Avaliação da consulta médica realizada por ingressantes na residência de Pediatria

Diversos autores relatam que a consulta médica se associa a melhores resultados quando se adota como referencial o modelo centrado no paciente. OBJETIVO: Avaliar se os médicos ingressantes na residência de Pediatria realizam consultas ambulatoriais segundo pressupostos do modelo centrado no paciente. MÉTODO: Em 2007, no início de seu estágio de ambulatório, dez residentes foram selecionados aleatoriamente para serem filmados durante a realização de uma consulta. Adotando-se como referencial teórico pressupostos do modelo centrado no paciente, os dados foram analisados por meio de metodologia qualitativa, por meio da técnica exploratória, com três juízes independentes. RESULTADOS: A maioria dos residentes explora precocemente a primeira queixa referida pelos pais, assumindo-a como principal; não explora outras queixas; decide e faz orientações terapêuticas de modo não compartilhado; conversa pouco com as crianças; cria longos momentos de silêncio durante a consulta; não explica o exame físico e às vezes utiliza o prontuário como a principal fonte de informação. CONCLUSÃO: Os residentes realizam consultas sem a inclusão da perspectiva dos pais e, portanto, não atendem segundo pressupostos do modelo centrado no paciente.

Inbreeding levels in Northeast Brazil: strategies for the prospecting of new genetic disorders

A new autosomal recessive genetic condition, the SPOAN syndrome (an acronym for spastic paraplegia, optic atrophy and neuropathy syndrome), was recently discovered in an isolated region of the State of Rio Grande do Norte in Northeast Brazil, in a population that was identified by the IBGE (Brazilian Institute of Geography and Statistics) as belonging to the Brazilian communities with the highest rates of "deficiencies" (Neri, 2003), a term used to describe diseases, malformations, and handicaps in general. This prompted us to conduct a study of consanguinity levels in five of its municipal districts by directly interviewing their inhabitants. Information on 7,639 couples (corresponding to about 40% of the whole population of the studied districts) was obtained. The research disclosed the existence of very high frequencies of consanguineous marriages, which varied from about 9% to 32%, suggesting the presence of a direct association between genetic diseases such as the SPOAN syndrome, genetic drift and inbreeding levels. This fact calls for the introduction of educational programs for the local populations, as well as for further studies aiming to identify and characterize other genetic conditions. Epidemiological strategies developed to collect inbreeding data, with the collaboration of health systems available in the region, might be very successful in the prospecting of genetic disorders.

Identificação química da clorofenilpiperazina (CPP) em comprimidos apreendidos

Designer drug is a term used to describe psychoactive drugs of abuse which are usually synthesized by modifying the molecular structures of existing drugs of abuse. The term gained widespread popularity when MDMA (ecstasy) experienced a popularity boom in the mid 1980´s. In Brazil, designer drugs seizures have increased in the last few years, and actually tablets with unknown psychoactive compounds began to be forwarded to the Forensic Laboratories. This work describes the analytical assays that were performed to identify the chlorophenylpiperazine, a psychoactive substance first time identified in seized tablets in Sao Paulo state.

A infecção tuberculosa e o tempo de prisão da população carcerária dos Distritos Policiais da zona oeste da cidade de São Paulo

INTRODUÇÃO: A tuberculose sempre foi um grave problema de saúde para grupos de pessoas confinadas, especialmente em presídios, devido à sua transmissão respiratória. OBJETIVO: Verificar a associação entre o tempo de prisão e a taxa de infecção tuberculosa na população carcerária dos Distritos Policiais da zona oeste da cidade de São Paulo. METODOLOGIA:Foi realizado um estudo observacional, no período de março de 2000 a maio de 2001, com a aplicação de um inquérito individual e da prova tuberculínica (PPD-RT23 - 2UT/0.1ml) nos detentos. RESULTADOS E DISCUSSÃO: Do total de 1.052 presos entrevistados, 932 concordaram em fazer a prova tuberculínica e, destes, 64,5% estavam infectados. Para as análises, os detentos foram classificados como primários e reincidentes e como não reatores e reatores à prova tuberculínica, segundo o tempo de prisão. Entre os 134 detentos primários que estavam presos há menos de 60 dias, 40,3% foram reatores ao PPD e dos 53 com mais de 366 dias de prisão a percentagem de reatores foi de 62,3%. Entre os 146 detentos reincidentes presos há menos de 60 dias, 72,6% foram reatores ao PPD e dos 25 com mais de 366 dias de prisão, 100,0% estava infectado. Em todos os períodos de permanência na prisão, os detentos reincidentes tiveram maior percentagem de infecção tuberculosa do que os detentos primários. A associação entre tempo de prisão e reatividade ao PPD foi confirmada pelo Teste de Tendência (p<0.001) do programa Epi-Info-6. CONCLUSÕES:Quanto maior o tempo de prisão, maior a taxa de infecção tuberculosa. Detentos reincidentes são um risco de infecção para os detentos primários.

Prevalence and social distribution of risk factors for chronic noncommunicable diseases in Brazil

OBJETIVOS: Evaluar los factores de riesgo de enfermedades crónicas no transmisibles (ECNT) e identificar las desigualdades sociales relacionadas con su distribución en la población adulta brasileña.MÉTODOS: Se estudiaron los factores de riesgo de ECNT (entre ellos el consumo de tabaco, el sobrepeso y la obesidad, el bajo consumo de frutas y vegetales [BCFV], la insuficiente actividad física en el tiempo de ocio [IAFTO], el estilo de vida sedentario y el consumo excesivo de alcohol) en una muestra probabilística de 54369 adultos de 26 capitales estatales de Brasil y el Distrito Federal en 2006. Se utilizó el Sistema de Vigilancia de los Factores Protectores y de Riesgo para Enfermedades Crónicas No Transmisibles por Entrevistas Telefónicas (VIGITEL), un sistema de encuestas telefónicas asistido por computadora, y se calcularon las prevalencias ajustadas por la edad para las tendencias en cuanto al nivel educacional mediante la regresión de Poisson con modelos lineales. RESULTADOS: Los hombres informaron mayor consumo de tabaco, sobrepeso, BCFV, estilo de vida sedentario y consumo excesivo de alcohol que las mujeres, pero menos IAFTO. En los hombres, la educación se asoció con un mayor sobrepeso y un estilo de vida sedentario, pero con un menor consumo de tabaco, BCFV e IAFTO. En las mujeres, la educación se asoció con un menor consumo de tabaco, sobrepeso, obesidad, BCFV e IAFTO, pero aumentó el estilo de vida sedentario CONCLUSIONES: En Brasil, la prevalencia de factores de riesgo para ECNT (excepto IAFTO) es mayor en los hombres que en las mujeres. En ambos sexos, el nivel de educación influye en la prevalencia de los factores de riesgo para ECNT

Os conhecimentos tradicional e científico do Saco do Arraial, estuário da Lagoa do Patos (RS)

Ethno-sciences study the logical behind the traditional population knowledge about environmental process. This case study aims at describing the ethno-knowledge of artisanal fishermen on the hydrodynamics of the estuary around Coreia community (Saco do Arraial), located in Dos Patos Lagoon, in southern Brazil, from an ethnooceangraphic perspective. For this purpose, mental maps, open-ended and in-depth semi-structured interviewing and participative research have been used. As well as scientific knowledge, rains and winds were had main hydrodynamic effort of Saco do Arraial, although astronomic influence in located hydrodynamic has been just a perception of traditional knowledge. Soon, these data have shown another important way to perceive the Patos Lagoon.

Determination of post-mortem interval using in situ tissue optical fluorescence

In this study we have used fluorescence spectroscopy to determine the post-mortem interval. Conventional methods in forensic medicine involve tissue or body fluids sampling and laboratory tests, which are often time demanding and may depend on expensive analysis. The presented method consists in using time-dependent variations on the fluorescence spectrum and its correlation with the time elapsed after regular metabolic activity cessation. This new approach addresses unmet needs for post-mortem interval determination in forensic medicine, by providing rapid and in situ measurements that shows improved time resolution relative to existing methods. (C) 2009 Optical Society of America

Characterization of dynamic solid phase DNA extraction from blood with magnetically controlled silica beads

A novel solid phase extraction technique is described where DNA is bound and eluted from magnetic silica beads in a manner where efficiency is dependent on the magnetic manipulation of the beads and not on the flow of solution through a packed bed. The utility of this technique in the isolation of reasonably pure, PCR-amplifiable DNA from complex samples is shown by isolating DNA from whole human blood, and subsequently amplifying a fragment of the beta-globin gene. By effectively controlling the movement of the solid phase in the presence of a static sample, the issues associated with reproducibly packing a solid phase in a microchannel and maintaining consistent flow rates are eliminated. The technique described here is rapid, simple, and efficient, allowing for recovery of more than 60% of DNA from 0.6 mu L of blood at a concentration which is suitable for PCR amplification. In addition, the technique presented here requires inexpensive, common laboratory equipment, making it easily adopted for both clinical point-of-care applications and on-site forensic sample analysis.

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.

Post-failure behaviour of impulsively loaded circular plates

The dynamic plastic response of a simply supported circular plate is analysed. Emphasis is given to the plate behaviour after it has broken free from the supports due to a local material failure. The theoretical rigid plastic analysis predicts various features of the response such as the time to failure, residual kinetic energy and the critical velocity at failure. The residual kinetic energy of the plate could be significant enough to cause secondary impact damage. It is shown that the shape of the plate changes after breaking free from the supports, which is important for forensic investigations. The solution for various cases were proven to be exact in the context of the upper and lower bounds theorems of the theory of plasticity. (C) 2009 Elsevier Ltd. All rights reserved.

Bait and Habitat Preferences, and Temporal Variability of Social Wasps (Hymenoptera: Vespidae) Attracted to Vertebrate Carrion

In addition to feeding on carrion tissues and fluids, social wasps can also prey on immature and adult carrion flies, thereby reducing their populations and retarding the decomposition process of carcasses. In this study, we report on the occurrence and behavior of social wasps attracted to vertebrate carrion. The collections were made monthly from September 2006 to October 2007 in three environments (rural, urban, and forest) in six municipalities of southeast Brazil, using baited bottle traps. We collected Agelaia pallipes (Olivier, 1791) (n = 143), Agelaia vicina (Saussure, 1854) (n = 106), Agelaia multipicta (Haliday, 1836) (n = 18), and Polybia paulista Ihering, 1896 (n = 3). The wasps were observed feeding directly on the baits and preying on adult insects collected in the traps. Bait and habitat associations, temporal variability of social wasps, and possible forensic implications of their actions are discussed.

Breeding of Ornidia obesa (Diptera: Syrphidae: Eristalinae) on Pig Carcasses in Brazil

On Mho obesa F. (Diptera: Syrphidae) is usually neglected in forensic entomology, although adults are rather frequent on vertebrate carrion. In this study, conducted in southeastern Brazil in 2008, we used two pig carcasses, one killed by cocaine overdose and the other by shooting, to evaluate mainly the possible influences of the type of death on the larval development of O. obesa in the pig remains. We recorded the breeding of 218 adult specimens of this syrphid fly from the carcass killed by shooting, and none from the carcass killed by cocaine. These observations may open a new perspective for the use of O. obesa in forensic studies, considering its breeding preferences and its complete development on vertebrate carrion.

Determining the season of death from the family composition of insects infesting carrion

Determining the season of death by means of the composition of the families of insects infesting carrion is rarely attempted in forensic studies and has never been statistically modelled. For this reason, a baseline-category logit model is proposed for predicting the season of death as a function of whether the area where the carcass was exposed is sunlit or shaded and of the relative abundance of particular families of carrion insects (Calliphoridae, Fanniidae, Sarcophagidae, and Formicidae). The field study was conducted using rodent carcasses (20-252 g) in an urban forest in southeastern Brazil. Four carcasses (2 in a sunlit and 2 in a shaded area) were placed simultaneously at the study site, twice during each season from August 2003 through June 2004. The feasibility of the model, measured in terms of overall accuracy, is 64 +/- 14%. It is likely the proposed model will assist forensic teams in predicting the season of death in tropical ecosystems, without the need of identifying the species of specimens or the remains of carrion insects.

Cannabinoid contents in cannabis products seized in Sao Paulo, Brazil, 2006-2007

A rapid and simple method was optimized for determination of Delta(9)-tetrahydrocannabinol (Delta(9)-THC), cannabidiol (CBD), and cannabinol (CBN) contents in cannabis products by gas chromatography with flame-ionization detection (GC-FID), using diazepam as internal standard. All parameters of validation of the method such as linearity, intraassay precision, and limits of detection and quantification of the analytes were satisfactory. Using the described method, cannabinoid contents of 55 cannabis product samples seized in Sao Paulo City, Brazil, in 2006 and 2007 were measured. Delta(9)-THC content in marijuana and hashish samples varied between 0.08% and 5.5%, with an average of 2.5%. The phenotypic ratio showed that the products were able to be designated as ""drug type.""

Genetic population data of 12 STR loci of the PowerPlex (R) Y system in the state of Sao Paulo population (Southeast of Brazil)

Allele frequency distributions and population data for 12 Y-chromosomal short tandem repeats (STRs) included in the PowerPlex (R) Y Systems (Promega) were obtained for a sample of 200 healthy unrelated males living in S (a) over tildeo Paulo State (Southeast of Brazil). A total of 192 haplotypes were identified, of which 184 were unique and 8 were found in 2 individuals. The average gene diversity of the 12 Y-STR was 0.6746 and the haplotype diversity was 0.9996. Pairwise analysis confirmed that our population is more similar with the Italy, North Portugal and Spain, being more distant of the Japan. (c) 2007 Elsevier Ireland Ltd. All rights reserved.