Trends in dermatomyositis- and polymyositis-related mortality in the state of Sao Paulo, Brazil, 1985-2007: multiple cause-of-death analysis

Background: Dermatomyositis (DM) and polymyositis (PM) are rare systemic autoimmune rheumatic diseases with high fatality rates. There have been few population-based mortality studies of dermatomyositis and polymyositis in the world, and none have been conducted in Brazil. The objective of the present study was to employ multiple-cause of-death methodology in the analysis of trends in mortality related to dermatomyositis and polymyositis in the state of Sao Paulo, Brazil, between 1985 and 2007. Methods: We analyzed mortality data from the Sao Paulo State Data Analysis System, selecting all death certificates on which DM or PM was listed as a cause of death. The variables sex, age and underlying, associated or total mentions of causes of death were studied using mortality rates, proportions and historical trends. Statistical analysis were performed by chi-square and H Kruskal-Wallis tests, variance analysis and linear regression. A p value less than 0.05 was regarded as significant. Results: Over a 23-year period, there were 318 DM-related deaths and 316 PM-related deaths. Overall, DM/PM was designated as an underlying cause in 55.2% and as an associated cause in 44.8%; among 634 total deaths females accounted for 71.5%. During the study period, age-and gender-adjusted DM mortality rates did not change significantly, although PM as an underlying cause and total mentions of PM trended lower (p < 0.05). The mean ages at death were 47.76 +/- 20.81 years for DM and 54.24 +/- 17.94 years for PM (p = 0.0003). For DM/PM, respectively, as underlying causes, the principal associated causes of death were as follows: pneumonia (in 43.8%/33.5%); respiratory failure (in 34.4%/32.3%); interstitial pulmonary diseases and other pulmonary conditions (in 28.9%/17.6%); and septicemia (in 22.8%/15.9%). For DM/PM, respectively, as associated causes, the following were the principal underlying causes of death: respiratory disorders (in 28.3%/26.0%); circulatory disorders (in 17.4%/20.5%); neoplasms (in 16.7%/13.7%); infectious and parasitic diseases (in 11.6%/9.6%); and gastrointestinal disorders (in 8.0%/4.8%). Of the 318 DM-related deaths, 36 involved neoplasms, compared with 20 of the 316 PM-related deaths (p = 0.03). Conclusions: Our study using multiple cause of deaths found that DM/PM were identified as the underlying cause of death in only 55.2% of the deaths, indicating that both diseases were underestimated in the primary mortality statistics. We observed a predominance of deaths in women and in older individuals, as well as a trend toward stability in the mortality rates. We have confirmed that the risk of death is greater when either disease is accompanied by neoplasm, albeit to lesser degree in individuals with PM. The investigation of the underlying and associated causes of death related to DM/PM broaden the knowledge of the natural history of both diseases and could help integrate mortality data for use in the evaluation of control measures for DM/PM.

Determination of Aflatoxins in Peanut Products in the Northeast Region of Sao Paulo, Brazil

The aim of the present study was to determine aflatoxin levels in peanut products traded in the Northeast region of Sao Paulo, Brazil. To this end, 240 samples of peanut products traded in the cities of Araras, Leme, Pirassununga and Porto Ferreira were collected from June 2006 to May 2007. The samples were analyzed for aflatoxins (AF) B(1), B(2), G(1) and G(2) by high performance liquid chromatography. Results showed 44.2% samples positive for AF at levels of 0.5 to 103.8 mu g.kg(-1). Nine of the positive samples (3.7% of the analysed samples) had total aflatoxin concentrations (B(1)+B(2)+G(1)+G(2)) higher than the limit established by Brazilian regulations (20 mu g.kg(-1)). Based on the above data, the probable mean daily intake (PDI(M)) of aflatoxins from peanut products in the Northeast region of Sao Paulo was estimated to be 0.23 ng kg b.w. day(-1). Although this PDI(M) value was relatively low, results indicate that aflatoxin contamination of peanut products may be a public health concern in Brazil, when considering the potential exposure of highly susceptible consumers. For example, it should be emphasized that children are potentially exposed to aflatoxins, since they consume large quantities of peanut candies, and these products had the highest number of samples positive for AFB(1).

Observational Characterization of the Downward Atmospheric Longwave Radiation at the Surface in the City of Sao Paulo

This work describes the seasonal and diurnal variations of downward longwave atmospheric irradiance (LW) at the surface in Sao Paulo, Brazil, using 5-min-averaged values of LW, air temperature, relative humidity, and solar radiation observed continuously and simultaneously from 1997 to 2006 on a micrometeorological platform, located at the top of a 4-story building. An objective procedure, including 2-step filtering and dome emission effect correction, was used to evaluate the quality of the 9-yr-long LW dataset. The comparison between LW values observed and yielded by the Surface Radiation Budget project shows spatial and temporal agreement, indicating that monthly and annual average values of LW observed in one point of Sao Paulo can be used as representative of the entire metropolitan region of Sao Paulo. The maximum monthly averaged value of the LW is observed during summer (389 +/- 14 W m(-2): January), and the minimum is observed during winter (332 +/- 12 W m(-2); July). The effective emissivity follows the LW and shows a maximum in summer (0.907 +/- 0.032; January) and a minimum in winter (0.818 +/- 0.029; June). The mean cloud effect, identified objectively by comparing the monthly averaged values of the LW during clear-sky days and all-sky conditions, intensified the monthly average LW by about 32.0 +/- 3.5 W m(-2) and the atmospheric effective emissivity by about 0.088 +/- 0.024. In August, the driest month of the year in Sao Paulo, the diurnal evolution of the LW shows a minimum (325 +/- 11 W m(-2)) at 0900 LT and a maximum (345 12 W m-2) at 1800 LT, which lags behind (by 4 h) the maximum diurnal variation of the screen temperature. The diurnal evolution of effective emissivity shows a minimum (0.781 +/- 0.027) during daytime and a maximum (0.842 +/- 0.030) during nighttime. The diurnal evolution of all-sky condition and clear-sky day differences in the effective emissivity remain relatively constant (7% +/- 1%), indicating that clouds do not change the emissivity diurnal pattern. The relationship between effective emissivity and screen air temperature and between effective emissivity and water vapor is complex. During the night, when the planetary boundary layer is shallower, the effective emissivity can be estimated by screen parameters. During the day, the relationship between effective emissivity and screen parameters varies from place to place and depends on the planetary boundary layer process. Because the empirical expressions do not contain enough information about the diurnal variation of the vertical stratification of air temperature and moisture in Sao Paulo, they are likely to fail in reproducing the diurnal variation of the surface emissivity. The most accurate way to estimate the LW for clear-sky conditions in Sao Paulo is to use an expression derived from a purely empirical approach.

Multifilter rotating shadowband radiometer calibration for spectral aerosol optical depth retrievals over Sao Paulo City, Brazil

Multifilter rotating shadowband radiometer (MFRSR) calibration values for aerosol optical depth (AOD) retrievals were determined by means of the general method formulated by Forgan [Appl. Opt. 33, 4841 (1994)] at a polluted urban site. The obtained precision is comparable with the classical method, the Langley plot, applied on clean mountaintops distant of pollution sources. The AOD retrieved over Sao Paulo City with both calibration procedures is compared with the Aerosol Robotic Network data. The observed results are similar, and, except for the shortest wavelength (415 nm), the MFRSR`s AOD is systematically overestimated by similar to 0.03. (c) 2008 Optical Society of America.

alpha plus alpha scattering reexamined in the context of the Sao Paulo potential

We have analyzed a large set of alpha + alpha elastic scattering data for bombarding energies ranging from 0.6 to 29.5 MeV. Because of the complete lack of open reaction channels, the optical interaction at these energies must have a vanishing imaginary part. Thus, this system is particularly important because the corresponding elastic scattering cross sections are very sensitive to the real part of the interaction. The data were analyzed in the context of the velocity-dependent Sao Paulo potential, which is a successful theoretical model for the description of heavy-ion reactions from sub-barrier to intermediate energies. We have verified that, even in this low-energy region, the velocity dependence of the model is quite important for describing the data of the alpha + alpha system.

Sedimentary Organic Matter in Cores of the Cananeia-Iguape Lagoonal-Estuarine System, Sao Paulo State, Brazil

Sedimentary organic matter is a good tool for environmental evaluation where the sediments are deposited. We determined the elemental and C- and N-isotopic compositions of 211 sub-surface sediment samples from 13 cores (ranging from 18 to 46cm), collected in the Cananeia-Iguape estuarine-lagoonal system. The aim of this research is to evaluate the environmental variations of this tropical coastal micro-tidal system over the last decades, through SOM distribution. The studied parameters show differences between the cores located in the northern (sandy-silt sediments) and southern (sand and silty-sand) portions. The whole area presents a mixed organic matter origin signature (local mangrove plants: < -25.6 parts per thousand PDB/ phytoplancton delta(13)C values: -19.4 parts per thousand PDB). The northern cores, which submitted higher sedimentation deposition (1.46cm year(-1)), are more homogenous, presenting lower delta(13)C (< -25.2 parts per thousand PDB) and higher C/N values (in general >14), directly related to the terrestrial input from Ribeira de Iguape River (24,000 km(2) basin). The southern portion presents lower sedimentation rates (0.38cm year(-1)) and is associated to a small river basin (1,340 km(2)), presenting values Of delta(13)C: -25.0 to 23.0 parts per thousand PDB and of C/N ratio: 11 to 15. In general, the elemental contents in the 15 cores may be considered from low to medium (< 2.0% C - < 0.1% N), compared to similar environments. Although a greater marine influence is observed in the southern system portion, the majority of the cores present an elevated increase of continental deposition, most likely related to the strong silting process that the area has been subjected to since the 1850s, when an artificial channel was built linking, directly, the Ribeira River to the estuarine-lagoonal system.

PLANT ACCUMULATIONS ALONG THE ITANHAEM RIVER BASIN, SOUTHERN COAST OF SAO PAULO STATE, BRAZIL

Examination of the mechanisms involved in the construction of present-day vegetative deposits along coastal waterways has made it possible to establish depositional patterns that can be compared with those found in similar environments in geologic time. These patterns include not only the composition and transport of the debris but also an estimation of the time involved in its deposition. Six sites with active deposits of plant macrodebris in the coastal basin of the Itanhaem River, Sao Paulo State, Brazil, were used in the study. In the central portion of the basin, the interior coastal plain is covered with restinga forest (dense, wet tropical forest of low altitudes), while the lower portion consists of mangrove swamps. The coast reflects anthropogenic intervention, and only a few scattered remnants of precolonization dune vegetation remain. The results after three years of study suggest that the accumulation of plant macrodebris in the middle and lower portions of the basin is parautochthonous, since only the leaves of genera typical of the restinga forest and mangrove swamp, respectively, were found. Along the coast the accumulations involved a mixture of parautochthonous and allochthonous elements. On the levee of the Branco River and within the mangrove swamp, deposition was slow, and many of the elements decayed quickly; such accumulations show little potential for preservation and eventual fossilization. A different site, however, reveals the rapid deposition of thick layers of plant debris, presumably associated with storms, and these accumulations are preserved for long periods, constituting good candidates for possible fossilization.

Increasing trends of sleep complaints in the city of Sao Paulo, Brazil

Objective: The aim of this study was to compare the prevalence of sleep habits and complaints and to estimate the secular trends through three population-based surveys carried out in 1987, 1995, and 2007 in the general adult population of the city of Sao Paulo, Brazil. Methods: Surveys were performed using the same three-stage cluster-sampling technique in three consecutive decades to obtain representative samples of the inhabitants of Sao Paulo with respect to gender, age (20-80 years), and socio-economic status. Sample sizes were 1000 volunteers in 1987 and 1995 surveys and 1101 in a 2007 survey. In each survey, the UNIFESP Sleep Questionnaire was administered face-to-face in each household selected. Results: For 1987, 1995, and 2007, respectively, difficulty initiating sleep (weighted frequency %; 95% CI) [(13.9; 11.9-16.2), (19.15; 16.8-21.6), and (25.0; 22.5-27.8)], difficulty maintaining sleep [(15.8; 13.7-18.2), (27.6; 24.9-30.4), and (36.5; 33.5-39.5)], and early morning awakening [(10.6; 8.8-12.7), (14.2; 12.2-16.5), and (26.7; 24-29.6)] increased in the general population over time, mostly in women. Habitual snoring was the most commonly reported complaint across decades and was more prevalent in men. There was no statistically significant difference in snoring complaints between 1987 (21.5; 19.1-24.2) and 1995 (19.0; 16.7-21.6), but a significant increase was noted in 2007 (41.7; 38.6-44.8). Nightmares, bruxism, leg cramps, and somnambulism complaints were significantly higher in 2007 compared to 1987 and 1995. All were more frequent in women. Conclusions: This is the first study comparing sleep complaints in probabilistic population-based samples from the same metropolitan area, using the same methodology across three consecutive decades. Clear trends of increasing sleep complaints were observed, which increased faster between 1995 and 2007 than from 1987 to 1995. These secular trends should be considered a relevant public health issue and support the need for development of health care and educational strategies to supply the population`s increased need for information on sleep disorders and their consequences. (C) 2010 Elsevier B.V. All rights reserved.

Analysis of foraminifera assemblages and sediment geochemical properties to characterise the environment near Araca and Saco da Cape la domestic sewage submarine outfalls of Sao Sebastiao Channel, Sao Paulo State, Brazil

Superficial bottom samples were collected near diffusers of domestic sewage submarine outfalls at Araca and Saco da Capela, Sao Sebastiao Channel, Brazil. The goal of this study was to investigate the distribution and composition of live benthic foraminifera assemblages and integrate the results obtained with geochemical analyses to assess human-induced changes. According to the results obtained no environmental stress was observed near the Saco da Capela submarine outfall diffusers. The foraminifera assemblage is characterised by species typical of highly hydrodynamic environments, with well-oxygenated bottom waters and low nutrient contents. In contrast, near Araca submarine outfall, organic enrichment was denoted by high phosphorus, sulphur and, to a lesser extent, total organic carbon content. Harmful influences on foraminifera could be identified by low richness and specific diversity, as well as the predominance of detritivore feeder species, which are associated with higher organic matter flux and low oxygen in the interstitial pore water. (C) 2009 Elsevier Ltd. All rights reserved.

Exercise of essential competencies for midwifery care by nurses in Sao Paulo, Brazil

General objective: to analyse the exercise of essential competencies for midwifery care by nurses and/or midwives in the public health system of Sao Paulo (eastern zone), Brazil. Specific objectives: to develop a profile of the public health institutions and of the nurses and/or midwives who care for women before, during and following child birth; to identify the activities performed in providing such care, as well as their frequency; and to specify the possible obstacles or difficulties encountered by them when exercising their competencies. Design: a descriptive and exploratory research design , using a quantitative approach. Setting: the study was conducted in all public health services of Sao Paulo (eastern zone), Brazil, namely 59 basic health-care units and six hospitals, during the period of October 2006-December 2007. Participants: the study population consisted of 272 nurses and/or midwives who provide care for pregnant women and newborns at the primary health-care units and maternity hospitals of the public health system. Participants comprised 100% of hospital nurse coordinators (n = 6), 61% of hospital maternity nursing and/or midwifery staff (n = 62) and 64% (n = 204) of nursing and/or midwifery staff working at primary health-care units. Methods and findings: the data collection was based on a single form given to the coordinators and two questionnaires, one handed out to antenatal and postnatal nursing and/or midwifery staff and another handed out to labour and birth nursing and/or midwifery staff. The results showed that nurses and/or midwives providing care for women during pregnancy, labour, birth and the postnatal period did not put the essential competencies for midwifery care into practice, because they encountered institutional barriers and personal resistance, and lacked protocols based on best practice and on the exercise of essential competencies needed for effective midwifery care. Key conclusions: the model of care in the public health services of Sao Paulo (eastern zone) is based much more on hierarchical positions than on professional competencies or on there commendations of the scientific community. As a result, health authorities need to review their midwifery policies to improve maternal-infant care by nurses and/or midwives in order to ensure the implementation of best midwifery practice. Practical implications: the results of this study support actions to improve the quality of care delivered to women and their families, while integrating nursing and midwifery care in Sao Paulo, Brazil. (C) 2009 Elsevier Ltd. All rights reserved.

The use of contingent valuation for evaluating protected areas in the developing world: Economic valuation of Morro do Diabo State Park, Atlantic Rainforest, Sao Paulo State (Brazil)

The Brazilian Atlantic Rainforest is internationally recognised as one of the most biodiverse and threatened tropical forests in the world [Myers, N., Mittermeier, R.A., Mittermeier, C.G., da Fonseca, G.A.B., Kent, J., 2000. Biodiversity hotspots for conservation priorities. Nature 403, 853-858]. The Seasonal Semi-Deciduous Forest is among the most fragmented and threatened biomes of the Atlantic Rainforest Domain. The largest remnant of this biome (35,000 ha) is protected by the Morro do Diabo State Park (MDSP), situated in the area known as the Pontal do Paranapanema, in Sao Paulo State, Brazil. Despite its environmental importance, the park is under political, economic and demographic pressure. The main aim of our research was to estimate the population`s willingness to pay (WTP) for the conservation of MDSP and for the Atlantic Rainforest`s remnants in Sao Paulo State as a whole, by means of the contingent valuation method (CVM). The results featured a high incidence of null WTP and of protest votes. Nevertheless, the population is willing to pay US$ 2,113,548.00/year (R$ 7,080,385.00/year) for the conservation of the MDSP (use and existence values), or US$ 60.39 ha/year (R$ 202.30/ha/year). The results indicate that the preservation value is strongly associated to the population`s ability to pay, increasing with income levels. Qualitative research questions showed that the population considers protected areas to be very important. Still, the valuation of MDSP revealed a gap between the government budget allotted to the park and the value assigned to the area by the public. (C) 2007 Elsevier B.V. All rights reserved.

Association Between Urinary Incontinence in Elderly Patients and Caregiver Burden in the City of Sao Paulo/Brazil: Health, Wellbeing, and Ageing Study

Aim: Some elderly patients with incontinence require the care of third parties, known as caregivers. Such care can occur on a daily basis leaving little opportunity for the caregiver to take care of himself/herself. The aims are to assess the association between urinary incontinence in elderly patients and caregiver burden and identify independent factors for caregiver`s burden in the city of Sao Paulo, Brazil. Methods: The Pan-American Health Organization and World Health Organization coordinated a multicenter study named Health, Wellbeing and Aging (SABE Study) in elderly people living in seven countries of Latin America and the Caribbean. In Brazil, the study population carried out in Sao Paulo in the year 2000 and reassessed in 2006 (COHORT A). Urinary incontinence was assessed by ICIQ-SF and caregiver burden by means of Zarit Burden Scale. Results: A total of 327 patients with caregivers were included in the study. The general prevalence of urinary incontinence was 25.8%, higher among the women. There was a significant positive association between caregiver burden and incontinent patients, demonstrating that urinary incontinence in elderly patients produced greater caregiver burden. In the present study, the variables with significant correlations were assessed using the multivariate logistic regression model. Category 2 of the ICIQ-SF (incontinent patients) increased the chances of caregiver burden 1.96-fold in comparison to Category 1 (continent patients). Likewise, the category of impaired cognition increased the chances of caregiver burden 2.34-fold. Conclusions: Urinary incontinence and cognitive impairment in elderly patients were associated to an increase in caregiver burden. Neurourol. Urodynam. 30:1281-1285, 2011. (C) 2011 Wiley-Liss, Inc.

Gender Differences in Life Expectancy and Disability-Free Life Expectancy Among Older Adults in Sao Paulo, Brazil

Background: Research on life expectancy has demonstrated the negative impact of disability on the health of older adults and its differential effects on women as evidenced by their higher disabled life expectancy (DLE). The goal of the present study was to investigate gender differences in total life expectancy (TLE), disability-free life expectancy (DFLE), and DLE; examine gender differences on personal care assistance among older adults in Sao Paulo, Brazil; and discuss the implications for public policies. Methods: The sample was drawn from two waves (2000, 2006) of the dataset of Salud, Bienestar, y Envejecimiento, a large longitudinal study conducted in Sao Paulo (n = 2,143). The study assessed disability using the activities of daily living (ADL). The interpolation of Markov Chain method was used to estimate gender differences in TLE, DLE, and DFLE. Findings: TLE at age 60 years was approximately 5 years longer for women than men. Women aged 60 years were expected to live 28% of their remaining lives twice the percentage for men with at least one ADL disability. These women also lived more years (M = 0.71, SE = 0.42) with three or more ADL disabilities than men (M = 0.82, SE = 0.16). In terms of personal care assistance, women received more years of assistance than men. Conclusion: Among older adults in Sao Paulo, women lived longer lives but experienced a higher and more severe disability burden than men. In addition, although women received more years of personal assistance than men, women experienced more unmet care assistance needs. Copyright (C) 2011 by the Jacobs Institute of Women`s Health. Published by Elsevier. Inc.

Prevalence of Urinary Incontinence in a Community Sample From the City of Sao Paulo

PURPOSE: The aim of this study was to analyze the prevalence of urinary incontinence (UI) in a community sample from the city of Sao Paulo. METHODS: This epidemiological survey was conducted at a family health program in Sao Paulo, Brazil, using randomized sampling. Data were collected by interviewing residents and were analyzed by Pearson`s correlation coefficients, chi-square tests, and logistic regression analysis. RESULTS: Seventy (10.7%) of the 657 subjects currently presented UI, including 50.7% with sporadic UI and 74.3% with UI upon moderate efforts. Ninety-three percent woke up during the night, 43.7% maintained continence until the bathroom, 63.4% had a sensation of wetness, and 77.5% reported no use of any continence aids. Female gender, advanced age, gynecologic or urologic surgery, dysuria, and urinary tract infection were correlated with UI (P < .001; r(2) = 0.572). CONCLUSION: The overall prevalence of UI was found to be high and was comparable to results from multiple countries.

Risk factors for neonatal transfers from the Sapopemba free-standing birth centre to a hospital in Sao Paulo, Brazil

Objective: to identify risk factors associated with neonatal transfers from a free-standing birth centre to a hospital. Design: epidemiological case-control study. Setting: midwifery-led free-standing birth centre in Sao Paulo, Brazil. Participants: 96 newborns were selected from 2840 births between September 1998 and August 2005. Cases were defined as all new borns transferred from the birth centre to a hospital (n = 32), and controls were defined as new borns delivered at the same birth centre, during the same time period, and who had not been transferred to a hospital (n = 64). Measurements and findings: data were collected from medical records available at the birth centre. Univariate and multivariate analyses were performed using logistic regression. The multivariate analysis included outcomes with p<0.25, specifically: smoking during pregnancy, prenatal care appointments, labour complications, weight in relation to gestational age, and one-minute Apgar score. Of the foregoing outcomes, those that remained in the full regression model as a risk factor associated with neonatal transfer were: smoking during pregnancy [p = 0.009, odds ratio (OR) = 4.1,95% confidence interval (CI) 1.03-16.33], labour complications (p<0.001, OR = 5.5, 95% CI 1.06-28.26) and one-minute Apgar score <= 7 (p<0.001, OR = 7.8,95% CI 1.62-37.03). Key conclusions and implications for practice: smoking during pregnancy, labour complications and one-minute Apgar score <= 7 were confirmed as risk factors for neonatal transfer from the birth centre to a hospital. The identified risk factors can help to improve institutional protocols and formulate hypotheses for other studies. (C) 2009 Elsevier Ltd. All rights reserved.