Surveillance Programme for Healthcare Associated Infections in the State of Sao Paulo, Brazil. Implementation and the first three years` results

Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of Sao Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of Sao Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Clinical relationships and ethical problems in primary care, Sao Paulo, SP, Brazil

Objectives: Main Objective: to identify ethical problems in primary care according to nurses` and doctors` perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care. Design: Synthesis to integrate and reinterpret primary results of qualitative studies. Setting: Primary healthcare centers, Sao Paulo, SP, Brazil. Participants and/or context: Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience. Methods: Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results. Results: Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills. Conclusions: Ethical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation. (C) 2009 Elsevier Espana, S.L. All rights reserved.

City tuberculosis control coordinators` perspectives of patient adherence to DOT in Sao Paulo State, Brazil, 2005

SETTING: Thirty-six priority cities in Sao Paulo State, Brazil, with a high incidence of tuberculosis (TB) cases, deaths and treatment default. OBJECTIVE: To identify the perspectives of city TB control coordinators regarding the most important components of adherence strategies adopted by health care teams to ensure patient adherence in 36 priority cities in the State of Sao Paulo, Brazil. DESIGN: Qualitative research with semi-structured interviews conducted with the coordinators of the National TB Control Programme involved in the management of TB treatment services in the public sector. RESULTS: The main issues thought to influence adherence to directly observed treatment (DOT) by coordinators include incentives and benefits delivered to patients, patient-health care worker bonding and comprehensive care, the encouragement given by others to follow treatment (family, neighbours and health professionals), and help provided by health professionals for patients to recover their self-esteem. CONCLUSION: The main aspects mentioned by city TB control coordinators regarding patient adherence to treatment and to DOT in Sao Paulo are improvements in communications, relationships based on trust, a humane approach and including the patients in the decision-making process concerning their health.

Rotifer abundance, biomass, and secondary production after the recovery of hydrologic connectivity between a river and two marginal lakes (Sao Paulo, Brazil)

Rotifera density, biomass, and secondary production on two marginal lakes of Paranapanema River were compared after the recovery of hydrologic connectivity with the river (Sao Paulo State, Brazil). Daily samplings were performed in limnetic zone of both lakes during the rainy season immediately after lateral inflow of water and, in the dry period, six months after hydrologic connectivity recovery. In order to identify the factors that affect rotifer population dynamics, lake water level, volume, depth, temperature, transparency, dissolved oxygen, pH, alkalinity, conductivity, suspended solids, nutrients, and chlorophyll-a were determined. Variations of water physical and chemical factors that affect rotifer population were related to the lake-river degree of connection and to water level rising after drought. The water lateral inflow from the river resulted in an increase in lake water volume, depth, and transparency and a decrease in water pH, alkalinity, and suspended solids. The lake with the wider river connection, more frequent biota exchange, and larger amount of particulate and dissolved materials was richer and more diverse, while rotifer density, biomass, and productivity were lower in both periods studied. Density, biomass, and secondary production were higher in the lake with the smaller river connection and the higher physical and chemical stability. Our results show that the connectivity affects the limnological stability, associated to seasonality. Stable conditions, caused by low connectivity in dry periods, were related with high density, biomass and secondary production. Conversely, instability conditions in rainy periods were associated to elevated richness and diversity values, caused by exchange biota due to higher connectivity. (C) 2008 Elsevier GmbH. All rights reserved.

Knowledge transfer in product development processes: A case study in small and medium enterprises (SMEs) of the metal-mechanic sector from Sao Paulo, Brazil

This paper reports a research that evaluated the product development methodologies used in Brazilian small and medium-sized metal-mechanic enterprises (SMEs), in a specific region of Sao Paulo. The tool used for collecting the data was a questionnaire, which was developed and applied through interviews conducted by the researchers in 32 companies. The main focus of this paper can be condensed in the synthesis-question ""Is only the company responsible for the development?"" which was analyzed thoroughly. The results obtained from this analysis were evaluated directly (through the respective percentages of answers) and statistically (through the search of an index which demonstrates if two questions are related). The results point to a degree of maturity in SMEs, which allows product development to be conducted in cooperation networks. (C) 2007 Elsevier Ltd. All rights reserved.

Tiering strategic environmental assessment and project environmental impact assessment in highway planning in Sao Paulo, Brazil

Constructing highways in dense urban areas is always a challenge. In Sao Paulo Metropolitan Region, heavy truck traffic contributes to clog streets and expressways alike. As part of the traffic neither originates nor head to the region, a peripheral highway has been proposed to reduce traffic problems. This project called Rodoanel, is an expressway approximately 175 km long. The fact that the projected south and north sections would cross catchments that supply most of the metropolis water demand was strongly disputed and made the environmental permitting process particularly difficult. The agency in charge commissioned a strategic environmental assessment (SEA) of a revamped project, and called it the Rodoanel Programme. However, the SEA report failed to satisfactorily take account of significant strategic issues. Among these, the highway potential effect of inducing urban sprawl over water protection zones is the most critical issue, as it emerged later as a hurdle to project licensing. Conclusion is that, particularly where no agreed-upon framework for SEA exists, when vertical tiering with downstream project EIA is sought, then a careful scoping of strategic issues is more than necessary. If an agreement on `what is strategic` is not reached and not recognized by influential stakeholders, then the unsettled conflicts will be transferred to project EIA. In such a context, SEA will have added another loop to the usually long road to project approval. (c) 2008 Elsevier Inc. All rights reserved.

Chemical-mineralogical characterization of C&D waste recycled aggregates from Sao Paulo, Brazil

This study presents a methodology for the characterization of construction and demolition (C&D) waste recycled aggregates based on a combination of analytical techniques (X-ray fluorescence (XRF), soluble ions, semi-quantitative X-ray diffraction (XRD), thermogravimetric analysis (TCA-DTG) and hydrochloric acid (HCl) selective dissolution). These combined analytical techniques allow for the estimation of the amount of cement paste, its most important hydrated and carbonated phases, as well as the amount of clay and micas. Details of the methodology are presented here and the results of three representative C&D samples taken from the Sao Paulo region in Brazil are discussed. Chemical compositions of mixed C&D aggregate samples have mostly been influenced by particle size rather than the visual classification of C&D into red or grey and geographical origin. The amount of measured soluble salts in C&D aggregates (0.15-25.4 mm) is lower than the usual limits for mortar and concrete production. The content of porous cement paste in the C&D aggregates is around 19.3% (w/w). However, this content is significantly lower than the 43% detected for the C&D powders (< 0.15 min). The clay content of the powders was also high, potentially resulting from soil intermixed with the C&D waste, as well as poorly burnt red ceramic. Since only about 50% of the measured CaO is combined with CO(2), the powders have potential use as raw materials for the cement industry. (C) 2008 Elsevier Ltd. All rights reserved.

Forest restoration in an indigenous land considering a forest remnant influence (Avai, Sao Paulo State, Brazil)

The expansion of agricultural and pasture areas over native forest areas has been broadly documented and represents the main cause of deforestation that has occurred for the last decades. Such reality is not different in indigenous lands, and has been considered as an important obstacle for individuals who directly depend upon the appropriate management of natural resources to maintain their traditions. We investigated the seed rain, seed bank and natural regeneration of native woody species within a degraded pasture land in different distances from an adjacent seasonal semideciduous forest fragment to define methodological procedures based on ecological processes that might subsidize forest restoration in an indigenous land. Most seeds and seedlings picked from the seed rain and seed bank belonged to anemochoric and autochoric dispersing shrubby and herbaceous species originated in the pasture land. The woody species regeneration, on the other hand, reached higher levels, in terms of abundance and richness, as the forest fragment became closer. Zoochoric dispersal was predominant among such species and was mainly detected closer to the forest fragment. Several woody species picked in the forest fragment were also found in the pasture land, thus reinforcing their important role in supplying propagules and easing the successional process. (c) 2007 Elsevier B.V. All rights reserved.

The effectiveness of Eucalyptus barrier in containing the edge effect on a subtropical forest fragment in the state of Sao Paulo, Brazil

Edge effects resulting from isolation and subsequent microclimatic changes are one of the most important threats to the forest fragments conservation. The efficiency of maintaining a barrier formed by three rows of Eucalyptus along the edge of a subtropical seasonal semi deciduous forest fragment, surrounded by Eucalyptus monoculture, was evaluated as a way of softening the microclimatic changes (light intensity, temperature and relative humidity) and the impacts of eucalypt mechanized harvesting on the native vegetation along the contact zone between the forest fragment and the plantation. The Eucalyptus barrier was effective in softening the microclimate. Light intensity was 35% lower in the presence of the barrier. The barrier also provided a reduction of 1 C in air temperature and increased in 3.4% in relative humidity throughout the year. The barrier was also effective in preventing the impact on native vegetation, avoiding damage to adult trees and preserving the regenerating forest stratum near the border, which was reduced to less than 20% in density and 50% in richness, with no such barrier. The barrier of Eucalyptus may, therefore, be recommended as an effective method to minimize the impacts of mechanized forest harvesting operations and mitigate the microclimatic conditions along the edge of forest fragments.

Sugar and ethanol production as a rural development strategy in Brazil: Evidence from the state of Sao Paulo

Sugar and ethanol production are key components of Brazil`s rural development and energy strategies, yet in recent years sugar production has been widely criticized for its environmental and labor practices. This study examines the relationship between rural development and sugarcane, ethanol, and cattle production in the state of Sao Paulo. Our results suggest that the value added components of sugarcane production, which include sugar refining and ethanol production, may have a strong positive affect on local human development in comparison to primary agricultural production activities and other land uses. These results imply that sugar production, when accompanied by a local processing industry can stimulate rural development. However, this paper also highlights the significant environmental and social harms generated by the sugar industry at large, which may undermine its development benefits if not addressed. (C) 2011 Elsevier Ltd. All rights reserved.

Rhodacaridae mites (Acari: Mesostigmata: Rhodacaroidea) from the state of Sao Paulo, Brazil, with descriptions of a new genus and three new species

- This paper reports the occurrence of five species of Rhodacaridae mites collected in the State of Sao Paulo, Brazil. One of these corresponds to a new genus and a new species, Binodacarus brasiliensis n. gen. n. sp.; two correspond to new species of kno

ECONOMICAL OCCUPATION OF AGRICULTURAL AREA OF PIRACICABA (SAO PAULO STATE, BRAZIL), INCLUDING RISK THROUGH LINEAR PROGRAMMING

The economic occupation of an area of 500 ha for Piracicaba was studied with the irrigated cultures of maize, tomato, sugarcane and beans, having used models of deterministic linear programming and linear programming including risk for the Target-Motad model, where two situations had been analyzed. In the deterministic model the area was the restrictive factor and the water was not restrictive for none of the tested situations. For the first situation the gotten maximum income was of R$ 1,883,372.87 and for the second situation it was of R$ 1,821,772.40. In the model including risk a producer that accepts risk can in the first situation get the maximum income of R$ 1,883,372. 87 with a minimum risk of R$ 350 year(-1), and in the second situation R$ 1,821,772.40 with a minimum risk of R$ 40 year(-1). Already a producer averse to the risk can get in the first situation a maximum income of R$ 1,775,974.81 with null risk and for the second situation R$ 1.707.706, 26 with null risk, both without water restriction. These results stand out the importance of the inclusion of the risk in supplying alternative occupations to the producer, allowing to a producer taking of decision considered the risk aversion and the pretension of income.

Occurrence of phytoplasma associated with sugarcane yellow leaf syndrome in three regions of Sao Paulo State, Brazil

Sugarcane yellow leaf syndrome caused serious damage to crops in the Sao Paulo State, Brazil, in the 1990`s. The syndrome was also reported in other countries and investigations into the etiology revealed an association between the disease and virus and/or phytoplasma. The disease is potentially important and occurs endemically in that State, and for this reason the present study was conducted in order to demonstrate the occurrence of phytoplasma in three traditional sugarcane-producing areas, in Sao Paulo State, through molecular detection From naturally infected plants. Symptomatic plants belonging to varieties SP71-6163, SP71-6180 and SP89-1115 were sampled from Piracicaba, Jau and Ribeirao Preto, and total DNA was extracted from foliar tissues. Nested PCR was conducted with primer pairs P1/ Tint-16F2n/R2, and the amplified products were analyzed by electrophoresis on agarose gels. Amplified DNA fragments of 1.2 kb evidenced the presence of phytoplasma in 36% of symptomatic plants and revealed its Occurrence in all sampled regions. The results demonstrated that phytoplasma is associated with the disease and that it is important to keep a safe inspection of nurseries and monitoring plants in the field, as well as to Select Sugarcane genotypes with a good level of resistance in breeding programs.

South American leaf blight intensity evaluated in six clones of young and adult rubber trees in the Vale do Ribeira region, Sao Paulo state, Brazil

Rubber tree clones present different intensity of symptoms, depending on their age. This is mostly clearly seen in the presence or absence of old leaves with ascopores, corresponding to flows of new and susceptible leaves. The objective of this work was to evaluate the intensity of symptoms of south American leaf blight (SALB) in six rubber tree clones, one and eight years old, in the Vale do Ribeira region, Sao Paulo state. The results Showed that clones FX 3864, RRIM 600, IAN 873 and IAN 717 Suffered more attacks when young, and RRIM 600, IAN 717 and FX 3864 when adult. The clone IAN 873 showed the smallest amounts of disease in the adult phase, due to uniform change in the leaves and a compact flow of new leaves, which happened during a season that was unfavorable to pathogen infection, presenting the phenomenon of avoidance or evasion in time.

Soil mineralogy of mangrove forests from the state of Sao Paulo, Southeastern Brazil

The minerals of the clay fraction in estuarine plains are mainly detrital being a mixture of marine and continental sediments, but can also be authigenic. Because of the importance of mangrove ecosystems in tropical estuarine areas and the relatively few existing studies of the mineralogical composition of soils in these environments, the aim of this study was to determine the mineralogical assemblage and identify potential contrasts along the coast of the State of Sao Paulo. Soils from I I mangroves distributed along the coastal plain of the State of Sao Paulo were sampled at depths of 0 to 20 and 60 to 80 cm, and samples of suspended sediments from the Ribeira do Iguape River were collected for analysis. Mineralogical analyses were performed on the clay and silt fractions by x-ray diffraction (XRD) and transmission electron microscopy, and fresh soil samples were analyzed by scanning electron microscopy-energy dispersive spectrometry and suspended sediments by XRD. The silt fraction contained quartz, feldspars, gibbsite, kaolinite, illite, and vermiculite, and the clay fraction contained smectite, kaolinite, illite, gibbsite, quartz, and feldspars. Locally, vermiculite, biotite, anatase, halloysite, and goethite may occur because of recent transport of sediments to the system. Pyrite was identified in fresh samples. The allochthonous minerals found either were terrestrial and transported by rivers or had originated from the continental platform by past transgressive events. We suggest that the neoformation of smectite and kaolinite occurs in mangrove soils. Different geomorphological settings along the Sao Paulo coast appear to regulate mineral distribution in mangrove soils.