PASEO DE LA REFORMA Y AVENIDA PAULISTA: PRÁCTICAS ESPACIALES DEFEÑAS Y PAULISTANAS

Por medio de un estudio analítico-comparativo, buscamos retratar las prácticas espaciales de los transeúntes de las avenidas más simbólicas de los dos principales centros financieros de América Latina: San Pablo y Ciudad de México. Las avenidas analizadas – la Avenida Paulista (estudiada en su extensión total, de 2,7 km) y el Paseo de la Reforma (analizado en los 3 km que comprenden la Puerta de los Leones, en la entrada del Bosque de Chapultepec y el cruce de la Avenida Bucarelli) – y sus entornos inmediatos, fueron elegidos, y estudiados empíricamente, por el hecho de trascender sus funciones de eje financiero y presentarse como espacios de realización de actividades de ocio. Tal hecho se explica, en parte, por la existencia de equipamientos comerciales y culturales en estas áreas, pero más que eso, se ha creado una cultura de prácticas que van más allá del usufructo de estos equipamientos, ya sea por la centralidad y facilidad de acceso a estas avenidas, con un ambiente muy agradable si consideramos la escasa cantidad de espacios públicos de calidad en estas ciudades, lo que permite la simple contemplación de la belleza de estos espacios, o por las interacciones que ahí se suelen desarrollar entre distintos grupos sociales (algunos más especificamente analizados) que las utilizan como punto de encuentro y sociabilidad.

A TERRITORIALIZAÇÃO DA PECUÁRIA DE CORTE NO OESTE PAULISTA

Este trabalho apresenta a ação hegemônica, desde a década de 1950, que a pecuária bovina de corte exerce nas áreas rurais do oeste paulista (SP). Enquanto uma totalidade parcial do espaço geográfico em que atua o setor, a região se transformou em um referencial nacional na tomada de preços dos bovinos em peso de abate. No atual processo de deslocamento da boiada nacional do Centro-Sul para o Norte do país, neste trabalho se retrata a participação dos agropecuaristas regionais nesse desenrolar. Mesmo com a diminuição do percentual da boiada nacional presente nas áreas agrícolas da região, dos escritórios localizados nos edifícios agropecuários de Araçatuba, Presidente Prudente e Ribeirão Preto, a elite ruralista dá o encaminhamento de suas possessões na longínqua frente de expansão da atividade em terras setentrionais do Brasil. 

BIOGEOGRAFIA DO EUCALIPTO NO VALE DO PARAÍBA PAULISTA

Este trabalho trata dos aspectos geográficos e históricos dos eucaliptos, na Austrália e no Brasil, com atenção especial para a situação no Vale do Paraíba, estado de São Paulo. O trabalho possui três capítulos, nos quais são tratados temas pertinentes à questão dos eucaliptos no Brasil. Existem diferentes tipos de plantios de eucaliptos, em áreas urbanas e rurais, com finalidades comerciais e não-comerciais. Focou-se principalmente os extensos plantios em áreas rurais, com finalidade comercial. Os resultados das medições e informações coletadas demonstram que no Vale do Paraíba paulista ocorrem impactos ambientais positivos e negativos a partir do cultivo de eucaliptos, exigindo medidas para minimizar os impactos negativos e recuperar as áreas rurais da região. 

ABORDAGEM DO TEMA “MIGRAÇÃO” NAS APOSTILAS DA REDE PÚBLICA ESTADUAL PAULISTA

Dentre os tantos assuntos estudados na disciplina de Geografia da rede pública estadual paulista, os fluxos migratórios se caracterizam por serem importantes, pois estão muito presentes no cotidiano do aluno: ao se deslocar de casa até a escola; da migração de seus pais de um estado até outro ou ainda de amigos que foram para outro país em busca de emprego, por exemplo. Por isso, esse assunto merece destaque em sala de aula e assim, se faz necessário, juntamente com o professor, um bom material de apoio: jornais, documentários, filmes, revistas, livros didáticos, apostilas e outros. Portanto, objetivamos analisar de que forma as apostilas de Geografia organizadas pela Secretaria de Educação do Estado de São Paulo apresentam os conteúdos relacionados aos processos migratórios. Para tanto, os materiais que apresentam tal assunto serão selecionadas e itens como: ilustrações, representações cartográficas, textos, exercícios, dentre outros, serão analisados para que posteriormente possamos contribuir para melhora do material. Como exemplo dessa análise, podemos citar o mapa “As Migrações, final do século XX” página 23 do caderno do aluno, volume 1, 3ª série do Ensino Médio, que ao apresentar os principais fluxos migratórios internacionais aponta apenas um questionamento aos alunos: “O que o mapa representa? Justifique”. Tal mapa com informações sobre efetivo de imigrantes, fluxos e porcentagem de imigrantes na população, poderia ser mais explorado em questões e discussões para melhor compreensão do aluno.

ESTRUTURAÇÃO E REESTRUTURAÇÃO DOS SISTEMAS DE MOVIMENTO, DE LOGÍSTICA E DE NORMAS E TRIBUTAÇÃO E SEUS IMPACTOS NO TERRITÓRIO PAULISTA/BRASIL

Relatar algumas das transformações produtivas e de consumo, ocorridas no estado de São Paulo, através das reestruturações nos sistemas de movimento, de logística e de normas e tributação, como também os impactos nos espaços urbanos, através das novas dinâmicas econômicas, impostas pelas demandas corporativas, é o objetivo desse artigo. A desconcentração produtiva e de consumo rumo ao interior só foi possível pela combinação ordenada e hierarquizada de alguns elementos básicos, como as inovações tecnológicas (meios e vias de transportes) e organizacionais (logística, normas e tributação) que otimizaram a fluidez territorial no estado de São Paulo. Destaca-se, portanto: 1) o aprimoramento da logística enquanto estratégia, planejamento e gestão de transportes, armazenamento e comunicações (inclusive na concessão de serviços públicos à iniciativa privada); 2) o aprimoramento tecnológico e a expansão dos sistemas de movimento (infraestruturas, meios de transportes) e; 3) os sistemas de normas e tributação que através das regulações e desregulamentações interferem no sistema circulatório de um determinado espaço. Assim, ambos os sistemas tem como objetivo desembaraçar os fluxos econômicos (bens, serviços, informações, capitais e pessoas) e propiciar uma maior fluidez territorial. Os impactos no território paulista, principalmente através da sua dinâmica econômica, revertem-se positivamente e negativamente, mudando a forma como se pensa e se realiza o ordenamento do território.

Hemorrhagic Shock Secondary To Button Battery Ingestion.

Button battery ingestion is a frequent pediatric complaint. The serious complications resulting from accidental ingestion have increased significantly over the last two decades due to easy access to gadgets and electronic toys. Over recent years, the increasing use of lithium batteries of diameter 20 mm has brought new challenges, because these are more detrimental to the mucosa, compared with other types, with high morbidity and mortality. The clinical complaints, which are often nonspecific, may lead to delayed diagnosis, thereby increasing the risk of severe complications. A five-year-old boy who had been complaining of abdominal pain for ten days, was brought to the emergency service with a clinical condition of hematemesis that started two hours earlier. On admission, he presented pallor, tachycardia and hypotension. A plain abdominal x-ray produced an image suggestive of a button battery. Digestive endoscopy showed a deep ulcerated lesion in the esophagus without active bleeding. After this procedure, the patient presented profuse hematemesis and severe hypotension, followed by cardiorespiratory arrest, which was reversed. He then underwent emergency exploratory laparotomy and presented a new episode of cardiorespiratory arrest, which he did not survive. The battery was removed through rectal exploration. This case describes a fatal evolution of button battery ingestion with late diagnosis and severe associated injury of the digestive mucosa. A high level of clinical suspicion is essential for preventing this evolution. Preventive strategies are required, as well as health education, with warnings to parents, caregivers and healthcare professionals.

Relationship Between Lower-limb Muscle Strength And Functional Independence Among Elderly People According To Frailty Criteria: A Cross-sectional Study.

Muscle strength and functional independence are considered to be determinants of frailty levels among elderly people. The aim here was to compare lower-limb muscle strength (LLMS) with functional independence in relation to sex, age and number of frailty criteria, and to ascertain the influence of these variables on elderly outpatients' independence. Quantitative cross-sectional study, in a tertiary hospital. The study was conducted on 150 elderly outpatients of both sexes who were in a cognitive condition allowing oral communication, between October 2005 and October 2007. The following instruments were used: five-times sit-to-stand test (FTSST), Functional Independence Measurement (FIM) and Lawton's Instrumental Activities of Daily Living Scale (IADL). Descriptive, comparative, multivariate, univariate and Cronbach alpha analyses were performed. The mean time taken in the FTSST was 21.7 seconds; the mean score for FIM was 82.2 and for IADL was 21.2; 44.7% of the subjects presented 1-2 frailty criteria and 55.3% > 3 criteria. There was a significant association between LLMS and functional independence in relation to the number of frailty criteria, without homogeneity regarding sex and age. Functional independence showed significant influence from sex and LLMS. Elderly individuals with 1 or 2 frailty criteria presented greater independence in all FTSST scores. The subjects with higher LLMS presented better functional independence.

Nebivolol Reduces Central Blood Pressure In Stage I Hypertensive Patients: Experimental Single Cohort Study.

Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. Experimental single cohort study conducted in the outpatient clinic of a university hospital. Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP.

Icatibant, An Inhibitor Of Bradykinin Receptor 2, For Hereditary Angioedema Attacks: Prospective Experimental Single-cohort Study.

Hereditary angioedema (HAE) with C1 inhibitor deficiency manifests as recurrent episodes of edema involving the skin, upper respiratory tract and gastrointestinal tract. It can be lethal due to asphyxia. The aim here was to evaluate the response to therapy for these attacks using icatibant, an inhibitor of the bradykinin receptor, which was recently introduced into Brazil. Prospective experimental single-cohort study on the efficacy and safety of icatibant for HAE patients. Patients with a confirmed HAE diagnosis were enrolled according to symptoms and regardless of the time since onset of the attack. Icatibant was administered in accordance with the protocol that has been approved in Brazil. Symptom severity was assessed continuously and adverse events were monitored. 24 attacks in 20 HAE patients were treated (female/male 19:1; 19-55 years; median 29 years of age). The symptoms were: subcutaneous edema (22/24); abdominal pain (15/24) and upper airway obstruction (10/24). The time taken until onset of relief was: 5-10 minutes (5/24; 20.8%); 10-20 (5/24; 20.8%); 20-30 (8/24; 33.4%); 30-60 (5/24; 20.8%); and 2 hours (1/24; 4.3%). The time taken for complete resolution of symptoms ranged from 4.3 to 33.4 hours. Adverse effects were only reported at injection sites. Mild to moderate erythema and/or feelings of burning were reported by 15/24 patients, itching by 3 and no adverse effects in 6. HAE type I patients who received icatibant responded promptly; most achieved improved symptom severity within 30 minutes. Local adverse events occurred in 75% of the patients.

Cluster Analysis To Identify Elderly People's Profiles: A Healthcare Strategy Based On Frailty Characteristics.

The new social panorama resulting from aging of the Brazilian population is leading to significant transformations within healthcare. Through the cluster analysis strategy, it was sought to describe the specific care demands of the elderly population, using frailty components. Cross-sectional study based on reviewing medical records, conducted in the geriatric outpatient clinic, Hospital de Clínicas, Universidade Estadual de Campinas (Unicamp). Ninety-eight elderly users of this clinic were evaluated using cluster analysis and instruments for assessing their overall geriatric status and frailty characteristics. The variables that most strongly influenced the formation of clusters were age, functional capacities, cognitive capacity, presence of comorbidities and number of medications used. Three main groups of elderly people could be identified: one with good cognitive and functional performance but with high prevalence of comorbidities (mean age 77.9 years, cognitive impairment in 28.6% and mean of 7.4 comorbidities); a second with more advanced age, greater cognitive impairment and greater dependence (mean age 88.5 years old, cognitive impairment in 84.6% and mean of 7.1 comorbidities); and a third younger group with poor cognitive performance and greater number of comorbidities but functionally independent (mean age 78.5 years old, cognitive impairment in 89.6% and mean of 7.4 comorbidities). These data characterize the profile of this population and can be used as the basis for developing efficient strategies aimed at diminishing functional dependence, poor self-rated health and impaired quality of life.

Neck Circumference As A New Anthropometric Indicator For Prediction Of Insulin Resistance And Components Of Metabolic Syndrome In Adolescents: Brazilian Metabolic Syndrome Study.

To evaluate the correlation between neck circumference and insulin resistance and components of metabolic syndrome in adolescents with different adiposity levels and pubertal stages, as well as to determine the usefulness of neck circumference to predict insulin resistance in adolescents. Cross-sectional study with 388 adolescents of both genders from ten to 19 years old. The adolescents underwent anthropometric and body composition assessment, including neck and waist circumferences, and biochemical evaluation. The pubertal stage was obtained by self-assessment, and the blood pressure, by auscultation. Insulin resistance was evaluated by the Homeostasis Model Assessment-Insulin Resistance. The correlation between two variables was evaluated by partial correlation coefficient adjusted for the percentage of body fat and pubertal stage. The performance of neck circumference to identify insulin resistance was tested by Receiver Operating Characteristic Curve. After the adjustment for percentage body fat and pubertal stage, neck circumference correlated with waist circumference, blood pressure, triglycerides and markers of insulin resistance in both genders. The results showed that the neck circumference is a useful tool for the detection of insulin resistance and changes in the indicators of metabolic syndrome in adolescents. The easiness of application and low cost of this measure may allow its use in Public Health services.

Biochemical, Anthropometric And Body Composition Indicators As Predictors Of Hepatic Steatosis In Obese Adolescents.

To describe the prevalence of hepatic steatosis and to assess the performance of biochemical, anthropometric and body composition indicators for hepatic steatosis in obese teenagers. Cross-sectional study including 79 adolecents aged from ten to 18 years old. Hepatic steatosis was diagnosed by abdominal ultrasound in case of moderate or intense hepatorenal contrast and/or a difference in the histogram ≥7 on the right kidney cortex. The insulin resistance was determined by the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index for values >3.16. Anthropometric and body composition indicators consisted of body mass index, body fat percentage, abdominal circumference and subcutaneous fat. Fasting glycemia and insulin, lipid profile and hepatic enzymes, such as aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase, were also evaluated. In order to assess the performance of these indicators in the diagnosis of hepatic steatosis in teenagers, a ROC curve analysis was applied. Hepatic steatosis was found in 20% of the patients and insulin resistance, in 29%. Gamma-glutamyltransferase and HOMA-IR were good indicators for predicting hepatic steatosis, with a cutoff of 1.06 times above the reference value for gamma-glutamyltransferase and 3.28 times for the HOMA-IR. The anthropometric indicators, the body fat percentage, the lipid profile, the glycemia and the aspartate aminotransferase did not present significant associations. Patients with high gamma-glutamyltransferase level and/or HOMA-IR should be submitted to abdominal ultrasound examination due to the increased chance of having hepatic steatosis.

Pituitary Macroadenoma Presenting As A Nasal Tumor: Case Report.

Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass. The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases. Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present.

Patients' Perceptions About Diagnosis And Treatment Of Chronic Myeloid Leukemia: A Cross-sectional Study Among Brazilian Patients.

Chronic myeloid leukemia (CML) requires strict daily compliance with oral medication and regular blood and bone marrow control tests. The objective was to evaluate CML patients' perceptions about the disease, their access to information regarding the diagnosis, monitoring and treatment, adverse effects and associations of these variables with patients' demographics, region and healthcare access. Prospective cross-sectional study among CML patients registered with the Brazilian Lymphoma and Leukemia Association (ABRALE). CML patients receiving treatment through the public healthcare system were interviewed by telephone. Among 1,102 patients interviewed, the symptoms most frequently leading them to seek medical care were weakness or fatigue. One third were diagnosed by means of routine tests. The time that elapsed between first symptoms and seeking medical care was 42.28 ± 154.21 days. Most patients had been tested at least once for Philadelphia chromosome, but 43.2% did not know the results. 64.8% had had polymerase chain reaction testing for the BCR/ABL gene every three months. 47% believed that CML could be controlled, but 33.1% believed that there was no treatment. About 24% reported occasionally stopping their medication. Imatinib was associated with nausea, cramps and muscle pain. Self-reported treatment adherence was significantly associated with normalized blood count, and positively associated with imatinib. There is a lack of information or understanding about disease monitoring tools among Brazilian CML patients; they are diagnosed quickly and have good access to treatment. Correct comprehension of CML control tools is impaired in Brazilian patients.

[evaluation Of Data On Live Birth Certificates From The Information System On Live Births (sinasc) In Campinas, São Paulo, 2009].

To assess the completeness and reliability of the Information System on Live Births (Sinasc) data. A cross-sectional analysis of the reliability and completeness of Sinasc's data was performed using a sample of Live Birth Certificate (LBC) from 2009, related to births from Campinas, Southeast Brazil. For data analysis, hospitals were grouped according to category of service (Unified National Health System, private or both), 600 LBCs were randomly selected and the data were collected in LBC-copies through mothers and newborns' hospital records and by telephone interviews. The completeness of LBCs was evaluated, calculating the percentage of blank fields, and the LBCs agreement comparing the originals with the copies was evaluated by Kappa and intraclass correlation coefficients. The percentage of completeness of LBCs ranged from 99.8%-100%. For the most items, the agreement was excellent. However, the agreement was acceptable for marital status, maternal education and newborn infants' race/color, low for prenatal visits and presence of birth defects, and very low for the number of deceased children. The results showed that the municipality Sinasc is reliable for most of the studied variables. Investments in training of the professionals are suggested in an attempt to improve system capacity to support planning and implementation of health activities for the benefit of maternal and child population.