Inquérito de saúde: condições de vida e usos de serviços de saúde das mães e crianças de Botucatu-SP, 2001-2002

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Padronização e melhoria de processos produtivos em empresas de panificação: estudo de múltiplos casos

An important tool for organizational change is the standardization of procedures for developing standards so that companies have greater control, thus providing a broad view of their processes and needs. This paper presents and analyzes a model of standard processes developed by the bakeries in PROPAN (Support Programme Bakery), detailing each stage of deployment to evaluate both its benefits for companies and employees and its shortcomings, to make proposals for improvements. Five bakeries were selected for this multi-case study, whose methodology consists of qualitative research using semi-structured interviews, on-site observations and document analysis. The main positive points of the model are the possibility of standardized recipes and procedures, a large decrease in wasted raw material and a significant increase in worker productivity. The main challenges are the lack of employee and owner commitment to the project, the lack of materials needed for deployment and the resistance of employees to change.

PROUNI: estudo multicasos com bolsistas beneficiários (estudantes e egressos) de sete instituições de ensino supeiror do Estado de São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação e resolutividade do serviço odontológico no Sistema Único de Saúde

Pós-graduação em Odontologia Preventiva e Social - FOA

Community structure and dynamics of Monogenea and Trematoda in three North American cyprinid species in the Salt Valley Watershed, Nebraska.

An investigation was made of the communities of gill monogene genus Dactylogyrus (Platyhelminthes, Monogenea) and the populations of blackspot parasite (Platyhelminthes, Trematoda) of Pimephales promelas, Notropis stramineus, and Semotilus atromaculatus in 3 distinct sites along the 3 converging tributaries in southeastern Nebraska from 2004 to 2006. This work constitutes the first multi-site, multi-year study of a complex community of Dactylogyrus spp. and their reproductive activities on native North American cyprinid species. The biological hypothesis that closely related species with direct lifecycles respond differently to shared environmental conditions was tested. It was revealed that in this system that, Cyprinid species do not share Dactylogyrus species, host size and sex are not predictive of infection, and Dactylogyrus community structure is stable, despite variation in seasonal occurrence and populations among sites. The biological hypothesis that closely related species have innate differences in reproductive activities that provide structure to their populations and influence their roles in the parasite community was tested. It was revealed that in this system, host size, sex, and collection site are not predictive of reproductive activities, that egg production is not always continuous and varies in duration among congeners, and that recruitment of larval Dactylogyrus is not continuous across parasites’ reproductive periods. Hatch timing and host availability, not reproductive timing, are the critical factors determining population dynamics of the gill monogenes in time and space. Lastly, the biological hypothesis that innate blackspot biology is responsible for parasite host-specificity, host recruitment strategies and parasite population structure was tested. Field collections revealed that for blackspot, host size, sex, and collection month and year are not predictive of infection, that parasite cysts survive winter, and that host movement is restricted among the 3 collection sites. Finally, experimental infections of hosts with cercaria isolated from 1st intermediate snail hosts reveal that cercarial biology, not environmental circumstances, are responsible for differences in infection among hosts.

Gender-based violence and socioeconomic inequalities: Does living in more deprived neighbourhoods increase women's risk of intimate partner violence?

This study investigates the influence of neighbourhood socioeconomic conditions on women's likelihood of experiencing intimate partner violence (IPV) in Sao Paulo, Brazil. Data from 940 women who were interviewed as part of the WHO multi-country study on women's health and domestic violence against women, and census data for Sao Paulo City, were analyzed using multilevel regression techniques. A neighbourhood socioeconomic-level scale was created, and proxies for the socioeconomic positions of the couple were included. Other individual level variables included factors related to partner's behaviour and women's experiences and attitudes. Women's risk of IPV did not vary across neighbourhoods in Sao Paulo nor was it influenced by her individual socioeconomic characteristics. However, women in the middle range of the socioeconomic scale were significantly more likely to report having experienced violence by a partner. Partner behaviours such as excessive alcohol use, controlling behaviour and multiple sexual partnerships were important predictors of IPV. A women's likelihood of IPV also increased if either her mother had experienced IPV or if she used alcohol excessively. These findings suggest that although the characteristics of people living in deprived neighbourhoods may influence the probability that a woman will experience IPV, higher-order contextual dynamics do not seem to affect this risk. While poverty reduction will improve the lives of individuals in many ways, strategies to reduce IPV should prioritize shifting norms that reinforce certain negative male behaviours. (C) 2012 Elsevier Ltd. All rights reserved.

The First Occurrence in the Fossil Record of an Aquatic Avian Twig-Nest with Phoenicopteriformes Eggs: Evolutionary Implications

Background: We describe the first occurrence in the fossil record of an aquatic avian twig-nest with five eggs in situ (Early Miocene Tudela Formation, Ebro Basin, Spain). Extensive outcrops of this formation reveal autochthonous avian osteological and oological fossils that represent a single taxon identified as a basal phoenicopterid. Although the eggshell structure is definitively phoenicopterid, the characteristics of both the nest and the eggs are similar to those of modern grebes. These observations allow us to address the origin of the disparities between the sister taxa Podicipedidae and Phoenicopteridae crown clades, and traces the evolution of the nesting and reproductive environments for phoenicopteriforms. Methodology/Principal Findings: Multi-disciplinary analyses performed on fossilized vegetation and eggshells from the eggs in the nest and its embedding sediments indicate that this new phoenicopterid thrived under a semi-arid climate in an oligohaline (seasonally mesohaline) shallow endorheic lacustine environment. High-end microcharacterizations including SEM, TEM, and EBSD techniques were pivotal to identifying these phoenicopterid eggshells. Anatomical comparisons of the fossil bones with those of Phoenicopteriformes and Podicipediformes crown clades and extinct palaelodids confirm that this avian fossil assemblage belongs to a new and basal phoenicopterid. Conclusions/Significance: Although the Podicipediformes-Phoenicopteriformes sister group relationship is now well supported, flamingos and grebes exhibit feeding, reproductive, and nesting strategies that diverge significantly. Our multi-disciplinary study is the first to reveal that the phoenicopteriform reproductive behaviour, nesting ecology and nest characteristics derived from grebe-like type strategies to reach the extremely specialized conditions observed in modern flamingo crown groups. Furthermore, our study enables us to map ecological and reproductive characters on the Phoenicopteriformes evolutionary lineage. Our results demonstrate that the nesting paleoenvironments of flamingos were closely linked to the unique ecology of this locality, which is a direct result of special climatic (high evaporitic regime) and geological (fault system) conditions.

Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial

Abstract Introduction Several studies have shown that maximizing stroke volume (or increasing it until a plateau is reached) by volume loading during high-risk surgery may improve post-operative outcome. This goal could be achieved simply by minimizing the variation in arterial pulse pressure (ΔPP) induced by mechanical ventilation. We tested this hypothesis in a prospective, randomized, single-centre study. The primary endpoint was the length of postoperative stay in hospital. Methods Thirty-three patients undergoing high-risk surgery were randomized either to a control group (group C, n = 16) or to an intervention group (group I, n = 17). In group I, ΔPP was continuously monitored during surgery by a multiparameter bedside monitor and minimized to 10% or less by volume loading. Results Both groups were comparable in terms of demographic data, American Society of Anesthesiology score, type, and duration of surgery. During surgery, group I received more fluid than group C (4,618 ± 1,557 versus 1,694 ± 705 ml (mean ± SD), P < 0.0001), and ΔPP decreased from 22 ± 75 to 9 ± 1% (P < 0.05) in group I. The median duration of postoperative stay in hospital (7 versus 17 days, P < 0.01) was lower in group I than in group C. The number of postoperative complications per patient (1.4 ± 2.1 versus 3.9 ± 2.8, P < 0.05), as well as the median duration of mechanical ventilation (1 versus 5 days, P < 0.05) and stay in the intensive care unit (3 versus 9 days, P < 0.01) was also lower in group I. Conclusion Monitoring and minimizing ΔPP by volume loading during high-risk surgery improves postoperative outcome and decreases the length of stay in hospital. Trial registration NCT00479011

Campi elettromagnetici pulsanti nella terapia dell'artrosi del cane

The aim of this study is to evaluate the effects of the pulsed electromagnetic fields (PEMFS) on pain relief and functional capacity of dogs with osteoarthritis by which a single centre study prospective clinical trial. PEMFs are non ionized, athermic and time varying electromagnetic fields that has been successfully used for the treatment of osteoarthritis in human thanks to their chondroprotective, antinflammatory and analgesic property. 20 dogs were treated with PEMFs , 3 times per week for a total of 20 sessions.We found beneficial effects on pain relief and lameness in the absence of adverse effect. The decrease of pain impacted positively on the health-dogs related quality of life and the grade of satisfaction of their owner was very high. The benefits were obvious at half therapy and lasted for a medium long time. This is the first published report concerning PEMFs treatment on canine osteoarthtitis. The result of this study proves that PEMFs is a non –invasive remedy, lacking in adverse effect , easy to employ and useful for controlling pain and inflammation associated with osteoarthritis.

Origin and Nature of Radio-Loud Broad Absorption Line Quasars

The origin of Broad Absorption Line Quasars (BAL QSOs) is still an open issue. Accounting for ~20% of the QSO population, these objects present broad absorption lines in their optical spectra generated from outflows with velocities up to 0.2 c. Nowadays, the hypotheses about their nature are principally related to orientation or evolutionary scenarios. In the first one, absorption lines are produced by outflows originated by the accretion disk, basically present in all QSOs, but seen only when they intercept the line of sight. In the second hypothesis, BAL QSOs would be young or recently re-fueled QSOs, still ejecting their dust cocoon. In this case orientation would not play a role, since the absorption features would be produced by spherically ejected matter. In this work we present the results of a multi-frequency study of a Radio-Loud BAL QSO sample, and a comparison sample of Radio-Loud non-BAL QSOs. We performed observations from radio to Near-Infrared, aiming at collecting useful informations about the orientation, the age, and the morphologies of these objects. Various techniques have been applied, including local and continental radio interferometry, single dish observations and spectroscopy. The comparison with the non-BAL QSO sample allows us to conclude that no particular orientation is present in BAL QSOs. Moreover, various morphologies and ages can be found, analogously to "normal" QSOs. Thus, the solution to this astrophysical problem seems not to reside in a peculiarity of the BAL QSO subclass with respect to non-BAL QSOs, since both the studied models do not completely explain the observed characteristics. Further experiments with future instrumentation will allow us to underline useful differences and test the physical conditions in BAL QSOs.

Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars

OBJECTIVES: To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D(0)-D(1-4); D(0-2)-D(3,4)) in permanent molars. METHODS: In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention (n=86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention (n=34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann-Whitney test, Spearman's rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested. RESULTS: Sound sites (n=13) had significantly minor fluorescence values than carious sites (n=107) (P<0.0001) as had sites with no/enamel caries (n=63) compared to dentinal caries (n=57). The AUCs for the same discriminations were 0.92 and 0.78 (P<0.001). For the D(0)-D(1-4) threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D(0-2)-D(3,4) threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho=+0.57, P=0.01). CONCLUSION: Within this study, the device's discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.

The self-administered 24-item geriatric pain measure (GPM-24-SA): psychometric properties in three European populations of community-dwelling older adults

OBJECTIVE: To explore the feasibility and psychometric properties of a self-administered version of the 24-item Geriatric Pain Measure (GPM-24-SA). DESIGN: Secondary analysis of baseline data from the Prevention in Older People-Assessment in Generalists' practices trial, an international multi-center study of a health-risk appraisal system. PARTICIPANTS: One thousand seventy-two community dwelling nondisabled older adults self-reporting pain from London, UK; Hamburg, Germany; and Solothurn, Switzerland. OUTCOME MEASURES: GPM-24-SA as part of a multidimensional Health Risk Appraisal Questionnaire including self-reported demographic and health-related information. RESULTS: Among the 1,072 subjects, 655 had complete GPM-24-SA data, 404 had 30% missing GPM-24-SA data. In psychometric analyses across the three European populations with complete GPM-24-SA data, the measure exhibited stable internal consistency, good convergent, divergent and discriminant validity, and produced stable pain measurements. However, factor analysis indicated differences in the GPM-24-SA across sites with discrepancies mainly related to items of a single subscale that failed to load appropriately. Analyses including imputation for subjects with

Use of fluorescein and indocyanine green angiography in polypoidal choroidal vasculopathy patients following photodynamic therapy

BACKGROUND: Exudative age-related macular degeneration (AMD) is a sight-threatening event in many elderly people. Some patients have a much better outcome in visual acuity (VA) than others after treatment with photodynamic therapy (PDT) with verteporfin. The combination of fluorescein angiography (FA) and indocyanine green (ICG) angiography using the Heidelberg Retina Angiograph II (HRA 2) should make a delineation of distinct pattern(s) possible in order to better select and assess therapy. METHODS: This is a retrospective, case-control, single-centre study. We identified a total of 168 eyes of 168 patients from July 2003 to June 2006, including 30 eyes of 30 patients with better visual outcome, defined in this study as VA < or = 0.48 logMAR (> or =20/60 Snellen chart) at the end of the study. Best-corrected VA, maximal central retinal thickness as measured by optical coherence tomography, and results of the FA/ICG angiography using the HRA 2 were analyzed. In this article, we discuss patients with polypoidal choroidal vasculopathy (PCV) and their characteristics. RESULTS: The average follow-up time was 15.3 months (range 4-28 months). Seventeen (57%) of the 30 patients with better visual outcome had PCV. All patients in the group with better visual outcome needed fewer PDT treatments compared with our control group of patients with an exudative AMD. INTERPRETATION: Simultaneous FA/ICG angiography using the HRA 2 allowed delineation of a subgroup of patients with PCV who showed a better visual outcome compared with those with other types of exudative AMD, after treatment with PDT.

Outcomes of the South African National Antiretroviral Treatment Programme for children: the IeDEA Southern Africa collaboration

OBJECTIVES: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. DESIGN AND SETTING: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. SUBJECTS: ART-naive children (< or = 16 years) who commenced treatment with > or = 3 antiretroviral drugs before March 2008. OUTCOME MEASURES: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox proportional hazards models stratified by site. Immune status, virological suppression and growth were described in relation to duration of ART. RESULTS: The median (interquartile range) age of 6 078 children with 9 368 child-years of follow-up was 43 (15 - 83) months, with 29% being < 18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (< 400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Together with young age, all markers of disease severity (low weight-for-age z-score, high viral load, severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. CONCLUSIONS: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART.

Admission blood glucose is an independent predictive factor for hospital mortality in polytraumatised patients

PURPOSE: The goal of this study was to analyse a possible association of admission blood glucose with hospital mortality of polytraumatised patients and to develop an outcome prediction model for this patient group. METHODS: The outcome of adult polytraumatised patients admitted to the University Hospital of Berne, Switzerland, between 2002 and 2004 with an ISS > or = 17, and more than one severely injured organ system was retrospectively analysed. RESULTS: The inclusion criteria were met by 555 patients, of which 108 (19.5%) died. Hyperglycaemia proved to be an independent predictor for hospital mortality (P < 0.0001), following multiple regression analysis. After inclusion of admission blood glucose, the calculated mortality prediction model performed better than currently described models (P < 0.0001, AUC 0.924). CONCLUSION: In this retrospective, single-centre study in polytraumatised patients, admission blood glucose proved to be an independent predictor of hospital mortality following regression analysis controlling for age, gender, injury severity and other laboratory parameters. A reliable admission blood glucose-based mortality prediction model for polytraumatised patients could be established. This observation may be helpful in improving the precision of future outcome prediction models for polytraumatised patients. These observations warrant further prospective evaluation.