824 resultados para Analysis of health policy


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This paper shows the possibility of obtaining new parameters for the mathematical modelling of data on stable isotopes in biological systems and its application in obtaining data on metabolic pools of blood plasma, blood serum, liver and muscle of broilers. This theory states that the modelling of turnover used for studies of isotopic incorporation when the metabolism has a single metabolic pool is feasible by the technique of setting an exponential. However, when the metabolism has more than one metabolic pool, it is necessary to apply the linearization technique, linear regression adjustment and evaluation of the assumptions of regression to obtain the kinetic parameters such as half-life (T1/2) and isotope exchange rate (k). The application of this technique on carbon-13 data from 100 one-day-old chicks, with the change of diet composed of grains of the photosynthetic cycle of plants from C4 to C3, in broilers has enabled the discovery that the liver, blood plasma and blood serum have a single metabolic pool; however, the pectoral muscle has two metabolic pools. For the liver, blood plasma and blood serum, the half-life values were found by the exponential fit being T1/2 = 1.4 days with the rate of exchange of k = 0.502, T1/2 = 2.4 days with k = 0.293 and T1/2 = 2.0 days with k = 0.348, respectively. For the pectoral muscle, after linearization, the half-life values were found for T1/2(1) = 1.7 and T1/2(2) = 3 days, with exchange rates of k1 = 0.405 and k2 = 0.235, representing approximately 66 and 34 %, respectively.

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A method for the identification and quantification of pesticide residues in water, soil, and sediment samples has been developed, validated, and applied for the analysis of real samples. The specificity was determined by the retention time and the confirmation and quantification of analyte ions. Linearity was demonstrated over the concentration range of 20 to 120 µg L(-1), and the correlation coefficients varied between 0.979 and 0.996, depending on the analytes. The recovery rates for all analytes in the studied matrix were between 86% and 112%. The intermediate precision and repeatability were determined at three concentration levels (40, 80, and 120 µg L(-1)), with the relative standard deviation for the intermediate precision between 1% and 5.3% and the repeatability varying between 2% and 13.4% for individual analytes. The limits of detection and quantification for fipronil, fipronil sulfide, fipronil-sulfone, and fipronil-desulfinyl were 6.2, 3.0, 6.6, and 4.0 ng L(-1) and 20.4, 9.0, 21.6, and 13.0 ng L(-1), respectively. The method developed was used in water, soil, and sediment samples containing 2.1 mg L(-1) and 1.2% and 5.3% of carbon, respectively. The recovery of pesticides in the environmental matrices varied from 88.26 to 109.63% for the lowest fortification level (40 and 100 µg kg(-1)), from 91.17 to 110.18% for the intermediate level (80 and 200 µg kg(-1)), and from 89.09 to 109.82% for the highest fortification level (120 and 300 µg kg(-1)). The relative standard deviation for the recovery of pesticides was under 15%.

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Purpose: This population-based, cross-sectional study aimed to record the DMFT index for 12 year-old children with dental caries and fluorosis levels in cities with and without public water supply fluoridation. Methods: From the 101 municipalities belonging to the Health Regional Department XV (DRSXV-SJRP) of the São Paulo state in the Southeast region of Brazil, 85 cities were selected after exclusion of those with incomplete data and less than ten years of fluoridation treatment in 2004. The criteria adopted for the assessment of dental caries and fluorosis levels were based on the guidelines published in the WHO Manual 4th edition. The data were analyzed using Fisher’s exact tests at a significance level of 5%. Results: The prevalence of caries in 12 year-old children had no significant association with fluoridated water, and was considered “moderate” and “high” in cities without fluoridation and “low” and “moderate” in cities with fluoridation. A significant association was found between water fluoridation and fluorosis (P=0.001), but not between water fluoridation and the DMFT index (P=0.119). Conclusion: The prevalence of fluorosis was related to water fluoridation in this study. However, fluorosis was also observed in non-fluoridated cities, which may result from fluoride intake through other sources.

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Orange juice is a rich source of flavonoids, mainly the flavanones hesperidin and narirutin, associated with health benefits in humans. The objective of this study was to analyze the uptake of flavonoids in humans after the consumption of two types of orange juice, fresh squeezed (fresh juice, FJ) and commercially extracted and pasteurized (processed juice, PJ). Preliminary measurements showed that the main flavanones in PJ were approximately three-fold higher than in FJ. This study involved healthy volunteers including 12 men and 12 women, aged 27 ± 6, with a BMI of 24 ± 3 kg/m2. Volunteers drank 11.5 mL/kg body weight of fresh orange juice, and after an interval of 30 days they drank the same quantity of pasteurized orange juice. Urine was collected from each volunteer during 24 hours following juice consumption. Urine metabolites were recovered by solid phase extraction, and measured by HPLC–ESI–MS. Analyses of the urine samples showed high concentrations of glucuronic acid and sulfate conjugates of hesperetin and naringenin. The data indicate that the concentrations of the flavanone metabolites following consumption of PJ were approximately three times higher than for FJ, thus matching the relative doses of these compounds in the juices provided to the volunteers.

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In Brazil, a policy on citizen participation and consultation in urban intervention programs, in particular in the development of master plans, was first introduced into the Federal Constitution in 1988. This article presents an historical reconstitution of Master Plans in Bauru – State of São Paulo – Brazil. The 1968, 1988 and 2005/2006 consultation methods are analyzed using established criteria. The degree of community participation in the processes is estimated by drawing on a typology based on the level of involvement by residents. The effects of participation caused by changes in political regime, technical planning vision, legal support to consultation, recognition of community importance and knowledge acquired during the process are highlighted and discussed.

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Small businesses are considered important engines for job growth and economic development by policy makers worldwide. One of the most commonly cited constraints of small businesses is a lack of access to capital. To address this constraint, small business loan guarantee programs have been established in over 100 countries. There are a variety of types of guarantee funds, with the most significant differences being which borrowers are eligible for guarantees, and how borrowers are approved for guarantees. There is currently no clear delineation between types of programs and the economic conditions they operate in, though some trends are becoming apparent. However, these trends may not be leading to the best economic outcomes possible. By better matching the structure of the guarantee fund to the economic conditions it operates in, the program’s success in meeting economic development goals may be greatly improved. Many programs in developing countries may not be taking advantage of bank expertise and may be limiting the scope of their effectiveness. At the same time, programs in developed countries may be wasting resources by scattering their efforts too thinly and subsidizing less competitive firms to the detriment of local economic development.

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A Qualitative Analysis of Youth Feedback of Nutrition School Enrichment Kits in Lincoln, NE Richard A. Losey, M.S. University of Nebraska, 2010 Advisor: Wanda M. Koszewski The qualitative analysis of the responses given by students participating in classrooms that used the Nutrition Education Program‟s (NEP) school enrichment kits was the primary focus of this research. Data was collected from the participants in written form. Three major themes appeared during analysis of the data, healthy eating habits, cleanliness and change. The theme of healthy eating habits is comprised of the following sub-themes: breakfast, nutrients, label reading, Food Guide Pyramid/MyPyramid and healthy snacks. Cleanliness is comprised of hand washing and food safety sub-themes. The change theme is made up of change in healthy eating habits, change in cleanliness and change in both healthy eating habits and cleanliness. The data suggests that participating students have made or intend to make changes regarding healthy eating habits and cleanliness, which is the goal of nutrition education. The students‟ responses indicate that the NEP school enrichment kits are effective in increasing the knowledge of students and promoting healthy lifestyle changes.

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Background: Malaria caused by Plasmodium vivax is an experimentally neglected severe disease with a substantial burden on human health. Because of technical limitations, little is known about the biology of this important human pathogen. Whole genome analysis methods on patient-derived material are thus likely to have a substantial impact on our understanding of P. vivax pathogenesis and epidemiology. For example, it will allow study of the evolution and population biology of the parasite, allow parasite transmission patterns to be characterized, and may facilitate the identification of new drug resistance genes. Because parasitemias are typically low and the parasite cannot be readily cultured, on-site leukocyte depletion of blood samples is typically needed to remove human DNA that may be 1000X more abundant than parasite DNA. These features have precluded the analysis of archived blood samples and require the presence of laboratories in close proximity to the collection of field samples for optimal pre-cryopreservation sample preparation. Results: Here we show that in-solution hybridization capture can be used to extract P. vivax DNA from human contaminating DNA in the laboratory without the need for on-site leukocyte filtration. Using a whole genome capture method, we were able to enrich P. vivax DNA from bulk genomic DNA from less than 0.5% to a median of 55% (range 20%-80%). This level of enrichment allows for efficient analysis of the samples by whole genome sequencing and does not introduce any gross biases into the data. With this method, we obtained greater than 5X coverage across 93% of the P. vivax genome for four P. vivax strains from Iquitos, Peru, which is similar to our results using leukocyte filtration (greater than 5X coverage across 96% of the genome). Conclusion: The whole genome capture technique will enable more efficient whole genome analysis of P. vivax from a larger geographic region and from valuable archived sample collections.

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Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient's recovery as it causes clinical complications and could even lead to the patient's death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirao Preto, Sao Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26-91 years), were evaluated consecutively. An anamnesis was taken before the patient's participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation. Copyright (C) 2012 S. Karger AG, Basel

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Objective: To To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. Methods: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). Results: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. Conclusions: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program. (C) 2012 Elsevier Ltd. All rights reserved.

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The purpose of this study was to present a spatial analysis of the social vulnerability of teenage pregnancy by geoprocessing data on births and deaths present on the Brazilian Ministry of Health databases in order to support intersectoral management actions and strategies based on spatial analysis in neighborhood areas. The thematic maps of the educational, occupational, birth and marital status of mothers, from all births and deaths in the city, presented a spatial correlation with teenage pregnancy. These maps were superimposed to produce social vulnerability map of adolescent pregnancy and women in general. This process presents itself as a powerful tool for the study of social vulnerability.

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We evaluated the diagnostic quality of first-trimester ultrasound images transmitted in realtime using low-cost telecommunications. A prospective sample of fetal ultrasound images from 11 weeks to 13 weeks and six days of pregnancy was obtained from pregnant women over 18 years old. The examinations were transmitted in realtime to three independent examiners who carried out a qualitative assessment based on parameters established by the Fetal Medicine Foundation. All fetal structures could be viewed and the quality of images received by the examiners was considered normal. There were significant differences for crown-rump length and nuchal translucency in the transmitted images but the loss in definition was acceptable. Thus the quality of images transmitted via the Internet through the use of low-cost software appeared suitable for screening for chromosomal abnormalities in the first trimester of pregnancy.

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Background: Many studies reported that brief interventions are effective in reducing excessive drinking. This study aimed to assess the efficacy of a protocol of brief intervention for college students (BASICS), delivered face-to-face, to reduce risky alcohol consumption and negative consequences. Methods: A systematic review with meta-analysis was performed by searching for randomized controlled trials (RCTs) in Medline, PsycInfo, Web of Science and Cochrane Library databases. A quality assessment of RCTs was made by using a validated scale. Combined mean effect sizes, using meta-analysis random-effects models, were calculated. Results: 18 studies were included in the review. The sample sizes ranged from 54 to 1275 (median = 212). All studies presented a good evaluation of methodological quality and four were found to have excellent quality. After approximately 12 months of follow-up, students receiving BASICS showed a significant reduction in alcohol consumption (difference between means = -1.50 drinks per week, 95% CI: -3.24 to -0.29) and alcohol-related problems (difference between means = -0.87, 95% CI: -1.58 to -0.20) compared to controls. Conclusions: Overall, BASICS lowered both alcohol consumption and negative consequences in college students. Gender and peer factors seem to play an important role as moderators of behavior change in college drinking. Characteristics of BASICS procedure have been evaluated as more favorable and acceptable by students in comparison with others interventions or control conditions. Considerations for future researches were discussed.

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The acquired enamel pellicle (AEP) is a thin film formed by the selective adsorption of salivary proteins onto the enamel surface of teeth. The AEP forms a critical interface between the mineral phase of teeth (hydroxyapatite) and the oral microbial biofilm. This biofilm is the key feature responsible for the development of dental caries. Fluoride on enamel surface is well known to reduce caries by reducing the solubility of enamel to acid. Information on the effects of fluoride on AEP formation is limited. This study aimed to investigate the effects of fluoride treatment on hydroxyapatite on the subsequent formation of AEP. In addition, this study pioneered the use of label-free quantitative proteomics to better understand the composition of AEP proteins. Hydroxyapatite discs were randomly divided in 4 groups (n = 10 per group). Each disc was exposed to distilled water (control) or sodium fluoride solution (1, 2 or 5%) for 2 hours. Discs were then washed and immersed in human saliva for an additional 2 hours. AEP from each disc was collected and subjected to liquid chromatography electrospray ionization mass spectrometry for protein identification, characterization and quantification. A total of 45 proteins were present in all four groups, 12 proteins were exclusively present in the control group and another 19 proteins were only present in the discs treated with 5% sodium fluoride. Relative proteomic quantification was carried out for the 45 proteins observed in all four groups. Notably, the concentration of important salivary proteins, such as statherin and histatin 1, decrease with increasing levels of fluoride. It suggests that these proteins are repulsed when hydroxyapatite surface is coated with fluoride. Our data demonstrated that treatment of hydroxyapatite with fluoride (at high concentration) qualitatively and quantitatively modulates AEP formation, effects which in turn will likely impact the formation of oral biofilms.