Sick leave due to dorsopathies among bus drivers from a company in São Paulo, Brazil.

Introduction: Dorsopathies are common among bus drivers and may result in absenteeism due to work disability. Dorsopathies have a multifactorial etiology, including those related to occupational risk factors. Objectives: To analyze the factors associated with sick leave due to dorsopathies among bus drivers from a public transport company. Methods: This was a cross-sectional, analytical study with information from a database of 2,229 professional bus drivers from a company in the city of São Paulo, Brazil. The study period was from 2016 to 2017. Independent variables were sex, age group, length of service, and work shift; the outcome was the history of sick leave due to dorsopathies in the study period. Logistic regression analysis was performed to investigate the factors associated with the outcome. Results: Mean sample age was 47.33 years, and mean length of service was 8.65 years. Most participants were men (98.06%) and worked during the day (85.9%). There was a 17% prevalence of sick leave in the study period, with an average of 1.86 days per medical certificate. Age group was the only variable with a statistically significant distribution, with a reduced probability of sick leave due to dorsopathies in those aged ≥ 40 years. Conclusions: Younger workers were more likely to be on sick leave due to dorsopathies than older workers. Actions aimed at permanent health promotion and disease prevention are important to improve the quality of life and well-being of these workers.

Implementation of a Virtual Reality recreation program in long-term care.

Introduction: This manuscript describes the implementation of a Virtual Reality (VR) recreation program at long-term care sites across Ontario, Canada, using the RE-AIM Framework to guide the implementation and its evaluation. Methods: We developed a VR recreation program to enhance the lives of long-term care residents, through 3 sequential phases. In Phase 1, we learned about resident and staff needs through focus groups, staff surveys and observations. In Phase 2, we developed 10 VR experiences, based on the data from Phase 1. In Phase 3, we implemented the VR experiences and supporting manual and measured their implementation, using the RE-AIM Framework. Results: We found the VR program to be highly (but not consistently) implementable across all sites. Factors that supported implementation were the following: resident interest in the content and technology, relative ease of use for staff to implement and formally integrating VR into the recreation calendar. Factors that impeded implementation were the following: the size of the headset, inability for the headset to cast given the sites' Information Technology infrastructure and some content that was not engaging. Conclusions: VR programs are highly implementable and this implementation is enhanced by integration of the program into existing recreational systems, ease of use and resident engagement.

Virtual reality and well-being in older adults: Results from a pilot implementation of virtual reality in long-term care.

INTRODUCTION: This paper describes the findings of a pilot implementation project that explored the potential of virtual reality (VR) technology in recreational programming to support the well-being of older adults in long-term care (LTC) homes. METHODS: 32 Adults in four LTC homes participated in a pilot implementation project where they viewed VR experiences of popular locations in Canada created especially for this project. Data in this paper are based on multiple viewing experiences (n = 102) over a two-week period. RESULTS: VR appeared to be an effective distraction from pain for the participants. Participants of this study found the VR experiences to be enjoyable and were relaxed and happy while viewing them. Most participants were attentive or focused while viewing the VR experiences, and the experiences were found to be a source of reminiscence for some of the participants. Participants related well to others around them during a majority of the experiences and the VR experiences were a point of conversation between the staff and the participants. CONCLUSION: The findings from this pilot implementation reveal that VR shows potential to enhance the physical, emotional, cognitive, and social well-being of older adults living in LTC, including those living with cognitive impairment.

DNA methylation profile of genes related to immune response in generalized periodontitis.

BACKGROUND AND OBJECTIVE: Epigenetic events, as the DNA methylation, may be related to development of inflammatory diseases. Due to the important role of host's response in the pathogenesis of periodontitis, the purpose of the present study was to investigate the methylation profile of genes related to immune response in gingival tissues from patients with generalized periodontitis (GP) compared to healthy individuals. METHODS: Gingival tissues were collected from 20 individuals with GP and 20 healthy individuals. Genomic DNA was extracted and submitted to enzymatic digestions. An initial screening using a panel of genes involved with the response immune was performed in pools containing six samples of each group. Genes that presented different levels of methylation between the groups were selected for individual assays for validation. RESULTS: The array results showed an unmethylated profile in the majority of genes evaluated in both groups. MALT1, LTB, and STAT5 genes presented a profile of partial methylation in the control compared with GP group. Validation individual assays using a larger number of samples (n = 20, each group) confirmed the hypomethylation of STAT5 in the GP group compared with control group (P < .001). CONCLUSION: Generalized periodontitis is associated with hypomethylation of the STAT5 gene. Further studies are necessary to evaluate the functional impact these findings.

Laserterapia versus técnica de compressão isquêmica: avaliação comparativa dos efeitos terapêuticos e funcionais da contratura do músculo trapézio / Laser therapy versus ischemic compression technique: comparative evaluation of the therapeutic and functional effects of trapezius contracture

Introdução: A contratura muscular ocorre quando o músculo se contrai de maneira incorreta e não volta ao seu estado normal de relaxamento, em resposta a uma sobrecarga de esforço. Objetivos: Comparou-se a utilização de duas técnicas e os benefícios proporcionados ao tratamento dos pacientes acometidos com contratura do músculo trapézio superior. Métodos: Tratou-se de um estudo transversal, intervencionista, comparativo e quantitativo no período de agosto de 2015 a junho de 2016, com 49 acadêmicos, que foram divididos em dois grupos (G1/G2). Os dados foram obtidos através da ficha de avaliação cinético-funcional desenvolvida para o estudo, que foi aplicada antes e ao término do tratamento fisioterapêutico, Escala dos Sintomas de Dyrek e Escala Visual Analógica. Resultados: Dos 49 acadêmicos, 80% eram do sexo feminino, sendo 95% solteiras, todos naturais de Fortaleza, todos cursando o ensino superior, com média de idade de 23,33 anos. No G1 (Compressão isquêmica) antes da aplicação a maior predominância foi a de nível de dor 7 e logo depois da aplicação o nível de maior predominância foi de dor 2, conforme Escala Visual Analógica. No G2 (Laserterapia) o nível de dor antes da aplicação foi de 7 e logo depois da aplicação, foi de dor 1 conforme Escala Visual Analógica. Conclusão: As técnicas de Laserterapia e a Compressão Isquêmica melhoraram o aporte sanguíneo da área tratada, porém na laserterapia houve a diminuição do limiar de dor e restabelecimento da normalidade funcional local. (AU)

Introduction: Muscle contracture occurs when the muscle contracts incorrectly and does not return to its normal state of relaxation in response to effort overload. Objectives: We compared the use of two techniques and the benefits provided to the treatment of patients with upper trapezius contracture. Methods: This was a cross-sectional, interventional, comparative and quantitative study between August 2015 and June 2016, with 49 academics divided into two groups (G1/G2). The data were obtained through the functional kinetic evaluation sheet developed for the study, which was applied before and at the end of the physiotherapeutic treatment, Dyrek Symptom Scale and Visual Analog Scale. Results: Of the 49 students, 80% were female, 95% single, all of them from Fortaleza/CE, all of them attending higher education, with a mean age of 23.33 years. In G1 (Ischemic Compression), before the application, the greatest predominance was pain level 7 and soon after the application the greater predominance was level pain 2, according to Visual Analog Scale. In G2 (Laser Therapy) the level of pain before the application was 7 and soon after the application was level pain 1 according to Visual Analog Scale. Conclusion: Laser therapy and ischemic compression improved the blood supply of the treated area, and laser therapy decreased th pain threshold and restored the local functional normality. (AU)

Perfil de metilação do DNA em genes relacionados à resposta imune na periodontite generalizada / DNA methylation profile of genes related to immune response in generalized periodontitis

A periodontite é uma doença inflamatória crônica, multifatorial, associada com a disbiose do biofilme dental e caracterizada pela destruição dos tecidos de suportes dos dentes. Embora a presença das bactérias seja essencial na patogênese da periodontite, fatores do hospedeiro, como os genéticos e epigenéticos e fatores ambientais e adquiridos participam do processo. Eventos epigenéticos, como a metilação do DNA, podem estar relacionados ao desenvolvimento de doenças com perfil inflamatório. Devido ao importante papel da resposta do hospedeiro na patogênese da periodontite, o objetivo do presente estudo foi investigar o perfil de metilação de genes relacionados à resposta imune em tecidos gengivais de pacientes com periodontite generalizada (PG) em comparação com indivíduos saudáveis. Métodos: Tecidos gengivais foram coletados de 20 indivíduos com PG e 20 indivíduos sem periodontite, como controle. O DNA genômico foi extraído e submetido a digestões enzimáticas. Uma triagem inicial utilizando um painel de genes envolvidos com a resposta imune foi realizada em pools contendo seis amostras de cada grupo. Os genes que apresentaram diferentes níveis de metilação entre os grupos foram selecionados para os ensaios individuais para validação. Resultados: Os resultados mostraram um perfil não metilado na maioria dos genes avaliados nos dois grupos. Os genes MALT1, LTB e STAT5 apresentaram um perfil de metilação parcial no controle comparado ao grupo PG. Ensaios individuais em um número maior de amostras (n = 20, cada grupo) confirmaram a hipometilação do STAT5 no grupo PG comparado ao grupo controle (p <0,001). Conclusão: A PG está associada à hipometilação do gene STAT5. Novos estudos são necessários para avaliar o impacto funcional desses achados.

Background and objective: Epigenetic events, as the DNA methylation, may be related to development of diseases with inflammatory profile. Due to the important role of host's response in the pathogenesis of periodontitis, the purpose of present study was to investigate the methylation profile of genes related to immune response in gingival tissues from patients with generalized periodontitis (GP) compared to healthy individuals. Methods: Gingival tissues were collected from 20 individuals with GP and 20 healthy individuals. Genomic DNA was extracted and submitted to enzymatic digestions. An initial screening using a panel of genes involved with the response immune was performed in pools containing six samples of each group. Genes that presented different levels of methylation between the groups were selected for individual assays for validation. Results: The array results showed an unmethylated profile in the majority of genes evaluated in both groups. MALT1, LTB and STAT5 genes presented a profile of partial methylation in the control compared to GP group. Individual assays in a larger number of samples (n=20, each group) confirmed the hypomethylation of STAT5 in the GP group compared to control group (p<0.001). Conclusion: GP is associated with hypomethylation of the STAT5 gene. Further studies are necessary to evaluate the functional impact these findings.

Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis.

Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis / Os efeitos do tabagismo sobre a perda dentária em indivíduos em terapia periodontal de suporte: uma revisão sistemática e meta-análise / Los efectos del consumo de tabaco en la pérdida de dientes entre personas con una terapia de mantenimiento periodontal: un revisión sistemática y metaanálisis

Abstract: Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

Resumo: A perda dentária tem sido relatada em estudos longitudinais sobre terapia periodontal de suporte (TPS), mas houve menos investigação sobre o efeito independente do tabagismo sobre a perda dentária, ajustado por importantes variáveis de confusão. Esta revisão sistemática teve como objetivo avaliar e analisar o efeito isolado do tabagismo sobre perda dentária em indivíduos em TPS. A estratégia incluiu fontes eletrônicas, busca manual, literatura cinzenta e artigos recentes (publicados a partir de abril de 2018), sem restrição quanto ao idioma; as datas de publicação foram incluídas. Foram selecionados estudos clínico-epidemiológicos com dados sobre perda dentária entre tabagistas em TPS, comparado com grupos-controle de não-tabagistas. A qualidade metodológica foi avaliada com a Escala de Newcastle-Ottawa. Foi realizada uma meta-análise, assim como, I2 testes de heterogeneidade e de sensibilidade. A qualidade das evidências foi avaliada com a escala GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Onze artigos foram incluídos na revisão sistemática, sendo quatro estudos de casos e controles e sete estudos de coorte. Dez dos 11 estudos concluíram que o tabagismo é importante fator de risco para a ocorrência de perda dentária. De acordo com a meta-análise de quatro dos estudos de coorte, os tabagistas em TPS apresentavam risco 3,24 vezes maior de ocorrência de perda dentária quando comparados aos não tabagistas (IC95%: 1,33-7,90). O risco global de viés nos estudos foi baixo. A revisão mostrou qualidade moderada das evidências científicas de que os tabagistas em TPS apresentam risco maior de perda dentária do que os não-tabagistas.

Resumen: La mortalidad dental ha sido estudiada en estudios longitudinales acerca de la terapia de mantenimiento periodontal (TMP), pero el efecto independiente de fumar en la pérdida de dientes (PD), ajustado a variables de confusión importantes, se ha evaluado muy poco. Esta revisión sistemática tuvo como objetivo evaluar y analizar el efecto aislado de fumar en la PD con personas bajo TMP. Se investigó en medios electrónicos, manuales, literatura gris, y artículos recientes (desde abril 2018), sin restricciones respecto a la lengua; incluyendo sus respectivas fechas de publicación. Además, se seleccionaron estudios clínicos epidemiológicos que trabajaban sobre datos de PD entre fumadores que estaban bajo TMP, en comparación con grupos de control de no fumadores. La calidad metodológica se evaluó usando la Escala de Newcastle-Ottawa. Se realizó un metaanálisis, así como tests de heterogeneidad I2 y sensibilidad. La evidencia de calidad fue evaluada usando GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Se incluyeron once trabajos en la revisión sistemática (cuatro de caso-control y siete estudios de cohortes). Diez de los once estudios concluyeron que fumar era un factor de riesgo importante para la ocurrencia de PD. Los metaanálisis de cuatro de los estudios de cohorte descubrieron que los fumadores tenían 3,24 veces más la oportunidad de sufrir PD, en comparación con los no fumadores TMP (IC95%: 1,33-7,90). En general, el riesgo de sesgo en los estudios fue bajo. La calidad de la evidencia científica respaldó moderadamente que los fumadores bajo TMP contaban con más oportunidad de PD que los no fumadores.

Limits of Brazil's Forest Code as a means to end illegal deforestation.

The 2012 Brazilian Forest Code governs the fate of forests and savannas on Brazil's 394 Mha of privately owned lands. The government claims that a new national land registry (SICAR), introduced under the revised law, could end illegal deforestation by greatly reducing the cost of monitoring, enforcement, and compliance. This study evaluates that potential, using data from state-level land registries (CAR) in Pará and Mato Grosso that were precursors of SICAR. Using geospatial analyses and stakeholder interviews, we quantify the impact of CAR on deforestation and forest restoration, investigating how landowners adjust their behaviors over time. Our results indicate rapid adoption of CAR, with registered properties covering a total of 57 Mha by 2013. This suggests that the financial incentives to join CAR currently exceed the costs. Registered properties initially showed lower deforestation rates than unregistered ones, but these differences varied by property size and diminished over time. Moreover, only 6% of registered producers reported taking steps to restore illegally cleared areas on their properties. Our results suggest that, from the landowner's perspective, full compliance with the Forest Code offers few economic benefits. Achieving zero illegal deforestation in this context would require the private sector to include full compliance as a market criterion, while state and federal governments develop SICAR as a de facto enforcement mechanism. These results are relevant to other tropical countries and underscore the importance of developing a policy mix that creates lasting incentives for sustainable land-use practices.

Evolução da qualidade das informações das declarações de óbito com menções de sífilis congênita nos óbitos perinatais no Brasil / Evolution of quality of information in death certificates mentioning congenital syphilis in perinatal deaths in Brazil

Resumo Objetivo avaliar a qualidade das informações das declarações de óbito (DO) com menções de sífilis congênita (SC) nos óbitos perinatais no Brasil (2001/2002 e 2012/2013). Métodos estudo transversal com dados do Sistema de Informações de Mortalidade de óbitos fetais e neonatais precoces. Foram calculadas taxas de mortalidade fetal, neonatal precoce e perinatal específicas por SC, percentual de incompletude por variáveis selecionadas, razões de causa básica e causa múltipla (CB/CM) e outros indicadores. Analisou-se causa básica original comparativamente à causa básica após investigação. Resultados em 2001/02 e 2012/13, ocorreram 330 e 933 óbitos perinatais, respectivamente, com menção de SC; a taxa de mortalidade perinatal passou de 4,2 a 12,8 por 100 mil nascimentos totais. A completude dos principais campos de preenchimento obrigatório melhorou, com CB/CM de 0,8 para SC, indicando registro adequado dessa causa com as causas múltiplas. A participação da SC como causa básica da morte aumentou pós-investigação, passando de 31,2% para 85,4% (óbitos fetais) e de 54,5% a 76,2% (neonatais precoces). Conclusão a taxa de mortalidade perinatal por SC aumentou, com melhora do preenchimento das DO. O uso das causas múltiplas de morte permitiu análise dos óbitos perinatais com menção de SC, o que é importante, dados os esforços na redução dessa doença.

Abstract Objective Evaluate the quality of information in death certificates (DC) mentioning congenital syphilis (CS) in perinatal deaths in Brazil (2001/02 and 2012/13). Methods Crossectional study with data from the Mortality Information System about fetal and early neonates. Fetal, early neonatal and perinatal mortality rates specific by CS, percentage of incompleteness by selected variables, underlying causes and multiple causes of death ratio (CB/CM), and other indicators were calculated. The original underlying cause was compared to the underlying cause after investigation. Results In 2001/02 and 2012/13, 330 and 933 perinatal deaths, respectively, with CS occurred; perinatal mortality rate increased from 4.2 to 12.8 per 100.000 total births. The completion of the main required fields has improved. The CB/CM ratio was 0.8 for CS, indicating adequate registration of this cause, with use of multiple causes. CS percentage as the underlying cause increased post-investigation, from 31.2% to 85.4% (fetal deaths) and from 54.5% to 76.2% (early neonates). Conclusion perinatal mortality rate due to CS increased over the study period. There was improvement in the completion of the DC. The use of multiple causes of death allowed the analysis of all perinatal deaths with CS mention, which is important given efforts in reducing CS.

Conhecimento de profissionais da Estratégia Saúde da Família sobredepressão pós-parto / Knowledge of professionals that work in the Family Health Strategy about post natal depression

Objetivo: investigar o conhecimento de profissionais da Estratégia Saúde da Família quanto aotratamento da depressão pós-parto (DPP). Métodos: pesquisa descritiva e qualitativa, realizada com62 participantes, entre 2012 e 2013, uso de entrevista semiestruturada e análise de discurso. As falasforam gravadas, transcritas e neste artigo são apresentados resultados de uma categoria, das trêsobtidas. Projeto aprovado por Comitê de Ética em Pesquisa (CAAE nº 04456812.1.0000.5294).Resultados: os participantes demonstram preocupação com o encaminhamento de casos de DPP,admitem a inexistência de profissionais especializados para acompanhamento e apresentam o médicoda equipe como principal ator na identificação da doença. Considerações Finais: o atendimento etratamento da puérpera parece fragmentado e não resolutivo. Torna-se evidente a necessidade deinvestimentos em atividades de saúde mental na atenção básica.

Objective: to investigate the knowledge of professionals that work in the Family Health Strategyregarding the treatment of postnatal depression (PND). Methods: descriptive and qualitativeresearch, held with 62 participants, from 2012 to 2013, using semi-structured interviews anddiscourse analysis. The speeches were recorded and transcribed. In this paper, one out of threecategories results is presented. This project was approved by Research Ethics Committee (CAAE04456812.1.0000.5294). Results: participants have shown concerning about the referral of cases ofPND, admit the absence of specialized professionals to monitoring and indicate the team doctor asthe major actor in the identification of this disease. Final Considerations: the health care andtreatment of the affected puerperal woman seems to be fragmented and non-resolutive. It becomesclear that there is a need for investments in mental health activities in primary care.

Objetivo: investigar el conocimiento de profesionales de la Estrategia Salud de la Familia en lo querespecta al tratamiento de la depresión posparto (DPP). Métodos: investigación descriptiva ycualitativa, realizada con 62 participantes, entre 2012 y 2013, con uso de entrevistasemiestructurada y análisis de discurso. Las testimonios fueron grabados y transcritos. En esteartículo, se presentan los resultados de una categoría, de las tres obtenidas. Proyecto aprobado porComité de Ética en Investigación (CAAE 04456812.1.0000.5294). Resultados: los participantesdemuestran preocupación por la remisión de los casos de DPP, admiten la ausencia de profesionalesespecializados para seguimiento y presentan el médico del equipo como el elemento central en laidentificación de la enfermedad. Consideraciones Finales: el cuidado y tratamiento de la mujer queha dado luz recientemente se muestra fragmentada no es resolutiva. Se hace evidente la necesidadde inversiones en las actividades de salud mental en la atención primaria.

Clinical and Microbiologic Evaluation of Scaling and Root Planing per Quadrant and One-Stage Full-Mouth Disinfection Associated With Azithromycin or Chlorhexidine: A Clinical Randomized Controlled Trial.

BACKGROUND: Conflicting data about the protocol of choice for non-surgical periodontal therapy with adjuvant use are still reported. This study aims to evaluate, through clinical and microbiologic parameters, the systemic use of azithromycin (AZ) and chlorhexidine (CHX) as adjuvants to non-surgical periodontal treatment performed by one-stage full-mouth disinfection (FMD) within 24 hours or conventional quadrant scaling (QS) in four weekly sections. METHODS: In this randomized controlled trial, 85 patients diagnosed with chronic periodontitis underwent different treatment protocols, in six groups: three FMD groups and three QS groups, each with no adjuvants, with CHX, and with AZ. Clinical periodontal parameters were recorded, and total and quantitative bacterial counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Streptococcus oralis were measured with real-time polymerase chain reaction at baseline and 90 and 180 days after treatment. RESULTS: In all groups, a significant reduction was observed in the percentage of periodontal diseased sites, gingival index, plaque index, and clinical attachment level gain at 90 days, demonstrating effectiveness of the treatment, independently of the adjuvant. The FMD with CHX group showed higher reduction in probing depth and percentage of periodontal diseases sites, as well as lower total bacterial count, than all the other groups at 180 days. CONCLUSIONS: The adjuvant use of AZ did not provide any significant benefit, independently of the treatment protocol. The adjuvant use of CHX showed a more expressive and significant improvement in clinical and microbiologic parameters, especially in the FMD protocol, followed by QS.

Incidência das hepatites virais no Brasil de 1997 a 2010 / Incidence of viral hepatitis in Brazil from 1997 to 2010 / Incidencia de la hepatitis viral en Brasil desde 1997 hasta 2010

Objetivo: analisar as tendências de incidência de hepatite B e C no Brasil no período de 1997-2010. Método: estudo ecológico, no qual se calcularam as taxas de incidência de hepatite B e C por 100.000 habitantes/ano, considerando os casos confirmados no período de 1997-2010. O programa Joinpoint foi empregado para estudar as tendências. Resultados: foram confirmados 153.921 casos de hepatite B. Encontrou-se tendência de aumento significativo da incidência no país. Na maioria das regiões, exceto Sul, observou-se tendência de aumento, apresentando baixa variação. Concernente à hepatite C, foram confirmados 129.045 casos, com tendência inicial crescente seguida de declínio significativo a partir de 2004. Por regiões, constatou-se aumento significativo da incidência no Nordeste e Sudeste, estabilidade no Norte e aumento inicial seguido de descenso no Sul e Centro-Oeste. Conclusão: os casos novos de hepatite B aumentaram significativamente, enquanto os de hepatite C diminuíram durante os últimos cinco anos.(AU)

Objective: analyzing the trends of the incidence of hepatitis B and C in Brazil in the period from 1997-2010. Method: an ecological study in which there were calculated the incidence rates of hepatitis B and C per 100.000 inhabitants/year, considering the confirmed cases in the period 1997-2010. The Joinpoint program was used to study the trends. Results: there were confirmed 153 921 cases of hepatitis B. Met trend of significant increase in incidence in the country. In most regions, except in the South, there was an upward trend, with low variation. Concerning hepatitis C, 129 045 cases were confirmed, with increasing initial trend followed by significant decline from 2004. By region, there was significant increase in incidence in the Northeast and Southeast, stability in the North and initial increase followed by decrease in the South and Midwest. Conclusion: new cases of hepatitis B increased significantly, while the hepatitis C decreased during the last five years.(AU)

Objetivo: analizar las tendencias de la incidencia de la hepatitis B y C en Brasil durante el período 1997-2010. Método: estudio ecológico en el que se calcula la tasa de incidencia de la hepatitis B y C por 100.000 habitantes/año, teniendo en cuenta los casos confirmados durante el período 1997-2010. El programa Joinpoint se utilizó para estudiar las tendencias. Resultados: 153 921 casos de hepatitis B fueron confirmados. Se encontró una tendencia de aumento significativo de la incidencia en el país. En la mayoría de las regiones, con excepción del Sur, hubo una tendencia al alza, con escasa variación. En cuanto a la hepatitis C, se confirmaron 129 045 casos, con el aumento de la tendencia inicial seguida de un descenso significativo a partir de 2004. Por regiones, hubo aumento significativo de la incidencia en el Noreste y Sureste, la estabilidad en el Norte e aumento inicial seguido de disminución en el Sur y Medio Oeste. Conclusión: los nuevos casos de hepatitis B aumentaron significativamente, mientras que los casos de hepatitis C se redujeron en los últimos cinco años.(AU)

Slowing Amazon deforestation through public policy and interventions in beef and soy supply chains.

The recent 70% decline in deforestation in the Brazilian Amazon suggests that it is possible to manage the advance of a vast agricultural frontier. Enforcement of laws, interventions in soy and beef supply chains, restrictions on access to credit, and expansion of protected areas appear to have contributed to this decline, as did a decline in the demand for new deforestation. The supply chain interventions that fed into this deceleration are precariously dependent on corporate risk management, and public policies have relied excessively on punitive measures. Systems for delivering positive incentives for farmers to forgo deforestation have been designed but not fully implemented. Territorial approaches to deforestation have been effective and could consolidate progress in slowing deforestation while providing a framework for addressing other important dimensions of sustainable development.

Risco de resiliência psicossocial: desafios na prática da vela / Risk and resilence psychosocial: challenges in practice of sail / Riesgos psicosociales y resiliencia: desafíos en la practica vela

O objetivo deste estudo foi analisar fatores de resiliência a partir de situações de risco na prática da vela. A pesquisa de campo envolveu 19 velejadores do Iate Clube da Paraíba, com idades entre 19 e 64 anos. Foram utilizados na coleta de dados,um questionário sociodemográfico e um roteiro de entrevista semi estruturada. As respostas foram transcritas e submetidas ao soft AQUAD 6 para a obtenção das categorias a partir da análise de conteúdo, sendo organizadas em diagramas. Os resultados apontaram para três categorias: sensações sem a prática da vela; sensaçõe sem situação de risco na prática da vela; e a resiliência na prática da vela. Observou-seque, nesta prática, houve avanços nos fatores emocionais, trazendo um ressiginificado para a vida. Assim, o equilíbrio emocional auxilia nas situações de risco encontradas no mar, conduzido pela melhoria dos fatores da resiliência.

The aim of this study was to analyze factors of resilience from a hazard in the practice of sail. The field research involved 19 sailors of Iate Clube da Paraíba, aged 19 to 64 years. Was used in data collection a sociodemographic questionnaire and a schedule of semistructured interviews, which were trans cribed and subjected to soft AQUAD 6, to obtain categories based on content analysis, being organized in diagrams. The results pointed tothree categories: feelings without practice of the sail; feeling at risk in the practice of sail;and resilience in the practice of sail. It was observed that in this practice, there has been progress in emotional, bringing new meanings to life. Thus, the emotional balancehelps insituations of risk found the sea led by improving the factores if resilience .

El objetivo del estudio fue analizar los factores de la resiliencia de las situaciones de riesgoen la práctica a vela. La investigación de campo participan 19 regatistas del Iate Clubede Paraíba, con edades entre 19 a 64 años. Fue utilizado en la recolección de datos un cuestionario sociodemográfico y de entrevistas semi-estructuradas, que fueron transcritas y sometidas a soft AQUAD 6, para obtener la categoria basado en el análisis de contenido, organizado en diagramas. Los resultados apuntaron a tres categorías: sin yachting sensaciones,sensaciones en situación de riesgo en la vela, y la resistencia en la vela. Se observó que esta práctica no había avançonos factores emocionales, trayendo un ressiginificado para la vida. Por lo tanto, el equilibrio emocional ayuda en situaciones de riesgo encontrado sen el mar llevada a cabo por la mejora de los factores de resiliencia.

Ecology, economy and management of an agroindustrial frontier landscape in the southeast Amazon.

The papers in this special issue address a major challenge facing our society: feeding a population that is simultaneously growing and increasing its per capita food consumption, while preventing widespread ecological and social impoverishment in the tropics. By focusing mostly on the Amazon's most dynamic agricultural frontier, Mato Grosso, they collectively clarify some key elements of achieving more sustainable agriculture. First, stakeholders in commodity-driven agricultural Amazonian frontiers respond rapidly to multiple forces, including global markets, international pressures for sustainably produced commodities and national-, state- and municipality-level policies. These forces can encourage or discourage deforestation rate changes within a short time-period. Second, agricultural frontiers are linked systems, land-use change is linked with regional climate, forest fires, water quality and stream discharge, which in turn are linked with the well-being of human populations. Thus, land-use practices at the farm level have ecological and social repercussions far removed from it. Third, policies need to consider the full socio-economic system to identify the efficacy and consequences of possible land management strategies. Monitoring to devise suitable management approaches depends not only on tracking land-use change, but also on monitoring the regional ecological and social consequences. Mato Grosso's achievements in reducing deforestation are impressive, yet they are also fragile. The ecological and social consequences and the successes and failures of management in this region can serve as an example of possible trajectories for other commodity-driven tropical agricultural frontiers.

Defending public interests in private lands: compliance, costs and potential environmental consequences of the Brazilian Forest Code in Mato Grosso.

Land-use regulations are a critical component of forest governance and conservation strategies, but their effectiveness in shaping landholder behaviour is poorly understood. We conducted a spatial and temporal analysis of the Brazilian Forest Code (BFC) to understand the patterns of regulatory compliance over time and across changes in the policy, and the implications of these compliance patterns for the perceived costs to landholders and environmental performance of agricultural landscapes in the southern Amazon state of Mato Grosso. Landholdings tended to remain in compliance or not according to their status at the beginning of the study period. The perceived economic burden of BFC compliance on soya bean and beef producers (US$3-5.6 billion in net present value of the land) may in part explain the massive, successful campaign launched by the farm lobby to change the BFC. The ecological benefits of compliance (e.g. greater connectivity and carbon) with the BFC are diffuse and do not compete effectively with the economic benefits of non-compliance that are perceived by landholders. Volatile regulation of land-use decisions that affect billions in economic rent that could be captured is an inadequate forest governance instrument; effectiveness of such regulations may increase when implemented in tandem with positive incentives for forest conservation.

Responding to climate change and the global land crisis: REDD+, market transformation and low-emissions rural development.

Climate change and rapidly escalating global demand for food, fuel, fibre and feed present seemingly contradictory challenges to humanity. Can greenhouse gas (GHG) emissions from land-use, more than one-fourth of the global total, decline as growth in land-based production accelerates? This review examines the status of two major international initiatives that are designed to address different aspects of this challenge. REDD+ is an emerging policy framework for providing incentives to tropical nations and states that reduce their GHG emissions from deforestation and forest degradation. Market transformation, best represented by agricultural commodity roundtables, seeks to exclude unsustainable farmers from commodity markets through international social and environmental standards for farmers and processors. These global initiatives could potentially become synergistically integrated through (i) a shared approach for measuring and favouring high environmental and social performance of land use across entire jurisdictions and (ii) stronger links with the domestic policies, finance and laws in the jurisdictions where agricultural expansion is moving into forests. To achieve scale, the principles of REDD+ and sustainable farming systems must be embedded in domestic low-emission rural development models capable of garnering support across multiple constituencies. We illustrate this potential with the case of Mato Grosso State in the Brazilian Amazon.

Sentido e significado: o prazer do risco nos velejadores / Sense and meaning: the pleasure of the risk in sailors

O estudo objetiva analisar os sentidos e significados do prazer do risco de velejadores. Trata-se de uma pesquisa de campo, participando 19 velejadores do Iate Clube da Paraíba, na cidade de João Pessoa ? Paraíba. Foi utilizado um questionário e um roteiro de entrevista semiestruturada. Para análise dos dados utilizou-se o software AQUAD, que auxiliou na obtenção da frequência absoluta das palavras, para definir as categorias analíticas, interpretadas por meio da análise de conteúdo. Os resultados conduziram a três categorias analíticas: sentidos e significados da prática da vela; os riscos na prática da vela; e o prazer da prática da vela. As categorias revelaram que os sentidos e significados desta prática contribui para a educação e respeito pela natureza, despertando novas emoções e sensações, relacionadas à atividade física e ao lazer. Os entrevistados apontaram que os riscos são inerentes a prática da vela e se associam à negligência, falta de manutenção e mudanças climáticas, sendo necessário, para segurança, crenças, equipamentos básicos e tecnológicos.

The study aims to analyze the senses and meanings of sailors? risk pleasure. This is a research with 19 sailors from Iate Clube da Paraíba, in the city of João Pessoa ? Paraíba. We used a questionnaire and a semi-structured script for interviews. The data analysis used the software AQUAD, which generated the absolute frequency of words used to define the analytical categories, interpreted through content analysis. The results led to three analytical categories: senses and meanings of sailing; risks in sailing, and pleasure of sailing. The categories revealed that the senses and meanings of this practice contribute to the education and respect for nature, awakening new emotions and sensations related to physical activity and leisure. The interviewees indicated that the risks are inherent to sailing and are associated with negligence, lack of maintenance and climate change, being necessary for safety issues, beliefs, basic and technological equipments.

HIV/HPV co-infection during pregnancy in southeastern Brazil: prevalence, HPV types, cytological abnormalities and risk factors.

OBJECTIVE: HIV(+) pregnant women are at a higher risk of HPV infection and development of cervical cancer. Our objectives were to assess the prevalence and HPV types in HIV(+) pregnant women and to identify risk factors for HPV infection and cytological abnormalities. METHODS: Cervicovaginal smears were collected during pregnancy from 140 women. Partial HPV L1 gene and the exon 4 of the human TP53 gene (containing codon 72) were PCR-amplified and sequenced. Amplified products indicating multiple HPV infection were further cloned and sequenced. The association of demographic, obstetric and HIV-related clinical variables with HPV infection and cervical lesions was tested by univariate analyses, and significant factors were subsequently tested by logistic regression multivariate analysis. RESULTS: HPV DNA tested positive for 118 patients and HPV types were identified in 104 samples. Twenty-eight different types were found, HPV-16 and HPV-58 being the most prevalent. High-risk types were present in 79.8% of samples and multiple infections in 16.3%. Abnormal cervical smears were found in 44 patients (31.4%). Absolute CD4(+) T-cell counts below 350 were associated with HPV infection. Younger age was associated with cervical abnormalities and higher CD4(+) T-cell count was an apparent protective factor. CONCLUSIONS: We found a high prevalence of HPV infection and high-risk types in this cohort. Our results highlighted the relevance of immune system integrity rather than TP53 variants for protecting this highly vulnerable population to HPV infection and carcinogenesis.