The epidemiologic paradox of low birth weight in Brazil

OBJECTIVE: To examine whether the low birth weight (LBW) paradox exists in Brazil. METHODS: LBW and cesarean section rates between 1995 and 2007 were estimated based on data from SINASC (Brazilian Live Births Database). Infant mortality rates (IMRs) were obtained using an indirect method that correct for underreporting. Schooling information was obtained from census data. Trends in LBW rate were assessed using joinpoint regression models. The correlations between LBW rate and other indicators were graphically assessed by lowess regression and tested using Spearman's rank correlation. RESULTS: In Brazil, LBW rate trends were non-linear and non-significant: the rate dropped from 7.9% in 1995 to 7.7% in 2000, then increased to 8.2% in 2003 and remained nearly steady thereafter at 8.2% in 2007. However, trends varied among Brazilian regions: there were significant increases in the North from 1999 to 2003 (2.7% per year), and in the South (1.0% per year) and Central-West regions (0.6% per year) from 1995 to 2007. For the entire period studied, higher LBW and lower IMRs were seen in more developed compared to less developed regions. In Brazilian States, in 2005, the higher the IMR rate, the lower the LBW rate (p=0.009); the lower the low schooling rate, the lower the LBW rate (p=0.007); the higher the number of neonatal intensive care beds per 1,000 live births, the higher the LBW rate (p=0.036). CONCLUSIONS: The low birth weight paradox was seen in Brazil. LBW rate is increasing in some Brazilian regions. Regional differences in LBW rate seem to be more associated to availability of perinatal care services than underlying social conditions.

Housing conditions as a social determinant of low birthweight and preterm low birthweight

OBJECTIVE: To assess the relationship between housing conditions and low birthweight and preterm low birthweight among low-income women. METHODS: A case-control study was conducted with post-partum women living in the city of Rio de Janeiro, Southeast Brazil, in 2003-2005. Two groups of cases, low birthweight (n=96) and preterm low birthweight infants (n=68), were compared against normal weight term controls (n=393). Housing conditions were categorized into three levels: adequate, inadequate, and highly inadequate. Covariates included sociodemographic and anthropometric characteristics, risk behaviors, violence, anxiety, satisfaction during pregnancy, obstetric history and prenatal care. RESULTS: Poor housing conditions was independently associated with low birthweight (inadequate - OR 2.3 [1.1;4.6]; highly inadequate - OR 7.6 [2.1;27.6]) and preterm low birthweight (inadequate - OR 2.2 [1.1;4.3]; highly inadequate - OR 7.6 [2.4;23.9]) and factors associated with outcomes were inadequate prenatal care and previous preterm birth. Low income and low maternal body mass index remained associated with low birthweight. CONCLUSIONS: Poor housing conditions were associated with low birthweight and preterm low birthweight.

How many low birthweight babies in low- and middle-income countries are preterm?

OBJECTIVE: To assess the prevalence of preterm birth among low birthweight babies in low and middle-income countries. METHODS: Major databases (PubMed, LILACS, Google Scholar) were searched for studies on the prevalence of term and preterm LBW babies with field work carried out after 1990 in low- and middle-income countries. Regression methods were used to model this proportion according to LBW prevalence levels. RESULTS: According to 47 studies from 27 low- and middle-income countries, approximately half of all LBW babies are preterm rather than one in three as assumed in studies previous to the 1990s. CONCLUSIONS: The estimate of a substantially higher number of LBW preterm babies has important policy implications in view of special health care needs of these infants. As for earlier projections, our findings are limited by the relative lack of population-based studies.

The predominance of M2-polarized macrophages in the stroma of low-hypoxic bladder tumors is associated with BCG immunotherapy failure

OBJECTIVE: Bacillus Calmette-Guérin (BCG) immunotherapy is the gold standard treatment for superficial bladder tumors with intermediate/high risk of recurrence or progression. However, approximately 30% of patients fail to respond to the treatment. Effective BCG therapy needs precise activation of the type 1 helper cells immune pathway. Tumor-associated macrophages (TAMs) often assume an immunoregulatory M2 phenotype and may directly interfere with the BCG-induced antitumor immune response. Thus, we aim to clarify the influence of TAMs, in particular of the M2 phenotype in stroma and tumor areas, in BCG treatment outcome. PATIENTS AND METHODS: The study included 99 patients with bladder cancer treated with BCG. Tumors resected before treatment were evaluated using immunohistochemistry for CD68 and CD163 antigens, which identify a lineage macrophage marker and a M2-polarized specific cell surface receptor, respectively. CD68+ and CD163+ macrophages were evaluated within the stroma and tumor areas, and high density of infiltrating cells spots were selected for counting. Hypoxia, an event known to modulate macrophage phenotype, was also assessed through hypoxia induced factor (HIF)-1α expression. RESULTS: Patients in whom BCG failed had high stroma-predominant CD163+ macrophage counts (high stroma but low tumor CD163+ macrophages counts) when compared with the ones with a successful treatment (71% vs. 47%, P = 0.017). Furthermore, patients presenting this phenotype showed decreased recurrence-free survival (log rank, P = 0.008) and a clear 2-fold increased risk of BCG treatment failure was observed in univariate analysis (hazard ratio = 2.343; 95% CI: 1.197-4.587; P = 0.013). Even when adjusted for potential confounders, such as age and therapeutic scheme, multivariate analysis revealed 2.6-fold increased risk of recurrence (hazard ratio = 2.627; 95% CI: 1.340-5.150; P = 0.005). High stroma-predominant CD163+ macrophage counts were also associated with low expression of HIF-1α in tumor areas, whereas high counts of CD163+ in the tumor presented high expression of HIF-1α in tumor nests. CONCLUSIONS: TAMs evaluation using CD163 is a good indicator of BCG treatment failure. Moreover, elevated infiltration of CD163+ macrophages, predominantly in stroma areas but not in the tumor, may be a useful indicator of BCG treatment outcome, possibly owing to its immunosuppressive phenotype.

Deteção e acompanhamento de movimento através de uma câmara de vídeo

A deteção e seguimento de pessoas tem uma grande variedade de aplicações em visão computacional. Embora tenha sido alvo de anos de investigação, continua a ser um tópico em aberto, e ainda hoje, um grande desafio a obtenção de uma abordagem que inclua simultaneamente exibilidade e precisão. O trabalho apresentado nesta dissertação desenvolve um caso de estudo sobre deteção e seguimento automático de faces humanas, em ambiente de sala de reuniões, concretizado num sistema flexível de baixo custo. O sistema proposto é baseado no sistema operativo GNU's Not Unix (GNU) linux, e é dividido em quatro etapas, a aquisição de vídeo, a deteção da face, o tracking e reorientação da posição da câmara. A aquisição consiste na captura de frames de vídeo das três câmaras Internet Protocol (IP) Sony SNC-RZ25P, instaladas na sala, através de uma rede Local Area Network (LAN) também ele já existente. Esta etapa fornece os frames de vídeo para processamento à detecção e tracking. A deteção usa o algoritmo proposto por Viola e Jones, para a identificação de objetos, baseando-se nas suas principais características, que permite efetuar a deteção de qualquer tipo de objeto (neste caso faces humanas) de uma forma genérica e em tempo real. As saídas da deteção, quando é identificado com sucesso uma face, são as coordenadas do posicionamento da face, no frame de vídeo. As coordenadas da face detetada são usadas pelo algoritmo de tracking, para a partir desse ponto seguir a face pelos frames de vídeo subsequentes. A etapa de tracking implementa o algoritmo Continuously Adaptive Mean-SHIFT (Camshift) que baseia o seu funcionamento na pesquisa num mapa de densidade de probabilidade, do seu valor máximo, através de iterações sucessivas. O retorno do algoritmo são as coordenadas da posição e orientação da face. Estas coordenadas permitem orientar o posicionamento da câmara de forma que a face esteja sempre o mais próximo possível do centro do campo de visão da câmara. Os resultados obtidos mostraram que o sistema de tracking proposto é capaz de reconhecer e seguir faces em movimento em sequências de frames de vídeo, mostrando adequabilidade para aplicação de monotorização em tempo real.

The telegraph as an omen of the future in James W. Carey's vision

In the history of modern communication, after the development of the printing press, the telegraph unleashed a revolution in communications. Today, Internet is in many ways its heir. Reflections on the telegraph may open up perspectives concerning tendencies, possibilities and pitfalls of the Internet. The telegraph has been well explored in important literature on communication and media which tends to emphasize the history of this technology, its social context and institutional meaning [e.g. Robert L. Thompson, 1947, Tom Standage, 2007 [1998]. James W. Carey, the North- American critical cultural studies' mentor, in his essay "Technology and Ideology. The Case of the Telegraph" (2009 [1983]), suggests a distinctive approach. In the telegraph, Carey sees the prototype of many subsequent commercial empires based on science and technology, a pioneer model for complex business management; an example of interest struggle for the patents control; an inductor of changes both in language and in structures of knowledge; and a promoter of a futurist and utopian thought of information technologies. Having in mind a revolution in communications promoted by the Internet, this paper revisits this seminal essay to explore its great attainment, as well as the problems of this kind of approach which conceives the innovation of the telegraph as a metaphor for all the innovations announcing the modern stage of history and determining still today the major lines of development in modern communication systems.

Efficacy of low-level laser therapy on scar tissue

Background: Physiotherapy has a very important role in the maintenance of the integumentary system integrity. There is very few evidence in humans. Nevertheless, there are some studies about tissue regeneration using low-level laser therapy (LLLT). Aim: To analyze the effectiveness of LLLT on scar tissue. Methods: Seventeen volunteers were stratified by age of their scars, and then randomly assigned to an experimental group (EG) — n = 9 – and a placebo group (PG) – n = 8. Fifteen sessions were conducted to both the groups thrice a week. However, in the PG, the laser device was switched off. Scars’ thickness, length, width, macroscopic aspect, pain threshold, pain perception, and itching were measured. Results: After 5 weeks, there were no statistically significant differences in any variable between both the groups. However, analyzing independently each group, EG showed a significant improvement in macroscopic aspect (p = 0.003) using LLLT. Taking into account the scars’ age, LLLT showed a tendency to decrease older scars’ thickness in EG. Conclusion: The intervention with LLLT appears to have a positive effect on the macroscopic scars’ appearance, and on old scars’ thickness, in the studied sample. However, it cannot be said for sure that LLLT has influence on scar tissue.

Is adolescent pregnancy a risk factor for low birth weight?

OBJECTIVE: The objective of this study was to evaluate whether adolescent pregnancy is a risk factor for low birth weight (LBW) babies. METHODS: This was a cross-sectional study of mothers and their newborns from a birth cohort in Aracaju, Northeastern Brazil. Data were collected consecutively from March to July 2005. Information collected included socioeconomic, biological and reproductive aspects of the mothers, using a standardized questionnaire. The impact of early pregnancy on birth weight was evaluated by multiple logistic regression. RESULTS: We studied 4,746 pairs of mothers and their babies. Of these, 20.6% were adolescents (< 20 years of age). Adolescent mothers had worse socioeconomic and reproductive conditions and perinatal outcomes when compared to other age groups. Having no prenatal care and smoking during pregnancy were the risk factors associated with low birth weight. Adolescent pregnancy, when linked to marital status "without partner", was associated with an increased proportion of low birth weight babies. CONCLUSIONS: Adolescence was a risk factor for LBW only for mothers without partners. Smoking during pregnancy and lack of prenatal care were considered to be independent risk factors for LBW.

Low prevalence of hypertension with pharmacological treatments and associated factors

OBJECTIVE: To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS: In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS: Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS: The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.

Vision antropologica de la descentralizacion del sistema de salud en Mexico

OBJETIVO: Analizar cambios organizacionales, políticos y económicos resultantes de la descentralización del sistema de salud en la población sin seguridad social en México. METODOS: Se visitaron tres estados del país seleccionados por el número de habitantes en condición de pobreza, el partido político en el poder y la etapa de implementación de la descentralización (la primera fue en 1984 y la segunda en 1997). Se realizaron entrevistas durante 2007 con informantes clave de los servicios de salud de los gobiernos estatales, personas que acudieron a consulta en los servicios estatales de salud y líderes comunitarios. Los datos fueron analizados desde una perspectiva antropológica y económica. RESULTADOS: La descentralización ocurrió de forma heterogénea en cada estado, observándose una transferencia de responsabilidades de la federación a los estados, más no así una ruptura con la dependencia del nivel central - federal. Las reformas impulsadas desde el nivel federal para crear un esquema fundamentado en principios de subsidiaridad financiera y democratización en salud enfrentan retos políticos y organizacionales para su consolidación. CONCLUSIONES: El enfoque antropológico muestra la relevancia de considerar factores organizacionales, políticos y económicos como parte del proceso de descentralización.

A vision of cyber-physical internet

When the Internet was born, the purpose was to interconnect computers to share digital data at large-scale. On the other hand, when embedded systems were born, the objective was to control system components under real-time constraints through sensing devices, typically at small to medium scales. With the great evolution of the Information and Communication Technology (ICT), the tendency is to enable ubiquitous and pervasive computing to control everything (physical processes and physical objects) anytime and at a large-scale. This new vision gave recently rise to the paradigm of Cyber-Physical Systems (CPS). In this position paper, we provide a realistic vision to the concept of the Cyber-Physical Internet (CPI), discuss its design requirements and present the limitations of the current networking abstractions to fulfill these requirements. We also debate whether it is more productive to adopt a system integration approach or a radical design approach for building large-scale CPS. Finally, we present a sample of realtime challenges that must be considered in the design of the Cyber-Physical Internet.

Efeito de filtros ópticos na função visual de espeleologistas

Speleologist’s perform their activity in demanding visual conditions of very low luminance - many visual tasks involve resolution of detail under conditions of low contrast. Work related conditions in a cave as exposure to heat, chemicals, dust and poor lighting conditions could influence the integrity of the visual system and predispose the eye to diseases that eventually affect vision. Poor lighting conditions cause a variety of symptoms of visual discomfort and may increase the risk of accidents. Good visual acuity is crucial for several and has an important role for safety purposes. The aim of this study was to evaluate lighting conditions and optical filters effects on visual performance in speleologists exposed to cave environments.

Climatology of the Iberia coastal low-level wind jet: weather research forecasting model high-resolution results

Coastal low-level jets (CLLJ) are a low-tropospheric wind feature driven by the pressure gradient produced by a sharp contrast between high temperatures over land and lower temperatures over the sea. This contrast between the cold ocean and the warm land in the summer is intensified by the impact of the coastal parallel winds on the ocean generating upwelling currents, sharpening the temperature gradient close to the coast and giving rise to strong baroclinic structures at the coast. During summertime, the Iberian Peninsula is often under the effect of the Azores High and of a thermal low pressure system inland, leading to a seasonal wind, in the west coast, called the Nortada (northerly wind). This study presents a regional climatology of the CLLJ off the west coast of the Iberian Peninsula, based on a 9km resolution downscaling dataset, produced using the Weather Research and Forecasting (WRF) mesoscale model, forced by 19 years of ERA-Interim reanalysis (1989-2007). The simulation results show that the jet hourly frequency of occurrence in the summer is above 30% and decreases to about 10% during spring and autumn. The monthly frequencies of occurrence can reach higher values, around 40% in summer months, and reveal large inter-annual variability in all three seasons. In the summer, at a daily base, the CLLJ is present in almost 70% of the days. The CLLJ wind direction is mostly from north-northeasterly and occurs more persistently in three areas where the interaction of the jet flow with local capes and headlands is more pronounced. The coastal jets in this area occur at heights between 300 and 400 m, and its speed has a mean around 15 m/s, reaching maximum speeds of 25 m/s.

Low-loss austempered ductile iron gears: experimental evaluation comparing materials and lubricants

An experimental study to evaluate the power dissipation of gears was performed. Three low-loss gear models were manufactured using standard 20° pressure angle tools. Austempered ductile iron (ADI) and 20MnCr5 carburized steel gears were tested in an FZG gear test machine using mineral, ester and polyalphaolephine (PAO)-based oils. The results compare power dissipation, the influence of different tooth flank geometries, materials and lubricants. This work concludes that conventional power-transmission gears can be replaced by these improved and more efficient low–loss models, which can be produced using common tools and that steel gears can be successfully replaced by austempered ductile iron gears.

Lesion detection performance in an anthropomorphic chest phantom: comparative analysis of low-dose CT data on two hybrid imaging systems

Introduction: multimodality environment; requirement for greater understanding of the imaging technologies used, the limitations of these technologies, and how to best interpret the results; dose optimization; introduction of new techniques; current practice and best practice; incidental findings, in low-dose CT images obtained as part of the hybrid imaging process, are an increasing phenomenon with advancing CT technology; resultant ethical and medico-legal dilemmas; understanding limitations of these procedures important when reporting images and recommending follow-up; free-response observer performance study was used to evaluate lesion detection in low-dose CT images obtained during attenuation correction acquisitions for myocardial perfusion imaging, on two hybrid imaging systems.