Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil

OBJECTIVE : To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS : Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS : A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS : Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.

A sensitivity study of the WRF model in wind simulation for an area of high wind energy

The performance of the Weather Research and Forecast (WRF) model in wind simulation was evaluated under different numerical and physical options for an area of Portugal, located in complex terrain and characterized by its significant wind energy resource. The grid nudging and integration time of the simulations were the tested numerical options. Since the goal is to simulate the near-surface wind, the physical parameterization schemes regarding the boundary layer were the ones under evaluation. Also, the influences of the local terrain complexity and simulation domain resolution on the model results were also studied. Data from three wind measuring stations located within the chosen area were compared with the model results, in terms of Root Mean Square Error, Standard Deviation Error and Bias. Wind speed histograms, occurrences and energy wind roses were also used for model evaluation. Globally, the model accurately reproduced the local wind regime, despite a significant underestimation of the wind speed. The wind direction is reasonably simulated by the model especially in wind regimes where there is a clear dominant sector, but in the presence of low wind speeds the characterization of the wind direction (observed and simulated) is very subjective and led to higher deviations between simulations and observations. Within the tested options, results show that the use of grid nudging in simulations that should not exceed an integration time of 2 days is the best numerical configuration, and the parameterization set composed by the physical schemes MM5–Yonsei University–Noah are the most suitable for this site. Results were poorer in sites with higher terrain complexity, mainly due to limitations of the terrain data supplied to the model. The increase of the simulation domain resolution alone is not enough to significantly improve the model performance. Results suggest that error minimization in the wind simulation can be achieved by testing and choosing a suitable numerical and physical configuration for the region of interest together with the use of high resolution terrain data, if available.

Generation of Nakagami correlated fading in GNSS signals affected by ionospheric scintillation

We propose a low complexity technique to generate amplitude correlated time-series with Nakagami-m distribution and phase correlated Gaussian-distributed time-series, which is useful for the simulation of ionospheric scintillation effects in GNSS signals. To generate a complex scintillation process, the technique requires solely the knowledge of parameters Sa (scintillation index) and σφ (phase standard deviation) besides the definition of models for the amplitude and phase power spectra. The concatenation of two nonlinear memoryless transformations is used to produce a Nakagami-distributed amplitude signal from a Gaussian autoregressive process.

Practical simulation of GNSS signals in the presence of ionospheric scintillaton

We propose a low complexity technique to generate amplitude correlated time-series with Nakagami-m distribution and phase correlated Gaussian-distributed time-series, which is useful in the simulation of ionospheric scintillation effects during the transmission of GNSS signals. The method requires only the knowledge of parameters S4 (scintillation index) and σΦ (phase standard deviation) besides the definition of models for the amplitude and phase power spectra. The Zhang algorithm is used to produce Nakagami-distributed signals from a set of Gaussian autoregressive processes.

Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD) = 10.42) in 2000 to 14.92/thousand inhabitants (SD = 10.04) in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

Performance evaluation of hospitals that provide care in the public health system, Brazil

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

Determinação do teor de compostos aromáticos policíclicos de óleos minerais isolantes para transformadores

Mestrado em Engenharia Química - Ramo Optimização Energética na Indústria Química

Análise da capacidade vital e da máxima capacidade de insuflação: relação com a função bulbar nos doentes com Esclerose Lateral Amiotrófica

Introdução: A Esclerose Lateral Amiotrófica (ELA) é considerada uma das doenças neuromusculares (DNM) com características mais limitantes e fatais, sendo caracterizada por fraqueza muscular progressiva. Objectivo: Analisar a evolução da Capacidade Vital e da Máxima Capacidade Inspiratória em doentes com ELA e a sua relação causal com a função bulbar. Procedimentos: A partir de uma população alvo de 203 pacientes com ELA, foram incluídos no estudo aqueles que tinham entre 2 a 4 testes de função respiratória considerados válidos (CV <2000ml) perfazendo um total de 22 indivíduos. As medidas CV e MCI foram analisadas. Resultados: A CV diminuiu ao longo do tempo (media±desvio padrão no 1ºmomento de avaliação =1779,5±692,3; media±desvio padrão no 4ºmomento de avaliação =1108,6±475,7). O comportamento da MCI foi mais estável ao longo dos 4 momentos de avaliação. Avaliou-se a correlação entre as duas variáveis, destacando-se a relação existente entre as duas nos doentes bulbares (coeficiente = 1). Quando avaliada a diferença entre a CV e a MCI, verificamos que o nível de significância no grupo (n=22) aumentou ao longo do tempo. Ao comparamos esta diferença por subgrupos, registou-se uma diferença significativa apenas nos doentes bulbares (1ºmomento – p=0,008 e último momento de avaliação – p 0). Conclusão: Nos doentes com disfunção bulbar a CV diminui ao longo do tempo. A relação entre MCI e CV é um bom factor preditivo da evolução e prognóstico da doença e de diagnóstico do envolvimento da musculatura bulbar.

O impacto de um programa de exercícios com o Inspirómetro de Incentivo na função pulmonar em doentes com Escoliose Idiopática

Introdução: A escoliose é uma deformidade vertebral muito comum e de grande importância social. A etiologia da escoliose idiopática da adolescência é desconhecida e descrita como multifatorial. Segundo a literatura existe uma forte correlação entre a função pulmonar anormal e a gravidade da deformidade da coluna vertebral. Tem sido proposto como abordagem terapêutica o uso de Inspirómetro de Incentivo, contudo, ainda se encontra incerto a sua eficácia nesta patologia. Objetivo: Analisar o impacto de um programa de exercícios domiciliários com o Inspirómetro de Incentivo em doentes com Escoliose Idiopática nos volumes pulmonares e na força muscular dos músculos respiratórios. Metodologia: Foram avaliados, por meio de um estudo experimental, 12 indivíduos do sexo feminino (com média e desvio padrão correspondentes a 15,1 e 1,6 respetivamente) com diagnóstico de Escoliose Idiopática antes e 3meses após a cirurgia corretiva e 12 indivíduos saudáveis também do sexo feminino (com média e desvio padrão correspondentes a 15,2 e 1,4 respetivamente). A função pulmonar foi avaliada através do espirómetro computorizado Spinolab®, a força dos músculos respiratórios avaliou-se através da mensuração da PImáx e PEmáx com o Microrpm®. Para finalizar a avaliação o participante foi sujeito a aplicação do THRESHOLD® com 30% da PImáx obtida. O protocolo domiciliário, referente à parte experimental, baseou-se no uso bi-diário do Inspirómetro de Incentivo Respiflo FS®, que foi fornecido aos participantes no dia da alta hospitalar. Resultados: Foram encontrados valores menores da função respiratória e força muscular (p<0,05) no grupo de doentes com Escoliose em relação ao grupo dos Saudáveis, excepto em relação ao Índice de Tiffeneau (p=0,17). No entanto, quando se comparou o grupo Controlo e o Grupo Experimental não severificaram diferenças estatisticamente significativas em relação às variáveis estudadas. Por fim, na análise dos parâmetros nos dois momentos de avaliação (inicial e final) entre o grupo dos Saudáveis e grupo Experimental verificou-se que existiam diferenças estatisticamente significativas ao nível da CFV (pi=0,02; pf=0,00), FEV1 (pi=0,01; pf=0,00) e PImáx inicial (p=0,02) e PImáx th inicial (p=0,03). Conclusão: A função pulmonar e a força dos músculos respiratórios em indivíduos com diagnóstico de Escoliose Idiopática encontra-se diminuída quando comparada com uma população saudável. Dentro das condições propostas no presente estudo, verificou-se que a aplicação de um programa de exercícios com o Inspirómetro de Incentivo com duração de 3 meses não revela resultados significativos ao nível da função pulmonar e da força dos músculos respiratórios.

Vitamin D Intake and Cardiometabolic: Risk Factors in Adolescents

Background: A growing body of research suggests that vitamin D might play an important role in overall health. No data exist on vitamin D intake for the Azorean adolescent population. The purpose of this study was to assess vitamin D intake and investigate a possible association between vitamin D intake and cardiometabolic risk factors in Azorean adolescents. Methods: A cross-sectional school-based study was conducted on 496 adolescents (288 girls) aged 15–18 years from the Azorean Islands, Portugal. Anthropometric measurements (waist circumference and height), blood pressure (systolic), and plasma biomarkers [fasting glucose, insulin, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs)] were measured to assess metabolic risk. Homeostasis model assessment (HOMA), TC-to-HDL-C ratio, and waist-to-height ratio were calculated. For each of these variables, a Z-score was computed by age and sex. A metabolic risk score was constructed by summing the Zscores of all individual risk factors. High risk was considered when the individual had ‡ 1 standard deviation(SD) of this score. Vitamin D intake was assessed with a semiquantitative food frequency questionnaire. Participants were classified into quartiles of vitamin D intake. Logistic regression was used to determine odds ratios for high cardiometabolic risk scores after adjusting for total energy intake, pubertal stage, fat mass percentage, and cardiorespiratory fitness. Results: Mean (SD) vitamin D intake was 5.8 (6.5) mg/day, and 9.1% of Azorean adolescents achieved the estimated average requirement of vitamin D (10 mg/day or 400 IU). Logistic regression showed that the odds ratio for a high cardiometabolic risk score was 3.35 [95% confidence interval (CI) 1.28–8.75] for adolescents in the lowest vitamin D intake quartile in comparison with those in the highest vitamin D intake quartile, even after adjustment for confounders. Conclusion: A lower level of vitamin D intake was associated with worse metabolic profile among Azorean adolescents.

AN ELISA SUITABLE FOR THE DETECTION OF RABIES VIRUS ANTIBODIES IN SERUM SAMPLES FROM HUMAN VACCINATED WITH EITHER CELL-CULTURE VACCINE OR SUCKLING-MOUSE-BRAIN VACCINE

An indirect ELISA for determination of post-vaccination rabies antibody was applied. Purified rabies virus was used as antigen to coat plates, and staphylococcal protein A linked with horseradish peroxidase was used for detecting IgG antibody in human sera. Sera from humans, vaccinated with cell-culture vaccine or suckling-mouse-brain vaccine, were examined. ELISA results were compared to those obtained from the virus neutralization test. The mean and standard deviation of OD were determined for 126 negative sera (pre-vaccination) and for 73 sera from vaccinated persons showing antibody titers lower than 0.5 IU/ml. Results were defined as ELISA -positive, -negative or -doubtful. Establishment of a doubtful region reduced the number of sera otherwise classified as positive (false-positive sera). In this way, the sensitivity, specificity and agreement values were respectively 87.5%, 92.4% and 88.5%. No significant differences were observed in these values when the group vaccinated with cell-culture vaccine and the group vaccinated with suckling-mouse-brain vaccine were compared. It was shown that much of the disagreement between the values obtained by neutralization test and ELISA occurred in sera obtained at the beginning of the immunization process, and was probably due to the presence of IgM in the serum samples, detected only by the former test. This ELISA method can be used as a screening test in rabies laboratories regardless of the kind of vaccine used for immunization.

Total IgE detection in paired cerebrospinal fluid and serum samples from patients with neurocysticercosis

Neurocysticercosis (NC), the presence of Taenia solium metacestodes in tissues, is the most frequent and severe parasitic infection of the central nervous system. We investigated the presence of total IgE by an automated chemiluminescence assay in 53 paired cerebrospinal fluid (CSF) and serum samples from patients with NC (P) and in 40 CSF samples from individuals with other neurological disorders as the control group (C). Total IgE concentration ranged from 1.2 to 6.6 IU/ml (mean = 1.4 IU/ml, standard deviation-sd = 1.1 IU/ml) in 28.3% of CSF samples from the P group, a value significantly higher than for the C group (£1.0 IU/ml). The serum samples from the P group showed concentrations ranging from 1.0 to 2330.0 IU/ml (mean = 224.1 IU/ml, sd = 452.1 IU/ml), which were higher than the normal value cited by the manufacturer (<100.0 IU/ml) in 32.1% of the samples. A significant difference was observed in CSF samples from the P and C groups (p = 0.005) and in serum samples from the P group compared to the normal value (p = 0.005), with sera showing more frequent abnormal results.

Mycoplasma pneumoniae and Chlamydia pneumoniae in calcified nodules of aortic stenotic valves

Aortic Valve Stenosis (AVS) has been explained as an atherosclerotic process of the valve as they often exhibit inflammatory changes with infiltration of macrophages, T lymphocytes and lipid infiltration. The present study investigated whether the bacteria Chlamydia pneumoniae (CP) and Mycoplasma pneumoniae (MP), detected previously in atherosclerotic plaques, are also present in AVS. Ten valves surgically removed from patients with AVS were analyzed by immunohistochemistry, in situ hybridization, and electron microscopy. The mean and standard deviation of the percentage areas occupied by CP antigens and MP - DNA were respectively 6.21 +/- 5.41 and 2.27 +/- 2.06 in calcified foci; 2.8 +/- 3.33 and 1.78+/- 3.63 in surrounding fibrotic areas, and 0.21 +/- 0.17 and 0.12 +/- 0.13 in less injured parts of the valve. There was higher amount of CP and MP in the calcified foci and in the surrounded fibrosis than in more preserved valvular regions. In conclusion, the fact that there were greater amounts of CP and MP in calcification foci of AVS favors the hypothesis that AS is not an inevitable degenerative process due to aging, but rather that it may be a response to the presence of these bacteria, similarly to the morphology detected in atherosclerosis damage.

Determination of Microcystin-LR in waters in the subnanomolar range by sol–gel imprinted polymers on solid contact electrodes

The present work reports new sensors for the direct determination of Microcystin-LR (MC-LR) in environmental waters. Both selective membrane and solid contact were optimized to ensure suitable analytical features in potentiometric transduction. The sensing layer consisted of Imprinted Sol–Gel (ISG) materials capable of establishing surface interactions with MC-LR. Non-Imprinted Sol–Gel (NISG) membranes were used as negative control. The effects of an ionic lipophilic additive, time of sol–gel polymerization, time of extraction of MC-LR from the sensitive layer, and pH were also studied. The solid contact was made of carbon, aluminium, titanium, copper or nickel/chromium alloys (80 : 20 or 90 : 10). The best ISG sensor had a carbon solid contact and displayed average slopes of 211.3 mV per decade, with detection limits of 7.3 1010 M, corresponding to 0.75 mg L1 . It showed linear responses in the range of 7.7 1010 to 1.9 109 M of MC-LR (corresponding to 0.77–2.00 mg L1 ), thus including the limiting value for MC-LR in waters (1.0 mg L1 ). The potentiometric-selectivity coefficients were assessed by the matched potential method for ionic species regularly found in waters up to their limiting levels. Chloride (Cl) showed limited interference while aluminium (Al3+), ammonium (NH4 + ), magnesium (Mg2+), manganese (Mn2+), sodium (Na+ ), and sulfate (SO4 2) were unable to cause the required potential change. Spiked solutions were tested with the proposed sensor. The relative errors and standard deviation obtained confirmed the accuracy and precision of the method. It also offered the advantages of low cost, portability, easy operation and suitability for adaptation to flow methods.

Stochastic model of transcription initiation of closely spaced promoters in escherichia coli

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica