Education Level Explains Differences in Stroke Incidence among City Districts in Joinville, Brazil: A Three-Year Population-Based Study

Background: Current evidence suggests an inverse association between socioeconomic status and stroke incidence. Our aim was to measure the variation in incidence among different city districts (CD) and their association with socioeconomic variables. Methods: We prospectively ascertained all possible stroke cases occurring in the city of Joinville during the period 2005-2007. We determined the incidence for each of the 38 CD, age-adjusted to the population of Joinville. By linear regression analysis, we correlated incidence data with mean years of education (MYE) and mean income per month (MIPM). Results: Of the 1,734 stroke cases registered, 1,034 were first-ever strokes. In the study period, the crude incidence in Joinville was 69.5 per 100,000 (95% confidence interval, 65.3-73.9). The stroke incidence among CD ranged from 37.5 (22.2-64.6) to 151.0 per 100,000 (69.0-286.6). The stroke incidence was inversely correlated with years of education (r = -0.532; p<0.001). MYE and MIPM were strongly related (R = 0.958), resulting in exclusion of MIPM by collinearity. Conclusions: Years of education can explain a wide incidence variation among CD. These results may be useful to guide the allocation of resources in primary prevention policies. Copyright (C) 2011 S. Karger AG, Basel

Anti-leishmanial effects of purified compounds from aerial parts of Baccharis uncinella C. DC. (Asteraceae)

Species of Baccharis exhibit antibiotic, antiseptic, wound-healing, and anti-protozoal properties, and have been used in the traditional medicine of South America for the treatment of several diseases. In the present work, the fractionation of EtOH extract from aerial parts of Baccharis uncinella indicated that the isolated compounds caffeic acid and pectolinaringenin showed inhibitory activity against Leishmania (L.) amazonensis and Leishmania (V.) braziliensis promastigotes, respectively. Moreover, amastigote forms of both species were highly sensible to the fraction composed by oleanolic + ursolic acids and pectolinaringenin. Caffeic acid also inhibited amastigote forms of L. (L.) amazonensis, but this effect was weak in L. (V.) braziliensis amastigotes. The treatment of infected macrophages with these compounds did not alter the levels of nitrates, indicating a direct effect of the compounds on amastigote stages. The results presented herein suggest that the active components from B. uncinella can be important to the design of new drugs against American tegumentar leishmaniases.

Acute chagasic myocardiopathy after orthotopic liver transplantation with donor and recipient serologically negative for Trypanosoma cruzi: A case report

Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. Chagas disease following solid-organ transplantation has occurred in Latin America. This report presents the occurrence of Chagas disease despite negative serological tests in both the donor and the recipient, as well as the effectiveness of treatment. A 21-year-old woman from the state of Sao Paulo (Brazil) underwent cadaveric donor liver transplantation in November 2005, due to cirrhosis of autoimmune etiology. Ten months after liver transplantation, she developed signs and symptoms of congestive heart failure (New York Heart Association functional class IV). The echocardiogram, which was normal preoperatively, showed dilated cardiac chambers, depressed left ventricular systolic function (ejection fraction = 35%) and moderate pulmonary hypertension. Clinical investigation discarded ischemic heart disease and autoimmune and other causes for heart failure. Immuno fluorescence (immunoglobulin M and immunoglobulin G) and hemagglutination tests for T cruzi were positive, and abundant T cruzi amastigotes were readily identified in myocardial biopsy specimens. Treatment with benznidazole for 2 months yielded an excellent clinical response. At the moment of submission, the patient remains in functional class I. This case highlighted that more appropriate screening for T cruzi infection is mandatory in potential donors and recipients of solid-organ transplants in regions where Chagas disease is prevalent. Moreover, it stressed that this diagnosis should always be considered in recipients who develop cardiac complications, since negative serological tests do not completely discard the possibility of disease transmission and since good results can be achieved with prompt trypanocidal therapy.

Neonatal Handling Reduces Renal Function in Adult Rats

Background/Aims: To evaluate the effects of neonatal handling on hydroelectrolytic balance in adult rats. Methods: The litters were divided into two groups: nonhandled and handled. The procedure consisted of handling the pups for 1 min/day in the first 10 days postnatally. When adults, animals had their body weight verified and were housed in individual metabolic cages. After a 24-hour period, urine samples were collected and the urinary and water intake volumes measured. Blood samples to determine osmolality, aldosterone, corticosterone, angiotensin II, creatinine, urea, sodium and potassium levels were collected. The kidneys were removed for histological assessment. Urinary osmolality, sodium, urea and creatinine were also measured and the creatinine clearance (CC) calculated. Results: No difference between groups was found in the body weight. Handled animals showed a reduction in the total kidney wet weight, water intake, urinary volume, CC, plasma angiotensin II, corticosterone and aldosterone when compared to the nonhandled and an increase in the urinary osmolality and sodium excretion fraction. No differences in serum potassium and no evidence of structural changes were demonstrated by histological analysis. Conclusion: Neonatal handling induced long-lasting effects decreasing renal function without evidence of kidney structural changes. Copyright (c) 2009 S. Karger AG, Basel

Leigh-like syndrome with the T8993G mutation in the mitochondrial ATPase 6 gene: long-term follow-up discloses a slowly progressive course

We describe the long-term clinical outcome of a patient with Leigh-like syndrome presenting as an early onset encephalopathy and peripheral neuropathy caused by the T8993G mutation in the mitochondrial DNA (mtDNA). Clinical follow-up for 20 years revealed a peculiar pattern of slow disease progression, characterized by the addition of new minor deficits, while worsening of previous symptoms was mild. Brain MRI revealed cerebellar atrophy, diffuse demyelination of corona radiata and parietal white matter, and bilateral and symmetrical putaminal lesions. The proportion of mutant mtDNAs in blood was 72% (+/- 0.02%) and in skeletal muscle was 81% (+/- 0.4%). Leigh-like syndrome caused by the T8993G mtDNA mutation is a progressive disease, although not necessarily associated with an aggressive clinical course. (C) 2009 Elsevier B.V. All rights reserved.

A modified approach for vestibuloplasty in severely resorbed mandible using an implant-retained postoperative stent: a case report

Background. Severely resorbed mandibles often present a short band of keratinized tissue associated with a shallow vestibule. As a result, prominent muscle insertions are present, especially in the mental region of the mandible. This case report describes the deepening of the vestibular sulcus in an atrophic mandible by combining free gingival grafts harvested from the palate and a postoperative acrylic resin stent screwed on osseointegrated implants placed at the anterior region of the mandible. Study design. During the second-stage surgery, a split-thickness labial flap was reflected and apically sutured onto the periosteum. Two free gingival grafts were obtained and then sutured at this recipient site. A previously custom-made acrylic stent was then screwed onto the most distally positioned implants. To document the procedure`s stability over time, a metal ball was placed in the most apical part of the vestibule and standardized cephalometric radiographs were taken before and 6 months after the procedure. Linear measurements of vestibular depths over the observation time were realized using specific software for radiographic analysis. Results. The proposed technique augmented the band of attached masticatory mucosa, deepened the vestibule and prevented the muscle reinsertion. The difference between the 2 measurements of vestibular depths was 9.39 mm (initial 20.88 mm, final 11.49 mm) after a 6-month postoperative period. Conclusion. The technique, in combination with palatal mucosal graft and use of a postoperative stent, decreased the pull of mentalis muscle and provided a peri-implantally stable soft tissue around implants. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e7-e14)

Reforma da administra????o p??blica e cultura pol??tica no Brasil: uma vis??o geral

Texto bastante did??tico que compreende uma revis??o da evolu????o da administra????o p??blica brasileira, dos anos 30 aos 90, incluindo tra??os da heran??a colonial. Enfoca a deteriora????o da administra????o p??blica federal e discute diretrizes para a reforma do Estado no Brasil, apontando problemas e resist??ncias pol??ticas a serem enfrentadas

Desafios da constru????o de uma pol??tica intersetorial de cultura e educa????o

A transi????o paradigm??tica vivenciada pela gest??o p??blica no Brasil tem provocado a busca por arranjos institucionais capazes de romper com a in??rcia institucional e responder ?? complexidade das novas demandas sociais. O presente estudo busca analisar a intersetorialidade a partir de fatores pol??ticos e institucionais que influenciaram o Programa Mais Educa????o, com foco na articula????o entre as ??reas de educa????o e cultura. Trata-se de pesquisa qualitativa realizada a partir do estudo sistem??tico da literatura sobre pol??ticas intersetoriais, analisada ?? luz do modelo sist??mico de Easton. Aborda conceitos como agendamento e implementa????o de pol??ticas p??blicas, centrando-se no debate contempor??neo sobre intersetorialidade. Analisa, a partir dos dados levantados sobre o Programa Mais Educa????o e entrevistas semi dirigidas com gestores dos diferentes minist??rios que o integram, mecanismos existentes na gest??o p??blica para que essa intersetorialidade se efetive. Constata a centralidade do papel das ideias na burocracia de governo em resposta a demandas sociais hist??ricas, contudo sorganizadas. O estudo reconhece a educa????o integral como um campo de atua????o complexo e interdisciplinar, cujo desenvolvimento de pol??ticas p??blicas mais efetivas, eficientes e eficazes, exige abordagens distintas e somat??ria de esfor??os entre as ??reas. A complexidade do modelo de gest??o do Programa reflete-se em um arranjo institucional inovador em que a intersetorialidade otimiza recursos e esfor??os das ??reas envolvidas, exigindo coordena????o intersetorial centralizada e coopera????o entre os ??rg??os

Financiamento da cultura

O Minist??rio da Cultura tem por atribui????o formular e implementar a pol??tica nacional de desenvolvimento da cultura, estimular, acolher e apoiar as iniciativas destinadas a desenvolver e fortalecer as atividades culturais no Brasil, nas suas diversas e variadas formas de manifesta????o. Um dos instrumentos da pol??tica de incentivo ?? cultura ?? a Lei Rouanet, que permite que parte do Imposto de Renda da Pessoa Jur??dica seja deduzido a t??tulo de apoio ??s atividades culturais. A Lei Rouanet (Lei 8313/91) foi formulada num momento em que a cultura brasileira passava por uma fase de descr??dito junto aos governantes. No seu conjunto, procurou corrigir falhas e distor????es da legisla????o anterior, de modo a estabelecer maior transpar??ncia no relacionamento entre o produtor cultural e o empres??rio, adequando-o ??s exig??ncias fiscais vigentes. Entretanto, os resultados n??o foram satisfat??rios. Buscando solucionar o problema, o Minist??rio da Cultura adotou quatro conjuntos de medidas. A iniciativa obteve aumento do n??mero de projetos apresentados, aprovados e incentivados, comprovando a efic??cia das medidas adotadas. Come??aram a surgir projetos das regi??es Norte e Nordeste e do interior dos estados, indicando o impacto desconcentrador das medidas

Caf?? com debate: prospec????o de conhecimento no setor p??blico

O Caf?? com Debate recebeu a Presidente do Centro de Gest??o de Estudos Estrat??gicos, L??cia Melo, para abordar o tema: Prospec????o de Conhecimento no Setor P??blico, no dia 27 de abril, na ENAP. A apresenta????o da palestrante destacou que frente ao cen??rio de explos??o do conhecimento aliado aos desafios da inova????o, h?? uma compreens??o crescente sobre a centralidade da gest??o do conhecimento na promo????o do desenvolvimento econ??mico e social. Os processos de decis??o devem ser baseados em informa????o estrat??gica de qualidade, analisada e tratada de acordo com as necessidades. Assim, a import??ncia da prospec????o do conhecimento se justifica pela contribui????o para o desenvolvimento de uma cultura de pensamento estrat??gico e de mais longo prazo entre os tomadores de decis??o. L??cia Melo tamb??m ressaltou o importante papel do CGEE na promo????o e realiza????o de estudos e pesquisas prospectivas de alto n??vel na ??rea de ci??ncia e tecnologia e suas rela????es com os setores produtivos

Caf?? com debate: desenvolvendo aprendizagem para alcan??ar uma cultura de excel??ncia

Richard Rochefort, especialista na tem??tica de melhoria do atendimento ao p??blico por meio da capacita????o, e Rodrigo Ortiz Assump????o, secret??rio-adjunto de Log??stica e Tecnologia da Informa????o do Minist??rio do Planejamento, Or??amento e Gest??o, relataram experi??ncias do Canad?? e do Brasil e destacaram a import??ncia de uma ???revolu????o cultural??? na administra????o p??blica. Para Rochefort, a sabedoria dos servidores mais experientes, aliada ?? energia dos jovens, ?? capaz de impulsionar e melhorar a qualidade do atendimento ao cidad??o. "A m??dia de idade dos servidores, no Canad??, ?? de 50 anos. Estamos ensinando como devem se adaptar a diferentes situa????es. Agora sabem o que est??o fazendo e por que est??o fazendo determinado servi??o e isso ?? motivo de orgulho, para eles. Sentem-se mais preparados e valorizados. J?? os jovens, que est??o ingressando na administra????o p??blica, devem se manifestar, demonstrar sua criatividade. ?? preciso fazer a diferen??a", disse. O canadense ressaltou, ainda, que o conhecimento ?? o ??nico ativo que aumenta de valor ?? medida que ?? compartilhado

Implementa????o e reformula????o de pol??ticas p??blicas: o caso do programa Cultura Viva

O presente artigo tem por objetivo demonstrar como um processo de implementa????o se modifica e ?? adaptado ao longo do tempo, podendo conduzir a um redesenho da pol??tica p??blica. Utiliza-se como estudo de caso o programa Cultura Viva. A pesquisa em que se baseia o artigo foi realizada por meio de entrevistas semiestruturadas com gestores do programa Cultura Viva e gestores de pontos de cultura, bem como por meio de um survey com os pontos de cultura do Estado de S??o Paulo e seus Munic??pios. Os resultados revelam que a implementa????o do programa alterou os crit??rios estabelecidos no processo de formula????o e incluiu novos instrumentos de gest??o, redesenhando assim a pol??tica p??blica