Farmers' actions toward sustainability: a typology of dairy farms according to sustainability indicators.

Milk production is an important economic and social activity in Brazil. Failure to meet institutional and market demands for quality and sustainability has led farmers, particularly small-scale farmers, to leave agriculture. The aim of this study was to assess and compare the sustainability of dairy farms in Paraná, Brazil. A semi-structured questionnaire was administered to 75 dairy farm operators. Sustainability indicators were generated on the basis of economic, environmental and social data using exploratory factor analysis. Factor scores were subjected to hierarchical clustering, which resulted in the formation of three groups of dairy farms. Groups 1, 2 and 3 had high, intermediate and low levels of sustainability, respectively. Group 1 comprised large-scale dairy farms with high productivity. Dairy farms with intermediate sustainability (group 2) had medium production capacity, and farms with low sustainability (group 1) had the smallest production scale and capacity. Large-scale dairy farms have greater economic, environmental and social sustainability and are, therefore, more likely to survive in the medium and long term.

Cost comparison of pressure ulcer preventive dressings: hydrocolloid dressing versus transparent polyurethane film.

OBJECTIVE: To evaluate and compare the costs of using a transparent polyurethane film (PF) and hydrocolloid dressing (HD) in the prevention of pressure ulcers (PUs). METHOD: This descriptive, observational, longitudinal, comparative study was conducted in the intensive care units, coronary care unit and medical clinic of a charity hospital in Brazil. Data were collected during a 30-day study period, consisting of physical examination, assessment of risk factors for PU development and application of the Braden scale, which were performed at inclusion in the study and once daily during hospitalisation. Either PF or HD was applied bilaterally in the sacral and trochanteric regions for prevention of PUs in patients at a moderate to high risk of PUs according to the Braden scale, and costs of using PU preventive dressings were estimated. RESULTS: The mean total costs per dressing change per patient when using the HD and PF to prevent PUs were 413.60 BRL and 74.04 BRL, respectively. There were significant between-group differences in mean costs for all variables, except for saline solution and nurse-technician services. CONCLUSION: Results showed that the mean cost per dressing change per patient was lower when using the transparent PF than when using the HD.

Impact of surgical wound dehiscence on health-related quality of life and mental health.

OBJECTIVE: To assess the impact of surgical wound dehiscence on health-related quality of life and mental health. Dehiscence of surgical wounds is a serious postoperative complication associated with high morbidity and mortality. METHOD: Sixty-one adult patients, who had undergone neurological, general, colorectal, orthopaedic, gynaecological, plastic, cardiovascular, urological or neurological surgery in a university hospital in Brazil, were assessed between 30 and 180 days after surgery. Twenty participants who achieved complete wound healing were allocated to the control group and 41 participants who developed surgical wound dehiscence were allocated to the dehiscence group. Patients unable to complete the questionnaires because of cognitive impairment and those who declined to participate or died were excluded from the study. Data were collected using a questionnaire assessing sociodemographic and clinical characteristics of participants; the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36); and the Beck Depression Inventory (BDI). RESULTS: Surgical wound dehiscences were 0.5-30 cm in length, 0.5-7 cm in depth, and located in the arms, legs or trunk. There were significant between-group differences in mean scores on the physical functioning (p<0.01), role physical (p<0.01), social functioning (p=0.01), and bodily pain (p=0.01) dimensions of the SF-36. Participants with wound dehiscence reported significantly higher BDI scores (more depressive symptoms) than controls (p=0.01). CONCLUSION: Surgical wound dehiscence had a negative impact on the physical functioning, role physical, social functioning, and bodily pain dimensions of health-related quality of life and on mental health. DECLARATION OF INTEREST: No conflict of interest to declare.

Using transparent polyurethane film and hydrocolloid dressings to prevent pressure ulcers.

OBJECTIVE: To compare the performance and effectiveness of a hydrocolloid dressing (HD) and a transparent polyurethane film (PF) in preventing pressure ulcer (PU) development. METHOD: The study was conducted in the intensive care unit, coronary care unit and medical clinic of the Holy House of Mercy of Passos, Brazil. Data were collected 48 hours after admission and during hospitalisation. The Braden scale was used for PU risk assessment. Consecutive eligible patients without PUs were randomly assigned by lottery to the two groups, either the HD or PF group. RESULTS: Of the 160 eligible patients, significant between-group differences were found in the mean total number of dressing changes (HD, 6.09±1.655 changes; PF, 5.59±2.036 changes; p=0.010), and mean number of dressing changes in the sacral region (HD, 2.50±0.871; PF, 2.05±0.825; p=0.001), with the PF group requiring significantly fewer changes than the HD group. The most common reasons for changing dressings in both groups were moisture (PF 51.1%; HD 47.9%) and shear (HD 43%; PF 38.9%), with a significant difference in shear between groups. The incidence of PUs was significantly lower (p=0.038) in the PF group (8.7%) compared with that in the HD group (15%). CONCLUSION: The results suggest that the transparent polyurethane film had a better performance and was more effective than the hydrocolloid dressing in preventing PU development.

Impact of compression therapy using Unna's boot on the self-esteem of patients with venous leg ulcers.

OBJECTIVE: To assess self-esteem in patients with venous leg ulcers treated with Unna's boot. • METHOD: A descriptive, analytic, clinical study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in São Paulo, Brazil. Patients of both sexes, aged ≥18 years, who had had a venous leg ulcer for more than one year and a Doppler ankle brachial index ranging from 0.8-1.0 were consecutively selected for inclusion. Patients were treated with wound dressings and Unna's boot. Self-esteem was assessed using the Brazilian version of the Rosenberg Self-Esteem Scale (RSE) at inclusion (baseline) and after 4, 8, and 12 months of compression therapy using Unna's boot. The scale is reverse-scored; thus lower scores indicate higher levels of self-esteem. • RESULTS: The patients showed a slight but significant improvement in self-esteem after 4 months of treatment (mean RSE score=17.12) compared with baseline (mean RSE score=24.90). However, a marked and significant improvement in self-esteem was observed after 8 months (mean RSE score=7.40) and 12 months (mean RSE score=2.10) of compression therapy using Unna's boot. • CONCLUSION: Patients with venous leg ulcers treated with Unna's boot for 12 months showed a significant improvement in self-esteem • DECLARATION OF INTEREST: All authors declare that no competing financial interests exist. There was no external funding for this study.

Analysis of follicular events in owl monkeys (Aotus azarai infulatus) using B-mode and Doppler ultrasound.

Ultrasound (B-mode) was used to analyze follicular events in 12 trained female owl monkeys (Aotus azarai infulatus). The animals were examined every 48 hours for over 90 days to measure and map follicular growth in both ovaries and to measure (using Doppler velocimetry) local hemodynamic changes during the peri-ovulatory stage. There were 44 follicular growth events, each with two or three follicular waves, and a mean ± SEM interval between events of 17 ± 1.13 days. There were various hemodynamic changes during follicular growth; both vascular resistance index and pulsatility index decreased during the time when the follicle diameter peaked. Thus, both B-mode and Doppler ultrasound were useful for monitoring ovarian follicular events in owl monkeys.

Antigenic fractions of Leishmania (Viannia) braziliensis: the immune response characterization of patients at the initial phase of disease.

American cutaneous leishmaniasis (ACL) has different clinical manifestations and these manifestations are dependent on the immunological status of the host. As CD4(+) and CD8(+) T cells and their mediators play a fundamental role in the host response to Leishmania and there is also a search for antigenic molecules to be used as future vaccines and tools for prognostic tests, this study characterized ACL patients' immune response after stimulation with soluble and insoluble fractions of L. (V.) braziliensis. We demonstrated a prevailing production of the Th2 cytokines, IL-4 and IL-10 and a specific production of IFN-γ and TNF-α in patients before treatment. There was also a predominance of CD4(+) T cells and a small percentage CD8(+) T cells. The insoluble antigenic fraction primarily stimulated CD4(+) T cells, while the soluble antigenic fraction showed a mixed profile, with CD4(+) T cells being the main responsible for Th2 cytokines and CD8(+) T cells for Th1 cytokines. Therefore, our results showed that a down-modulation of the Th1 type of response occurs in the initial phase of L. braziliensis disease, being the antigenic fractions capable of stimulating a specific immune response.

Dot enzyme-linked immunosorbent assay (dot-ELISA) for schistosomiasis diagnosis using dacron as solid-phase.

Dacron and nitrocellulose were evaluated as matrices for the dot enzyme linked immunosorbent assay (dot-ELISA) for schistosomiasis and compared to indirect immunofluorescence (IMF). Titration of sera from 18 schistosomiasis patients against soluble worm antigen preparation (SWAP) was carried out and sera from healthy individuals from non-endemic areas were used as controls. The IMF was less sensitive than the dot-ELISAs, although the difference was not statistically significant (p > 0.05). The dot-ELISA based on nitrocellulose was as sensitive as that using dacron. Stability did not differ between nitrocellulose and dacron. Specificity was lower when dacron was used than when nitrocellulose was used, although the difference was not statistically significant (p > 0.05). In conclusion, this work showed that nitrocellulose and dacron performed similarly in dot-ELISA, suggesting that they may be used alternatively in population surveillance in endemic areas.

[American cutaneous leishmaniasis in a military training center located in Zona da Mata, Pernambuco, Brazil]. / Leishmaniose tegumentar americana em centro de treinamento militar localizado na zona da mata de pernambuco, Brasil.

An outbreak of American cutaneous leishmaniasis has been occurred in military training unit localized in 'Zona da Mata' of Pernambuco State, Brazil, where were registered 26 human cases. An epidemiological survey was carried out by entomological investigation and Montenegro skin test (MST). Lutzomyia choti presents predominance (89.9%) in sandflies identified. Out of 545 men who realized training activities were 24.12% positive to MST.

Esquistossomose hepato-esplênica em crianças: avaliação morfológica e funcional após esplenectomia e auto-implante esplênico / Hepatosplenic schistosomiasis in children: morphologic and functional evaluation after splenectomy and autologous splenic implantation

A esquistossomose mansônica hepato-esplênica com varizes sangrantes do esôfago é infrequente em crianças, entretanto, determina morbidade atingindo a produtividade desses futuros adultos. Uma das opções para o tratamento cirúrgico é a esplenectomia associada à ligadura da veia gástrica esquerda e esclerose endoscópica das varizes, nos casos de recidiva hemorrágica. Auto-implante esplênico tem sido adicionado em crianças. Há evidências de que a esplenose pós-esplenectomia por trauma mantém, de forma parcial, as funções imunológica e de filtração esplênicas. Todavia, estudos semelhantes não foram realizados em pacientes esquistossomóticos. Foram analisados 23 pacientes, de 9 a 18 anos, com esquistossomose hepato-esplênica submetidos à esplenectomia, ligadura de veia gástrica esquerda e auto-implante esplênico no omento maior. Avaliou-se a função de filtração através da pesquisa de corpúsculos de Howell-Jolly em esfregaços de sangue periférico, cuja presença indica ausência ou insuficiência de função de filtração esplênica. Foi realizada análise morfológica da esplenose através de exame cintilográfico, usando enxofre coloidal, marcado com Tecnécio 99m. Observou-se captação dos implantes esplênicos em todos os pacientes, entretanto, em dois (8,7 por cento), o número de nódulos esplênicos observados foi inferior a cinco, sendo considerado insuficiente. Em correspondência, esses dois pacientes foram os únicos que apresentaram positividade para corpúsculos de Howell-Jolly. Os dados confirmam o auto-implante esplênico no omento maior como método eficaz de produção de esplenose e manutenção da função de filtração esplênica em mais de 90 por cento dos pacientes

[Epidemiologic significance of Aedes albopictus breeding places in bromeliads]. / Significado epidemiológico dos criadouros de Aedes albopictus em bromélias.

A breeding place of immature stages of Aedes albopictus in bromeliads is described. The epidemiological role of bromeliaceae as natural or artificial containers, is discussed. The ability of the mosquito to expand its habitat calls for attention especially as regards its adaptability as an invading species.

[Immature forms of anophelines in artificial containers]. / Formas imaturas de anofelíneos em recipientes artificiais.

Immature stages of Anopheles bellator and of An. argyritarsis were found in artificial containers. The great number of on-returnable containers now produced, may be playing an important role in the increase in the number of available breeding places for culicid mosquitoes.

[New findings of Anopheles mosquitoes in artificial containers]. / Novos encontros de anofelíneos em recipientes artificiais.

New findings of Anopheles mosquitoes in artificial containers are reported. In one, a plastic container served as a breeding place for Anopheles bellator larvae and, in another, four instar larvae of An. albitarsis s.l. were found in an abandoned toilet basin. Reflections are offered as to the selective pressure represented by the production, of an ever increasing scale, of disposable objects.

Apyrase and alpha-glucosidase in the salivary glands of Aedes albopictus.

An apyrase and an alpha-glucosidase were detected in the salivary glands extracts of adult Aedes albopictus. The apyrase is a 61,000 Da secreted protein that hydrolyses ATP and ADP. This protein is synthe-sized in adults and is preferentially accumulated in the distal lateral lobes of the female salivary glands. The alpha-glucosidase is a secreted 67,000 Da protein. This enzyme is synthesized during adult life and accumulated in the proximal-lateral lobes of both males and females. The results are discussed and compared with data previously obtained with Aedes aegypti salivary glands.

American cutaneous leishmaniasis in Pernambuco, Brazil: eco-epidemiological aspects in 'Zona da Mata' region.

American cutaneous leishmaniasis (ACL) has been increasing in Pernambuco, thus becoming an important problem for Public Health. The incindence is predominant in the region called 'Zona da Mata', in the east of this state. This region corresponds geographically to the primitive area of the Atlantic forest. In order to characterize the eco-epidemiology expression of ACL in this region, two localities situated in the municipalities of Amaraji e Cortes have been selected by the criterion of higher incindence of human cases. Five stocks of patients were characterized and identified on the basis of enzyme profiles as a new variant of Leishmania (V.) braziliensis. A survey of wild and domestic animals was carried out by means of a parasitological and serological diagnosis. Through the analysis of the spleen and liver imprints, were detected amastigotes compatible with Leishmania in five Nectomys s. squamipes, five Bolomys 1. pixuna, two Rattus r. alexandrinus and one Rattus r. frugivorus. For two years we carried out monthly sandflies captures using CDC light traps as well as manual captures. Lutzomyia whitmani was predominant, which accounted for 97.4% of the total. These data indicate a strong evidence on the vector and the potential reservoirs of L. braziliensis in this region.

[Comparative study of larval and ovitrap efficacy for surveillance of dengue and yellow fever vectors]. / Estudo comparativo de eficácia de larvitrampas e ovitrampas para vigilância de vetores de dengue e febre amarela.

A comparative study of the efficiency of ovitraps and larval-traps was undertaken with a view to improving the entomological survey of vectors of Dengue and Yellow Fever-Aedes aegypti and Aedes albopictus-in S. Paulo State, Brazil. The region studied is infected only by Aedes albopictus, a species that keeps to wild habitats but colonizes artificial breeding grounds as well. The first part of the study was located in a periurban area of Tremembé county were 3 hollon trees, 23 ovitraps and 5 larval-traps were compared. The second part of these experiments took place in Lavrinhas county (Pinheiros district), where 20 ovitraps and 5 larval-traps were tested. The results showed that the ovitrap was more efficient than larval-traps and were positive even in the presence of natural breeding grounds. It was also observed un the evaluation of the results of "thermonebulization (fog)" that the ovitraps showed strong reduction in the average number of eggs, but this was not observed in the Breteau Index.

[Microhabitats of Aedes albopictus (Skuse) in the region of the Paraiba Valley, São Paulo State, Brazil]. / Microhabitats de Aedes albopictus (Skuse) na região do Vale do Paraíba, Estado de São Paulo, Brasil.

The objective of this study was the determination of extent of the spatial distribution of Aedes albopictus in the Paraíba River Valley, State S. Paulo, Brazil. Thus, collections of larvae and pupae mosquitoes were carried out at six sites distributed along a transection with a 10-km extension. The target was the tree-holes but artificial containers were also used in this investigation. Aedes terrens and Ae. albopictus were the only species of genus Aedes present in the tree-holes mentioned. The segregation of seven species of the tree-hole community was undertaken in the light of macrohabitat and microhabitat features. Thus, the distribution of Ae. albopictus was found to cover the rural, rural-urban and urban zones, but the rural-urban held the preference. Ae. albopictus never present in the residual and primary forest. The favorable factor to infestation with Ae. albopictus in the Paraíba Valley seems to have been the large number of natural niches made vacant by human influence. The rain has been important in the production of larvae and pupae, but the rainfall period does not coincide with the maximum production on them. The tree-holes whose volume exceeded 600 ml were the most productive breeding places. The abundance of these two stages occurs in the summer and autumn. However, the highest peak was observed in the months of March and April. These seasonal variations were found to be common in both the bamboo trap and the artificial container. The temperature data suggest a limit of from 17 to 23 degrees C for the best development of larvae. In the light of this, the strain of Ae. albopictus studied seems to have originated in tropical Asia. Just as happened with Ae. aegypti it may become an important epidemiological vector for the dengue fever and provide links for yellow fever transmission in Brazil.