HOMA-IR as a Predictor of PAI-1 Levels in Women with Severe Obesity.

BACKGROUND: Obesity is a chronic inflammatory disorder that increases the risk of cardiovascular diseases (CVDs). Given the high CVD mortality rate among individuals with obesity, early screening should be considered. Plasminogen activator inhibitor (PAI-1), a cytokine that links obesity and CVDs, represents a promising biomarker. However, PAI-1 is not part of the clinical routine due to its high cost. Therefore, it is necessary to find good predictors that would allow an indirect assessment of PAI-1. METHODS: This study enrolled 47 women with severe obesity (SO). The obtained anthropometric measurements included weight, height, neck (NC), waist (WC), and hip circumference (HC). Blood samples were collected to analyse glucose and lipid profiles, C-reactive protein, liver markers, adiponectin, and PAI-1 (determined by ELISA immunoassay). Homeostasis model assessment-adiponectin (HOMA-AD), homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), triglyceride-glucose index (TyG), and atherogenic index of plasma (AIP) were calculated. The women were grouped according to PAI-1 levels. The data were analysed using IBM SPSS Statistics, version 21. The significance level for the analysis was set at 5%. RESULTS: Women with SO who have higher levels of PAI-1 have lower values of high-density lipoprotein cholesterol (HDL) (p = 0.037) and QUICKI (0.020) and higher values of HOMA-AD (0.046) and HOMA-IR (0.037). HOMA-IR was demonstrated to be a good predictor of PAI-1 in this sample (B = 0.2791; p = 0.017). CONCLUSIONS: HOMA-IR could be used as a predictor of PAI-1 levels, pointing out the relevance of assessing glycaemic parameters for the prevention of CVDs in women with SO.

The impact of the obesity onset on the inflammatory and glycemic profile of women with severe obesity.

BACKGROUND: The stage of life at the onset of obesity is an important factor in assessing inflammatory state and cardiometabolic risk. OBJECTIVES: This study aimed to evaluate the relationship between the obesity onset and the inflammatory profile in women with severe obesity. SETTING: Public hospital, Brazil. METHODS: Forty-eight women with severe obesity (20-59 yr old) were evaluated according to weight, height, neck circumference (NC), waist circumference (WC), and hip circumference, as well blood metabolic and inflammatory parameters. The participants were grouped according to obesity onset stage of life (early group: ≤19 yr; late group: >19 yr). RESULTS: The demographic means of the participants were: age of 39.7 years, weight of 122.7 kg and body mass index (BMI) of 48.4 kg/m2. The late group presented significantly higher values of leptin (lep)/adiponectin (adipo) ratio and homeostatic model assessment for insulin resistance (HOMA-IR) than the early group. The late group also had a lower adipo/lep ratio. Moreover, the late group showed correlations between the lep/adipo ratio and BMI (r = .460, P = .021), NC (r = .478, P = .016), and WC (r = .535, P = .006). Adipo was also correlated with NC (r = -.418, P = .038), WC (r = -.437, P = .029), and glycated hemoglobin (HbA1C) (r = -.485, P = .019). By contrast, in the early group, the lep/adipo ratio showed correlations with insulin (r = .647, P = .004) and HOMA-B (r = .564, P = .015). CONCLUSIONS: The inflammatory profile is correlated with anthropometric values in women with late-onset obesity. Inflammatory markers seemed to correlate with the glycemic profile in women with early-onset obesity. Furthermore, inflammation was higher in women with late-onset obesity compared to those with early-onset obesity.

Preparedness of the Brazilian health-care system to provide access to a disease-modifying Alzheimer's disease treatment.

BACKGROUND: While the majority of patients with Alzheimer's disease resides in low and middle-income countries, little is known of their preparedness for emerging disease-modifying treatments. We analyze the preparedness of Brazil, one of the most populous middle-income countries, from a capacity and institutional preparedness perspective. METHODS: Desk research and 12 interviews for background and capacity data. Markov model to estimate wait times for access to treatment. FINDINGS: Brazil has no national dementia strategy or established pathway for evaluation of cognitive concerns, and dementia is typically diagnosed late if at all. While members of private health plans have ready access to elective specialty care, wait times in the public sector are long. Assuming potentially treatment-eligible patients are referred from primary to specialty care based on a brief cognitive exam and a blood test for the Alzheimer's pathology, available capacity will not be sufficient to match the projected demand. The biggest obstacle is availability of dementia specialist visits, and the effect of population growth and ageing means that the wait list for specialist appointment will continue to grow from around 400,000 in 2022 to over 2.2 million in 2040. We do not project substantial wait times for confirmatory biomarker testing and treatment delivery but note that this is a consequence of patients waiting for their specialist appointments. These queues will result in estimated persistent wait times for treatment of around two years on average with substantial differences between the public and private sectors, as capacity growth is insufficient to keep up with increasing demand. DISCUSSION: Our findings suggest that Brazil is ill-prepared to provide timely access to an Alzheimer's treatment with predicted wait times of about two years, largely because of a limited number of dementia specialists.

Taylor's rule, political cycle, and Latin America-An analysis of time series in search of responsibility for monetary stabilization.

The decades before 1990 were dramatic for Latin American economies. However, from 1990 onwards, a set of policies followed by the various states in the region acheived economic stabilization with real income recovery. The attribution of this success has been disputed by politicians, economists and officials from international economic support institutions. This work will analyze the responsibility for this success in 4 economies in the region (Brazil, Colombia, Mexico and Peru). Through the combined analysis of ARDL, Markov states and structural breaks, we highlight different sources of responsibility in different periods. Additionally, detailing the states of each regime, we verify the duration of the regimes related to inflation rates and to interest rates in the region. We identify specific governments as associated with moments of economic stabilization in the region, so the hypothesis of the political cycle cannot be rejected for the set of results achieved. As policy implication, we claim that Taylor rules are endogenous to Political Budget Cycles and so stabilization plans are restricted to political tenures.

Baricitinib plus Standard of Care for Hospitalized Adults with COVID-19

BackgroundBaricitinib, an oral selective Janus kinase 1 and 2 inhibitor, improved outcomes in a previous randomized controlled trial of hospitalized adults with COVID-19, in combination with remdesivir. MethodsIn this phase 3, global, double-blind, randomized, placebo-controlled trial, 1525 hospitalized adults with COVID-19 receiving standard of care (SOC) were randomly assigned (1:1) to once-daily baricitinib 4-mg (N=764) or placebo (N=761) for up to 14 days. SOC included systemic corticosteroids in [~]79% of participants (dexamethasone [~]90%). The primary endpoint was the proportion who progressed to high-flow oxygen, non-invasive ventilation, invasive mechanical ventilation, or death by day 28. A key secondary endpoint was all-cause mortality by day 28. ResultsOverall, 27.8% of participants receiving baricitinib vs 30.5% receiving placebo progressed (primary endpoint, odds ratio 0.85, 95% CI 0.67-1.08; p=0.18). The 28-day all-cause mortality was 8.1% for baricitinib and 13.1% for placebo, corresponding to a 38.2% reduction in mortality (hazard ratio [HR] 0.57, 95% CI 0.41-0.78; nominal p=0.002); 1 additional death was prevented per 20 baricitinib-treated participants. Reduction in mortality was seen for all pre-specified subgroups of baseline severity (most pronounced for participants on high-flow oxygen/non-invasive ventilation at baseline [17.5%, baricitinib vs 29.4%, placebo; HR 0.52, 95% CI 0.33-0.80; nominal p=0.007]). The frequency of adverse events, serious adverse events, serious infections, and venous thromboembolic events was similar between groups. ConclusionsWhile reduction of disease progression did not achieve statistical significance, treatment with baricitinib in addition to SOC (predominantly dexamethasone) significantly reduced mortality with a similar safety profile between groups of hospitalized COVID-19 participants.

Cointegrated land use and CO2 emissions-the silent Columbian cattle revolution.

The objective of this research is to discuss the relationship between the growth of livestock and the environmental impact it generates in Colombia. For this, data were extracted from the FAO STAT for the period of 1961 to 2017. The livestock inventory has had a significant growth during the last 50 years. This has generated environmental exposure and the release of carbon, sequestered by continuous deforestation performed in the practice of extensive livestock. Recurring to vector error correction models, we observed the existence of long-term relations between CO2 emissions from dairy cattle and emissions from slaughtered cattle, deforestation, pastures, and forest development. Changes in CO2 emissions from dairy cattle tend to be anticipated by changes in CO2 emissions from the other analyzed sources, which prove how the current investment in dairy cattle results from the accumulated debates in Colombia regarding the different sources of livestock emissions.

Advanced oxidative processes in the degradation of 17ß-estradiol present on surface waters: kinetics, byproducts and ecotoxicity.

Endocrine disruptors represent risks to aquatic ecosystem and humans, and are commonly detected in surface water. Photochemical treatments can be used to remove 17ß-estradiol (E2), but few studies have analyzed the kinetics, intermediates, and 17ß-estradiol degradation pathways in natural matrices. In this study, the photochemical behavior of E2 under ultraviolet irradiation (UVC, 254 nm) associated with oxidants (H2O2 or O3) or photocatalyst (TiO2) was investigated to evaluate the degradation potential and the transformation pathway in a natural surface water matrix. Additionally, computational modeling analyses with Ecological Structure Activity Relationships (ECOSAR) software were performed to predict the toxicity from the E2 and its transformation byproducts. E2 degradation kinetics showed adjusted to the pseudo-first-order kinetic model, being kUV/O3 > kUV/TiO2 > kUV/H2O2 > kUV. Eight transformation byproducts were identified by liquid chromatography with time-of-flight mass spectrometry (HPLC/TOF-MS) in natural surface water samples. These byproducts formed as the result of opening the aromatic ring and adding the hydroxyl radical. The E2 degradation pathway was proposed based on the byproducts identified in this study and in previous studies, suggesting the formation of aliphatic and hydroxylated byproducts. E2 treatment presented both very toxic and not harmful byproducts.

Olympic rowing: model of competitive activity of international level elite female athletes / Remo olímpico: modelo de atividade competitiva das atletas de elite internacional / Remo olímpico: modelo de actividad competitiva de las atletas de elite internacional

ABSTRACT Introduction: High-performance training should focus on motor capability determinants in competition to make physical preparation effective. Objective: To analyze and draw up an elite model based on competitive activity, to guide the theory and practice of female rowers, using data on the 42 finalists of the 2010-2018 world championships. Methods: Forty-two rowers from 2010-2018 world championships participated in the study, final A, women's single scull without weight restrictions. The statistical comparison was performed and differences between 500 meter splits analyzed for each variable were discussed. Results: Strong correlation was observed between time (r=-0.99, p<0.01), power (r=0.99, p<0.01), technical level (r=0.99, p<0.01) and speed. In the competitive model, the relationship between speed at 2000 meters and time (r=-0.96, p<0.01), speed (r=0.94, p<0.01) and power (r=0.96, p<0.01) showed a strong correlation with speed in the splits of the third 500 meters of the race. In terms of stroke rate (r=-0.56, p<0.01) and stroke length (r=0.54, p<0.01), the strongest correlation occurs at the start, in the first 100 meters of competition. Conclusion: Having performed these analyses, it is possible to confirm the need to investigate competitive activity in order to supplement the rower's fitness preparation system. Level of evidence I; Diagnostic studies-Investigating a diagnostic test.

RESUMO Introdução: O treinamento no alto rendimento deve focar a capacidade motora determinante na competição, assim a preparação física se torna eficaz. Objetivo: Analisar e elaborar um modelo de elite, a partir da atividade competitiva, para orientar a teoria e a prática desportiva das remadoras, a partir dos dados das 42 finalistas dos mundiais de 2010 a 2018. Métodos: Participaram do estudo 42 remadoras de mundiais entre 2010 a 2018, final A, barco individual feminino sem restrição de peso. Realizou-se a comparação estatistica e as diferenças entre as parciais de cada 500 metros analisadas para cada variável foram discutidas. Resultados: Observou-se o seguinte: forte correlação entre o tempo (r=-0,99; p<0,01), a potência (r=0,99; p<0,01), o índice técnico e a velocidade (r=0,99; p<0,01). No modelo competitivo, a relação entre a velocidade nos 2000 metros com o tempo (r=-0,96; p<0,01), a velocidade (r=0,94; p<0,01) e a potência (r=0,96; p<0,01) apresentou forte correlação com a velocidade na parcial dos terceiros 500 metros da prova. Já na quantidade (r=-0,56; p<0,01) e amplitude de remadas (r=0,54; p<0,01), a maior correlação apresenta-se na partida, nos primeiros 100 metros de competição. Conclusão: Feitas essas análises, pode-se assegurar a necessidade de investigar a atividade competitiva com o objetivo de complementar o sistema de preparação da condição física do remador. Nível de evidência I; Estudos diagnósticos-Investigação de um exame para diagnóstico.

RESUMEN Introducción: El entrenamiento en el alto rendimiento debe enfocar la capacidad motora determinante en la competición, así la preparación física se vuelve eficaz. Objetivo: Analizar y elaborar un modelo de élite, a partir de la actividad competitiva, para orientar la teoría y la práctica deportiva de las remadoras, a partir de los datos de las 42 finalistas de los mundiales de 2010 a 2018. Métodos: Participaron en el estudio 42 remadoras de mundiales entre 2010 a 2018, final A, barco individual femenino sin restricción de peso. Se realizó la comparación estadística y fueron discutidas las diferencias entre las parciales de cada 500 metros analizadas para cada variable. Resultados: Se observó lo siguiente: fuerte correlación entre el tiempo (r=-0,99, p<0,01), la potencia (r=0,99, p<0,01), el índice técnico y la velocidad (r=0,99, p<0,01). En el modelo competitivo, la relación entre la velocidad en los 2000 metros con el tiempo (r=-0,96, p<0,01), la velocidad (r=0,94, p<0,01) y la potencia (r=0,96, p<0,01) presentó fuerte correlación con la velocidad en la parcial de los terceros 500 metros de la prueba. Ya en la cantidad (r=-0,56, p<0,01) y amplitud de remadas (r=0,54, p<0,01) la mayor correlación se presenta en la partida, en los primeros 100 metros de competición. Conclusión: Hechos estos análisis, se puede asegurar la necesidad de investigar la actividad competitiva con el objetivo de complementar el sistema de preparación de la condición física del remador. Nivel de evidencia I; Estudios de diagnósticos-Investigación de un examen para diagnóstico.

New Challenges in Oncology for the Brazilian Private Health Sector: Specialists' Concerns After the ISPOR International Congress in Boston, Massachusetts, 2017.

The congress of the International Society for Pharmacoeconomics and Outcomes Research is one of the main worldwide forums for the dissemination of research and knowledge on healthcare economics. Brazil is the largest country in Latin America, with a per-capita gross domestic product of $15 200 in 2017 and healthcare expenditure of the order of $1 318 per inhabitant. Brazilian specialists participated actively in the society's latest congress, which took place in Boston, Massachusetts, from May 20 to 24, 2017. They met to discuss the main topics dealt with at the congress and their applicability to Brazilian realities. The topics chosen were precision medicine, new challenges for economic modeling within oncology and immuno-oncology, data to aid in managerial decision making (ie, data from real-world studies), and, lastly, strategies for accessing high-cost medications in Brazil. This opinion article sought to report the main conclusions and consensus reached by this group of specialists on the occasion of this discussion.

Predição do desempenho a partir das características antropométricas, fisiológicas e de força no remo / Prediction of performance from anthropometric, physiological and strength components in rowing / Predicción del rendimiento de las características antropométricas, fisiológicas y fuerza en el remo

RESUMO Introdução: O desempenho de remadores no remoergômetro é motivo de curiosidade entre os cientistas. Os modelos de predição podem medir o desempenho no remoergômetro. Neste sentido, as variáveis estudadas foram analisadas como possíveis preditores de desempenho. Objetivo: Desenvolver diferentes modelos de regressão a fim de predizer o desempenho com o uso das variáveis antropométricas composição corporal, consumo máximo de oxigênio e força. Métodos: Vinte remadores participaram do estudo (21,35 ± 0,98 anos). Foram aplicados os testes de consumo máximo de oxigênio, força, 500 m e o exame de absorciometria radiológica de dupla energia. A regressão linear múltipla foi realizada no SPSS 16 para os quatro diferentes modelos de regressão. A confiabilidade dos modelos foi indicada pelo coeficiente de determinação R2 e pelo erro padrão da estimativa (SEE). Resultados: Os modelos de antropometria-potência (R2 = 0,92; SEE = 0,06), VO2 Pico (R2 = 0,88; SEE = 0,07), força-potência (R2 = 0,93; SEE = 0,06) apresentaram predição confiável para o desempenho nos 500 m em remoergômetro, assim como a combinação de todas as variáveis (R2 = 0,94; SEE = 0,08). Conclusão: Feitas essas análises, pode-se assegurar a necessidade desses modelos com o objetivo de complementar a identificação, seleção de talentos e, sobretudo, melhora no desempenho.

ABSTRACT Introduction: The performance of rowers in the rowing ergometer is a matter of curiosity among scientists. Prediction models can measure performance on the rowing ergometer. In this sense, the studied variables were analyzed as possible predictors of performance. Objective: To develop different regression models in order to predict performance using the anthropometric variables body composition, maximal oxygen consumption, and strength. Methods: Twenty rowers participated in the study (21.35±0.98 years). The tests of maximal oxygen consumption, strength, 500 m, and dual-energy X-ray absorptiometry were applied. Multiple linear regressions were performed on SPSS 16 for the four different regression models. The reliability of the models was indicated by the coefficient of determination R2 and by the standard error of the estimation (SEE). Results: The anthropometry-power models (R2=0.92, SEE=0.06), VO2 peak (R2=0.88, SEE=0.07), strength-power (R2=0.93, SEE=0.06) presented reliable prediction for 500 m in the rowing ergometer, as well as the combination of all the variables (R2=0.94, SEE=0.08). Conclusion: Once these analyzes have been made, we can assure the necessity of these models with the objective of complementing the identification, selection of talents and, above all, improvement in performance.

RESUMEN Introducción: El rendimiento de los remeros en el remoergómetro es motivo de curiosidad entre los científicos. Los modelos de predicción pueden medir el rendimiento en el remoergómetro. En este sentido, las variables estudiadas fueron analizadas como posibles predictores de rendimiento. Objetivo: Desarrollar diferentes modelos de regresión a fin de predecir el rendimiento con el uso de las variables antropométricas, composición corporal, consumo máximo de oxígeno y fuerza. Métodos: Veinte remeros participaron del estudio (21,35 ± 0,98 años). Se aplicaron las pruebas de consumo de máximo oxígeno, fuerza, 500 m y el examen de absorciometría de rayos X de doble energía. La regresión lineal múltiple fue realizada en el SPSS 16 para los cuatro diferentes modelos de regresión. La confiabilidad de los modelos fue indicada por el coeficiente de determinación R2 y el error estándar de la estimación (SEE). Resultados: Los modelos de antropometría-potencia (R2 = 0,92; SEE = 0,06), VO 2pico (R2 = 0,88; SEE = 0,07), fuerza-potencia (R2 = 0,93; SEE = 0,06) presentaron predicción confiable para el rendimiento en los 500 m en remoergómetro, así como la combinación de todas las variables (R2 = 0,94; SEE = 0,08). Conclusión: Hechos estos análisis, se puede asegurar la necesidad de esos modelos con el objetivo de complementar la identificación, selección de talentos y, sobre todo, mejora en el rendimiento.

Portuguese agriculture and the evolution of greenhouse gas emissions-can vegetables control livestock emissions?

One of the most serious externalities of agricultural activity relates to greenhouse gas emissions. This work tests this relationship for the Portuguese case by examining data compiled since 1961. Employing cointegration techniques and vector error correction models (VECMs), we conclude that the evolution of the most representative vegetables and fruits in Portuguese production are associated with higher controls on the evolution of greenhouse gas emissions. Reversely, the evolution of the output levels of livestock and the most representative animal production have significantly increased the level of CO2 (carbon dioxide) reported in Portugal. We also analyze the cycle length of the long-term relationship between agricultural activity and greenhouse gas emissions. In particular, we highlight the case of synthetic fertilizers, whose values of CO2 have quickly risen due to changes in Portuguese vegetables, fruit, and animal production levels.

Continuidade Assistencial a mulheres com câncer de colo de útero em redes de atenção à saúde: estudo de caso, Pernambuco / Care Continuity to women with cervical cancer in health care networks: case study, Pernambuco

RESUMO O objetivo do estudo foi analisar a continuidade da assistência a mulheres com câncer de colo uterino. Estudo de caso qualitativo, em redes de saúde. Realizaram-se entrevistas com roteiro semiestruturado e técnica de análise narrativa de conteúdo. As mulheres perceberam barreiras no diagnóstico, no tratamento e na acessibilidade entre níveis de atenção. Observaram comunicação informal entre especialistas; limitações na comunicação entre níveis de atenção; inexistência de contrarreferência; e que o vínculo paciente-serviço era maior na esfera da oncologia. A falta de contrarreferência dificultou a acumulação de conhecimento e a coordenação do cuidado pela Atenção Básica.

ABSTRACT The aim of the study was to analyze the continuity of care for women with cervical cancer. Qualitative study of case, in health networks. Interviews were performed with semi-structured script and technique of content's narrative analysis. Women perceived barriers in the diagnosis, treatment and accessibility between levels of care. They observed informal communication between specialists; limitations in the communication between levels of care; absence of counter-reference; and that the patient-service relationship was greater in the oncology sphere. The lack of counter-reference hindered the accumulation of knowledge and coordination of care for Primary Care.

Atividade antifúngica, in vitro, do óleo de café verde / Antifungal activity, in vitro, of the green coffee oil

O objetivo deste trabalho foi avaliar o efeito do contato direto e da fração volátildo óleo de café verde, testado nas concentrações de 500, 1.000, 1.500 e 2.000 µL L-1, sobre o crescimento micelial e a esporulação dos fungos Penicillium roqueforti e Rhizopus stolonifer. O óleo essencial de cravo-da-índia na concentração de 800 µL L-1 foi utilizado para comparação. Nas concentrações de 1.500 e 2.000 µL L-1, o óleo de café verde em contato direto proporcionou redução da esporulação do fungo R. stolonifer , sendo estatisticamente semelhante ao óleo de cravo-da-índia. Na fração volátil do óleo de café verde, observou-se redução significativa da esporulação de P. roqueforti e R. stolonifer na concentração de 2.000 µL L-1. O óleo de café verde, em contato direto ou por volatilização, reduziu significativamente o crescimento micelial e a esporulação de ambos os fungos em comparação com a testemunha.(AU)

The objective of this study was to evaluate the effect of direct contact and volatile fraction of from green coffee oil, tested at concentrations of 500, 1,000, 1,500 and 2,000 µL L-1, on mycelial growth and sporulation of Penicillium roqueforti and Rhizopus stolonifer . The essential oil of clove at a concentration of 800 µL L-1 was used for comparison. At concentrations of 1,500 and 2,000 µL L-1, the green coffee oil in direct contact caused a reduction of sporulation for R. stolonifer, similar to clove oil. In the volatile fraction of the green coffee oil, there was a significant reduction in sporulation of P. roqueforti and R. stolonifer at a concentration of 2,000 µL L-1. The green coffee oil, in direct contact or by volatilization, significantly reduced the mycelial growth and sporulation of both fungi compared to the control.(AU)

Elementos que influenciam o acesso à atenção primária na perspectiva dos profissionais e dos usuários de uma rede de serviços de saúde do Recife / Factors that influence access to primary care in the perspective of professionals and users of a health services network in Recife-PE, Brazil

Apesar de todo o arcabouço institucional e do aparato jurídico-legal do SUS criado para melhorar o acesso da população aos serviços de saúde, ainda existem muitas barreiras que interferem na concretização do acesso universal à saúde no Brasil. Objetivamos analisar os elementos que influenciam o acesso aos serviços de atenção primária no município de Recife na perspectiva de profissionais e usuários. Trata-se de um estudo de caso realizado através de entrevistas semiestruturadas com46 informantes. A análise de conteúdo foi o método escolhido para trabalhar os dados. As principais barreiras que emergiram da pesquisa foram o subfinanciamento dos serviços, a cobertura ainda insuficiente da Estratégia de Saúde da Família (ESF) e a oferta insuficiente de profissionais. Entre os elementos facilitadores, os mais relevantes foram a própria existência da ESF, a comunicação informal e o trabalho do agente comunitário de saúde. Conclui-se que, mesmo com a implantação da ESF e dos benefícios gerados, ainda há a necessidade de a estratégia ser uma prioridade da gestão, com maior investimento na estrutura e na organização dos serviços ofertados para que os usuários tenham acesso universal e equânime à rede de saúde de Recife.

Despite all juridical-legal in the SUS apparatus that have been created to improve the population's access to health services, there are still many barriers that interfere in the concretion of the universal access to health care in Brazil. This study aims to analyze the factors which influence the access to primary care health services in Recife from the perspective of its professionals and users. This is a case study which used as data collection technique the semi structured interviews conducted with 46 informants. Bardin's content analysis was the method adopted to work with the data. The main barriers that emerged from the research were the underfunding of services, insufficient coverage family health strategy (FHS), and insufficient supply of professionals. Nevertheless, the most significant facilitating issues were: the existence of the FHS, the informal communication and the work of the community health agent. We conclude that even with the implementation of the FHS and the benefits generated, there is still the need for the strategy to be a management priority, with greater investments in the structure and organization of services offered to users in order for them to have universal access and equitable primary care services in the city of Recife.

Imobilização de fungos filamentosos com potencial para uso agroindustrial / Immobilization of filamentous fungi with potential for agribusiness

A imobilização celular representa uma alternativa para a condução de bioprocessos. As células ficam retidas em matrizes e podem ser utilizadas por longos períodos. O objetivo deste trabalho foi testar uma nova metodologia de imobilização de fungos com custo reduzido, avaliar a viabilidade e segurança dos fungos submetidos ao novo método de encapsulamento e determinar a temperatura ideal para armazenar os fungos imobilizados. Os micélios dos fungos Aspergillus niger, Cladosporium cladosporioides e Penicillium solitum foram misturados com 15 g de arroz triturado e 3 g de alginato de sódio, que gotejava em uma solução de cloreto de cálcio a 0,25 M para a formação dos grânulos. Após a secagem em estufa a 26ºC, os grânulos foram armazenados em temperaturas ambiente, geladeira e freezer. Os plaqueamentos foram realizados a cada 15 dias em meio de cultura. As avaliações do tamanho das colônias e esporulação foram realizadas 7, 14 e 21 dias após o plaqueamento, durante 195 dias para A. niger, 225 dias para C. cladosporioides e 210 dias para P. solitum. A temperatura de armazenamento não afetou o desenvolvimento micelial de A. niger e P. solitum. Porém, a esporulação foi reduzida para os grânulos armazenados no freezer. O desenvolvimento micelial de C. cladosporioides foi influenciado pela temperatura. Os grânulos conservados em temperatura ambiente tiveram menor viabilidade. Na análise de microscopia eletrônica de varredura, observou-se que a imobilização é um método seguro no qual o micélio fúngico permanece no interior do grânulo, facilitando o transporte, o armazenamento e a aplicação de micro-organismos.(AU)

Cellular immobilization represents an alternative for the bioprocess conduction, in which the cells are kept in a matrix and can be used over long periods. The objective of this work was to test a new fungi immobilization methodology with reduced cost to evaluate the viability of these fungi when submitted to the new encapsulation method, and to determine the ideal temperature to store the immobilized fungi. The mycelium of the fungi Aspergillus niger, Cladosporium cladosporioides and Penicillium solitum were mixed with 15 g of titrated rice and 3 g of sodium alginate, which was dripped in a 0.25 M calcium chloride solution for the formation of pellets. After drying in an oven at 26ºC, the granules were stored at three temperatures: room, refrigerator and freezer. The platings were carried out every 15 days in culture medium. The evaluations of the colony size and sporulation were carried out 7, 14 and 12 days after plating, for 195 days for A. niger, 225 days for C. cladosporioides, and 210 days for P. solitum. Storage temperature did not affect the mycelial development of A. niger and P. solitum. However, sporulation was reduced for the granules stored in the freezer. The mycelial development of C. cladosporioides was influenced by temperature. The granules conserved at room temperature had lower viability than those stored in the refrigerator and freezer. In the Scanning Electronic Microscopy analysis, it was observed that the immobilization is a safe method in which the fungus mycelium remains inside the granule, facilitating transport, storage and application of micro-organisms.(AU)

Análise geoespacial: um estudo sobre a dengue / Geospatial analysis: a study about dengue

OBJETIVO: Descrever/analisar o espaço geográfico dos coeficientes de incidência de dengue segundo área urbana da Região Norte do município de Palmas/TO, Brasil. MÉTODOS: Trata-se de um estudo analítico ecológico transversal, que avalia hipóteses de relações de causa (variáveis socioeconômicas e ambientais) e efeito (casos confirmados de dengue) simultaneamente. É ecológico, pois a unidade de observação passa de indivíduos para grupos de indivíduos, onde áreas geográficas foram usadas como unidades de análise (epidemiologia espacial). RESULTADOS: Revelam que o número de casos de dengue registrados em Palmas (2011) aumentou 170% em relação ao ano anterior. CONCLUSÃO: Alertarmos para uma epidemia através dos dados apresentados. Assim, sugerimos a necessidade de alterações nas estratégias utilizadas atualmente e aprimoramento das ações de vigilância para controlar o vetor Aedes aegypti, reduzindo a infestação a níveis inferiores a 1%, e consequentemente, minimizar o impacto da doença na saúde da população.

OBJECTIVE: To describe/analyze the geographic space of the incidence rates according to the urban area. METHOD: This was an analytical cross-sectional ecological study to evaluate hypotheses of the relationships of cause (socioeconomic and environmental variables) and effect (confirmed cases of dengue) simultaneously. It was ecological, as the observation unit passed from individuals to groups of individuals, in which geographical areas were used as units of analysis (spatial epidemiology). RESULTS: Revealed that the number of reported cases of dengue in Palmas (2011) increased 170% in relationship to the previous year. CONCLUSION: We call attention to an epidemic through the data presented. Thus, we suggest the need for changes in the strategies used today and enhancement of surveillance actions to control the mosquito Aedes aegypti, reducing the infestation to levels below 1%, and consequently to minimize the impact of the disease on the health of the population.

Tabagismo e sua relação com dados sociais, uso de álcool, café e prática de esportes, em estudantes da Universidade do Vale do Sapucaí (UNIVÁS), Pouso Alegre, MG - Brasil / Tabagism and its relation with social background, sports and use of alcohol and coffee among students at Vale do Sapucaí University, Pouso Alegre, State of Minas Gerais, Brazil

Introdução: o tabagismo é a principal causa de morte evitável e estima-se que ocorra mais de 5 milhões de mortes/ano em todo o mundo. A universidade, ainda que traga sentimentos positivos, pode constituir-se em período crítico, vulnerável ao início e à manutenção do uso de tabaco, álcool e outras drogas. Diante dessa realidade, vários estudos sugerem que medidas antitabágicas sejam direcionadas prioritariamente a essa população. Objetivo: avaliar o estilo de vida e as atitudes relacionadas ao tabagismo entre estudantes da Universidade do Vale do Sapucaí (UNIVÁS), em Pouso Alegre- MG. Metodologia: estudo transversal com amostragem estratificada proporcional por conglomerados realizado na Univás em Pouso Alegre-MG, em 2009. Foi utilizado questionário autoaplicável, com questões relativas ao perfil de cada aluno, seus hábitos e atitudes relacionadas ao tabagismo em 450 universitários das áreas de ciências biológicas, humanas e exatas. Resultados: 204 (48%) eram da área biológica, 287 (63,8%) femininos, 370 (82,3%) solteiros, 265 (58,9%) tinham trabalho remunerado, com maior proporção nas áreas de ciências humanas e exatas (p<0,05). A maioria dos alunos residia com seus familiares. O tabagismo foi anotado em 7,8% dos alunos, com predominancia no genero masculino (54,5%) e nos cursos relativos às áreas de humanas (60,6%) e naqueles com hábito de ingerir bebidas alcoólicas (p<0,05). Conclusão: a maioria dos universitários era do genero feminino, com trabalho remunerado e residia com os familiares. Reduzida parcela era tabagista, sendo a maioria do genero masculino, da área de humanas e fazia uso regular de bebidas alcoólicas.

Introduction: Tabagism, the main cause of evitable death, is estimated to cause 5 million deaths/year worldwide. Despite the positive feelings that may be associated to university, it is a critical period in which students are vulnerable to initiate and maintain tobacco, alcohol and drug use. Several studies suggest that anti-tobacco measures should give special attention to this part of the population. Objective: To assess tabagism-relate life style and attitudes among students at Vale do SapucaÝ University, Pouso Alegre, State of Minas Gerais, Brazil. Methodology: This cross-sectional study of a stratified sample proportional to the number of students at Vale do SapucaÝ University in 2009 investigates 450 selfadministered questionnaires in which students of biological, human and exact sciences answered questions on their characteristics, habits and attitudes that may relate to tabagism. Results: Most students lived with their families, 204 (48 %) were enrolled in courses of the biological sciences, 287 (63.8 %) were female, 370 (82.3 %) were single, and 265 (58.9 %) had a regular job, especially those enrolled in courses of the human and exact sciences. Tabagism was found among 7.8 % of the respondents, predominantly among male students (54.5 %), students of human sciences (60.6 %) and individuals with habits of frequent alcohol use (p<0.05).Conclusion: Most university students were female, had a regular job and lived with their families. A reduced number of the students smoked tobacco, most of them being males, enrolled in a course of the human sciences and reporting alcohol use.

Time elapsed since the last medical visit: analysis of a statistical model applied to the case of Spanish women.

OBJECTIVE: This study aims at two objectives: I) to develop a model capable of predicting the statistical distribution of the variable "time elapsed since the last medical visit"; II) to empirically test the theoretical model. METHODS: To develop the theoretical model, the author will use a demonstration that is statistical in nature. In order to test the theoretical distribution, the 2006 Encuesta Nacional de España data regarding females will be used. RESULTS: The results found show that the distribution of the time elapsed since the last medical visit follows a Poisson distribution. This conclusion was empirically validated, and additionally, a few determinants were found that increase the likelihood that Spanish women will resort to a doctor, namely, inactivity, residence in small places and being older. CONCLUSION: The study concluded that the time elapsed since the last medical visit follows a Poisson distribution; thus, going to a medical appointment is still seen as a rare phenomenon for Spanish women. By comparing this data with our results, we found that a higher ratio of physicians to population, a higher time availability for each woman (especially in a labor inactivity setting) and strong personal relationships can lead to a higher medical visit rate, thus reducing the time elapsed since the last visit.

Tempo decorrido desde a última consulta: análise de um modelo estatístico aplicado ao caso das mulheres na Espanha / Time elapsed since the last medical visit: analysis of a statistical model applied to the case of Spanish women

OBJETIVO: Os objetivos deste artigo são dois: I) Desenvolver um modelo que caracterize a distribuição da variável "tempo decorrido desde a última consulta médica" e II) testar empiricamente esse modelo. MÉTODOS: Para desenvolver o modelo teórico, recorrerá a uma demonstração de natureza estatística. Para testar o modelo teórico serão usados os dados da "Encuesta Nacional de Espana" de 2006, referentes ao gênero feminino. RESULTADOS: Os resultados alcançados mostram que a distribuição do tempo decorrido desde a última consulta médica segue uma distribuição de Poisson. Empiricamente, foi validada essa conclusão e adicionalmente verificou-se que algumas condicionantes aumentam a probabilidade de uma mulher espanhola recorrer a consulta médica, nomeadamente, a situação de inatividade, a residência em lugares de menor densidade e idade superior. CONCLUSÃO: O trabalho conclui que o tempo decorrido desde a última consulta médica, seguindo uma distribuição de Poisson, revela implicitamente que a ida a uma consulta é ainda encarada como um fenômeno raro para as mulheres na Espanha. Cruzando esta evidência com os resultados, salienta-se que maior razão de clínicos por população, maior disponibilidade temporal de cada mulher (sobretudo em situações de inatividade laboral) e maior conhecimento pessoal poderão levar a maior uso das consultas médicas, diminuindo, assim, o tempo decorrido desde a última consulta.

OBJECTIVE: This study aims at two objectives: I) to develop a model capable of predicting the statistical distribution of the variable "time elapsed since the last medical visit"; II) to empirically test the theoretical model. METHODS: To develop the theoretical model, the author will use a demonstration that is statistical in nature. In order to test the theoretical distribution, the 2006 Encuesta Nacional de España data regarding females will be used. RESULTS: The results found show that the distribution of the time elapsed since the last medical visit follows a Poisson distribution. This conclusion was empirically validated, and additionally, a few determinants were found that increase the likelihood that Spanish women will resort to a doctor, namely, inactivity, residence in small places and being older. CONCLUSION: The study concluded that the time elapsed since the last medical visit follows a Poisson distribution; thus, going to a medical appointment is still seen as a rare phenomenon for Spanish women. By comparing this data with our results, we found that a higher ratio of physicians to population, a higher time availability for each woman (especially in a labor inactivity setting) and strong personal relationships can lead to a higher medical visit rate, thus reducing the time elapsed since the last visit.