Evaluation of the vulnerability of families assisted in Primary Care in Brazil

Objective: to characterize the profiles of families in the area covered by a Primary Health Center and to identify those in a vulnerable situation. Method: this is an epidemiological, observational, cross-sectional and quantitative study. 320 home visits were made, defined by a random sample of the areas covered by the Urban Center 1 in the city of Sao Sebastiao, in Brazil's Federal District. A structured questionnaire was used for data collection, elaborated based on the Family Development Index (FDI). Results: there was a predominance of young families, women, and low levels of schooling. The FDI permitted the identification of families in situations of "high" and "very high" vulnerability. The most critical dimensions were: "access to knowledge" and "access to work". Conclusion: the study indicated the importance of greater investments in the areas of education, work and income, and highlighted the need for the use of a wider concept of vulnerability by the health services.

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

Abstract Background Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level. Objectives To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics. Methods The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed. Results Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics. Conclusions Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

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

Abstract 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 São 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. São 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 São 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.

Prior history of sexually transmitted diseases in women living with AIDS in São Paulo, Brazil

OBJECTIVES: To describe the epidemiological profile, risk behaviors, and the prior history of sexually transmitted diseases (STDs) in women living with acquired immunodeficiency syndrome (AIDS). METHODS: Cross-sectional study, performed at the Centro de Referência e Treinamento em DST/AIDS of São Paulo. The social, demographic, behavioral, and clinical data such as age, schooling, marital status, age at first sexual intercourse, number of sexual partners, parity, use of drugs, time of HIV diagnosis, CD4 count, and viral load determination were abstracted from the medical records of women living with AIDS who had gynecological consultation scheduled in the period from June 2008 to May 2009. RESULTS: Out of 710 women who were scheduled to a gynecological consultation during the period of the study, 598 were included. Previous STD was documented for 364 (60.9%; 95% CI: 56.9%-64.8%) women. The associated factors with previous STDs and their respective risks were: human development index (HDI) < 0.50 (ORaj = 5.5; 95% CI: 2.8-11.0); non-white race (ORaj = 5.2; 95% CI: 2.5-11.0); first sexual intercourse at or before 15 years of age (ORaj = 4.4; 95% CI: 2.3-8.3); HIV infection follow-up time of nine years or more (ORaj = 4.2; 95% CI: 2.3-7.8)]; number of sexual partners during the entire life between three and five partners (ORaj = 2.2; 95% CI: 1.1-4.6), and six or more sexual partners (ORaj = 3.9; 95% CI: 1.9-8.0%); being a sex worker (ORaj = 1.9; 95% CI: 1.1-3.1). CONCLUSIONS: A high prevalence of a prior history of STDs in the studied population was found. It is essential to find better ways to access HIV infection prevention, so that effective interventions can be more widely implemented.

Survey of Trachoma within School Students in the State of Roraima, Brazil

Purpose: Trachoma, a blinding conjunctivitis, is the result of repeated infection with Chlamydia trachomatis. There are no recent data for the state of Roraima, Brazil, where it was thought that trachoma no longer existed. These data are derived from school children sampled in this state, with additional data collected from the contacts of children with trachoma. Design: A population-based cross-sectional study with random sampling of students in grades 1 through 4 of all public schools within municipalities where the human development index was less than the national average in 2003. The sample was stratified according to population size. Participants: A sample size of 7200 was determined and a total of 6986 (93%) students were examined, along with an additional 2152 contacts. Methods: All students were examined for trachoma according to World Health Organization criteria. Demographic data and contact information also was collected. The family and school contacts of students with trachoma then were located and examined. Main Outcome Measures: Prevalence and grade of trachoma, age, gender, race, and municipality location. Results: The overall prevalence of trachoma was 4.5% (95% confidence interval [CI], 3.7%–5.3%), but there were municipalities within the state where the prevalence of inflammatory trachoma was more than 10%. The prevalence was greater in rural areas (4.9%; 95% CI, 3.7%–6.0%) compared with urban areas (3.9%; 95% CI, 2.9%–4.9%). Living in indigenous communities was associated with trachoma (odds ratio, 1.6; 95% CI, 0.9 –2.6). An additional 2152 contacts were examined, and the overall trachoma prevalence was 9.3% (95% CI, 8.1–10.5). Conclusions: Trachoma continues to exist in Roraima, Brazil, where there are municipalities with a significant prevalence of disease. The indigenous population is highly mobile, crossing state and international borders, raising the possibility of trachoma in neighboring countries. Trachoma prevalence among the contacts of students with trachoma was higher than the school population, highlighting the importance of contact tracing.

Prevalência de tracoma entre escolares brasileiros

OBJETIVO: Estimar a prevalência e descrever a distribuição do tracoma entre escolares em municípios brasileiros. MÉTODOS: Estudo de corte transversal, usando amostragem por conglomerados, da população escolar dos municípios brasileiros com Índice de Desenvolvimento Humano-Municipal menor que a média nacional. O inquérito de prevalência de tracoma foi realizado pelo Ministério da Saúde entre 2002 e 2007. Foram selecionados 119.531 alunos de 2.270 escolas localizadas em 1.156 municípios. Os alunos foram submetidos ao exame ocular externo, com lupa (2,5X), para detecção de sinais clínicos de tracoma segundo critérios da OMS. Estimou-se a prevalência de tracoma segundo estado e em nível nacional, e seus respectivos intervalos de 95% de confi ança. Para a comparação de variáveis categóricas foram usados os testes do Qui-quadrado e do Qui-quadrado de tendência linear. RESULTADOS: Foram detectados 6.030 casos de tracoma, resultando em prevalência de 5,0% (IC95% 4,5;5,4). Não foi encontrada diferença signifi cante entre os sexos. A prevalência de tracoma foi de 8,2% entre menores de cinco anos de idade, diminuindo nas faixas etárias mais altas (p < 0,01). Houve diferença signifi cante entre as prevalências de tracoma na zona urbana e rural, 4,3% versus 6,2%, respectivamente (p < 0,01). Foram detectados casos em 901 municípios (77,7% da amostra), em todas as regiões do País. Em 36,8% dos municípios selecionados a prevalência foi superior a 5%. CONCLUSÕES: O estudo mostra que o tracoma é um importante problema de saúde pública no Brasil, contradizendo a crença de que a endemia estaria controlada no País. O inquérito realizado apresenta uma linha de base para avaliação das intervenções planejadas com vistas ao alcance da meta mundial de certifi cação da eliminação do tracoma como causa de cegueira no Brasil, até 2020.

Volumetric and anatomical MRI for hypoxic-ischemic encephalopathy: relationship to hypothermia therapy and neurosensory impairments.

OBJECTIVE: To relate volumetric magnetic resonance imaging (MRI) findings to hypothermia therapy and neurosensory impairments. STUDY DESIGN: Newborns > or =36 weeks' gestation with hypoxic-ischemic encephalopathy who participated in the National Institute of Child Health and Human Development hypothermia randomized trial at our center were eligible. We determined the relationship between hypothermia treatment and usual care (control) to absolute and relative cerebral tissue volumes. Furthermore, we correlated brain volumes with death or neurosensory impairments at 18 to 22 months. RESULT: Both treatment groups were comparable before randomization. Total brain tissue volumes did not differ in relation to treatment assignment. However, relative volumes of subcortical white matter were significantly larger in hypothermia-treated than control infants. Furthermore, relative total brain volumes correlated significantly with death or neurosensory impairments. Relative volumes of the cortical gray and subcortical white matter also correlated significantly with Bayley Scales psychomotor development index. CONCLUSION: Selected volumetric MRI findings correlated with hypothermia therapy and neurosensory impairments. Larger studies using MRI brain volumes as a secondary outcome measure are needed.

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

INTRODUCTION HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.

(Table 3) Age-related trends of desert pavement properties in the Transantarctic Mountains

Compared to mid-latitude deserts, the properties, formation and evolution of desert pavements and the underlying vesicular layer in Antarctica are poorly understood. This study examines the desert pavements and the vesicular layer from seven soil chronosequences in the Transantarctic Mountains that have developed on two contrasting parent materials: sandstone-dolerite and granite-gneiss. The pavement density commonly ranges from 63 to 92% with a median value of 80% and does not vary significantly with time of exposure or parent material composition. The dominant size range of clasts decreases with time of exposure, ranging from 16-64 mm on Holocene and late Quaternary surfaces to 8-16 mm on surfaces of middle Quaternary and older age. The proportion of clasts with ventifaction increases progressively through time from 20% on drifts of Holocene and late Quaternary age to 35% on Miocene-aged drifts. Desert varnish forms rapidly, especially on dolerite clasts, with nearly 100% cover on surfaces of early Quaternary and older age. Macropitting occurs only on clasts that have been exposed since the Miocene. A pavement development index, based on predominant clast-size class, pavement density, and the proportion of clasts with ventifaction, varnish, and pits, readily differentiated pavements according to relative age. From these findings we judge that desert pavements initially form from a surficial concentration of boulders during till deposition followed by a short period of deflation and a longer period of progressive chemical and physical weathering of surface clasts. The vesicular layer that underlies the desert pavement averages 4 cm in thickness and is enriched in silt, which is contributed primarily by weathering rather than eolian deposition. A comparison is made between desert pavement properties in mid-latitude deserts and Antarctic deserts.

国際協力の罪と罰：買わない日本人

会社でも学校でも結果を問われる時代になった。会社では賃金のうち年功序列的部分が縮小され、業績給部分の割合が増えている。大学生の成績も、以前より明確な基準を用いて、学生の間に明白な差をつけて採点することが要求されるようになってきている。これまでは努力を含めて「何をどれだけ投入したか」が基準として重視されていたのに対して、最近は「何をどれだけ実現したか」という成果が重視されるようになってきている。（以下略）

Servicio Web para gestión de juego cooperativo sobre desarrollo humano

Este Proyecto Fin de Carrera (PFC) tiene como objetivos el análisis, diseño e implementación de un sistema web que permita a los usuarios familiarizarse con el Índice de Desarrollo Humano (IDH), publicado anualmente por Naciones Unidas, ofreciendo un servicio de gestión y descarga de una aplicación móvil relacionada con dicho índice. La aplicación móvil es un juego educativo basado en preguntas sobre el IDH de los países, desarrollada en paralelo con este proyecto. El servicio web implementado en este proyecto facilita tanto la descarga, administración y actualización de contenidos como la interacción entre los usuarios. El sistema está formado por un servidor web, una base de datos de usuarios y contenidos y un portal web desde el cual puede descargarse la aplicación móvil, realizar consultas sobre estadísticas de juego y conocer el IDH sin necesidad de jugar. El buscador avanzado que ha sido desarrollado para conocer el IDH permite al usuario adquirir destrezas y entrenarse por sí solo para mejorar sus resultados de juego. Los administradores del sistema tienen la capacidad de gestionar el contenido del portal, los usuarios que solicitan darse de alta y la funcionalidad ofrecida, es decir, actualización del juego, foros y noticias. La instalación del sistema implementado en un servidor web ha permitido su verificación exitosa así como la provisión del servicio de información y sensibilización sobre el IDH, actualizado mediante la información de Naciones Unidas, motivación original del proyecto. ABSTRACT This Final Year Project takes as targets the analysis, design and implementation of a web system that allows to the users to familiarize with the Human Development Index (HDI), published annually by United Nations, offering a service of management and download a mobile application associated with that index. The mobile application is an educational game based on questions on the IDH of the countries, developed in parallel with this project. The web service implemented by means of this Project facilitates download, administration and update of contents and the interaction between the users across the cooperative game. The system consists of a web server, a database of users and content and a web portal from which you can download the mobile application, perform queries on game statistics, or discover the HDI without need for play. The advanced search engine that has been developed for the HDI allows the user to purchase and train for skills to improve their game results. System administrators have the ability to manage the content of the portal, users requesting register and the functionality offered, i.e., update to the game, forums and news. The installation of the system that was implemented has allowed successful verification and the provision of an information and awareness on the HDI, updated with the information from the United Nations, original motivation of the project.

Aplicación móvil para el acceso a juego de naipes sobre el desarrollo humano

Este Proyecto Fin de Carrera (PFC) tiene como objetivo el análisis, diseño e implementación de un videojuego móvil multijugador, con un enfoque educativo, para la sensibilización sobre el Índice de Desarrollo Humano (IDH). El sistema resultante se ha desarrollado para la Plataforma Android, utilizando el Framework AndEngine, que utiliza aceleración hardware de la GPU para garantizar un buen rendimiento en terminales de gama baja, de modo que pueda utilizarse en un amplio número de terminales móviles disponibles en el mercado. La aplicación se presenta como un juego de cartas con los diferentes países y sus datos humanitarios, los jugadores deben conocer el peso de los índices de desarrollo (esperanza de vida, renta, educación) de los países en comparación con los países de los otros jugadores. El sistema de juego premia a los jugadores con mayores conocimientos sobre los datos humanos de los diferentes países del mundo, de ese modo los mejores jugadores serán los que tengan más conocimientos de estos datos. El juego permite jugar partidas en solitario utilizando jugadores manejados por la CPU, o multijugador mediante WIFI o 3G. La actualización de la información y de los datos de las partidas se realiza a través de la comunicación con un servidor web ya implementado de forma complementaria a la realización de este proyecto. El sistema ha sido integrado y validado satisfactoriamente con diferentes terminales móviles y usuarios de diferente perfil de edad y uso. El videojuego se puede descargar de la página web creada en un proyecto complementario a éste (pendiente de publicación web), y ya se encuentra también disponible en Google Play. https://play.google.com/store/apps/details?id=xnetcom.pro.cartas&hl=es_419 ABSTRACT. This Project End of Career (PFC) takes as an aim the analysis, design and implementation of a multiplayer mobile videogame, with an educational approach, for the awareness on the Human Development Index (HDI). The resultant system has been developed for the Platform Android, using the AndEngine Framework, which uses hardware acceleration of the GPU to ensure a good performance on low-end terminals, so that it can be used in a wide range of mobile handsets available in the market. The application is presented as a card game with the different countries and his humanitarian information, the players must know the weight of the indexes of development (life expectancy, revenue, education) of the countries in comparison with the countries of other players. The game system rewards players with more knowledge on human information of different countries, thus the best players will be those with more knowledge of these information. The game allows to play items in solitarily using players handled by the CPU, or multiplayer by means of WIFI or 3G. The update of the information and data of the online games is done through communication with a web server implemented as a complement to the realization of this project. The system has been built and successfully validated with different mobile terminals and users of different age and usage profile. The game can be downloaded from the website created in a complementary project to this (web publication pending), and is now also available on Google Play https://play.google.com/store/apps/details?id=xnetcom.pro.cartas&hl=es_419

Exceso de peso, aspectos económicos, políticos y sociales en el mundo: un análisis ecológico

Se analizaron las prevalencias de exceso de peso, según índice de masa corporal (IMC), en adultos y su asociación con algunas variables demográficas, socioeconómicas e índice de democracia. Se realizó un diseño ecológico que consideró un total de 105 países, con datos de IMC de 2000 a 2006. Las demás variables se obtuvieron en correspondencia con el año del dato de estado nutricional, o su referente más cercano. Se utilizaron los puntos de corte de la Organización Mundial de la Salud (OMS) para IMC. Se calcularon correlaciones de Spearman y modelos de regresión múltiple. El sobrepeso y la obesidad se correlacionaron en ambos sexos con la disponibilidad energética y con el Índice de Desarrollo Humano (IDH) y sus variables constitutivas. En cuanto a las variables relacionadas con democracia, la correlación fue inversa y más fuerte con el nivel ponderal de los hombres. En conclusión, indicadores de condiciones de vida más favorables en los países se asociaron de forma directa con mayores prevalencias de exceso de peso poblacional, con comportamientos diferentes en función del género.

Work-related health problems among resident immigrant workers in Italy and Spain

Background: in both Spain and Italy the number of immigrants has strongly increased in the last 20 years, currently representing more than the 10% of workforce in each country. The segregation of immigrants into unskilled or risky jobs brings negative consequences for their health. The objective of this study is to compare prevalence of work-related health problems between immigrants and native workers in Italy and Spain. Methods: data come from the Italian Labour Force Survey (n=65 779) and Spanish Working Conditions Survey (n=11 019), both conducted in 2007. We analyzed merged datasets to evaluate whether interviewees, both natives and migrants, judge their health being affected by their work conditions and, if so, which specific diseases. For migrants, we considered those coming from countries with a value of the Human Development Index lower than 0.85. Logistic regression models were used, including gender, age, and education as adjusting factors. Results: migrants reported skin diseases (Mantel-Haenszel pooled OR=1.49; 95%CI: 0.59-3.74) and musculoskeletal problems among those employed in agricultural sector (Mantel-Haenszel pooled OR=1.16; 95%CI: 0.69-1.96) more frequently than natives; country-specific analysis showed higher risks of musculoskeletal problems among migrants compared to the non-migrant population in Italy (OR=1.17; 95% CI: 0.48-1.59) and of respiratory problems in Spain (OR=2.02; 95%CI: 1.02-4.0). In both countries the risk of psychological stress was predominant among national workers. Conclusions: this collaborative study allows to strength the evidence concerning the health of migrant workers in Southern European countries.

El bienestar en España: una perspectiva de largo plazo, 1850-1991

Los historiadores económicos han estimado tradicionalmente el bienestar en términos de renta por persona. Durante la última década se han publicado, sin embargo, diversos trabajos que utilizan otros indicadores. Siguiendo esta línea de investigación, el artículo contrasta cuatro indicadores del bienestar en España (renta per capita, índice de Desarrollo Humano, Índice Físico de Calidad de Vida y estatura), dos de los cuales son inéditos (IDH e IFCV). Los resultados complican el objeto de estudio, pero sirven para proponer algunas hipótesis que deben ser ratificadas o desmentidas por futuras investigaciones.