Health in Brazil 2 Maternal and child health in Brazil: progress and challenges

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5.5% a year in the 1980s and 1990s, and by 4.4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2.5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil`s progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women`s health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.

Population structure and inbreeding effects on growth traits of Santa Ines sheep in Brazil

The aim of this study was to describe the population structure, inbreeding and to quantify their effect for different weights, of Santa Ines sheep. For this reason, 6490 data of production and 17,097 animals in the pedigree data set were utilized to evaluate birth weight (BW), weight at 60 days (W60) and weight at 180 days (W180). The genetic structure analysis of the population was realized by the software ENDOG (v.4.6.), resulting in some level of inbreeding for 21.72% of the animals in the pedigree data, being 41.02% the maximum value, and average of 10.74% for the inbred individuals. The population average inbreeding was 2.33% and the average relatedness was 0.73%. The effective number of ancestors was 156 animals and the effective number of founders was 211 individuals. A significant depressive effect of the inbreeding can be verified for all traits. The monitored parameters related with the genetic variability on this population must be constant in order to prevent the decrease in the genetic progress. The utilization of a program for directed mating in the present flock is an appropriate alternative to keep the level of inbreeding under control. (C) 2010 Elsevier B.V. All rights reserved.

Bioethanol from lignocelluloses: Status and perspectives in Brazil

The National Alcohol Program - ProAlcool, created by the government of Brazil in 1975 resulted less dependency on fossil fuels. The addition of 25% ethanol to gasoline reduced the import of 550 million barrels oil and also reduced the emission CO(2) by 110 million tons. Today, 44% of the Brazilian energy matrix is renewable and 13.5% is derived from sugarcane. Brazil has a land area of 851 million hectares, of which 54% are preserved, including the Amazon forest (350 million hectares). From the land available for agriculture (340 million hectares), only 0.9% is occupied by sugarcane as energy crop, showing a great expansion potential. Studies have shown that in the coming years, ethanol yield per hectare of sugarcane, which presently is 6000 L/ha, could reach 10,000 L/ha, if 50% of the produced bagasse would be converted to ethanol. This article describes the efforts of different Brazilian institutions and research groups on second generation bioethanol production, especially from sugarcane bagasse. (C) 2009 Elsevier Ltd. All rights reserved.

Diagnostic reference levels for the most frequent radiological examinations carried out in Brazil

Objectives. A large-scale survey of doses to patients undergoing the most frequent radiological examinations was carried out in health services in Sao Paulo (347 radiological examinations per 1 000 inhabitants), the most populous Brazilian state. Methods. A postal dosimetric kit with thermoluminescence dosimeters was used to evaluate the entrance surface dose (ESD) to patients. A stratified sampling technique applied to the national health database furnished important data on the distribution of equipment and the annual number of examinations. Chest, head (skull and sinus), and spine (cervical, thoracic, and lumbar) examinations were included in the trial. A total of 83 rooms and 868 patients were included, and 1 415 values of ESD were measured. Results. The data show large coefficients of variation in tube charge, giving rise to large variations in ESD values. Also, a series of high ESD values associated with unnecessary localizing fluoroscopy were detected. Diagnostic reference levels were determined, based on the 75th percentile (third quartile) of the ESD distributions. For adult patients, the diagnostic reference levels achieved are very similar to those obtained in international surveys. However, the situation is different for pediatric patients: the ESD values found in this survey are twice as large as the international recommendations for chest radiographs of children. Conclusions. Despite the reduced number of ESD values and rooms for the pediatric patient group, it is recommended that practices in chest examinations be revised and that specific national reference doses and image quality be established after a broader survey is carried out.

Determination of cadmium and lead in cetacean Dolphinidae tissue from the coast of Bahia state in Brazil by GFAAS

In the present study, cadmium and lead in the muscle, lung, liver and kidney of dolphins (Sotalia guianensis and Stenella clymene) of the Bahia coast in the northwest of Brazil were determined by graphite furnace atomic absorption spectrometry. Samples were digested using a diluted oxidant mixture (HNO(3) + H(2)O(2)) with a microwave heating program performed in five steps. The optimized temperatures and chemical modifier for the pyrolysis and atomization were 700 degrees C, 1400 degrees C and Pd plus Mg for Cd, and 900 degrees C, 1800 degrees C and NH(4)H(2)PO(4) for Pb, respectively. Characteristic masses and limits of detections (n = 20, 3 sigma) for Cd and Pb were 1.6 and 9.0 pg and 0.82 ng g(-1) and 0.50 ng g(-1), respectively. Repeatability ranged from 0.87 to 8.22% for Cd and 4.31 to 8.09% for Pb. The found concentrations presented no statistical differences at the 95% confidence level when compared with the ICP OES methods. Addition and recovery tests were also performed and the results ranged between 87 and 112% for both elements. Samples of cetacean Dolphinidae (S. guianensis and S. clymene) were analyzed, and the higher concentrations ranged from 0.09 to 46.2 mu g g(-1) for Cd and 0.04 to 0.47 mu g g(-1) for Pb in liver, and from 0.133 to 277 mu g g(-1) for Cd in the kidney. (C) 2010 Elsevier By. All rights reserved.

Antiparasitic, antineuroinflammatory, and cytotoxic polyketides from the marine sponge Plakortis angulospiculatus collected in Brazil

Investigation of the bioactive crude extract from the sponge Plakortis angulospiculatus from Brazil led to the isolation of plakortenone (1) as a new polyketide, along with five known polyketides (2-6) previously isolated from other Plakortis sponges. The known polyketides were tested in antileishmanial, antitrypanosomal, antineuroinflammatory, and cytotoxicity assays. The results show that plakortide P (3) is a potent antiparasitic compound, against both Leishmania chagasi and Trypanosona cruzi, and exhibited antineuroinflammatory activity. The known polyketides 2-6 were tested for cytotoxicity against four human cancer cell lines, but displayed only moderate cytotoxic activity.

The political economy of exchange rate policy in Brazil: 1964-1999

This paper was developed as part of a broader research program on the political economy of exchange rate policies in Latin America and the Caribbean. We are grateful for helpful comments and suggestions from Jeff Frieden, Ernesto Stein, Jorge Streb, Marcelo Neri and seminar participants at Getulio Vargas Foundation, PUC-Rio, IDB workshop on The Political Economy of Exchange Rate Policies in Latin America and the Caribbean, and LACEA meeting in Buenos Aires. We thank René Garcia for providing us with a Fortran program for estimating the Markov Switching Model, Ilan Goldfajn for sending us updated estimates of the real exchange rate series of Goldfajn and Valdés (1996), Altamir Lopes and Ricardo Markwald for kindly furnishing data on Brazilian external accounts, and Carla Bernardes, Gabriela Domingues, Juliana Pessoa de Araújo, and, specially, Marcelo Pinheiro for excellent research assistant. Both authors thank CNPq for a research fellowship.

A model of rural conflict : violence and land reform policy in Brazil

In the past ten years the struggle for land in Brazil has taken the shape of invasions of private land by welI organized groups of land less squatters. It is argued in this paper that these invasions and the resulting contlicts are a direct response to the land reform program which has been adopted by the govemment since 1985. which is based on the expropriation of farms and the creation of settlement projects. The set of formal and informal institutions which compromise the land reform program are used as the background for a game-theory model of rural contlicts. T estable implications are derived trom this model with particular emphasis on the etfect of policy variables on violence. These are then tested with panel data at state levei from 1988 to 1995. - It is shown that govemment policy which has the intent of reducing the amount of violence has the opposite etfect of leading to more incentives for contlicts.

Acquired immunodeficiency syndrome in Brazil

Aim. To describe the acquired immunodeficiency syndrome (AIDS) epidemic in Brazil and analyze the impact of federal government measures addressing the problem since its onset.Method. Retrospective review of AIDS epidemic data from its onset in 1980 up to the last published data in June 2001.Results. AIDS was first reported in Brazil in 1980. By 1988, all 27 Brazilian states had diagnosed cases, and until June 2000 more than half of Brazilian municipalities had recorded at least one case of the disease. The AIDS incidence reached its peak between 1996 and 1997 (14.7 per 100,000 population), and then declined between 1998 and 2000 to 9 per 100,000 population. In the last two decades, the proportion of deaths has been also significantly reduced. These were not random events, but reflected the efficiency of the program implemented by the Brazilian Health Ministry's Coordination on Sexually Transmitted Diseases and AIDS. The program includes an epidemiological surveillance modeling system, which records cases from several regular epidemiological bulletins; national network of diagnosis and monitoring of HIV-infected individuals (ill or not); highly active antiretroviral therapy available free to all patients; mother-infant protection program; educational programs on condom use; the introduction of the female condom; development of AIDS studies in different areas to provide practical solutions; constant preoccupation about drug costs accounting for the patent breaking; and national production of many drugs currently in use.Conclusion. Well-planned and implemented national program against AIDS can significantly reduce the burden of this disease to the population.

Population structure and stock assessment of Hoplias malabaricus (Characiformes: Erythrinidae) caught by artisanal fishermen in river-reservoir transition area in Brazil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Polycyclic aromatic hydrocarbons (PAHs) in raw cane sugar (rapadura) in Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Cara inchada of cattle, an infectious, apparently soil antibiotics-dependant periodontitis in Brazil

O objetivo desta revisão das pesquisas sobre a cara inchada dos bovinos (CI), realizadas no decorrer dos últimos 30 anos, é de elucidar melhor a sua etiologia. A CI geralmente tem sido considerada de origem nutricional, causada primariamente por deficiência ou desequilíbrio mineral. A doença caracteriza-se por uma periodontite rapidamente progressiva, que afeta os tecidos peridentários a nível dos premolares e molares no período de erupção dos dentes e que se inicia geralmente em bezerros jovens. A doença causou grandes perdas econômicas aos pecuaristas da Região Centro-Oeste do Brasil, nas décadas de 1960 e 1970, com a ocupação de novas terras para criação de gado. O freqüente abaulamento lateral dos ossos maxilares nos bezerros, que deu à doença o nome popular de cara inchada, foi demonstrado ser conseqüente à periostite crônica ossificante resultante da alveolite purulenta da CI. Das lesões peridentárias foi isolado, em grande número, Bacteroides melaninogenicus, sempre junto com Actinomyces (Corynebacterium) pyogenes. Bactérias classificadas como pertencentes ao grupo sacarolí-tico e não-sacarolítico dos pigmentados de negro Bacteroides melaninogenicus e Bacteroides spp também foram isoladas, em pequeno número, de bovinos jovens sadios de fazendas CI-negativas. Ensaios in vitro mostraram que os antibióticos estreptomicina e actinomicina, bem como os sobrenadantes de cultivos de actinomicetos do solo de fazendas CI-positivas, aplicadas nas bactérias ensaiadas em concentrações subinibidoras, aumentaram significativamente (até 10 vezes) a aderência de B.melaninogenicus a células epiteliais da gengiva bovina. Esses antibióticos são produzidos no solo em conseqüência de um aumento do número de actinomicetos, incluindo os do gênero Streptomyces, quando há modificação de sua microbiota em áreas previamente ocupadas por mata virgem ou vegetação natural de Cerrado, que foram cultivadas pela primeira vez na formação de pastagem para o gado. em face da epidemiologia da CI, há fortes evidências de que a ingestão desses antibióticos pelos bovinos, junto com a forrageira, seja importante fator desencadeante para o desenvolvimento da periodontite. Através do aumento da aderência de B. melaninogenicus ao epitélio da gengiva marginal, em face da ingestão dos antibióticos pelos animais, as bactérias conseguem colonizar, formar a placa bacteriana e tornar-se patogênicas. Há evidência de que o fator desencadeante (aparentemente, os antibióticos) esteja também presente no leite de vacas-mães de bezerros afetados pela CI. Foi demonstrado que as bactérias envolvidas na periodontite produzem enzimas e endotoxinas capazes de ação destrutiva sobre os tecidos peridentários. A epidemiologia da CI, com a diminuição de sua incidência e o seu desaparecimento no decorrer dos anos, pode ser explicada pelo fato de que o prévio equílibrio da microbiota no solo virgem foi alcançado novamente e a produção dos antibióticos se reduziu. Desta maneira, a CI deve ser considerada como uma periodontite infecciosa multifatorial, causada sobretudo por bactérias anaeróbias pertencentes ao grupo Bacteroides melaninogenicus e, ao que tudo indica, desencadeada pela ingestão contínua, com a forrageira, de concentrações subinibidoras de antibióticos de solos recentememente cultivados. Esta hipótese é reforçada pela observação recente de novos surtos de CI, em áreas anteriormente positivas para a doença, em conseqüência da reforma de pastagens e capineiras após muitos anos. A natureza infecciosa da CI-periodontite foi confirmada através de experimento, em que virginiamicina mostrou-se eficaz no tratamento oral de bovinos afetados pela doença. Os antibióticos espiramicina e virginiamicina, usados como aditivos em suplementos minerais no campo, mostraram-se eficientes na prevenção da CI.

Genetic and environmental effects over milk production of buffalo cows in Brazil

The objective of this paper was to evaluate the relevance of environmental and genetics effects on milk production of buffalo cows in Brazil. The data were based on the Buffalo Genetic Improvement Program - PROMEBUL, using information of 1,911 cows (107 Jafarabadi, 101 Mediterranean, 1,056 Mu/Tab and 647 crossbred females) with parturition between 1982 and 2003. The mathematic model for evaluating milk production included the fixed effects of herd, parturition year (1982 to 2003) and month (January to December), calf's sex (male or female), genetic group (Jafarabadi, Mediterranean, Murrah, and crossbreed), number of milking (one or two), lactation order (1 to 12) and duration of lactation (as a linear effect). The mean milk production in herds was 1,590.36 +/- 609.25 kg. All sources of variation were significant (P<0.05) for the studied characteristics, except calf's sex. The mean milk production per genetic group was 1,651.4; 1,592.2; 1,578.3 and 1,135.5 kg, for Murrah, Mediterranean, Crossbred and Jafarabadi, respectively. The duration of lactation was the most important source of variation over milk production, followed by the year of parturition, herd, parturition order, genetic group and month of parturition.

Diagnosis of Public Programs focused on Herbal Medicines in Brazil

The present study is aimed to diagnose the current public programs focused on herbal medicines in Brazil by means of in loco visits to 10 programs selected by means of questionnaires sent to 124 municipalities that count on herbal medicine services. The main purpose of the implementation of program programs is related to the development of medicinal herbs. 70% of them are intended for the production of herbal medicines and 50% are aimed to ensure the access of the population to medicinal plants and or herbal medicines. The initiative of the implementation of these programs was related to the managers (60%). The difficulties in this implementation were due to the lack of funding (100%) of the programs. In 60% of the programs, the physicians did not adhere to herbal medicine services due to the lack of knowledge of the subject. Training courses were proposed (80%) to increase the adhesion of prescribers to the system. Some municipalities use information obtained from patients to assess the therapeutic efficiency of medicinal plants and herbal medicines. of the programs underway, cultivation of medicinal plants was observed in 90% and 78% of them adopt quality control. In most programs, this control is not performed in accordance with the legal requirements. The programs focused on medicinal plants and herbal medicines implemented in Brazil face sonic chronic problems of infrastructure, management, operational capacity and self-sustainability, which can be directly related to the absence of a national policy on medicinal plants and herbal medicines.

Reductions in the Prevalence and Incidence of Geohelminth Infections following a City-wide Sanitation Program in a Brazilian Urban Centre

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)