Biological and socioeconomic factors as moderator in relationship between leisure-time physical activity and cardiometabolic risk in adolescents from southern Brazil

BACKGROUND@#Given the important repercussions that sociodemographic factors can have on physical activity, especially in the field of leisure, and cardiometabolic risk, it seems relevant to analyze the implications of these variables on the relationship between physical activity in leisure time (LTPA) and cardiometabolic risk. In this sense, the present study aims to verify the moderating role of biologic and socioeconomic factors in the relationship between LTPA and cardiometabolic risk in adolescents in southern Brazil.@*METHODS@#Cross-sectional study that included 1596 adolescents selected at random (58.2% girls), aged between 10 and 17 years. LTPA, biological and socioeconomic factors were assessed using a self-reported questionnaire and the cardiometabolic risk score (total cholesterol/HDL-c ratio, triglycerides, fasting glucose, systolic blood pressure, and waist circumference, considering the participant's age and sex) was included as an outcome. Associations and moderations were tested by multiple linear regression models.@*RESULTS@#It was observed a positive interaction of LTPA and sex (p = 0.048) and LTPA and school system (p = 0.037), and negative interaction of LTPA and skin color (p = 0.040), indicating that these factors were moderators in the relationship between LTPA and clustered cardiometabolic risk score (cMetS) in adolescents. A reduction in cardiometabolic risk was observed according to the increase in weekly minutes of LTPA among boys, non-white adolescents, and students from municipal schools.@*CONCLUSIONS@#The association between LTPA and cardiometabolic risk was moderated by sex, skin color, and school system in adolescents from southern Brazil.

O efeito do calor e do frio na mortalidade não-acidental da população residente nas regiões metropolitanas brasileiras ao longo do período de 2000-2014: estudo de série temporal / Heat and cold effect on non-accidental mortality of the population living in brazilian metropolitan regions over the period 2000-2014: time series study

O aumento do risco relativo de mortalidade por diversas causas é associado a temperatura ambiente extremas. Fatores a nível individual e comunitários podem influenciar esta associação podendo aumentar ou diminuir seus efeitos. Estes podem ser variáveis ao longo do tempo, o que poderia fazer esta associação oscilar ao longo dos anos. Esta tese investigou os efeitos a curto prazo da temperatura ambiente na mortalidade da população geral e idosos do Brasil, bem como a modificação desta associação ao longo do tempo. O primeiro manuscrito verificou quais modificadores de efeito modulam a associação temperatura-mortalidade a curto prazo. O segundo manuscrito verificou se houve mudança na associação temperatura-mortalidade ao longo de três períodos sequenciais. Foi analisado mortalidade não-acidental da população geral e idosa, e para estes foi subdividido em causas circulatórias, respiratórias e outras causas. Ambos os estudos utilizaram um modelo aditivo generalizado combinado com distributed lag non-linear models e período de defasagem de 21 dias para estimar a associação temperatura-mortalidade para cada região metropolitana, grupo e período. Os estudos incluíram um teste de heterogeneidade entre os locais e estimativas combinadas para Brasil e regiões geográficas via metanálise. Modelos de metarregressão incluindo fatores a nível do local foram utilizados para análise de possíveis modificadores da associação. Os resultados do primeiro manuscrito evidenciam um efeito do frio e do calor na mortalidade não-acidental da população geral e idosa, bem como para mortalidade cardiovascular, respiratória e outras causas dos idosos do Brasil, principalmente nas regiões metropolitanas e geográficas do Sudeste e Sul do Brasil, sendo geralmente as baixas temperaturas as promotoras de maiores riscos relativos de óbitos. Os fatores geográficos foram os responsáveis por explicar a maior parte da heterogeneidade entre os locais, com destaque para amplitude da temperatura média. Os resultados do segundo manuscrito exibem estimativas pontuais de risco relativo de mortalidade associado ao frio e ao calor diferentes a cada quinquênio, sendo esta flutuação de padrões distintos conforme tipo de causa e região brasileira. A heterogeneidade da associação temperatura-mortalidade entre os locais cresceu ao longo dos períodos para todos os grupos. Nos grupos mortalidade não-acidental e circulatório, nos três períodos, a amplitude da temperatura é a variável que melhor explica esta heterogeneidade. No grupo respiratório a amplitude diária da temperatura foi forte explicador nos dois primeiros períodos. Os resultados desta tese sugerem efeito da temperatura ambiente sobre a mortalidade no Brasil, com maior foco nas regiões Sul e Sudeste. Assim, planejamento de ações com foco de adaptação as temperaturas extremas tanto altas quanto baixas são necessárias e de imediato foco nas regiões Sul e Sudeste.

The increase in the relative risk of mortality from various causes is associated with extreme ambient temperatures. Factors at the individual and community level can influence this association and may increase or decrease its effects. These can be variable over time, which could cause this association to fluctuate over the years. This thesis investigated the short-term effects of ambient temperature on mortality in the general population and the elderly in Brazil, as well as the modification of this association over time. The first manuscript verified which effect modifiers modulate the short-term association of temperature and mortality. The second manuscript verified whether there was a change in the association between temperature and mortality over three sequential periods. Non-accidental mortality of the general and elderly population was analyzed, and for these it was subdivided into circulatory, respiratory and other causes. Both studies used a generalized additive model combined with distributed lag non-linear models and a lag of 21 days, to estimate the temperature-mortality association for each metropolitan region, group and period. The studies included a test of heterogeneity between locations and combined estimates for Brazil and geographic regions via meta-analysis. Meta-regression models including factors at the local level were used to analyze possible modifiers of the association. The results of the first manuscript show an effect of cold and heat on non-accidental mortality in the general and elderly population, as well as for cardiovascular, respiratory and other causes of the elderly in Brazil, especially in the metropolitan and geographic regions of the Southeast and South of Brazil. Brazil, with low temperatures being generally the promoters of higher relative risks of death. The geographical factors were responsible for explaining most of the heterogeneity between the locations, with emphasis on the amplitude of the average temperature. The results of the second manuscript show specific estimates of the relative risk of mortality associated with cold and heat differently every five years, with this fluctuation of different patterns according to the type of cause and the Brazilian region. The heterogeneity of the temperature-mortality association between sites increased over the periods for all groups. In the non-accidental and circulatory mortality groups, in the three periods, the temperature amplitude is the variable that best explains this heterogeneity. In the respiratory group, the daily temperature range was a strong factor in the first two periods. The results of this thesis suggest the effect of ambient temperature on mortality in Brazil, with a greater focus on the South and Southeast regions. Thus, action planning with a focus on adaptation to extreme temperatures, both high and low, is necessary and immediately focus on the South and Southeast regions.

Conditional Survival and Associated Prognostic Factors in Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy: A Retrospective Study at a Single Institution / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate the changes of conditional survival (CS) probabilities and to identify the prognostic parameters that significantly affect CS over time post-surgery in upper tract urothelial carcinoma (UTUC) patients. MATERIALS AND METHODS: A total of 330 patients were examined in the final analysis. Primary end point was conditional cancer-specific survival (CSS), overall survival (OS), and intravesical recurrence-free survival (IVRFS) after surgery. The Kaplan-Meier method was used for calculation of CS. Cox regression hazard ratio model was used to determine the predictors of CS. RESULTS: UTUC patients who had already survived 5 years after radical nephroureterectomy had a more favorable CS probability in all given survivorships compared to those with shorter survival times. Patients with unfavorable pathologic features showed a higher increment of 5-year conditional CSS and OS compared to their counterparts. For 5-year conditional CSS, several factors, including high-grade tumor, lymphovascular invasion, and tumor location showed significant association with risk elevation over time. Only age remained as a predictor of 5-year conditional OS with increased risk in all given survivorships. For 5-year IVRFS, no variables remained as significant predictive factors over time after surgery. CONCLUSION: Our study provides valuable information for practical survival estimation and relevant prognostic factors for patients with UTUC after surgery.

A study on the changes in attractive force of magnetic attachments for overdenture

PURPOSE: Although magnetic attachment is used frequently for overdenture, it is reported that attractive force can be decreased by abrasion and corrosion. The purpose of this study was to establish the clinical basis about considerations and long term prognosis of overdenture using magnetic attachments by investigating the change in attractive force of magnetic attachment applied to the patients. MATERIALS AND METHODS: Among the patients treated with overdenture using magnetic attachments in Dankook University Dental Hospital, attractive force records of 61 magnetic attachments of 20 subjects who re-visited from July 2013 to June 2014 were analyzed. Dental magnet tester (Aichi Micro Intelligent Co., Aichi, Japan) was used for measurement. The magnetic attachments used in this study were Magfit IP-B Flat, Magfit DX400, Magfit DX600 and Magfit DX800 (Aichi Steel Co., Aichi, Japan) filled with Neodymium (NdFeB), a rare-earth magnet. RESULTS: Reduction ratio of attractive force had no significant correlation with conditional variables to which attachments were applied, and was higher when the maintenance period was longer (P<.05, r=.361). Reduction ratio of attractive force was significantly higher in the subject group in which attachments were used over 9 years than within 9 years (P<.05). Furthermore, 16.39% of total magnetic attachments showed detachment of keeper or assembly. CONCLUSION: Attractive force of magnetic attachment is maintained regardless of conditional variables and reduction ratio increased as the maintenance period became longer. Further study on adhesive material, attachment method and design improvement to prevent detachment of magnetic attachment is needed.

A Meta Analysis of Effectiveness of Death Education / 한국호스피스완화의료학회지

PURPOSE: We comprehensively analyzed domestic studies on the effects of death preparation education in order to present objective data. METHODS: Meta-analysis was conducted with a total of 22 master's and doctoral theses published between 2004 and 2014. RESULTS: According to our analysis, the death preparation education had a mid-size effect. The effect size of a moderator variable was the greatest in infants and children, and the effect size was bigger in younger ages. The effect size was the greatest when education was given through a total of 10~15 sessions, twice a week, and less than 60 minutes per session. The effect variable and death-related variable showed a significant effect size, and sub-variables were equivalent to the death-related variable with a biggest effect size. Non-death related variables had a mid-level effect size and sub-variables were found to have the highest ego integrity. CONCLUSION: The significance of this study lies its systematic integration of advanced research on the effects of death preparation education through meta-analysis. By suggesting guidelines for the design of a death preparation education program, evidence-based basic data were proposed which will more likely strengthen intervention effects. Based on these results, more studies are needed to develop and extensively carry out a death preparation program which can meet needs of specific age groups from children to seniors.

The Hawthorne Effect between Covert and Overt Observations in the Monitoring of Hand Hygiene Adherence among Healthcare Personnel at Coronary Care Unit and Cardiac Surgery Intensive Care Unit / 병원감염관리

BACKGROUND: Direct observation of healthcare workers is commonly used in hospitals to investigate hand hygiene compliance. However, the hand hygiene compliance rate may increase due to the Hawthorne effect, which is the modification of behavior simply because subjects become aware that they are being observed. The objective of this study was to investigate the occurrence of the Hawthorne effect when directly observing hand hygiene compliance in intensive care unit (ICU) healthcare personnel. METHODS: A total of 87 staff members from the coronary care unit and cardiac surgery ICU of a general hospital in Seoul were included in this study: 24 residents and interns, 55 nurses, and 8 nursing assistants. Both covert and overt observations, where subjects were either unaware or aware of any direct observation, were performed on separate occasions. RESULTS: A total of 1,052 covert and 1,336 overt observations were documented over 30 and 34 occasions, respectively. Overall hand hygiene compliance was significantly higher with overt observation than with covert observation (1,041/1,336, 77.9% vs. 659/1,052, 62.6%, P<0.001). The Hawthorne effect was present in all professions and behaviors, with the exception of nursing assistants, and prior to touching a patient. CONCLUSION: Direct observation of hand hygiene compliance was associated with the Hawthorne effect when observations were made overtly and this was likely to contribute to an overestimation of compliance rate.

Psychiatric Applications of Placebos / 대한정신약물학회지

As the placebo effect is inevitable in almost all types of treatment implemented in the context of the doctor-patient relationship, it would be a wise strategy to try to enhance the treatment effect by understanding its mechanism and applying it clinically. However, for various reasons there is resistance to therapeutical application of placebos. The main reason for this resistance comes from the confusion about the concept of the placebo, and it is necessary to differentiate the placebo response and the placebo effect and understand them clearly. Meta-analytical reviews of clinical studies showed that the placebo effect accounts for part of clinical effect of drugs. Authors reviewed meta-analytic studies dealing with the placebo effect on depression, sleep disorders, dementia, anxiety and addiction. In addition, we discussed the current state of placebo use and also the way to promote the placebo effect.

Spatio-temporal patterns of tuberculosis incidence in Ribeirão Preto, State of São Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis / Padrões espaço-temporais da incidência de tuberculose em Ribeirão Preto, Estado de São Paulo, sudeste do Brasil, e suas relações com a vulnerabilidade social: uma análise bayesiana

INTRODUCTION: The purpose of this ecological study was to evaluate the urban spatial and temporal distribution of tuberculosis (TB) in Ribeirão Preto, State of São Paulo, southeast Brazil, between 2006 and 2009 and to evaluate its relationship with factors of social vulnerability such as income and education level. METHODS: We evaluated data from TBWeb, an electronic notification system for TB cases. Measures of social vulnerability were obtained from the SEADE Foundation, and information about the number of inhabitants, education and income of the households were obtained from Brazilian Institute of Geography and Statistics. Statistical analyses were conducted by a Bayesian regression model assuming a Poisson distribution for the observed new cases of TB in each area. A conditional autoregressive structure was used for the spatial covariance structure. RESULTS: The Bayesian model confirmed the spatial heterogeneity of TB distribution in Ribeirão Preto, identifying areas with elevated risk and the effects of social vulnerability on the disease. We demonstrated that the rate of TB was correlated with the measures of income, education and social vulnerability. However, we observed areas with low vulnerability and high education and income, but with high estimated TB rates. CONCLUSIONS: The study identified areas with different risks for TB, given that the public health system deals with the characteristics of each region individually and prioritizes those that present a higher propensity to risk of TB. Complex relationships may exist between TB incidence and a wide range of environmental and intrinsic factors, which need to be studied in future research.

INTRODUÇÃO: O objetivo deste estudo ecológico é avaliar a distribuição espacial e temporal da tuberculose (TB) na área urbana de Ribeirão Preto, São Paulo, entre os anos de 2006 e 2009, e estudar as suas relações com fatores de vulnerabilidade social como renda e educação. MÉTODOS: Foram utilizados dados do TBWeb, um sistema de notificação de dados de TB. As medidas de vulnerabilidade social foram obtidas da Fundação SEADE (Sistema Estadual de Análise de Dados) e informações sobre o número de habitantes, educação e renda dos chefes dos domicílios foram obtidas do Instituto Brasileiro de Geografia e Estatística. A análise estatística utilizou um modelo bayesiano de regressão assumindo que os novos casos de TB observados em cada área assumem uma distribuição de Poisson. RESULTADOS: O modelo bayesiano confirmou a heterogeneidade especial da distribuição da TB em Ribeirão Preto, identificando áreas com elevado risco de TB e os efeitos da vulnerabilidade social sobre a doença. Foi evidenciado que a taxa de TB associa-se com as medidas de renda, educação e vulnerabilidade social. Entretanto, são observadas áreas com baixa vulnerabilidade social e alto nível educacional, mas altas taxas de TB. CONCLUSÕES: O estudo identificou áreas com diferentes riscos de TB, permitindo que o sistema público de saúde lide com as diferentes características de cada região e priorize aquelas que apresentem maior propensão de risco de TB. São evidentes relações complexas entre a incidência de TB e um amplo número de fatores ambientais e intrínsecos, o que mostra a necessidade destes serem estudados em trabalhos futuros.

Does the way I see you affect the way I see myself? Associations between interviewers' and interviewees' "color/race" in southern Brazil / Como te percebo afeta o modo como me vejo? Relações da "cor/raça" de entrevistadores e de entrevistados no Sul do Brasil

This study assessed the associations between female interviewers' self-classified "color/race" and participants' self- and interviewer-classified "color/race". A cross-sectional study was carried out among adult individuals living in Pelotas, southern Brazil. Associations were examined by means of contingency tables and multinomial regression models, adjusting for interviewees' socioeconomic and demographic factors. Individuals aged > 40 years were 2.1 times more likely to classify themselves as brown (versus white) when interviewed by black (as compared to white) interviewers. Participants in the same age group were 2.5 times less likely to classify themselves as black (versus white), when interviewed by black interviewers. These differences were even greater among men 40 years or older. Compared to white interviewers, black female interviewers were 2.5 times less likely to classify men aged > 40 years as black. These results highlight the complexity of racial classification, indicating the influence of the interviewer's physical characteristics on the interviewee's "color/race".

Avaliou-se a relação entre "cor/raça" de entrevistadoras, auto e heteroclassificação de "cor/raça" dos entrevistados. Foi realizado um estudo com indivíduos adultos de Pelotas, Rio Grande do Sul, Brasil. As associações foram verificadas com tabelas de contingência e modelos multinomiais, ajustando-se para variáveis sócio-econômicas e demográficas dos entrevistados. Indivíduos com > 40 anos tiveram uma chance 2,1 vezes maior de se classificarem como pardos do que como brancos, quando abordados por entrevistadoras pretas, em relação às brancas. Entrevistados dessa mesma faixa etária apresentaram 2,5 vezes menos chances de se classificarem como pretos do que como brancos, ao serem abordados por entrevistadoras pretas. Essas diferenças foram mais expressivas entre homens de > 40 anos. Entrevistadoras pretas tiveram chance 2,5 vezes menor de classificar homens de > 40 anos como pretos do que como brancos, em comparação com as brancas. Os resultados indicam o caráter complexo da classificação racial, sugerindo a influência de características pessoais das entrevistadoras sobre a "cor/raça" dos entrevistados.

Paracoccidioidomicose pulmonar: relato de dois casos enfatizando o sinal do halo invertido / Pulmonary paracoccidioidomycosis and reversed halo sign: a two-case report

Este trabalho relata dois casos de paracoccidioidomicose pulmonar comprovados histologicamente, nos quais foi encontrado o sinal radiológico do halo invertido. Este sinal, descrito inicialmente como patognomônico da pneumonia criptogênica em organização, foi posteriormente encontrado e descrito na paracoccidioidomicose.

The present study reports two histologically proven cases of pulmonary paracoccidioidomycosis where a reversed halo sign was found. The reversed halo, initially described as a pathognomonic sign of cryptogenic organizing pneumonia, has later been found and described in paracoccidioidomycosis.

A multifaceted intervention to prevent American cutaneous leishmaniasis in Colombia: results of a group-randomized trial / Prevención de leishmaniasis cutánea americana en Colombia mediante una intervención múltiple: resultados de un ensayo de grupos aleatorios

Introducción. La leishmaniasis cutánea americana es endémica en Colombia, donde cada año son notificados aproximadamente 6000 casos nuevos. En la actualidad las medidas de prevención y control están limitadas al diagnóstico y tratamiento de los casos. Objetivo. Evaluar la eficacia de una intervención múltiple para prevenir la transmisión de Leishmania en el foco endémico de Tumaco, costa Pacífica de Colombia. Materiales y métodos. Se realizó un ensayo de grupos aleatorizados. Veinte veredas fueron pareadas según prevalencia de Leishmania, habitantes y participación comunitaria y luego asignadas aleatoriamente a intervención o control. La intervención incluyó toldillos impregnados con deltametrina, repelente (N, N-dietil-m-toluamida 20 por ciento y Permetrina 0,5 por ciento), modificación de lugares de reposo para los vectores y educación. Al cabo de un año se comparó la incidencia de infección y enfermedad producida por Leishmania en los dos grupos, se monitorearon la adherencia a la intervención y la aparición de efectos adversos. Los resultados finales fueron ajustados por el efecto de correlación intra-grupo. Resultados. Se presentaron 10 casos de leishmaniasis cutánea americana en el grupo que recibió la intervención y 23 en el grupo control, OR=0,42, IC95 por ciento 0,14-1,26. La intervención tuvo un mayor efecto en los niños menores de 10 años, en aquellos que residían en la periferia de la vereda y en veredas con una prevalencia de infección en niños pequeños mayor del 1 por ciento. Se reportaron eventos adversos leves asociados con el uso de los toldillos impregnados y el repelente en 2 por ciento de los participantes. Conclusión. Los casos nuevos de Leishmaniasis cutánea americana se redujeron en un 58 por ciento en el grupo que recibió la intervención. Sin embargo, el número pequeño de casos hace que la estimación de la medida de efecto sea imprecisa y no nos permite afirmar que la intervención tiene un efecto protector. Poblaciones específicas podr...

Introduction. American cutaneous leishmaniasis is endemic in Colombia, where approximately 6.000 new cases are reported every year. Current prevention and control measures are restricted to the diagnosis and treatment of cases. Objective. To evaluate the efficacy of a multifaceted intervention to prevent the transmission of Leishmania in the endemic focus of Tumaco, on the Pacific Coast of Colombia. Materials and methods. A group-randomized trial was conducted. Twenty villages were matched according to prevalence of Leishmania infection, number of inhabitants and level of community participation, and then randomly assigned to intervention or control. The intervention included deltamethrin-impregnated bednets, repellent (20% diethyltoluamide and 0.5% permethrin), modification of sand fly resting sites, and health education. Villages were under surveillance for one year and the use of the intervention measures monitored. The incidence of American cutaneous leishmaniasis and Leishmania infection in the two groups were compared, adherence to the intervention and adverse events were monitored, and the results were adjusted for village intraclass correlation. Results. Ten cases of American cutaneous leishmaniasis were confirmed in the intervention and 23 in the control group, OR = 0.42, 95% CI 0.14-1.26. The intervention had a greater effect in children < 10 years old, in people living on the periphery of the village and in villages with a prevalence of infection in small children > 1%. Adverse events associated with the use of the bednets and the repellent were reported in 2% of the participants and were always mild. Conclusion. Incident cases of American cutaneous leishmaniasis were reduced by 58% in the intervention group. However, the small number of cases renders the effect estimate imprecise and precludes us to claim a protective effect for the intervention. Specific populations could be the targets of simpler and more cost-effective interventions in the future.

Trauma raquimedular – perfil epidemiológico dos pacientes atendidos pelo serviço público do estado de Goiás nos anos de 2000 a 2003 / Spinalcord injury – statistical research of patients treated by the public service of Goiás state at 2000 and 2003

As fraturas de coluna são lesões que, se desprezadas no atendimento inicial, cursam com alta morbidade. Não é raro que pacientes sofram lesões medulares em decorrência de um socorro inicial inadequado ou de um primeiro atendimento hospitalar mal conduzido. Com o surgimento de equipes de resgate nos grandes centros urbanos, que adotam protocolos rígidos de prevenção de traumas raquimedulares (uso de colares cervicais, pranchas), espera-se que o número de lesões secundárias diminua. Todo politraumatizado deve ser examinado para afastar a hipótese de lesões vertebrais. No estado de Goiás, todos os pacientes com fraturas de coluna são encaminhados ao Hospital de Urgências de Goiânia (HUGO) e Hospital das Clínicas da Faculdade de Medicina (FMHC), da Universidade Federal de Goiás (UFG), cuja responsabilidade de tratamento é da equipe de Cirurgia da Coluna Vertebral da FMHC-UFG. O serviço de fisioterapia desta equipe realizou um levantamento epidemiológico dos pacientes com trauma raquimedular. Foram avaliados 632 pacientes no período de janeiro de 2000 a dezembro de 2003, com faixa etária predominante de pacientes jovens com até 25 anos, sendo a maioria do sexo masculino. A principal etiologia de lesão medular foi acidente de trânsito (44%), o nível de lesão mais freqüente foi o tóraco-lombar (51%), o quadro sensitivo e motor permaneceu inalterado em 44% e o principal déficit foi a paraplegia (26%); 75% dos casos não apresentaram complicações e os primeiros socorros, em sua maioria (54%), foram prestados por leigos. O objetivo desta pesquisa é demonstrar a necessidade de elaborar e implantar campanhas educativas e preventivas, visando diminuir a incidência de pacientes vítimas de lesão medular.

Spinal cord injury has a high morbidity rate when it is undertreated. Commonly that kind of injury takes place in conjuntion with an inadequate first attendance or a fraught initial medical assistance. The emerging of high-specialized rescue groups with rigid spinal cord injury prevention protocols hopefully will decrease the prevalence of several injuries. Every accident victim must be assessed for vertebral fractures. At the state of Goiás, all the spinal fractured patient are taken to the Hospital de Urgências de Goiânia (HUGO) and Hospital das Clínicas da Faculdade de Medicina (FMHC) da Universidade Federal de Goiás (UFG), which treatment responsibility falls over the Grupo de Cirurgia da Coluna Vertebral (Spinal Cord Surgery group) of the FMHC-UFG. The physical therapy group did an injured patients epidemiological research. From January 2000 to December 2003, 632 patients’ histories were collected. Most of those patients were males under 25 years old. The main etiology was spinal cord injury caused by car accident (44%), with a mean toraco-lumbar level (51%) with no sensitive and motor functions alteration (44%). The main deficit was paraplegia (26%). Seventy five per cent were complications free and at 54% of the cases the first aids were conducted by non-medical persons. The main of this study is to demonstrate the importance of educational and preventive programs in reducing of the spinal cord injured incidence.

The World Health Survey: a report on the field experience in Brazil / Pesquisa Mundial de Saúde: relato da experiência de campo no Brasil

This article reports on the field experience with the World Health Survey in Brazil with the aim of collaborating in the development and enhancement of the methodology and analyzing interview questions based on the interviewers' experience. The authors comment on the field experience and application of the questionnaire, based on reports by regional coordinators and interviewers, in order to shed light on the context in which the interviews took place. The article reports on how the respondents grasped and interpreted the questionnaire. The authors propose improvements in interviewer training and simple interview reporting measures aimed at improved logistics with such nationwide survey instruments.

O objetivo deste trabalho é relatar as experiências decampo da Pesquisa Mundial de Saúde no Brasil com ointuito de colaborar com o desenvolvimento e aprimoramentoda metodologia e analisar questões doquestionário confrontando-as com a experiência dosentrevistadores. Comentou-se sobre a experiência decampo e a aplicação do questionário aproveitando-serelatos de coordenadores regionais e dos entrevistadorespara conhecer o contexto em que transcorreramas entrevistas. Foram relatadas as experiências com relaçãoao entendimento e compreensão do questionáriopor parte dos entrevistados. Os autores propõem melhoriasna forma de treinamento dos entrevistadores emedidas simples para que elas possam ser relatadasvisando o aprimoramento da logística na aplicação deinstrumentos desta abrangência territorial.

Se puede reducir el índice de cesárea? Experiencia del Hospital Clínico de la Universidad de Chile

Se presenta la experiencia de la Maternidad del Hospital Clínico de la Universidad de Chile de un programa dise¤ado especialmente con el objetivo de disminuir las cesáreas evitables. Tomando el porcentaje de cesáreas del trimestre enero-marzo de 2003 como base. Se efectuó un programa de intervención entre los meses de abril-septiembre de 2003, que considera: entrega diaria del turno de residencia, segunda opinión para operación cesárea, diagnóstico pormenorizado de pelvis en ficha clínica, auditoría mensual de cesáreas "evitables" y estandarización de un protocolo de presentaciones distócicas. El propósito del estudio fue evaluar el efecto de la introducción de un sistema de auditoría en la reducción de la tasa de cesáreas, según propuesta de Robson y cols. El porcentaje global de cesáreas disminuyó de 44,9 por ciento a 37,1 por ciento, en nulíparas de 39,0 por ciento a 29,5 por ciento y en multíparas de 48,1 por ciento a 42,2 por ciento, diferencias estadísticamente significativas.

Multicollinearity may lead to artificial interaction: an example from a cross sectional study of biomarkers.

Collinearity is the situation which arises in multiple regression when some or all of the explanatory variables are so highly correlated with one another that it becomes very difficult, if not impossible, to disentangle their influences and obtain a reasonably precise estimate of their effects. Suppressor variable is one of the extreme situations of collinearity that one variable can substantially increase the multiple correlation when combined with a variable that is only modestly correlated with the response variable. In this study, we describe the process by which we disentangled and discovered multicollinearity and its consequences, namely artificial interaction, using the data from cross-sectional quantification of several biomarkers. We showed how the collinearity between one biomarker (blood lead level) and another (urinary trans, trans-muconic acid) and their interaction (blood lead level* urinary trans, trans-muconic acid) can lead to the observed artificial interaction on the third biomarker (urinary 5-aminolevulinic acid).

Influência da separaçäo precoce na interaçäo mäe-bebê / Influence of early separation on the interaction between mother and newborn infant

O presente estudo tem como objetivo avaliar a interaçäo mäe-bebê a partir de diferentes tempos de contato no período pós-parto imediato. A idéia do estudo era a comparaçäo de dois grupos: um que seguiria a rotina do Centro Obstétrico do Hospital de Clínicas de Porto Alegre e outro ao qual se ofereceria um tempo extra de contato. Devido à ocorrência de efeito Hawthorne, perdeu-se o grupo-controle (näo houve diferença no tempo de contato das duplas em cada um dos grupos durante o período sensível). Assim, as 29 duplas que efetivamente entraram na pesquisa foram acompanhadas, sendo avaliadas as interaçöes, como um único grupo, já que o tempo extra de contato e o apoio às mäes no período de pós-parto imediato foram os mesmos, o que pode ter contribuído para os bons resultados das interaçöes. Após o primeiro, o sexto e o décimo segundo meses de vida do bebê, as duplas apresentaram, respectivamente, taxa de 95 por cento, 100 por cento e 92,8 por cento de boas e muito boas interaçöes. Investigaçöes futuras nesta área, com amostras maiores, devem ser realizadas, fornecendo outras contribuiçöes aos profissionais da saúde, gerando conhecimento capaz de auxiliar na prevençäo de doenças mentais, abandono e abuso, a baixo custo