Uso de medicamentos por pessoas com deficiências em áreas do estado de São Paulo

OBJETIVO: Analisar o consumo de medicamentos e os principais grupos terapêuticos consumidos por pessoas com deficiências físicas, auditivas ou visuais. MÉTODOS: Estudo transversal em que foram analisados dados do Inquérito Multicêntrico de Saúde no Estado de São Paulo (ISA-SP) em 2002 e do Inquérito de Saúde no Município de São Paulo (ISA-Capital), realizado em 2003. Os entrevistados que referiram deficiências foram estudados segundo as variáveis que compõem o banco de dados: área, sexo, renda, faixa etária, raça, consumo de medicamentos e tipos de medicamentos consumidos. RESULTADOS: A percentagem de consumo entre as pessoas com deficiência foi de: 62,8 por cento entre os visuais; 60,2 por cento entre os auditivos e 70,1 por cento entre os físicos. As pessoas com deficiência física consumiram 20 por cento mais medicamentos que os não-deficientes. Entre as pessoas com deficiência visual, os medicamentos mais consumidos foram os diuréticos, agentes do sistema renina-angiotensina e analgésicos. Pessoas com deficiência auditiva utilizaram mais analgésicos e agentes do sistema renina-angiotensina. Entre indivíduos com deficiência física, analgésicos, antitrombóticos e agentes do sistema renina-angiotensina foram os medicamentos mais consumidos. CONCLUSÕES: Houve maior consumo de medicamentos entre as pessoas com deficiências quando comparados com os não-deficientes, sendo os indivíduos com deficiência física os que mais consumiram fármacos, seguidos de deficientes visuais e auditivos

O programa de incentivo à instalação de cozinhas comunitárias: avaliação de uma política pública brasileira

O trabalho tem como objetivo descrever e avaliar as Cozinhas Comunitárias (CC) apoiadas pelo Ministério do Desenvolvimento Social (MDS) em funcionamento no Brasil em 2006. Trata-se de estudo transversal que investigou as CC, com projetos contemplados nos editais do MDS realizados entre os anos de 2003 a 2005. Inicialmente foram identificadas as CC em funcionamento e estas CC foram visitadas para a coleta de dados relativos ao atendimento prestado, avaliação da estrutura física e das refeições oferecidas. A estrutura física foi avaliada por meio de um check-list, baseado nas exigências da legislação sanitária, e a oferta de refeições foi caracterizada pelos alimentos e preparações oferecidas pelas CC para determinar o valor nutricional das refeições. A maioria das cozinhas financiadas (60%) estava em fase de implementação no momento da entrevista, entre as cozinhas em funcionamento, a maioria estava localizada nos Estados de Santa Catarina e Paraná. Observou-se também que cerca de 20% das cozinhas não ofereciam refeições regularmente. Ao realizar a avaliação nutricional das refeições, foi observada uma grande heterogeneidade na oferta de alimentos. Ao avaliar as condições higiênico-sanitárias, quase a totalidade das CC foram classificadas como deficientes ou regulares, indicando inadequação na produção de refeições. O Programa das Cozinhas Comunitárias pode exercer importante papel nas políticas de segurança alimentar e nutricional do país, no entanto, devem ser realizados esforços no sentido de garantir a implantação em comunidades situadas nos Estados menos desenvolvidos, com fixação de números mínimos para atendimento, de parâmetros nutricionais e garantia de fornecimento seguro de alimentos

Uma nova classificação de alimentos baseada na extensão e propósito do seu processamento

Este artigo descreve uma nova classificação de alimentos baseada na extensão e propósito do processamento industrial usado na sua produção. Três grupos são definidos: alimentos não processados ou minimamente processados (grupo 1), alimentos processados utilizados como ingredientes de preparações culinárias ou pela indústria de alimentos (grupo 2), e produtos alimentícios ultra-processados (grupo 3). O uso da classificação é ilustrado aplicando-a a dados coletados por Pesquisa de Orçamentos Familiares conduzida em 2002/2003 em uma amostra probabilística de 48.470 domicílios brasileiros. A disponibilidade diária foi de 1.792kcal/capita, sendo 42,5por cento de alimentos do grupo 1, 37,5por cento do grupo 2 e 20por cento do grupo 3. A contribuição do grupo 3 aumentou com a renda familiar, correspondendo a um terço do total calórico nos domicílios mais afluentes. Discute-se o impacto sobre a qualidade geral da dieta, padrões de alimentação e condições de saúde que poderia ocorrer com a substituição de alimentos do grupo 1 e ingredientes do grupo 2 por produtos alimentícios do grupo 3

Renda familiar, preço de alimentos e aquisição domiciliar de frutas e hortaliças no Brasil

OBJETIVO: Analisar a influência da renda familiar e do preço de alimentos sobre a participação de frutas e hortaliças dentre os alimentos adquiridos pelas famílias brasileiras. MÉTODOS: Foram utilizados dados da Pesquisa de Orçamentos Familiares realizada pelo Instituto Brasileiro de Geografia e Estatística, com amostra probabilística de 48.470 domicílios brasileiros entre 2002 e 2003. A participação de frutas e hortaliças no total de aquisições de alimentos foi expressa como percentual do total de calorias adquiridas e como calorias provenientes desses alimentos ajustadas para o total de calorias adquirido. Empregaram-se técnicas de análise de regressão múltipla para estimação de coeficientes de elasticidade, controlando-se variáveis sociodemográficas e preço dos demais alimentos. RESULTADOS: Observou-se aumento da participação de frutas e hortaliças no total de aquisições de alimentos com a diminuição de seu próprio preço ou com o aumento da renda. A diminuição do preço de frutas e hortaliças em 1 por cento aumentaria sua participação em 0,79 por cento do total calórico; o aumento de 1 por cento na renda familiar aumentaria essa participação no total calórico em 0,27 por cento. O efeito da renda tendeu a ser menor nos estratos de maior renda. CONCLUSÕES: A redução do preço de frutas e hortaliças, tanto pelo apoio à cadeia de produção dos alimentos quanto por medidas fiscais, é um promissor instrumento de política pública capaz de aumentar a participação desses alimentos na dieta brasileira

Trends in morbid obesity and in bariatric surgeries covered by the Brazilian public health system

Background Obesity is an increasingly serious public health problem on a global level. Morbid obesity, defined as a body mass index greater than 40 kg/m2, is associated with increased mortality and a high burden of obesity-related morbidities. Methods To study the prevalence of morbid obesity in Brazil, three national anthropometric surveys were reanalyzed. Data about bariatric surgeries were obtained from the Ministry of Health Hospital Information System, which is available online. Results A 255% rise in the prevalence of morbid obesity was observed, starting at 0.18% in 1975-1976 and growing to 0.33% in 1989 and 0.64% in 2002-2003. There was a higher rate in the South in the first two surveys, but the prevalence in the Southeast rose steadily, reaching 0.77% in 2002-2003 and overtaking the South. Since 1999, the Brazilian Unified Health System has covered surgical treatment for morbid obesity. From 2000 to 2006, there was a sixfold increase in the number of surgeries, which topped the 2,500 mark in 2006. The geographic distribution of these surgeries is heavily concentrated in the Southeast, the most developed region of Brazil, where there is also the highest prevalence of morbid obesity. This was followed by the Southern region. Conclusions The figures for the rise in morbid obesity in Brazil are startling, especially the increase among men. This is a situation that calls for further study, alongside measures to encourage the adoption of healthy lifestyles. Preventive measures aimed at slowing down or reversing the obesity epidemic are urgently required

Echocardiographic study of paediatric patients with mucopolysaccharidosis

Principle Mucopolysaccharidosis is an inborn error of metabolism causing glucosaminoglycans tissue storage. Cardiovascular involvement is variable but contributes significantly towards the morbidity and mortality of the patients. Objective To characterise the echocardiographic abnormalities in children and adolescents with different types of mucopolysaccharidosis. Method Echocardiograms and medical records of 28 patients aged 2–14 years, seen from 2003 to 2005, were revised. At that time, the enzymatic replacement therapy was still not available in our institution.Results Echocardiographic alterations were detected in 26 patients (93 per cent), whereas 16 (57 per cent) had abnormal auscultation, and only 6 (21 per cent) presented with cardiovascular complaint. Mitral valve thickening with dysfunction (regurgitation, stenosis, or double lesion) was diagnosed in 60.8 per cent, left ventricular hypertrophy in 43 per cent and aortic valve thickening with regurgitation in 35.8 per cent of the patients. There was no systolic dysfunction and mild left diastolic dysfunction was shown in 21.5 per cent of the patients. Pulmonary hypertension was present in 36 per cent of the patients, causing the only two deaths recorded. There was a strong association between the accumulation of dermatan sulphate and the presence of mitral valve dysfunction (p = 0.0003), aortic valve dysfunction (p = 0.006), and pulmonary hypertension (p = 0.006). Among individuals with two or more examinations, 82 per cent had a worsening evolution. Conclusions Echocardiographic alterations in children with Mucopolysaccharidosis are frequent and have a progressive character Left valve lesions, ventricular hypertrophy, and pulmonary hypertension were the most common findings and there was an association between the accumulation of dermatan sulphate and cardiovascular involvement. Unlike in adults, pulmonary hypertension was the main cause of death, not left ventricle systolic dysfunction

Characterization of Dengue Virus Type 2: New Insights on the 2010 Brazilian Epidemic

Dengue viruses (DENV) serotypes 1, 2, and 3 have been causing yearly outbreaks in Brazil. In this study, we report the reintroduction of DENV2 in the coast of Sao Paulo State. Partial envelope viral genes were sequenced from eighteen patients with dengue fever during the 2010 epidemic. Phylogenetic analysis showed this strain belongs to the American/Asian genotype and was closely related to the virus that circulated in Rio de Janeiro in 2007 and 2008. The phylogeny also showed no clustering by clinical presentation, suggesting that the disease severity could not be explained by distinct variants or genotypes. The time of the most recent common ancestor of American/Asian genotype and the Sao Paulo and Rio de Janeiro (SP/RJ) monophyletic cluster was estimated to be around 40 and 10 years, respectively. Since this virus was first identified in Brazil in 2007, we suggest that it was already circulating in the country before causing the first documented outbreak. This is the first description of the 2010 outbreak in the State of Sao Paulo, Brazil, and should contribute to efforts to control and monitor the spread of DENVs in endemic areas.

Impact of outdoor biomass air pollution on hypertension hospital admissions

Background This study aimed to evaluate the association between the total suspended particles (TSP) generated from burning sugar cane plantations and the incidence of hospital admissions from hypertension in the city of Araraquara. Methods The study was an ecological time-series study. Total daily records of hypertension (ICD 10th I10-15) were obtained from admitted patients of all ages in a hospital in Araraquara, Sao Paulo State, Brazil, from 23 March 2003 to 27 July 2004. The daily concentration of TSP (mu g/m(3)) was obtained using a Handi-Vol sampler placed in downtown Araraquara. The local airport provided daily measures of temperature and humidity. In generalised linear Poisson regression models, the daily number of hospital admissions for hypertension was considered to be the dependent variable and the daily TSP concentration the independent variable. Results TSP presented a lagged effect on hypertension admissions, which was first observed 1 day after a TSP increase and remained almost unchanged for the following 2 days. A 10 mu g/m(3) increase in the TSP 3 day moving average lagged in 1 day led to an increase in hypertension-related hospital admissions during the harvest period (12.5%, 95% CI 5.6% to 19.9%) that was almost 30% higher than during non-harvest periods (9.0%, 95% CI 4.0% to 14.3%). Conclusions Increases in TSP concentrations were associated with hypertension-related hospital admissions. Despite the benefits of reduced air pollution in urban cities achieved by using ethanol produced from sugar cane to power automobiles, areas where the sugar cane is produced and harvested were found to have increased public health risk.

Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992-2003

Background: The objective of this study was to assess trends in cancer mortality by educational level in Barcelona from 1992 to 2003. Methods: The study population comprised Barcelona inhabitants aged 20 years or older. Data on cancer deaths were supplied by the system of information on mortality. Educational level was obtained from the municipal census. Age-standardized rates by educational level were calculated. We also fitted Poisson regression models to estimate the relative index of inequality (RII) and the Slope Index of Inequalities (SII). All were calculated for each sex and period (1992-1994, 1995-1997, 1998-2000, and 2001-2003). Results: Cancer mortality was higher in men and women with lower educational level throughout the study period. Less-schooled men had higher mortality by stomach, mouth and pharynx, oesophagus, larynx and lung cancer. In women, there were educational inequalities for cervix uteri, liver and colon cancer. Inequalities of overall and specific types of cancer mortality remained stable in Barcelona; although a slight reduction was observed for some cancers. Conclusion: This study has identified those cancer types presenting the greatest inequalities between men and women in recent years and shown that in Barcelona there is a stable trend in inequalities in the burden of cancer.

Inequalities in mortality of men by oral and pharyngeal cancer in Barcelona, Spain and Sao Paulo, Brazil, 1995-2003

Background: Large inequalities of mortality by most cancers in general, by mouth and pharynx cancer in particular, have been associated to behaviour and geopolitical factors. The assessment of socioeconomic covariates of cancer mortality may be relevant to a full comprehension of distal determinants of the disease, and to appraise opportune interventions. The objective of this study was to compare socioeconomic inequalities in male mortality by oral and pharyngeal cancer in two major cities of Europe and South America. Methods: The official system of information on mortality provided data on deaths in each city; general censuses informed population data. Age-adjusted death rates by oral and pharyngeal cancer for men were independently assessed for neighbourhoods of Barcelona, Spain, and Sao Paulo, Brazil, from 1995 to 2003. Uniform methodological criteria instructed the comparative assessment of magnitude, trends and spatial distribution of mortality. General linear models assessed ecologic correlations between death rates and socioeconomic indices (unemployment, schooling levels and the human development index) at the inner-city area level. Results obtained for each city were subsequently compared. Results: Mortality of men by oral and pharyngeal cancer ranked higher in Barcelona (9.45 yearly deaths per 100,000 male inhabitants) than in Spain and Europe as a whole; rates were on decrease. Sao Paulo presented a poorer profile, with higher magnitude (11.86) and stationary trend. The appraisal of ecologic correlations indicated an unequal and inequitably distributed burden of disease in both cities, with poorer areas tending to present higher mortality. Barcelona had a larger gradient of mortality than Sao Paulo, indicating a higher inequality of cancer deaths across its neighbourhoods. Conclusion: The quantitative monitoring of inequalities in health may contribute to the formulation of redistributive policies aimed at the concurrent promotion of wellbeing and social justice. The assessment of groups experiencing a higher burden of disease can instruct health services to provide additional resources for expanding preventive actions and facilities aimed at early diagnosis, standardized treatments and rehabilitation.

THE SPECTRAL EVOLUTION AND EJECTA OF RECURRENT NOVA U Sco IN THE 2010 OUTBURST

Synoptic spectroscopic observations of the U Sco 2010 outburst from maximum light to quiescence as well as a contemporaneous X-ray observation are presented and analyzed. The X-ray spectrum 52 days after outburst indicates a hot source ( kT(bb) similar to 70 eV). Narrow-line components from the irradiated companion atmosphere were observed in hydrogen and helium optical recombination lines. The formation of a nebular spectrum is seen for the first time in this class of recurrent novae, allowing a detailed study of the ejecta using photoionization models. Unusual [O III] auroral-to-nebular line ratios were found and possible scenarios of their origin are discussed. The modeling of the emission line spectrum suggests highly heterogeneous ejecta with masses around or above 3 x 10(-6) M(sun).

Confronting dark energy models using galaxy cluster number counts

The mass function of cluster-size halos and their redshift distribution are computed for 12 distinct accelerating cosmological scenarios and confronted to the predictions of the conventional flat Lambda CDM model. The comparison with Lambda CDM is performed by a two-step process. First, we determine the free parameters of all models through a joint analysis involving the latest cosmological data, using supernovae type Ia, the cosmic microwave background shift parameter, and baryon acoustic oscillations. Apart from a braneworld inspired cosmology, it is found that the derived Hubble relation of the remaining models reproduces the Lambda CDM results approximately with the same degree of statistical confidence. Second, in order to attempt to distinguish the different dark energy models from the expectations of Lambda CDM, we analyze the predicted cluster-size halo redshift distribution on the basis of two future cluster surveys: (i) an X-ray survey based on the eROSITA satellite, and (ii) a Sunayev-Zeldovich survey based on the South Pole Telescope. As a result, we find that the predictions of 8 out of 12 dark energy models can be clearly distinguished from the Lambda CDM cosmology, while the predictions of 4 models are statistically equivalent to those of the Lambda CDM model, as far as the expected cluster mass function and redshift distribution are concerned. The present analysis suggests that such a technique appears to be very competitive to independent tests probing the late time evolution of the Universe and the associated dark energy effects.

Chemical evolution of the Galactic bulge as traced by microlensed dwarf and subgiant stars III. Detection of lithium in the metal-poor bulge dwarf MOA-2010-BLG-285S

Context. To study the evolution of Li in the Galaxy it is necessary to observe dwarf or subgiant stars. These are the only long-lived stars whose present-day atmospheric chemical composition reflects their natal Li abundances according to standard models of stellar evolution. Although Li has been extensively studied in the Galactic disk and halo, to date there has only been one uncertain detection of Li in an unevolved bulge star. Aims. Our aim with this study is to provide the first clear detection of Li in the Galactic bulge, based on an analysis of a dwarf star that has largely retained its initial Li abundance. Methods. We performed a detailed elemental abundance analysis of the bulge dwarf star MOA-2010-BLG-285S using a high-resolution and high signal-to-noise spectrum obtained with the UVES spectrograph at the VLT when the object was optically magnified during a gravitational microlensing event (visual magnification A similar to 550 during observation). The Li abundance was determined through synthetic line profile fitting of the (7)Li resonance doublet line at 670.8 nm. The results have been corrected for departures from LTE. Results. MOA-2010-BLG-285S is, at [Fe/H] = -1.23, the most metal-poor dwarf star detected so far in the Galactic bulge. Its old age (12.5 Gyr) and enhanced [alpha/Fe] ratios agree well with stars in the thick disk at similar metallicities. This star represents the first unambiguous detection of Li in a metal-poor dwarf star in the Galactic bulge. We find an NLTE corrected Li abundance of log epsilon(Li) = 2.16, which is consistent with values derived for Galactic disk and halo dwarf stars at similar metallicities and temperatures. Conclusions. Our results show that there are no signs of Li enrichment or production in the Galactic bulge during its earliest phases. Observations of Li in other galaxies (omega Cen) and other components of the Galaxy suggest further that the Spite plateau is universal.

Constraints on cold dark matter accelerating cosmologies and cluster formation

We discuss the properties of homogeneous and isotropic flat cosmologies in which the present accelerating stage is powered only by the gravitationally induced creation of cold dark matter (CCDM) particles (Omega(m) = 1). For some matter creation rates proposed in the literature, we show that the main cosmological functions such as the scale factor of the universe, the Hubble expansion rate, the growth factor, and the cluster formation rate are analytically defined. The best CCDM scenario has only one free parameter and our joint analysis involving baryonic acoustic oscillations + cosmic microwave background (CMB) + SNe Ia data yields (Omega) over tilde = 0.28 +/- 0.01 (1 sigma), where (Omega) over tilde (m) is the observed matter density parameter. In particular, this implies that the model has no dark energy but the part of the matter that is effectively clustering is in good agreement with the latest determinations from the large- scale structure. The growth of perturbation and the formation of galaxy clusters in such scenarios are also investigated. Despite the fact that both scenarios may share the same Hubble expansion, we find that matter creation cosmologies predict stronger small scale dynamics which implies a faster growth rate of perturbations with respect to the usual Lambda CDM cosmology. Such results point to the possibility of a crucial observational test confronting CCDM with Lambda CDM scenarios through a more detailed analysis involving CMB, weak lensing, as well as the large-scale structure.

Detection of high-velocity material from the wind-wind collision zone of Eta Carinae across the 2009.0 periastron passage

We report near-infrared spectroscopic observations of the Eta Carinae massive binary system during 2008-2009 using the CRIRES spectrograph mounted on the 8m UT 1 Very Large Telescope (VLT Antu). We detect a strong, broad absorption wing in He I lambda 10833 extending up to -1900 km s(-1) across the 2009.0 spectroscopic event. Analysis of archival Hubble Space Telescope/Space Telescope Imaging Spectrograph ultraviolet and optical data identifies a similar high-velocity absorption (up to -2100 km s(-1)) in the ultraviolet resonance lines of Si IV lambda lambda 1394, 1403 across the 2003.5 event. Ultraviolet resonance lines from low-ionization species, such as Si II lambda lambda 1527, 1533 and CII lambda lambda 1334, 1335, show absorption only up to -1200 km s(-1), indicating that the absorption with velocities -1200 to -2100 km s(-1) originates in a region markedly more rapidly moving and more ionized than the nominal wind of the primary star. Seeing-limited observations obtained at the 1.6m OPD/LNA telescope during the last four spectroscopic cycles of Eta Carinae (1989-2009) also show high-velocity absorption in He I lambda 10833 during periastron. Based on the large OPD/LNA dataset, we determine that material with velocities more negative than -900 km s(-1) is present in the phase range 0.976 <= phi <= 1.023 of the spectroscopic cycle, but absent in spectra taken at phi <= 0.947 and phi >= 1.049. Therefore, we constrain the duration of the high-velocity absorption to be 95 to 206 days (or 0.047 to 0.102 in phase). We propose that the high-velocity absorption component originates in shocked gas in the wind-wind collision zone, at distances of 15 to 45 AU in the line-of-sight to the primary star. With the aid of three-dimensional hydrodynamical simulations of the wind-wind collision zone, we find that the dense high-velocity gas is along the line-of-sight to the primary star only if the binary system is oriented in the sky such that the companion is behind the primary star during periastron, corresponding to a longitude of periastron of omega similar to 240 degrees-270 degrees. We study a possible tilt of the orbital plane relative to the Homunculus equatorial plane and conclude that our data are broadly consistent with orbital inclinations in the range i = 40 degrees-60 degrees.