The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006]

Background: In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.Objective: To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.Methods: Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.Results: Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.Conclusions: This safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

Inclusão social do deficiente visual: experiência e resultados de Assis

OBJETIVOS: Traçar o perfil do usuário da Sala de Recursos para Deficiente Visual na cidade de Assis - SP, avaliar a porcentagem de deficientes visuais empregados e comparar o emprego com idade, gênero, tipo de deficiência e doença causadora da deficiência, entre dois períodos: de 1984 a 1996 e de 1997 a 2009. MÉTODOS: Foi realizado estudo retrospectivo dos prontuários médicos e da ficha escolar dos portadores de deficiência visual que frequentaram a Sala de Recursos para Deficiente Visual, no período de 1984 a 2009 na cidade de Assis - SP, divididos em dois períodos de 1984 a 1996 (G1) e de 1997 a 2009 (G2). Analisaram-se dados demográficos, a doença que provocou a baixa visão, o tipo de deficiência visual (cegueira ou baixa visão), escolaridade, recursos ópticos, frequência à Sala de Recursos para Deficiente Visual e taxa de emprego. Foi feita associação da taxa de emprego com: idade, gênero, raça/cor, tipo de deficiência e doença nos dois diferentes períodos. RESULTADOS: Foram encontrados 149 deficientes visuais sendo: 61,07% homens, 38,9% mulheres, 82,5% brancos e 17,4% não brancos e a mediana da idade foi de 18 anos. Dos 149 deficientes visuais, 63,75% eram portadores de baixa visão e 36,24% portadores de cegueira. As principais doenças que levaram à deficiência visual dos 149 pacientes foram em ordem decrescente: retinocoroidite por toxoplasmose (17,40%), atrofia óptica congênita (12,10%), alta hipermetropia (8,72%), retinose pigmentar e alta miopia (6,71% cada uma) e glaucoma congênito e catarata congênita (6,04% cada uma). A frequência à Sala de Recursos para Deficiente Visual foi boa em mais de 50% dos pacientes. Estavam trabalhando regularmente 44,7% e 12,3% dos maiores de 14 anos respectivamente nos períodos de 1984 - 1996 e de 1997 - 2009. Não houve diferença entre os dois períodos quanto às características demográficas, tipo de deficiência e doenças, havendo correlação da taxa de emprego apenas com a idade (pacientes com média de idade maior apresentavam maior porcentagem de emprego). CONCLUSÕES: Os deficientes visuais eram na maioria homens, brancos, portadores de baixa visão e portadores de toxoplasmose ocular. Quase metade (44,7%) dos pacientes com mais de 14 anos encontrava-se trabalhando regularmente até 1996 sugerindo que esforços conjuntos de oftalmologistas e educadores auxilia na inclusão social destes pacientes. A taxa de emprego caiu no período de 1997 a 2009 e a de aposentados aumentou.

Analysis of the expression of toll-like receptors 2 and 4 and cytokine production during experimental Leishmania chagasi infection

Toll-like receptors (TLRs) recognise pathogen-derived molecules and influence immunity to control parasite infections. This study aimed to evaluate the mRNA expression of TLRs 2 and 4, the expression and production of the cytokines interleukin (IL)-12, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-17, IL-10 and transforming growth factor (TGF)-β and the production of nitric oxide (NO) in the spleen of mice infected with Leishmania chagasi. It also aimed to evaluate any correlations between mRNA expression TLR2 and 4 and cytokines and NO production. Infection resulted in increased TLR2-4, IL-17, TNF-α and TGF-β mRNA expression during early infection, with decreased expression during late infection correlating with parasite load. IFN-γ and IL-12 mRNA expression decreased at the peak of parasitism. IL-10 mRNA expression increased throughout the entire time period analysed. Although TGF-β, TNF-α and IL-17 were highly produced during the initial phase of infection, IFN-γ and IL-12 exhibited high production during the final phase of infection. IL-10 and NO showed increased production throughout the evaluated time period. In the acute phase of infection, there was a positive correlation between TLR2-4, TNF-α, IL-17, NO, IL-10 and TGF-β expression and parasite load. During the chronic phase of infection, there was a positive correlation between TLR2-4, TNF-α, IL-17 and TGF-β expression and parasite load. Our data suggest that infection by L. chagasi resulted in modulation of TLRs 2 and 4 and cytokines.

Sorologia Anti PGL-1 e risco de ocorrência de hanseníase em área de alta endemicidade do Estado de São Paulo: quatro anos de seguimento

Os testes sorológicos para diagnóstico de hanseníase, usando o glicolipídeo-fenólico-1 (PGL-1), considerado antígeno específico do M. leprae, têm aberto algumas possibilidades de estudo do comportamento epidemiológico desta doença. Algumas questões, como tempo de latência da doença, infecção subclínica e importância do contato intra-domiciliar (contatos) no controle da endemia, puderam ser melhor analisadas usando este instrumental. Este estudo teve por objetivo verificar a existência de associação entre a situação sorológica e a ocorrência de hanseníase. Foram seguidas, durante 4 anos, 6.520 pessoas com idade igual ou superior a 5 anos, submetidas no início do seguimento ao teste sorológico Anti PGL-1, pertencentes ao universo de 7.416 habitantes da área urbana de um município paulista caracterizado por elevada endemicidade de hanseníase. Foi identificado um grupo de 590 indivíduos soropositivos (9,0 %). Foram diagnosticados, no período, 82 casos novos de hanseníase, 26 no grupo de soropositivos (441 casos novos/10.000 indivíduos) e 48 no de soronegativos (81/10.000). Entre os que não fizeram sorologia, surgiram 8 casos novos (89/10.000). Procurou-se controlar, na análise, a condição de contato, dado que a taxa de soropositividade padronizada por idade e sexo era de 9,61% no grupo de contatos e 7,65% no de não-contatos. Tomando-se os não-contatos soronegativos como o grupo de não expostos, foram calculados os riscos relativos de adoecimento no período, a partir das taxas de detecção padronizadas por idade, resultando no seguinte: os contatos ID soropositivos apresentaram a taxa de 1.704/10.000, 27 vezes maior que a dos não-expostos, igual a 63/10.000; os não-contatos soropositivos e os contatos soronegativos apresentaram taxas, respectivamente, de 274 e 198/10.000, ambas maiores que as dos não-expostos e iguais entre si. A soropositividade associou-se à elevação de 8,6 vezes do risco de hanseníase entre os contatos e de 4,4 entre os não-contatos. Na situação epidemiológica estudada, caracterizada por elevada endemicidade de hanseníase, 50% dos casos novos surgiram entre os não-contatos soronegativos, ou seja, sem fonte de infecção conhecida. Portanto, o teste anti-PGL-1 usado revela-se, na prática, de pouca aplicabilidade. Resta estudar ainda o comportamento da sorologia anti-PGL-1 em áreas de média e baixa endemicidade para que se possa tirar conclusões mais consubstanciadas sobre sua utilidade no controle da endemia. Recomenda-se o aprofundamento das pesquisas sorológicas e de outras que aprimorem o diagnóstico precoce da infecção subclínica, inclusive para detecção de formas paucibacilares, para se ampliar as possibilidades de influir no controle endêmico.

A comparative analisys of pelvic floor muscle strength in women with stress and urge urinary incontinence

Aims: To assess pelvic floor muscle (PFM) strength in women with stress urinary incontinence (SUI) and urge urinary incontinence (UUI).Materials and Methods: 51 women were prospectively divided into two groups, according to the symptoms as SUI (G1 = 22) or UUI (G2 = 29). Demographic data, such as number of pads/ 24 hours, number of micturations/ 24 hours and nocturia, delay time of urgent void (i.e., the time period for which an urgent void could be voluntarily postponed), number of parity and vaginal deliveries were obtained using a clinical questionnaire. Objective urine loss was evaluated by 60-min. Pad Test, subjective urine stream interruption test (UST) and visual survey of perineal contraction. Objective evaluations of PFM were performed in all patients (vaginal manometry).Results: Median of age, mean number of pads/ 24 hours, nocturia and warning time were significantly higher in UUI comparing to SUI group. During UST, 45.45% in G1 and 3.44%, in G2, were able to interrupt the urine stream (p < 0.001). The 60-min. Pad Test was significantly higher in G2 compared to G1 women (2.7 +/- 2.4 vs 1.5 +/- 1.9 respectively, p = 0.049). Objective evaluation of PFM strength was significantly higher in the SUI than in the UUI patients. No statistical difference was observed regarding other studied parameters.Conclusion: Pelvic floor muscle weakness was significantly higher in women with UUI when compared to SUI.

Propolis as storage media for avulsed teeth: microscopic and morphometric analysis in rats

The maintenance of the avulsed teeth in appropriate media for preserving the cellular viability has been important for repairing the periodontal ligament and preventing the root resorption after tooth reimplantation. Propolis is a substance capable of preserving cellular viability. This study aimed to analyze the propolis substance as a storage media for maintaining the avulsed teeth, besides to determine the ideal time period for keeping the tooth inside it. Thus, 60 maxillary right central incisors of rats were extracted and divided into five groups. In groups I and II, teeth were kept in propolis for 60 min and 6 h, respectively; in group III, teeth were kept in milk for 6 h; in group IV, teeth were kept dry for 60 min; and in group V, they were immediately reimplanted. All teeth had their root canals filled with calcium hydroxide paste. Following, teeth were reimplanted in their sockets. After 15 and 60 days, animals were killed and the obtained samples were processed in laboratory for microscopic and morphometric analyzing. The results showed that the occurrence of inflammatory resorption, dental ankylosis and the formation of the connective tissue parallel to the root surface were similar among groups. It could be verified a greater occurrence of replacement resorption in group IV when comparing to other groups. In groups I and IV, the presence of periodontal ligament-like connective tissue was substantially smaller than the other groups. Regarding to the cementum amount over the root, it could be observed that this was present in smaller amount in groups I and IV. Group II was similar to groups III and IV. Therefore, according to the results of this study, the use of propolis as a storage media for maintaining avulsed teeth could be highlighted, and the 6-h period was more appropriate than the 60-min period.

Histomorphometric evaluation of periodontal compression and tension sides during orthodontic tooth movement in rats

OBJECTIVE: The purpose of this study was to evaluate the thickness of the periodontal ligament of rat molars during orthodontic tooth movement (OTM). METHODS: Thirty Wistar rats were divided into three groups of 10 animals each: GI, GII and GIII and the mice were euthanized at 7, 14 and 21 days, respectively. Experimental subjects were compared to their respective controls by the Mann-Whitney test. Comparison of values between compression and tension sides were performed during the same and different time periods through Analysis of Variance (ANOVA), Kruskal-Wallis test and, subsequently, Tukey's test. RESULTS: Groups GI and GII showed decreased PDL size in the apical regions of the mesiobuccal root and in the cervical region of the distobuccal root. There was also an increased PDL in the cervical regions of the mesiobuccal root, apical region of the distobuccal root and middle region of both roots. CONCLUSION: The reduction and increase in PDL size were seen in the same root, which characterizes tooth inclination. The apical, middle and cervical regions were compared with one another in each time period and at three times: 7, 14 and 21 days. They were also compared in each region, confirming a tipping movement in GI and GII and a gradual decreased intensity between GI to GII, reaching normal dimension in GIII.

Fixation of autogenous bone grafts with ethyl-cyanoacrylate glue or titanium screws in the calvaria of rabbits

This study compared the fixation of autogenous onlay bone grafts with cyanoacrylate glue (Super Bonder) and with titanium screws. Twenty rabbits underwent bilateral parietal ostectomies. Bone segments were fixed anteriorly to the resulting bone defect. In group I, the grafts were fixed with 4 min long, 1.5 mm diameter screws; in group II, adhesive was used. The animals were killed after 5, 15, 30, 60 and 120 days. Histomorphometric analysis was used to quantify the maintenance of the graft area. Discrete areas of inflammatory reaction were seen in both groups after 5 days and for group II after 15 days. After 30 days, new bone formation was seen at the interface of the grafts. After 120 days, the graft was incorporated into the host bed in group I and partially incorporated in group II. There was a significant statistical difference regarding the mean graft areas between 15 and 120 days (p < 0.001) and between fixation methods (p < 0.002). Fixation with adhesive promoted a significantly greater area of bone graft than screw fixation, independent of time period. The adhesive was biocompatible, presented similar stability to the screw and maintained the bone area, although there was a delay in graft incorporation.

Population size and survivorship for juvenile lemon sharks (Negaprion brevirostris) on their nursery grounds at a marine protected area in Brazil

Os tubarões enfrentam muitos obstáculos para sobreviver nos primeiros anos de vida e muitas espécies ocupam áreas de berçário. Embora estimativas de sobrevivência, particularmente para jovens, sejam essenciais para acessar, monitorar e manejar efetivamente populações animais, existem poucos cálculos destas estimativas para populações de tubarões e poucas estimativas baseadas em métodos diretos para estes animais em suas áreas de berçário. Métodos de marcação e recaptura foram utilizados no presente estudo para estimar o tamanho populacional e a sobrevivência de jovens tubarões-limão (Negaprion brevirostris) em uma área de berçário na Reserva Biológica do Atol das Rocas, Brasil. Os indivíduos foram amostrados entre 1999 e 2003 e as estimativas de tamanho populacional variaram entre 12 a 100 indivíduos jovens e a taxa de sobrevivência entre 24 e 54%, com média de 44,6% durante o período de amostragem mais robusto. A população destes tubarões jovens diminuiu ao longo de nosso estudo, ainda que as taxas de sobrevivência tenham aumentado durante o mesmo período. Mesmo um nível moderado de pesca e a remoção de fêmeas maduras em áreas adjacentes podem afetar dramaticamente pequenas populações de tubarões num berçário pequeno e isolado como o Atol das Rocas. As taxas de sobrevivência e tamanho populacional relativamente mais baixos em Rocas podem ser resultado das diferenças nas características físicas deste berçário, comparadas a outros utilizados pela espécie no Atlântico norte-ocidental. Tais parâmetros comparativamente mais baixos no Atol das Rocas sugerem a fragilidade da população jovem de tubarões-limão neste berçário.

Cytokine production in lungs and adrenal glands of high and low antibody producing mice infected with Paracoccidioides brasiliensis

Mice genetically selected for high (H) and low (L) antibody production (HIV-A and L-IV-A) were used in an experimental model of paracoccidioidomycosis. In a previous work, it was observed that male HIV-A animals were more susceptible to the infection due to adrenal gland damage. Male HIV-A and LIV-A animals were intravenously inoculated with Paracoccidioides brasiliensis (strain 18) and sacrificed 2, 4, 6, 8 and 10 weeks after inoculation. At each time interval, lungs and adrenals were removed to estimate recoverability of the fungus, as well as to determine Th1 (IFN-gamma, TNF-alpha) and Th2 (IL-4 and IL-10) cytokine profiles. While viable fungi recoverability from the lungs of HIV-A mice was higher after 4 and 8 weeks, there was less fungal recovery from the adrenals of LIV-A animals after the 2nd week, with total fungal elimination after the 8th week. With regard to Th2 cytokines, there was an inhibition in IL-4 production in the organs from infected animals, the extent of which varied according to the organ and the time period after initiation of infection. IL-10 production was found to be lower in both organs. Determination of Th1 cytokines revealed that IFN-gamma production increased in both organs, mainly in the adrenal of LIV-A after 8 and 10 weeks, when these animals showed a total fungal elimination. A significant difference was observed between HIV-A and LIV-A concerning TNF-alpha production in both organs and at all recovery times, in that LIV-A produced a higher level of this cytokine, mainly in the adrenal. These results may explain the high susceptibility of HIV-A to P. brasiliensis infection, is due, at least in part, to adrenal involvement. The higher production of Th1 cytokines by LIV-A in comparison to HIV-A mice may account for LIV-A resistance to P. brasiliensis infection. Our data reveal the importance of this experimental model in the study of the adrenal involvement in paracoccidioidomycosis, since this gland may be highly compromised in the patients, leading to the development of Addison's Disease.

Are large-scale distributional shifts of the blue-winged macaw (Primolius maracana) related to climate change?

Aim To evaluate whether observed geographical shifts in the distribution of the blue-winged macaw (Primolius maracana) are related to ongoing processes of global climate change. This species is vulnerable to extinction and has shown striking range retractions in recent decades, withdrawing broadly from southern portions of its historical distribution. Its range reduction has generally been attributed to the effects of habitat loss; however, as this species has also disappeared from large forested areas, consideration of other factors that may act in concert is merited.Location Historical distribution of the blue-winged macaw in Brazil, eastern Paraguay and northern Argentina.Methods We used a correlative approach to test a hypothesis of causation of observed shifts by reduction of habitable areas mediated by climate change. We developed models of the ecological niche requirements of the blue-winged macaw, based on point-occurrence data and climate scenarios for pre-1950 and post-1950 periods, and tested model predictivity for anticipating geographical distributions within time periods. Then we projected each model to the other time period and compared distributions predicted under both climate scenarios to assess shifts of habitable areas across decades and to evaluate an explanation for observed range retractions.Results Differences between predicted distributions of the blue-winged macaw over the twentieth century were, in general, minor and no change in suitability of landscapes was predicted across large areas of the species' original range in different time periods. No tendency towards range retraction in the south was predicted, rather conditions in the southern part of the species' range tended to show improvement for the species.Main conclusions Our test permitted elimination of climate change as a likely explanation for the observed shifts in the distribution of the blue-winged macaw, and points rather to other causal explanations (e.g. changing regional land use, emerging diseases).

Antagonistic interactions between garden yeasts and microfungal garden pathogens of leaf-cutting ants

We investigate the diversity of yeasts isolated in gardens of the leafcutter ant Atta texana. Repeated sampling of gardens from four nests over a 1-year time period showed that gardens contain a diverse assemblage of yeasts. The yeast community in gardens consisted mostly of yeasts associated with plants or soil, but community composition changed between sampling periods. In order to understand the potential disease-suppressing roles of the garden yeasts, we screened isolates for antagonistic effects against known microfungal garden contaminants. In vitro assays revealed that yeasts inhibited the mycelial growth of two strains of Escovopsis (a specialized attine garden parasite), Syncephalastrum racemosum (a fungus often growing in gardens of leafcutter lab nests), and the insect pathogen Beauveria bassiana. These garden yeasts add to the growing list of disease-suppressing microbes in attine nests that may contribute synergistically, together with actinomycetes and Burkholderia bacteria, to protect the gardens and the ants against diseases. Additionally, we suggest that garden immunity against problem fungi may therefore derive not only from the presence of disease-suppressing Pseudonocardia actinomycetes, but from an enrichment of multiple disease-suppressing microorganisms in the garden matrix.

Tempo de jejum dos suínos no manejo pré-abate sobre a perda de peso corporal, o peso do conteúdo estomacal e a incidência de úlcera esofágica-gástrica

O objetivo deste trabalho foi avaliar os efeitos do tempo de jejum (9, 12, 15 e 18 horas) dos animais na granja (TJG) e da posição na carroceria do caminhão (PBO) durante o transporte da granja ao frigorífico sobre: a perda de peso corporal (PPC), o peso do estômago cheio (PEC) e vazio (PEV), o peso do conteúdo estomacal (PCE) e o escore de lesão na mucosa esofágica-gástrica (ELG). Foram utilizadas 192 fêmeas, com peso vivo médio de 134,51±11,80kg. No modelo, foram considerados os efeitos de bloco (estação do ano, BL), TJG, PBO e da interação entre BL x TJG. Verificou-se efeito significativo do TJG apenas sobre o peso do conteúdo estomacal. Não se observou efeito significativo da PBO sobre qualquer das variáveis avaliadas. Dos suínos avaliados, 90,3% apresentaram PEC menor que 500 gramas e 8,56% com PEC entre 500 e 800 gramas. A prevalência de suíno com ELG foi baixa (14,97%), sendo que, dos animais com ELG, 13,90% apresentaram lesão de grau 1 e 1,09% eram grau dois. Conclui-se que animais submetidos a jejum na granja de 15 horas apresentam menor peso do conteúdo estomacal ao abate.

Efeito da profundidade de semeadura na emergência de plântulas de tomate (Lycopersicon esculentum Mill.)

Com o objetivo de avaliar o efeito da profundidade de semeadura na emergência de plântulas de tomate (Lycopersicon esculentum Mill.), utilizou-se sementes da cultivar Tropic à profundidade de 0,5; 1,5; 2,5; 3,5; 4.5 e 5,5 cm em substrato solo e areia na proporção de 3:1, mantendo-se constante o teor de água do mesmo em 70% da capacidade de campo. O delineamento experimental empregado foi inteiramente casualizado com quatro repetições de 50 sementes por tratamento, quantificando-se os efeitos das profundidades através das determinações de índice e velocidade de emergência e estande final em porcentagem. Os resultados revelaram que a profundidade de semeadura de 1,5 cm proporcionou índice de velocidade de emergência e estande final, significativamente superiores às demais, razão por que pode ser considerada como a mais indicada à semeadura de tomate.

Escarificação ácida, temperatura e luz no processo germinativo de sementes de Senna alata (L.) Roxb

O objetivo deste trabalho foi determinar o tempo ótimo de escarificação das sementes de Senna alata em ácido sulfúrico e verificar o efeito da temperatura, em condição de luz e escuro, na germinação de sementes dessa espécie. As sementes foram imersas em ácido sulfúrico concentrado por períodos de 0, 15, 30 e 60 minutos, e o teste de germinação realizado em BOD a 25ºC, utilizando quatro repetições de 50 sementes em cada período de tempo, sendo o delineamento estatístico inteiramente casualizado com 4 tratamentos. No segundo experimento, para verificar o efeito da temperatura e da condição de luz mais adequada a germinação, utilizou-se temperaturas de 10 a 45ºC, com intervalos de 5ºC, em condição de luz fluorescente branca ou escuro contínuo (gerbox preto). Utilizou-se o delineamento experimental inteiramente casualizado, disposto em esquema fatorial 8x2, com 4 repetições, de 50 sementes cada. em todos os testes as avaliações da porcentagem e índice de velocidade de germinação foram feitas diariamente, durante 10 dias, onde as sementes foram consideradas germinadas quando apresentaram 2 mm de raiz. Os dados foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey a 5% de probabilidade. A escarificação do tegumento com ácido sulfúrico durante 60 minutos, foi ideal para as sementes de Senna alata, por proporcionar maiores valores na porcentagem e velocidade de germinação. A germinação ocorre entre 15 e 40ºC, sendo consideradas fotoblásticas neutras entre 20 e 40ºC e fotoblásticas negativas preferenciais a 15ºC. O melhor desempenho germinativo foi obtido nas temperaturas de 25, 30 e 35ºC, onde ocorreram maior porcentagem e velocidade de germinação.