External quality assessment in the voluntary counseling and testing centers in the Brazilian Amazon using dried tube specimens: results of an effectiveness evaluation

INTRODUCTION : In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodeficiency virus (HIV) tests using the dried tube specimen (DTS) method (EQA-RT/DTS-HIV). Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs) in the Brazilian Legal Amazonian area one year after its introduction. METHODS : Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs) (n=39) and VCTC coordinators (n=32) were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program's logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program. RESULTS: The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure), registration in Quali-TR online system 38.7% (process), and VCTC completed the full process in the program's first round 63.4% (result). Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance. CONCLUSIONS: All three program dimensions exhibited satisfactory results (>75%). Nevertheless, the study findings highlight the need to improve certain program components. Additionally, long-term follow-ups is needed to provide a more thorough picture of the process for external quality assessment.

Spatial and temporal country-wide survey of temephos resistance in Brazilian populations of Aedes aegypti

The organophosphate temephos has been the main insecticide used against larvae of the dengue and yellow fever mosquito (Aedes aegypti) in Brazil since the mid-1980s. Reports of resistance date back to 1995; however, no systematic reports of widespread temephos resistance have occurred to date. As resistance investigation is paramount for strategic decision-making by health officials, our objective here was to investigate the spatial and temporal spread of temephos resistance in Ae. aegypti in Brazil for the last 12 years using discriminating temephos concentrations and the bioassay protocols of the World Health Organization. The mortality results obtained were subjected to spatial analysis for distance interpolation using semi-variance models to generate maps that depict the spread of temephos resistance in Brazil since 1999. The problem has been expanding. Since 2002-2003, approximately half the country has exhibited mosquito populations resistant to temephos. The frequency of temephos resistance and, likely, control failures, which start when the insecticide mortality level drops below 80%, has increased even further since 2004. Few parts of Brazil are able to achieve the target 80% efficacy threshold by 2010/2011, resulting in a significant risk of control failure by temephos in most of the country. The widespread resistance to temephos in Brazilian Ae. aegypti populations greatly compromise effective mosquito control efforts using this insecticide and indicates the urgent need to identify alternative insecticides aided by the preventive elimination of potential mosquito breeding sites.

Cardiovascular risk factors in a population of Brazilian schoolchildren

Epidemiological and clinical evidence suggests that a judicious diet, regular physical activity and blood pressure (BP) monitoring must start in early childhood to minimize the impact of modifiable cardiovascular risk factors. This study was designed to evaluate BP and metabolic parameters of schoolchildren from Vitória, Espírito Santo State, Brazil, and correlate them with cardiovascular risk factors. The study was conducted on 380 students aged 10-14 years (177 boys, 203 girls) enrolled in public schools. Baseline measurements included body mass index, BP and heart rate. The students were submitted to exercise spirometry on a treadmill. VO2max was obtained from exercise testing to voluntary exhaustion. Fasting serum total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG), and glucose were measured. Nine point nine percent of the boys and 11.7% of the girls were hypertensive or had pre-hypertensive levels. There was no significant correlation between VO2max and TC, LDL-C, or TG in prepubertal children, but a slight negative correlation was detected in post-pubertal boys for HDL-C and TG. In addition, children with hypertension (3.4%) or pre-hypertensive levels (6.6%) also had comorbidity for overweight and blood lipid abnormalities (14% for triglycerides, 44.7% for TC, 25.9% for LDL-C, 52% for low HDL-C). The present study shows for the first time high correlations between prehypertensive blood pressure levels and the cardiovascular risk factors high TC, high LDL-C, low HDL-C in schoolchildren. These are important for the formulation of public health policies and strategies.

Random-start controlled ovarian stimulation for emergency fertility preservation in a patient with myelodysplastic syndrome: a case report

This study reports a case of a gonadotropin-releasing hormone agonist trigger in a young female with myelodysplastic syndrome (MDS) who underwent fertility preservation using random-start controlled ovarian stimulation. This method involves the stimulation of the ovary regardless of a patient's menstrual-cycle phase. A review of the related literature is also provided. A 17-year-old patient was diagnosed with MDS and required initiation of peripheral blood stem cell transplantation within a maximum of 3 weeks and was in the luteal phase of the menstrual cycle when the possibility of attempting preservation of fertility was presented to her. She opted for a random-start controlled ovarian stimulation with gonadotropins. With successful hemorrhagic prophylaxis, 17 oocytes were retrieved including 10 mature and 7 immature oocytes. Of the immature oocytes, 3 were successfully matured in vitro and a vitrification protocol was used to freeze the 13 mature oocytes.

Exchange students in Brazil: some factors behind its choice - empirical evidences from a Brazilian school

O Brasil sempre foi um lugar conveniente para se visitar em termos de cultura, diversão e entretenimento. No entanto, este estudo visa o lado educacional do país, particularmente, os estudantes estrangeiros que escolhem o Brasil para programas de intercâmbio. Fins e razões por trás das escolhas dos estudantes foram identificados através de pesquisas quantitativas e qualitativas, juntamente com a revisão da literatura já existente. A pesquisa primária foi feita por meio de entrevistas com estudantes de intercâmbio já no Brasil. Os dados coletados foram analisados e são apresentados de forma estatística, juntamente com a representação gráfica. O seguinte estudo apontou que os denominados “turistas” e, assim chamados, “money seekers”, serem os principais fatores por trás da escolha de estudantes. A pesquisa também mostra que os alunos mais satisfeitos foram os que escolheram o Brasil por causa da qualidade da universidade sede, assim como para explorar as perspectivas de emprego, juntamente com iniciar uma carreira no Brasil.

Comparative advantage, heterogeneous firms and variable mark-ups

We develop a model of comparative advantage with monopolistic competition, that incorporates heterogeneous firms and endogenous mark-ups. We analyse how these features vary across countries with different factor endowments, and across markets of different size. In this model we can obtain trade gains via two channels. First, when we open the economy, most productive firms start to export their product, then, they demand more producing factors and wages rises, thus, those firms that are less productive will be forced to stop to produce. Second channel is via endogenous mark-ups, when we open the economy, the competition gets ``tougher'', then, mark-ups falls, thus, those firms that are less productive will stop to produce. We also show that comparative advantage works as a ``third channel'' of trade gains, because, all trade gains results are magnified in comparative advantage industry of both countries. We also make a numerical exercise to see how endogenous variables of the model vary when trade costs fall.

Brazilian privatization : a decade of experience

In this paper we review the ten-year-old Brazilian experience with privatization. We start by describing the expansion in the last half century of the role played by state enterprises, and then the privatization effort in the Figueiredo and Sarney administrations. After that, we examine what haa changed with Collor and what the prospects for his privatization program are.

Prevalence and causes of visual impairment in a Brazilian population: The Botucatu Eye Study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Genetic and environmental parameters for racing time at different distances in Brazilian Thoroughbreds

The aim of the present study was to investigate genetic parameters for racing time in Thoroughbred horses racing at distances between 1000 and 1600 m subdivided into 100-m intervals. The data provided by TURFETOTAL Ltda comprised races that occurred in the Gavea and Cidade Jardim race tracks over a period of 11 years (1992-2002) and consisted of 32 145 races and 238 890 time records. The variance components necessary to obtain the heritability and repeatability estimates of the traits studied were estimated with the MTDFREML program, and animal age at race (3 years old or younger, 4, 5 and older than 5 years), sex (male and female), number of races (1-32 145), and postposition at start (1-11) as fixed effects, and animal and permanent environmental random effects were included in a one-trait animal model. Males were significantly superior to females at all distances. Excluding the 1100 m distance, animals 4 years of age were significantly faster than the mean of the other ages for all distances analysed. Horses older than 5 years showed a significantly lower performance than the mean of the other ages for all distances analysed, except for the 1100 m. Postpositions one and two did not differ significantly from one another for any of the distances analysed. These two inner positions both together varied from the other positions depending on race length. The components of additive genetic and permanent environmental variance varied in a similar way, tending to decrease with increasing racing distance, and the other temporary environmental variance almost doubled from 1000 to 1600 m. As was the case for the additive genetic and environmental variances, heritability and repeatability estimates tended to decrease with increasing distance, indicating that selection based on racing time will be less successful when the racing distance increases.

Conquering Brazil: the invasion by the exotic gekkonid lizard Hemidactylus mabouia (Squamata) in Brazilian natural environments

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Aragonite distribution and preservation of sediment cores from the Brazilian Continental Slope

We present late Quaternary records of aragonite preservation determined for sediment cores recovered on the Brazilian Continental Slope (1790-2585 m water depth) where North Atlantic Deep Water (NADW) dominates at present. We have used various indirect dissolution proxies (carbonate content, aragonite/calcite contents, and sand percentages) as well as gastropodal abundances and fragmentation of Limacina inflata to determine the state of aragonite preservation. In addition, microscopic investigations of the dissolution susceptibility of three Limacina species yielded the Limacina Dissolution Index which correlates well with most of the other proxies. Excellent preservation of aragonite was found in the Holocene section, whereas aragonite dissolution gradually increases downcore. This general pattern is attributed to an overall increase in aragonite corrosiveness of pore waters. Overprinted on this early diagenetic trend are high-frequency fluctuations of aragonite preservation, which may be related to climatically induced variations of intermediate water masses.

Element concentrations and stable isotope record of planktonic foraminifera of sediment cores from the northeastern Brazilian Continental Margin

Detailed 14C AMS data and isotope based stratigraphies from high-resolution paleoceanographic records for the last 22 ka of cores from the upper continental slope off NE Brazil reveal sedimentation rates of up to 100 cm per 1000 yr. Variations in the sediment composition relate to changes in the input of terrigenous material. The sedimentation is controlled by sea level and by the climatic regime of the hinterland. Short-term changes in the tropical wind field may act as a climatic trigger. The zonality of the SE trades was probably increased and the monsoonal activity over Africa reduced during the Younger Dryas period.

Phytoplankton, dissolved inorganic nutrients and hydrography during the ACEx/SIMTECO campaign in the southern Brazilian shelf in June 2012 (SW Atlantic - Winter 2012)

The response of phytoplankton assemblages to hydrographical forcing across the southern Brazilian shelf was studied based on data collected during wintertime (June/2012), complemented with MODIS-Aqua satellite imagery. The in situ data set was comprised by water column structure properties (derived from CTD casts), dissolved inorganic nutrients (ammonium, nitrite, nitrate, phosphate and silicate) and phytoplankton biomass [chlorophyll a (Chl a) concentration] and composition. Phytoplankton assemblages were assessed by both microscopy and HPLC-CHEMTAX approaches. A canonical correspondence analysis associating physical, chemical and phytoplankton composition data at surface evinced a tight coupling between the phytoplankton community and hydrographic conditions, with remarkable environmental gradients across three different domains: the pelagic, outer shelf Tropical Water (TW); the mid shelf domain under influence of Subtropical Shelf Water (STSW); and the inner shelf domain mainly under influence of riverine outflow of the Plata River Plume Water (PPW). Results showed that intrusion of low salinity and nutrient-rich PPW stimulated the phytoplankton growth and diversity within the inner shelf region, with enhanced Chl a levels (>1.3 mg/m**3) and a great abundance of diatoms, ciliates, dinoflagellates, raphidophyceans and cryptophytes. Conversely, other diatoms (e.g. Rhizosolenia clevei), tiny species of prochlorophytes and cyanobacteria and a noticeable contribution of dinoflagellates and other flagellates associated with lower Chl a levels (<0.93 mg/m**3), characterized the TW domain, where low nutrient concentrations and deep upper mixed layer were found. The transitional mid shelf domain showed intermediate levels of both nutrients and Chl a (ranging 1.06-1.59 mg/m**3), and phytoplankton was mainly composed by dinoflagellates, such as Dinophysis spp., and gymnodinioids. Results have shown considerable phytoplankton diversity in winter at that section of the southwestern Atlantic Ocean.