Determinants of vaccination after the Colombian health system reform

OBJECTIVE: To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. METHODS: A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. RESULTS: The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). CONCLUSIONS: The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

Levantamento de anomalias nos sistemas impermeabilizantes de coberturas planas

As coberturas planas são um dos principais elementos construtivos de uma edificação, necessitando por isso de materiais com qualidade e certificados por organismos competentes, bem como de uma conceção e execução minuciosas. Em Portugal, os estudos sobre as anomalias realmente observadas em coberturas planas são ainda bastante reduzidos. Nesse âmbito, o presente trabalho teve como objetivo, efetuar o levantamento e a análise estatística das principais anomalias e causas identificadas em coberturas planas de 75 edifícios, permitindo assim a elaboração de um estudo que possa contribuir para a prevenção dessas anomalias e que indique também as medidas necessárias à reparação e os respetivos custos associados. As anomalias foram analisadas através da observação "in situ" das coberturas o que conduziu ao preenchimento de fichas de obra com os dados recolhidos. Da análise estatística efetuada aos edifícios, verificou-se que as principais anomalias detetadas estão relacionadas com perfurações e fissurações do sistema impermeabilizante, resultantes da falta de conhecimento dos utilizadores. Foi possível verificar erros de execução de remates em pontos singulares da cobertura, por falta de pormenores construtivos desses pontos ou erros de execução por parte do aplicador. Em muitos dos casos estudados, não foi detetada nenhuma anomalia, porque se considerou razoável considerar que o sistema impermeabilizante tenha atingido o fim de vida útil. O custo médio por metro quadrado associado à reabilitação de uma cobertura plana é influenciado principalmente por dois fatores: área e acessibilidade da cobertura. O tipo de anomalia e/ou a sua causa não determinaram o custo por metro quadrado da reparação efetuada, pois esta foi sempre de caracter integral e nunca pontual.

Qualidade de vida do doente com insuficiência cardíaca do Centro Hospitalar Tâmega e Sousa

A Insuficiência Cardíaca (IC), como uma doença crónica, tem vindo a ser alvo de análise devido ao seu impacto, não só a nível económico, mas também a nível da qualidade de vida (QV). Vários estudos demonstram que os doentes com IC apresentam um comprometimento da QV, em várias dimensões. OBJETIVO: Descrever a QV dos doentes com IC do Centro Hospitalar Tâmega e Sousa (CHTS). METODOLOGIA: O estudo é quantitativo, transversal, prospetivo e descritivo. Foi aplicado, entre janeiro a junho de 2012, o Euro Quality of Life Instrument-5D (EQ-5D) para avaliar o estado de saúde (ES) e o Kansas City Cardiomyopathy Questionnaire (KCCQ) para avaliar a QV de 326 doentes com IC, dos quais 226 seguidos na Consulta Externa (77,9% masculinos, idade média 67,5 ±11,6 anos, desvio padrão) e 100 na Clínica de IC (CIC) (73,0% masculinos, idade média 59,0 anos, desvio padrão ±12,7). Foi usada a estatística descritiva, teste t, qui quadrado e a análise da variância. RESULTADOS: Os doentes do género feminino, do grupo etário 75-100 anos, solteiros, divorciados, separados ou viúvos, que não sabem ler nem escrever, sem apoio dos amigos e sem condições económicas mínimas para o tratamento da IC apresentaram pior ES e QV. Os doentes submetidos à terapia de ressincronização cardíaca e às cirurgias valvular e de revascularização tiveram melhor QV. Os doentes com IC de etiologia isquémica e em classe III-IV da New York Heart Association apresentaram pior ES. Nestas classes e com fração de ejeção ≤35% os doentes tiveram pior QV. Os doentes da CIC evidenciaram melhor ES e QV. CONCLUSÕES: A QV dos doentes com IC do CHTS é influenciada pelos fatores pessoais, clínicos e pelo local de intervenção. É fundamental mensurar a QV, na prática clínica, para evidenciar a perceção do ES dos doentes e o impacto da IC na QV.

Temporal variation in reproductive phenology of Patella spp.: past and present.

World Congress of Malacology, Universidade dos Açores, Ponta Delgada, 21-28 de julho.

O uso do smartphone na avaliação do risco de queda associado ao envelhecimento

Introdução: O declínio do equilíbrio, da força dos membros inferiores e o medo de cair são fatores de risco de queda associados ao envelhecimento e a sua avaliação pode ser realizada pelo teste One Leg Standing (OLS), Sit to Stand (STS) e pela Falls Eficacy Scale (FES), respetivamente. As aplicações para smartphone constituem uma alternativa para a avaliação dos fatores de risco de queda no envelhecimento. Objetivo: Analisar a capacidade de uma aplicação para smartphone na avaliação dos testes STS, OLS e FES. Metodologia: Realizou-se um estudo analítico numa amostra de 27 voluntários com idade ≥ 60 anos. Realizaram-se os testes STS, OLS e a FES (versão iconográfica, apresentada no smartphone). Os dados foram recolhidos simultaneamente por um smartphone e pelo Qualisys Motion Capture Systems associado a uma plataforma de forças. Foi utilizado o r de Pearson ou Spearman para analisar as possíveis correlações. Resultados: No STS obteve-se uma correlação muito forte (rp=0.97) no número de repetições de ciclos Sit Stand Sit (SLS) e forte na duração média do SLS (rp=0.85) e das subfases Sit to Stand (rp=0.69) e Stand to Sit (rp=0.778), com p<0.001. As medidas de inclinação do tronco apresentaram correlações fortes, com exceção do ângulo inicial (p≥0.05). No OLS, verificou-se uma correlação moderada entre o deslocamento do centro de pressão peak to peak médio-lateral (rs=0.45; p=0.017) e antero-posterior (rs=0.39; p=0.046), root mean square médio-lateral (rs=0.39; p=0.046) e antero-posterior (rs=0.46; p=0.017) e área do estatocinesiograma (rs=0.45; p=0.018). Na FES obteve-se uma correlação moderada em três categorias: ‘tomar banho/duche’ (rs=0.49; p=0.010), ‘deitar/levantar da cama (rs=0.43; p=0.024) e ‘chegar aos armários’ (rs=0.38; p=0.050). Conclusão: A aplicação para smartphone parece avaliar corretamente os ciclos e a variação da inclinação do tronco no STS, porém parece necessitar de ser reajustada na FES e na velocidade do deslocamento do centro de pressão, no OLS.

Iron oxide/gold core/shell nanomagnetic probes and CdS biolabels for amplified electrochemical immunosensing of Salmonella typhimurium

There is an imminent need for rapid methods to detect and determine pathogenic bacteria in food products as alternatives to the laborious and time-consuming culture procedures. In this work, an electrochemical immunoassay using iron/gold core/shell nanoparticles (Fe@Au) conjugated with anti-Salmonella antibodies was developed. The chemical synthesis and functionalization of magnetic and gold-coated magnetic nanoparticles is reported. Fe@Au nanoparticles were functionalized with different self-assembled monolayers and characterized using ultraviolet-visible spectrometry, transmission electron microscopy, and voltammetric techniques. The determination of Salmonella typhimurium, on screen-printed carbon electrodes, was performed by square-wave anodic stripping voltammetry through the use of CdS nanocrystals. The calibration curve was established between 1×101 and 1×106 cells/mL and the limit of detection was 13 cells/mL. The developed method showed that it is possible to determine the bacteria in milk at low concentrations and is suitable for the rapid (less than 1 h) and sensitive detection of S. typhimurium in real samples. Therefore, the developed methodology could contribute to the improvement of the quality control of food samples.

Electrochemical evaluation of total antioxidant capacity of beverages using a purine-biosensor

In this paper, it was evaluated the total antioxidant capacity (TAC) of beverages using an electrochemical biosensor. The biosensor consisted on the purine base (guanine or adenine) electro-immobilization on a glassy carbon electrode surface (GCE). Purine base damage was induced by the hydroxyl radical generated by Fenton-type reaction. Five antioxidants were applied to counteract the deleterious effects of the hydroxyl radical. The antioxidants used were ascorbic acid, gallic acid, caffeic acid, coumaric acid and resveratrol. These antioxidants have the ability to scavenger the hydroxyl radical and protect the guanine and adenine immobilized on the GCE surface. The interaction carried out between the purinebase immobilized and the free radical in the absence and presence of antioxidants was evaluated by means of changes in the guanine and adenine anodic peak obtained by square wave voltammetry (SWV). The results demonstrated that the purine-biosensors are suitable for rapid assessment of TAC in beverages.

Electrochemical immunosensor for multiplexed detection of food-borne pathogens using nanocrystal bioconjugates and MWCNT screen-printed electrode

Bacterial food poisoning is an ever-present threat that can be prevented with proper care and handling of food products. A disposable electrochemical immunosensor for the simultaneous measurements of common food pathogenic bacteria namely Escherichia coli O157:H7 (E. coli), campylobacter and salmonella were developed. The immunosensor was fabricated by immobilizing the mixture of anti-E. coli, anticampylobacter and anti-salmonella antibodies with a ratio of 1:1:1 on the surface of the multiwall carbon nanotube-polyallylamine modified screen printed electrode (MWCNT-PAH/SPE). Bacteria suspension became attached to the immobilized antibodies when the immunosensor was incubated in liquid samples. The sandwich immunoassay was performed with three antibodies conjugated with specific nanocrystal ( -E. coli-CdS, -campylobacter-PbS and -salmonella-CuS) which has releasable metal ions for electrochemical measurements. The square wave anodic stripping voltammetry (SWASV) was employed to measure released metal ions from bound antibody nanocrystal conjugates. The calibration curves for three selected bacteria were found in the range of 1 × 103 – 5 × 105 cells mL−1 with the limit of detection (LOD) 400 cells mL−1 for salmonella, 400 cells mL−1 for campylobacter and 800 cells mL−1 for E. coli. The precision and sensitivity of this method show the feasibility of multiplexed determination of bacteria in milk samples.

Suspected acute toxoplasmosis in pregnant women

OBJECTIVE: To determine the prevalence of reagent serology for suspected acute toxoplasmosis in pregnant women and to describe clinical, laboratory and therapeutic profiles of mothers and their children. METHODS: A retrospective study was conducted with IgM-anti-Toxoplasma gondii-reagent pregnant women and their children who attended the public health system in the state of Paraná, Southern Brazil, from January 2001 to December 2003. Information were obtained from clinical, laboratory (ELISA IgM/IgG) and ultrasonographic data and from interviews with the mothers. To test the homogeneity of the IgM indices in relation to the treatment used, the Pearson's Chi-square test was applied. Comparisons were considered significant at a 5% level. RESULTS: Two hundred and ninety (1.0%) cases of suspected IgM-reagent infection were documented, with a prevalence of 10.7 IgM-reagent women per 1,000 births. Prenatal care started within the first 12 weeks for 214/290; 146/204 were asymptomatic. Frequent complaints included headaches, visual disturbance and myalgia. Ultrasonography revealed abnormalities in 13 of 204 pregnancies. Chemoprophylaxis was administered to 112/227; a single ELISA test supported most decisions to begin treatment. Pregnant women with IgM indices =2.000 tended to be treated more often. Among exposed children, 44/208 were serologically followed up and all were IgG-reagent, and three IgM-reagent cases showed clinical symptoms. CONCLUSIONS: The existence of pregnant women with laboratorially suspected acute toxoplasmosis who were not properly followed up, and of fetuses that were not adequately monitored, shows that basic aspects of the prenatal care are not being systematically observed. There is need of implementing a surveillance system of pregnant women and their children exposed to T. gondii.

A denoising approach for iterative side information creation in distributed video coding

In distributed video coding, motion estimation is typically performed at the decoder to generate the side information, increasing the decoder complexity while providing low complexity encoding in comparison with predictive video coding. Motion estimation can be performed once to create the side information or several times to refine the side information quality along the decoding process. In this paper, motion estimation is performed at the decoder side to generate multiple side information hypotheses which are adaptively and dynamically combined, whenever additional decoded information is available. The proposed iterative side information creation algorithm is inspired in video denoising filters and requires some statistics of the virtual channel between each side information hypothesis and the original data. With the proposed denoising algorithm for side information creation, a RD performance gain up to 1.2 dB is obtained for the same bitrate.

Development of polyaniline microarray electrodes for cadmium analysis

Disposable screen-printed electrodes (SPCE) were modified using a cosmetic product to partially block the electrode surface in order to obtain a microelectrode array. The microarrays formed were electropolymerized with aniline. Scanning electron microscopy was used to evaluate the modified and polymerized electrode surface. Electrochemical characteristics of the constructed sensor for cadmium analysis were evaluated by cyclic and square-wave voltammetry. Optimized stripping procedure in which the preconcentration of cadmium was achieved by depositing at –1.20 V (vs. Ag/AgCl) resulted in a well defined anodic peak at approximately –0.7 V at pH 4.6. The achieved limit of detection was 4 × 10−9 mol dm−3. Spray modified and polymerized microarray electrodes were successfully applied to quantify cadmium in fish sample digests.

Perfil de citocinas no colostro em função da idade gestacional e do crescimento fetal

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A comprehensive approach to evaluate nutritional status in Crohn's patients in the era of biologic therapy: a case-control study

Objectives - Evaluate the nutritional status of patients with inactive or mildly active Crohn's disease (CD), and identify possible causes for potential deficiencies. Methods - A total of 78 CD patients and 80 healthy controls were evaluated in respect of nutritional status, dietary intake, and life styles factors. Results - These 73/78 CD patients were on immunomodulating therapies. Mean body mass index (BMI) was lower in patients as compared to controls (P= 0.006) but 32% of CD patients and 33.8% of controls had a BMI > 25, whereas 8% and 23.8% in each group, respectively, were obese (BMI > 30Kg/m(2)). Fat free mass was significantly decreased in both genders (P < 0.05) whereas fat mass was decreased only in males (P= 0.01). Energy intake was significantly lower in CD patients (P < 0.0001) and we observed significantly lower adjusted mean daily intakes of carbohydrates, monounsaturated fat, fiber, calcium, and vitamins C, D, E, and K (P < 0.05). 29% of patients had excluded grains from their usual diet, 28% milk, 18% vegetables, and 11% fruits. Milk exclusion resulted in a significantly lower consumption of calcium and vitamin K (P < 0.001) and the exclusion of vegetables was associated to a lower consumption of vitamins C and E (P < 0.05). Physical activity was significantly lower in CD patients (P= 0.01) and this lack of physical activity was inversely correlated with increased fat mass percentage (r=-0.315, P= 0.001). Conclusions - Results showed that the most prevalent form of malnutrition in CD patients was an excess of body weight, which was concomitant with an inadequate dietary intake, namely micronutrients, clearly related to dietary exclusion of certain foods.

O papel da curadoria como difusora da arte contemporânea

Dissertação de Mestrado em Património, Museologia e Desenvolvimento

Knowledge, attitude and practice of mammography among women users of public health services

OBJECTIVE: To evaluate knowledge, attitude and practice related to mammography among women users of local health services, identifying barriers to its performance. METHODS: A total of 663 women were interviewed at 13 local health centers in a city of Southeastern Brazil, in 2001. Interviewees were randomly selected at each center and they were representative from different socioeconomic conditions. The number of interviewees at each center was proportional to monthly mean appointments. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test. RESULTS: Only 7.4% of the interviewees had adequate knowledge on mammography, while 97.1% of women had an adequate attitude. The same was seen for the practice of mammography that was adequate in 35.7% of the cases. The main barrier to mammography was lack of referral by physicians working at the health center (81.8%). There was an association between adequacy of attitude and five years or more of education and being married. There was also an association between adequacy of mammography practice and being employed and family income up to four minimum wages. CONCLUSIONS: Women users of local health services had no adequate knowledge and practice related to mammography despite having an adequate attitude about this exam.