c) 2007 Elsevier B.V. All rights reserved.

Dentistry in Brazil: Its History and Current Trends

The objectives of this article are to provide a short history of dentistry and dental education in Brazil and to analyze the nature of its development to date. The databases consulted are those provided by the Brazilian Federal Council of Dentistry, Brazilian Ministry of Health, Brazilian Ministry of Education, National Institute of Studies and Educational Research Anisio Teixeira, and Brazilian Institute of Geography and Statistics. Formal dental education in Brazil started in the late nineteenth century with the creation of courses annexed to existing schools of medicine in Rio de Janeiro and Bahia. Today, there are 191 institutions of higher education nationwide granting degrees in dentistry (137 private [71.7 percent] and fifty-four public [28.3 percent]), with a total of 17,157 student positions offered annually. These schools graduate around 10,000 professionals per year-one of the highest rates in the world. Both the distribution of schools of dentistry and of dentists varies among the regions of the country, with the greatest concentrations in major metropolitan centers with high population density, resulting in limited coverage in the more deprived regions. A review of epidemiological data for oral health and distribution of dentists in Brazil indicates that there is a lack of systematic planning for the allocation of the dental workforce and a lack of consideration of regional needs in the development of dental training programs in Brazil today.

Detection of hybrids and genetic introgression in wild stocks of two catfish species (Siluriformes: Pimelodidae): The impact of hatcheries in Brazil

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

Population dynamics, structure and behavior of Anopheles darlingi in a rural settlement in the Amazon rainforest of Acre, Brazil

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

Time-based competitiveness in Brazil: whys and hows

The objective of the paper is to report research carried out over two years aiming at developing a framework to support the management of manufacturing organizations for whom reducing throughput time is strategically important, either because they compete based on short lead times or because they choose to pursue other objectives such as cost reduction by means of reducing their manufacturing cycle times. A step-by-step method is proposed based on the analyses of a number of Brazilian best practice cases (all manufacturing companies and all part of large multi-national corporations) and on the relevant literature.

Canine bartonellosis: serological and molecular prevalence in Brazil and evidence of co-infection with Bartonella henselae and Bartonella vinsonii subsp berkhoffii

The purpose of this study was to determine the serological and molecular prevalence of Bartonella spp. infection in a sick dog population from Brazil. At the São Paulo State University Veterinary Teaching Hospital in Botucatu, 198 consecutive dogs with clinicopathological abnormalities consistent with tick-borne infections were sampled. Antibodies to Bartonella henselae and Bartonella vinsonii subsp. berkhoffii were detected in 2.0% ( 4/197) and 1.5% ( 3/197) of the dogs, respectively. Using 16S-23S rRNA intergenic transcribed spacer ( ITS) primers, Bartonella DNA was amplified from only 1/198 blood samples. Bartonella seroreactive and/or PCR positive blood samples ( n = 8) were inoculated into a liquid pre-enrichment growth medium ( BAPGM) and subsequently sub-inoculated onto BAPGM/blood-agar plates. PCR targeting the ITS region, pap31 and rpoB genes amplified B. henselae from the blood and/or isolates of the PCR positive dog ( ITS: DQ346666; pap31 gene: DQ351240; rpoB: EF196806). B. henselae and B. vinsonii subsp. berkhoffii ( pap31: DQ906160; rpoB: EF196805) co-infection was found in one of the B. vinsonii subsp. berkhoffii seroreactive dogs. We conclude that dogs in this study population were infrequently exposed to or infected with a Bartonella species. The B. henselae and B. vinsonii subsp. berkhoffii strains identified in this study are genetically similar to strains isolated from septicemic cats, dogs, coyotes and human beings from other parts of the world. To our knowledge, these isolates provide the first Brazilian DNA sequences from these Bartonella species and the first evidence of Bartonella co-infection in dogs.