Role of physical exercise in low back pain rehabilitation: a randomized controlled trial of a three-month exercise program in patients who have completed multidisciplinary rehabilitation.

STUDY DESIGN: Randomized controlled trial with 1-year follow-up. OBJECTIVE: To analyze the effects of an exercise program or routine follow-up on patients with chronic low back pain who have completed functional multidisciplinary rehabilitation. The short- and long-term outcome in terms of symptoms and physical and social functioning was compared. SUMMARY OF BACKGROUND DATA: Systematic reviews have shown that functional multidisciplinary rehabilitation improves physical function and reduces pain in patients with chronic low back pain. However, long-term maintenance of these improvements is inconsistent and the role of exercise in achieving this goal is unclear. METHODS: One hundred five chronic patients with low back pain who had completed a 3-week functional multidisciplinary rehabilitation program were randomized to either a 3-month exercise program (n = 56) or routine follow-up (n = 49). The exercise program consisted of 24 training sessions during 12 weeks. Patients underwent evaluations of trunk muscle endurance, cardiovascular endurance, lumbar spine mobility (flexion and extension range-of-motion, fingertip-to-floor distance), pain and perceived functional ability at the beginning and the end of functional multidisciplinary rehabilitation, at the end of the exercise program (3 months) and at 1-year follow-up. Disability was also assessed at the same time points except at the beginning of functional multidisciplinary rehabilitation. RESULTS: At the end of the functional multidisciplinary rehabilitation, both groups improved significantly in all physical parameters except flexion and extension range-of-motion. At the 3 month and 1 year follow-up, both groups maintained improvements in all parameters except for cardiovascular endurance. Only the exercise program group improved in disability score and trunk muscle endurance. No differences between groups were found. CONCLUSION: A favorable long-term outcome was observed after functional multidisciplinary rehabilitation in both patient groups. Patients who participated in an exercise program obtained some additional benefits. The relevance of these benefits to overall health status need to be further investigated.

Comparison of H/Al stoichiometry of mineral and organic soils in Brazil

Exchangeable Al has been used as a criterion for the calculation of lime requirement in several Brazilian States. However, the laboratory method with extraction by a 1 mol L-1 KCl solution followed by indirect alkaline titration is not accurate for some Brazilian soils, mainly in the case of soils with high organic matter content. The objective of this study was therefore to evaluate the stoichiometry of H+/Al3+ in KCl soil extracts. The results suggested that organically complexed Al is the main contributor to exchangeable acidity in soils enriched with organic matter. Liming recommendations for organic soils based exclusively on exchangeable Al determined by the NaOH titration method should therefore be revised.

Mammographic screening for breast cancer: background of a pilot program in the Canton of Vaud.

For several years now, substantial efforts have been devoted to the development and the implementation of a screening program for breast cancer in the Canton of Vaud. A four-year pilot phase is now starting, involving two regional hospitals with their catchment areas; women over 50 and under 70 years old will be invited to participate in the program. A double view mammography will be made, with a double reading made by the hospital radiologists; a third reading will be made in case of discrepancy between the two first radiologists. Patients classified as positive for screening (e.g., with a suspect radiological image) will be referred to their practitioner for further diagnosis and treatment. The medical and public health background of this program is discussed, more specifically the reasons for developing a screening program, the choice of mammography rather than other tools, and the need to implement screening as an organized program.

Morphological and molecular characterization of Pisolithus in soil under eucalyptus plantations in Brazil

Eighteen Pisolithus basidiomes were collected from Eucalyptus plantations in the state of Minas Gerais, Brazil. These basidiomes were characterized morphologically and molecularly. The basidiomes varied in shape, color and size. One of them was found underground, indicating a hypogeous fungus. The main morphological distinctive characteristic was spore ornamentation, which distinguished two groups. One group with short and erect spines was identified as Pisolithus microcarpus, and the other with long and curved spines as Pisolithus marmoratus, after analyzing the cladogram obtained by phylogenetic relationship based on internal transcribed spacer (ITS) regions of the nuclear ribosomal DNA of these isolates.

Replication of an ivg protocol to estimate bioaccessible arsenic in materials from a gold mining area in Brazil

Tests for bioaccessibility are useful in human health risk assessment. No research data with the objective of determining bioaccessible arsenic (As) in areas affected by gold mining and smelting activities have been published so far in Brazil. Samples were collected from four areas: a private natural land reserve of Cerrado; mine tailings; overburden; and refuse from gold smelting of a mining company in Paracatu, Minas Gerais. The total, bioaccessible and Mehlich-1-extractable As levels were determined. Based on the reproducibility and the accuracy/precision of the in vitro gastrointestinal (IVG) determination method of bioaccessible As in the reference material NIST 2710, it was concluded that this procedure is adequate to determine bioaccessible As in soil and tailing samples from gold mining areas in Brazil. All samples from the studied mining area contained low percentages of bioaccessible As.

Revisiting the S-index for soil physical quality and its use in Brazil

The S-index was introduced in 2004 in a publication by A.R. Dexter. S was proposed as an indicator of soil physical quality. A critical value delimiting soils with rich and poor physical quality was proposed. At present, Brazil is world leader in citations of Dexter's publication. In this publication the S-theory is mathematically revisited and extended. It is shown that S is mathematically correlated to bulk density and total porosity. As an absolute indicator, the value of S alone has proven to be incapable of predicting soil physical quality. The critical value does not always hold under boundary conditions described in the literature. This is to be expected because S is a static parameter, therefore implicitly unable to describe dynamic processes. As a relative indicator of soil physical quality, the S-index has no additional value over bulk density or total porosity. Therefore, in the opinion of the author, the fact that bulk density or total porosity are much more easily determined than the water retention curve for obtaining S disqualifies S as an advantageous indicator of relative soil physical quality. Among the several equations available for the fitting of water retention curves, the Groenevelt-Grant equation is preferable for use with S since one of its parameters and S are linearly correlated. Since efforts in soil physics research have the purpose of describing dynamic processes, it is the author's opinion that these efforts should shift towards mechanistic soil physics as opposed to the search for empirical correlations like S which, at present, represents far more than its reasonable share of soil physics in Brazil.

BEYOND THE “LEAST LIMITING WATER RANGE”: RETHINKING SOIL PHYSICS RESEARCH IN BRAZIL

As opposed to objective definitions in soil physics, the subjective term “soil physical quality” is increasingly found in publications in the soil physics area. A supposed indicator of soil physical quality that has been the focus of attention, especially in the Brazilian literature, is the Least Limiting Water Range (RLL), translated in Portuguese as "Intervalo Hídrico Ótimo" or IHO. In this paper the four limiting water contents that define RLLare discussed in the light of objectively determinable soil physical properties, pointing to inconsistencies in the RLLdefinition and calculation. It also discusses the interpretation of RLL as an indicator of crop productivity or soil physical quality, showing its inability to consider common phenological and pedological boundary conditions. It is shown that so-called “critical densities” found by the RLL through a commonly applied calculation method are questionable. Considering the availability of robust models for agronomy, ecology, hydrology, meteorology and other related areas, the attractiveness of RLL as an indicator to Brazilian soil physicists is not related to its (never proven) effectiveness, but rather to the simplicity with which it is dealt. Determining the respective limiting contents in a simplified manner, relegating the study or concern on the actual functioning of the system to a lower priority, goes against scientific construction and systemic understanding. This study suggests a realignment of the research in soil physics in Brazil with scientific precepts, towards mechanistic soil physics, to replace the currently predominant search for empirical correlations below the state of the art of soil physics.

Políticas e práticas de conciliação entre família e trabalho no Brasil: issues and policies in Brazil

O objetivo deste trabalho é situar a problemática da conciliação entre trabalho remunerado e responsabilidades familiares no recente processo de transformação da estrutura das famílias e do mercado de trabalho no Brasil. A partir de dados da Pesquisa Nacional por Amostra de Domicílios do Instituto Brasileiro de Geografia e Estatística, é feita uma caracterização das mudanças nas estruturas das famílias brasileiras e da inserção das mulheres no mercado de trabalho de acordo com a estrutura da família. Particularmente, pretendemos mostrar que o baixo desenvolvimento de serviços coletivos que permitem socializar os custos dos cuidados com a família prejudica a quantidade e qualidade da inserção feminina, sobretudo das mães, no mercado de trabalho.

Dépistage néonatal systématique de la mucoviscidose en Suisse: dès janvier 2011 [Implementation of the neonatal cystic fibrosis screening program in Switzerland: beginning January 2011].

The diagnosis of cystic fibrosis (CF) is often delayed because of the nonspecificity of a wide variety of clinical symptoms at disease onset. Newborn screening for CF has been advocated to reduce delays in diagnosis, facilitating preventive care for early respiratory and nutritional involvement. According to American and European consensus and experience of existing programs, a Swiss Nationwide Cystic Fibrosis Newborn Screening Program started in January 2011. Screening strategy combines two steps: an immunoreactive trypsinogen assay and DNA mutation analysis in dried blood samples at day 4 (Guthrie cards).

Molecular biology of baculovirus and its use in biological control in Brazil

Baculoviruses are insect viruses found mainly in Lepidoptera. The family Baculoviridae is taxonomically divided in two genera, Nucleopolyhedrovirus and Granulovirus, which differ by occlusion body morphology. NPVs (Nucleopolyhedroviruses) have polyhedrical inclusion bodies (PIBs) containing multiple viral particles, while GVs (Granuloviruses) appear to be generally single particles occluded in oval shaped occlusion bodies. During the life cycle, two different viral progenies are produced: BV (Budded Virus) and PDV (Polyhedra Derived Virus), which are essential for the infectious process and virus propagation in host cells. Baculoviruses are being used for pest control and they are especially safe due to their specificity and invertebrate-restricted host range. Baculoviruses have been used as vectors for high level protein expression ofheterologous genes from prokaryotic and eukaryotic organisms. Also, recombinant DNA techniques have allowed the production of genetically modified viral insecticides. This study is a review on the taxonomy, structure, replication and molecular biology of baculoviruses, as well as their use as bioinsecticides in Brazil.

Provenance and family variation of Pinus caribaea var. hondurensis from Guatemala and Honduras, grown in Brazil, Colombia and Venezuela

Pinus caribaea var. hondurensis (Sénécl) Barr. & Golf. is a tropical pine that naturally occurs in lowland areas of Belize, El Salvador, Guatemala, Honduras, Nicaragua, and eastern Mexico. It has been one of the most studied tropical pines and the one with the most commercial importance in Brazil. The objective of this work was to select the best provenances for plantations and best trees in families for the establishment of seed orchards. For that a trial with five provenances and 47 open-pollinated families was planted near Planaltina, Federal District, in the Cerrado Region of Brazil. The provenances tested were Poptun (Guatemala), Gualjoco, Los Limones, El Porvenir and Santa Cruz de Yojoa (Honduras) and assessed at 12 years of age. Poptun and Gualjoco had larger volume, and Los Limones and El Porvenir the lowest incidence of forks and foxtails. Individual tree heritabilities for volume, stem form and branch diameter were 0.34, 0.06, and 0.26 respectively. More than 90% of the trees had defects, common in unimproved P. caribaea. Selection criteria for quality traits need to be relaxed in the first generation of breeding to allow for larger genetic gains in productivity. Results from this test compared with P. caribaea var. hondurensis trials in other Brazilian, Colombian and Venezuelan sites suggest that provenance x site and family x site interactions are not as strong as in other pine species.

Nouveau programme de formation en médecine interne générale: implications pour les médecins de premier recours [The new postgraduate training program in general internal medicine: implications for the primary care physician].

The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. Thus, the primary care physicians have more than ever an important role to play in educating tomorrows doctors. A competency-based model of training requires a regular assessment of the residents. The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.

X-Ray systems: radiation protection program in basic research applications

Although the radiation doses involved in basic research radiology are relatively small, the increasing number of radiological procedures makes risks becoming increasingly high. Quality control techniques in radiological practice have to ensure an adequate system of protection for people exposed to radiation. These techniques belong to a quality assurance program for X-ray machines and are designed to correct problems related to equipment and radiological practices, to obtain radiological images of high quality and to reduce the unnecessary exposures.

Detection of three Allexivirus species infecting garlic in Brazil

Garlic viruses often occur in mixed infections under field conditions. In this study, garlic samples collected in three geographical areas of Brazil were tested by Dot-ELISA for the detection of allexiviruses using monoclonal specific antibodies to detect Garlic virus A (GarV-A), Garlic virus B (GarV-B), Garlic virus C (GarV-C) and a polyclonal antiserum able to detect the three virus species mentioned plus Garlic virus D (GarV-D). The detected viruses were biologically isolated by successive passages through Chenopodium quinoa. Reverse Transcriptase Polimerase Chain Reaction (RT-PCR) was performed using primers designed from specific regions of the coat protein genes of Japanese allexiviruses available in the Genetic Bank of National Center of Biotechnology Information (NCBI). By these procedures, individual garlic virus genomes were isolated and sequenced. The nucleotide and amino acid sequence analysis and the one with serological data revealed the presence of three distinct allexiviruses GarV-C, GarV-D and a recently described allexivirus, named Garlic mite-borne filamentous virus (GarMbFV), in Brazil.

Yield and performance of sugarcane in on-farm interface with rubber in Brazil

Agroforestry systems are indicated as an alternative for sugarcane (Saccharum officinarum) cultivation in Piracicaba, SP, Brazil, however there are not many field experiments on plant performance under these conditions in the world. The objective of this work was to assess crop yield and partitioning in a sugarcane-rubber (Hevea brasiliensis) interface in on-farm conditions. The availability of irradiance for the crop along the interface was simulated and its effe ct over sugarcane dry matter production was tested. Crop yield was negatively affected by distance of the trees, but development and sucrose were not affected. Above ground dry matter increased from 16.6 to 51.5 t ha-1 from trees. Partitioning did not have a defined standard, as harvest index increased from 0.85 to 0.93, but specific leaf area was not significant along the transect, ranging from 13.48 to 15.73 m² kg-1. Light is the main factor of competition between the trees and the crop, but the relative importance of below ground interactions increases closer to the trees. Feasibility of the system depends on maturity of the trees and management strategies.