Mortality by road transport injury in Brazilian municipalities between 2000 and 2018.

OBJECTIVES: This study aimed to investigate patterns of mortality by road transport injury (RTI) in Brazilian municipalities, focused on deaths of motorcyclists, between 2000 and 2018, and their relation with population size and economic status. STUDY DESIGN: This was an ecological epidemiological study with a descriptive and analytical nature. METHODS: The age-standardized RTI mortality rates were calculated for the Brazilian municipalities, referring to the 3-year periods of 2000/2002 (T1), 2009/2011 (T2), and 2016/2018 (T3). The rates were stratified according to macroregion and population size and were compared in terms of percentage variation from one 3-year period to another. The Moran Global and Local indices were used in the spatial point-pattern analysis of the rates. To verify the association with the gross domestic product (GDP) per capita, the Spearman correlation coefficient was applied. RESULTS: A decline in RTI mortality rates was found between 2000 and 2018, with the most significant declines observed in municipalities from the South and Southeast regions of Brazil. However, increases were observed among motorcyclists. Clusters of municipalities were detected, which presented high mortality rates among the motorcyclists in the Northeast region and in some states of the North and Midwest regions. The mortality rates showed a negative correlation with the GDP per capita of the Brazilian municipalities. CONCLUSIONS: Although there were decreases in RTI mortality rates between 1990 and 2018, there was a significant increase in deaths among motorcyclists, especially in the Northeast, North, and Midwest regions of the country. Such differences can be explained by unequal growth in the size of the motorcycle fleet in those regions, by less law enforcement capability, and by the implementation of educational actions.

Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals-a cluster randomised controlled trial.

BACKGROUND: An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. METHODS: The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3-5/5D who are frail, measured by a Frailty Index (FI) of > 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index - Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. DISCUSSION: This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial's findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. TRIAL REGISTRATION: ClinicalTrials.gov NCT04538157. Registered on 3 September 2020.

Fetal hemoglobin regulating genetic variants identified in homozygous (HbSS) and heterozygous (HbSA) subjects from South Mexico.

Hemoglobin S is caused by a nucleotide change in HBB gene (HBB:c.20A>T, p.Glu6Val), is presented in diverse forms: simple carriers (HbSA), homozygotes (HbSS) also known as sickle cell anemia, and compound heterozygotes with other ß-hemoglobinopathies. It is worldwide distributed, in Mexico, is frequently observed in the southern states Guerrero, Oaxaca and Chiapas. Elevated fetal hemoglobin (HbF) is associated with mild phenotype; single-nucleotide variants (SNVs) in modifier genes, such as BCL11A, HBG2, HBBP1 pseudogene and HBS1L-MYB intergenic region, upregulate HbF synthesis. The aim of this study was to identify HbF regulating genetic variants in HbSS and HbSA Mexican subjects. We studied 39 individuals (HbSS = 24, 61%, HbSA = 15, 39%) from Chiapas (67%) and Guerrero (33%), peripheral blood was collected in ethylenediamine tetraacetic acid (EDTA) for molecular and hematological studies, DNA was isolated by salting-out technic and genotyping was performed through allelic discrimination by real time polymerase chain reaction (RT-PCR) using Taqman® probes for 15 SNV (in BCL11A: rs6706648, rs7557939, rs4671393, rs11886868, rs766432, rs7599488, rs1427407; HBS1L-MYB: rs28384513, rs7776054, rs9399137, rs4895441, rs9402686, rs1320963; HBG2: rs7482144; and HBBP1: rs10128556). The obtained data were analyzed using IMB SPSS v.22.0 software. All minor alleles were observed in frequencies over 0.05, the most frequent was rs9402686 (0.82), while the less frequent was rs101028556 (0.08). In HbSS group, the mean fetal hemoglobin was 11.9 ± 5.9% and was significantly elevated in BCL11A rs11886868 wildtype homozygotes and in carriers of HBS1L-MYB intergenic region rs7776054 (p = 0.04 and p = 0.03, respectively). In conclusion, in HbSS Mexican patients, two SNVs were observed related to increased HbF; BCL11A rs11886868 and HBS1L-MYB rs7776054.

Sickle cell anemia (SCA) is one of the most common types of hemoglobinopathies in people of African ancestry, it is caused by homozygosity of HbS mutation (HBB:c.20A>T). It is known that fetal hemoglobin plays a key role in decreasing HbS polymerization which damages the erythrocyte structure and is responsible for the characteristic hemolytic crises endured by these patients. Single-nucleotide variant (SNV) in genes that regulate fetal hemoglobin (HbF) after birth have been associated with its increment, thus ameliorating the hematologic phenotype of this pathology and other ß-hemoglobinopathies. Therefore, in this study, we identified, for the first time in Mexican patients with SCA (HbSS) and HbS carriers (HbSA), the presence of 15 SNVs on BCL11A, HBS1L-MYB and HBG2; all HbSS patients had anemia and elevated HbF; 2 variants were related to increased HbF rs11688888C of BCL11A and rs7776054G of HBSIL-MYB; and finally, all minor alleles were found at a frequency higher than 0.05.

Association Between Severity of Anaphylaxis and Co-occurrence of Respiratory Diseases: A Systematic Review and Meta-analysis of Observational Studies.

BACKGROUND AND OBJECTIVE: Asthma is very prevalent in all grades of severity of anaphylaxis. Asthma and chronic obstructive pulmonary disease (COPD) have been associated with the severity of anaphylaxis. Objective: We carried out a systematic review and meta-analysis to assess the influence of respiratory diseases on the severity of anaphylaxis. METHODS: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for observational studies. The target studies were those that compared the severity of anaphylaxis between patients who had or did not have respiratory diseases. RESULTS: A total of 13 studies assessed the severity of anaphylaxis in respiratory disease. Respiratory disease increased the severity of anaphylaxis (OR, 1.87; 95%CI, 1.30-2.70), as did asthma (OR, 1.89; 95%CI, 1.26-2.83). For the meta-analysis of all studies (adjusted and nonadjusted), COPD increased the severity of anaphylaxis (OR, 2.47; 95%CI, 1.46-4.18). In the case of asthma studies, only 1 study assessed the influence of severity of asthma on severity of anaphylaxis. CONCLUSIONS: Evidence showing that respiratory disease increases the severity of anaphylaxis is low to moderate, although studies do not usually assess the importance of severity of asthma.

Association Between Severity of Anaphylaxis and Co-occurrence of Respiratory Diseases: A Systematic Review and Meta-analysis of Observational Studies

Background: Asthma is very prevalent in all grades of severity of anaphylaxis. Asthma and chronic obstructive pulmonary disease (COPD)have been associated with the severity of anaphylaxis.Objective: We carried out a systematic review and meta-analysis to assess the influence of respiratory diseases on the severity of anaphylaxis.Methods: We searched PubMed/MEDLINE, EMBASE, and the Web of Science for observational studies. The target studies were those thatcompared the severity of anaphylaxis between patients who had or did not have respiratory diseases.Results: A total of 13 studies assessed the severity of anaphylaxis in respiratory disease. Respiratory disease increased the severity ofanaphylaxis (OR, 1.87; 95%CI, 1.30-2.70), as did asthma (OR, 1.89; 95%CI, 1.26-2.83). For the meta-analysis of all studies (adjustedand nonadjusted), COPD increased the severity of anaphylaxis (OR, 2.47; 95%CI, 1.46-4.18). In the case of asthma studies, only 1 studyassessed the influence of severity of asthma on severity of anaphylaxis.Conclusions: Evidence showing that respiratory disease increases the severity of anaphylaxis is low to moderate, although studies do notusually assess the importance of severity of asthma.(AU)

Antecedentes: El asma es muy frecuente en todos los grados de gravedad de la anafilaxia y así mismo el asma y la enfermedad pulmonarobstructiva crónica (EPOC) se han asociado con las anafilaxias graves.Objetivo: Realizamos una revisión sistemática y un meta-análisis para evaluar la influencia de las enfermedades respiratorias en lagravedad de la anafilaxia.Métodos: Se realizaron búsquedas en PubMed / MEDLINE, EMBASE y Web of Science de estudios observacionales, en donde se compararonla gravedad de la anafilaxia entre pacientes que tenían o no enfermedades respiratorias.Resultados: Un total de 13 estudios evaluaron la influencia de las enfermedades respiratorias en la gravedad de la anafilaxia. La enfermedadrespiratoria aumentó la gravedad de la anafilaxia (OR, 1,87; IC 95%, 1,30-2,70). En general, el asma también aumentó la gravedad dela anafilaxia (OR, 1,89; IC del 95%, 1,26-2,83). En el meta-análisis de todos los estudios con EPOC (ajustado y no ajustado), la mismaaumentó la gravedad de la anafilaxia (OR, 2,47; IC del 95%, 1,46-4,18). En los estudios con asma, solo uno evaluó la influencia de lagravedad del asma en la gravedad de la anafilaxia.Conclusiones: La evidencia que muestra que la enfermedad respiratoria aumenta la gravedad de la anafilaxia es baja a moderada, aunquelos estudios no suelen evaluar la importancia de la gravedad del asma.(AU)

Evaluating the performance of convolutional neural networks with direct acyclic graph architectures in automatic segmentation of breast lesion in US images.

BACKGROUND: Outlining lesion contours in Ultra Sound (US) breast images is an important step in breast cancer diagnosis. Malignant lesions infiltrate the surrounding tissue, generating irregular contours, with spiculation and angulated margins, whereas benign lesions produce contours with a smooth outline and elliptical shape. In breast imaging, the majority of the existing publications in the literature focus on using Convolutional Neural Networks (CNNs) for segmentation and classification of lesions in mammographic images. In this study our main objective is to assess the ability of CNNs in detecting contour irregularities in breast lesions in US images. METHODS: In this study we compare the performance of two CNNs with Direct Acyclic Graph (DAG) architecture and one CNN with a series architecture for breast lesion segmentation in US images. DAG and series architectures are both feedforward networks. The difference is that a DAG architecture could have more than one path between the first layer and end layer, whereas a series architecture has only one path from the beginning layer to the end layer. The CNN architectures were evaluated with two datasets. RESULTS: With the more complex DAG architecture, the following mean values were obtained for the metrics used to evaluate the segmented contours: global accuracy: 0.956; IOU: 0.876; F measure: 68.77%; Dice coefficient: 0.892. CONCLUSION: The CNN DAG architecture shows the best metric values used for quantitatively evaluating the segmented contours compared with the gold-standard contours. The segmented contours obtained with this architecture also have more details and irregularities, like the gold-standard contours.

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011.

BACKGROUND AND OBJECTIVE: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. METHODS: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. RESULTS: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. CONCLUSIONS: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis.

Clinical profile of patients with severe anaphylaxis hospitalized in the Spanish Hospital System: 1997-2011

Background: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. Methods: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. Results: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. Conclusions: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis (AU)

Antecedentes: Los estudios que recogen datos sobre comorbilidades que empeoran la gravedad de la anafilaxia, carecen de un acercamiento exhaustivo. Objetivo: Usando la puntuación de Elixhauser (un sistema de puntuación asociado con mayor estancia hospitalaria, mayor gasto hospitalario y muerte), establecimos que comorbilidades fueron asociadas con anafilaxia grave. Métodos: Usamos para el estudio la base de datos de altas hospitalarias del Ministerio Español de Sanidad, entre 1997 a 2011. Se obtuvo varios modelos de regresión logística, en las cuales las variables dependientes fueron desenlaces relacionados con eventos asociados habitualmente a una gran gravedad de los episodios (muerte, parada cardio-respiratoria, necesidad de uso de ventilación mecánica invasiva o medicamentos vaso-presores, ingreso en la Unidad de Cuidados Intensivos y duración de la estancia) y las variables independientes fueron las 30 comorbilidades que comprenden la puntuación Elixhauser, junto con edad, sexo y las grandes causas de anafilaxia. Resultados: Encontramos que un mayor riesgo para anafilaxia grave estuvo asociado (3 o más regresiones logísticas con significación estadística) con una edad de más de 50 años, o haber experimentado arritmias cardiacas, alteraciones de la coagulación, disbalance hidro-electrolítico, enfermedad pulmonar crónica o anafilaxia por Echinococcus. Así mismo, en un análisis ajustado, una puntuación mayor del sistema Elixhauser se asoció con la mayoría de las variables de desenlace usadas para analizar la gravedad de la anafilaxia. Conclusiones: Enfermedades cardio-vasculares y respiratorias incrementan la gravedad de la anafilaxia y un mal estado de salud (representado por mayores puntuaciones del Sistema de puntuación de Elixhauser) se asocian con mayor gravedad de la anafilaxia (AU)

Gender, race and socioeconomic influence on diagnosis and treatment of thyroid disorders in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Thyroid diseases are common, and use of levothyroxine is increasing worldwide. We investigated the influence of gender, race and socioeconomic status on the diagnosis and treatment of thyroid disorders using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35-74 years of age) from six Brazilian cities. Diagnosis of thyroid dysfunction was by thyrotropin (TSH), and free thyroxine (FT4) if TSH was altered, and the use of specific medications. Multivariate logistic regression models were constructed using overt hyperthyroidism/hypothyroidism and levothyroxine use as dependent variables and sociodemographic characteristics as independent variables. The frequencies of overt hyper- and hypothyroidism were 0.7 and 7.4%, respectively. Using whites as the reference ethnicity, brown, and black race were protective for overt hypothyroidism (OR=0.76, 95%CI=0.64-0.89, and OR=0.53, 95%CI=0.43-0.67, respectively, and black race was associated with overt hyperthyroidism (OR=1.82, 95%CI=1.06-3.11). Frequency of hypothyroidism treatment was higher in women, browns, highly educated participants and those with high net family incomes. After multivariate adjustment, levothyroxine use was associated with female gender (OR=6.06, 95%CI=3.19-11.49) and high net family income (OR=3.23, 95%CI=1.02-10.23). Frequency of hyperthyroidism treatment was higher in older than in younger individuals. Sociodemographic factors strongly influenced the diagnosis and treatment of thyroid disorders, including the use of levothyroxine.

Increased incidence of admissions for anaphylaxis in Spain 1998-2011.

We report on trends in anaphylaxis admissions in the Spanish hospital system during the period 1998-2011. Data on admissions for anaphylaxis were obtained from the Spanish Information System for Hospital Data for the period 1998-2011. Patients were selected using the codes for anaphylaxis in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Poisson regression models were used to estimate incidence rate ratios. We recorded a 1.89-fold increase in admissions for anaphylaxis in Spanish hospitals during the study period, particularly in patients aged 0-14 years (1.65- to 3.22-fold until 2009 and 4.09- to 12.59-fold until 2011) and in food anaphylaxis in all age groups (2.78-fold until 2009 and 8.74-fold until 2011). The incidence of anaphylaxis is perceived as having increased in recent years, especially anaphylaxis caused by food and anaphylaxis affecting the pediatric population.

Two novel class I integron arrays containing IMP-18 metallo-ß-lactamase gene in Pseudomonas aeruginosa clinical isolates from Puerto Rico.

During a ß-lactam resistance surveillance study, 12 IMP-18-positive Pseudomonas aeruginosa isolates belonging to 9 different pulsed-field gel electrophoresis groups were identified. In nine isolates, a class I integron with a novel gene array was identified that contained bla(IMP-18) and bla(OXA-224), while in two isolates the class I integron contained bla(IMP-18) and bla(OXA-2) but in a new arrangement. Our findings show the dissemination of two novel class I integrons in P. aeruginosa from different regions of Puerto Rico.

Repercussões da insuficiência renal crônica na capacidade de exercício, estado nutricional, função pulmonar e musculatura respiratória de crianças e adolescentes / Consequences of chronic renal insufficiency on the exercise capacity, nutritional status, pulmonary function and respiratory musculature of children and adolescents

OBJETIVO: Avaliar a capacidade funcional, função pulmonar, musculatura respiratória e estado nutricional de crianças e adolescentes portadores de insuficiência renal crônica (IRC) em tratamento conservador. MÉTODOS: Este estudo foi realizado com 30 voluntários, divididos em dois grupos: Portadores de IRC em tratamento conservador (Grupo IRC) e grupo sem comprometimento da função renal (Grupo Controle). Os voluntários foram submetidos à avaliação fisioterapêutica, espirometria, avaliação de força e resistência da musculatura respiratória, do estado nutricional e da capacidade funcional. Para a análise dos dados, foi utilizado o teste de Mann-Whitney com nível de significância de 5 por cento. RESULTADOS: No Grupo IRC, o índice de Tiffeneau foi significativamente menor (p= 0,003). Em relação à função muscular respiratória, os valores de pressão expiratória máxima foram menores (p= 0,010) e os valores do tempo do teste de resistência, maiores (p= 0,003). Na avaliação funcional, as variáveis que diferiram estatisticamente foram: menor distância caminhada (p< 0,001) e maior pressão arterial média (p< 0,001); freqüência respiratória final (p< 0,001) e escala de Borg (p= 0,048). Quanto ao estado nutricional, todas as variáveis, estatisticamente significativas, foram menores. CONCLUSÕES: Crianças e adolescentes portadores IRC, em tratamento conservador, podem apresentar alterações importantes da capacidade funcional, musculatura respiratória e estado nutricional.

OBJECTIVE: To evaluate functional capacity, pulmonary function, respiratory musculature and nutritional status among children and adolescents with chronic renal insufficiency (CRI) undergoing conservative treatment. METHODS: This study was conducted with 30 volunteers, divided into two groups: a group of children and adolescents with CRI undergoing conservative therapy (CRI Group) and a group without renal disease (Control Group). The volunteers underwent physical therapy evaluation, spirometry, strength and resistance tests on their respiratory musculature, nutritional status evaluation and functional capacity assessment. The data were analyzed using the Mann-Whitney test with a significance level of 5 percent. RESULTS: The Tiffeneau index was significantly lower in the CRI Group (p= 0.003). In relation to respiratory muscle function, the maximum expiratory pressure values were lower (p= 0.010) and the time values of the resistance test were greater (p= 0.003). In the functional assessment, the variables that differed statistically were: lower distance walked (p< 0.001), greater mean arterial pressure (p< 0.001), final respiratory rate (p< 0.001) and Borg scale (p= 0.048). Regarding nutritional status, all the statistically significant variables were lower. CONCLUSIONS: Children and adolescents with CRI undergoing conservative treatment may present significantly impaired functional capacity, respiratory musculature and nutritional status.

Caveolin isoform expression during differentiation of C6 glioma cells.

Caveolae, a specialized form of lipid rafts, are cholesterol- and sphingolipid-rich membrane microdomains implicated in potocytosis, endocytosis, transcytosis, and as platforms for signal transduction. One of the major constituents of caveolae are three highly homologous caveolin isoforms (caveolin-1, caveolin-2, and caveolin-3). The present study expands the analysis of caveolin isoform expression in C6 glioma cells. Three complementary approaches were used to assess their differential expression during the dibutyryl-cyclic AMP-induced differentiation of C6 cells into an astrocyte-like phenotype. Immunoblotting, conventional RT-PCR, and real-time RT-PCR analysis established the expression of the caveolin-3 isoform in C6 cells, in addition to caveolin-1 and caveolin-2. Similar to the other isoforms, caveolin-3 was associated with light-density, detergent-insoluble caveolae membrane fractions obtained using sucrose-density gradient centrifugation. The three caveolin isoforms display different temporal patterns of mRNA/protein expression during the differentiation of C6 cells. Western blot and real-time RT-PCR analysis demonstrate that caveolin-1 and caveolin-2 are up-regulated during the late stages of the differentiation of C6 cells. Meanwhile, caveolin-3 is gradually down-regulated during the differentiation process. Indirect immunofluorescence analysis via laser-scanning confocal microscopy reveals that the three caveolin isoforms display similar subcellular distribution patterns. In addition, co-localization of caveolin-1/caveolin-2 and caveolin-1/caveolin-3 was detected in both C6 glioma phenotypes. The findings reveal a differential temporal pattern of caveolin gene expression during phenotypic differentiation of C6 glioma cells, with potential implications to developmental and degenerative events in the brain.

Impact of an integrated adolescent reproductive health program in Brazil.

An impact evaluation of an integrated school- and health-clinic-based adolescent reproductive health initiative was undertaken by the State Secretariats of Health and Education in Bahia, Brazil during 1997-99. The project was initiated in response to continued high pregnancy rates among adolescents and growing numbers of new HIV infections among young adults. It sought to promote responsible sexual and health-seeking behaviors among public secondary-school students, including the use of public health clinics. The study design included a matched control group used to measure project impact. The findings indicate that the project was successful in increasing the flow of sexual and reproductive health information to secondary-school students and that it had an impact on adolescents' intentions to use public health clinics in the future. No effects on sexual or contraceptive-use behaviors or on use of public clinics were observed, however. Client exit-interview data from a subset of project clinics indicate that adolescents who use clinic-based services are overwhelmingly female and considerably older on average and much more likely ever to have been pregnant than are adolescents in the target population for the project.

Hypertension in a female nursing staff--Pattern of occurrence, diagnosis, and treatment.

OBJECTIVE: To report the pattern of occurrence, diagnosis, and treatment of hypertension in a female nursing staff of an emergency hospital. METHODS: We carried out a cross-sectional study that included interviews and blood pressure measurements of 494 nursing professionals at an emergency hospital in the city of Salvador, in the state of Bahia, Brazil. We considered hypertensive all individual with blood pressure > or = 140/90 mmHg or normal pressure if on regular treatment. RESULTS: We found a prevalence of hypertension of 36.4%. Only 18.3% of the individuals ignored their hypertensive condition, and 64.2% admitted not being having regular treatment. Of those individuals who were having treatment, 69.4% had elevated blood pressure on examination. The major reasons for not being on treatment was the occasional elevation of blood pressure (22.2%) and medical counseling (20.0%). CONCLUSION: The results point to the need to introduce hypertension control measures in this occupational group, because of the magnitude of the disease and the potential impact on diffusion of knowledge and measures to control hypertension.

[Reliability of arterial blood pressure measurement in an arterial hypertension study]. / Confiabilidade da medida de pressão arterial sangüínea em um estudo de hipertensão arterial.

PURPOSE: To evaluate the relaibility of the blood pressure measurements in an arterial hypertension study. METHODS: It was evaluated 502 nurse workers of a public hospital. After careful training and selection of the observers for the quality control at the fieldwork, it was analyzed the correlation between the 1st and 2nd measurements, final digit preference and mean systolic (SBP) and diastolic pressure (DBP). 5% of the sample had their measures compared with those checked by an expert. RESULTS: There was a great confiability intra-observer (96.2% in the SBP and 93.4% in the DBP). The final digit distribution was almost identical. At the 5% sample, there was a strong correlation between them (96.0% in the SBP and 93.9% in the DBP). CONCLUSION: This methodology is feasible in national studies and confers validity to the results.

Confiabilidade da medida de pressão arterial sanguínea em um estudo de hipertensão arterial / Reliability of arterial blood pressure measurements in an arterial hypertension study

Purpose - To evaluate the reliability of the blood pressure measurements in an arterial hypertension study. Methods - It was evaluated 502 nurse workers of a public hospital. After careful training and selection of the observers, for the quality control at the field work, it was analyzed the correlation between the 1st and 2st measuments, final digit preference and mean systolic (SBP) and diastolic pressure(DBP). 5% of the sample had their measures compared with those checked by an expert. Results - There was a great confiability intraobserver (96.2% in the SBP and 93.4% in the DBP). The final digit distribution was almost identical. At the 5% sample, there was a strong correlation between them (96. 0% in the SBP and 93.9% in the DBP). Conclusion - This methodology is feasible in national studies and confers validity to the results

Objetivo - Avaliar a confiabilidade das medidas de pressão arterial sanguínea em um estudo sobre hipertensão arterial (HA). Métodos - Foram examinadas 502 trabalhadoras de enfermagem em hospital de Salvador. Após cuidadoso processo de treinamento e seleção para controle de qualidade do trabalho de campo, os valores aferidos foram analisados, quanto à correlação entre as medidas e à distribuição dos dígitos terminais e das médias de pressão arterial sistólica (PAS) e diastólica (PAD). Comparou-se amostra de 5% das medidas com as efetuadas, de modo cego, na mesma ocasião, por supervisora médica. Resultados - Observou-se grande confiabilidade intra-observadora (96,2% na PAS e 93,4% na PAD). A distribuição entre os dígitos terminais foi praticamente eqüitativa. Na amostra, houve grande correlação entre as medidas (96,0% na PAS e 93,9% na PAD). Conclusão - As estratégias adotadas para a uniformização das medidas foram satisfatórias, garantindo a confiabilidade dos resultados e factíveis em estudos nacionais

[Women, health, and labor in Brazil: challenges for new action]. / Mulher, saúde e trabalho no Brasil: desafios para um novo agir.

Despite the remarkable rise in women's participation in the labor market in Brazil, its consequences on health are still virtually unknown. This study aims to identify theoretical and methodological problems in the relationship between labor and women's health from a gender perspective. Characteristics of women's occupational placement are described and analyzed as resulting from their role in social reproduction. The study examines the development of several conciliatory strategies between paid work and housework which are discussed as potential determinants of health problems and support the need for a critical reappraisal of theoretical and methodological strategies to reach a better understanding of the complexity and specificities of women's living and working conditions. The author also stresses the role of women's recent participation in the trade union movements in defense of health, body rights, and women's issues in the workplace, as well as the need for a new framework embodied in the women's social movement. The study thus points to the challenge to produce knowledge on this subject in order to unveil the uniqueness of the national scenario marked by unemployment, informal jobs, low salaries, weak trade unions and other civil organizations, and traditional domestic and marriage relationships.

[Gender and health in Brazil: considerations based on the National Household Sampling Survey]. / Gênero e saúde no Brasil: considerações a partir da Pesquisa Nacional por Amostra de Domicílios.

As in the principal industrial countries, Brazilian women have lived longer than men. However, paradoxically, women present higher morbidity indicators than men. Knowledge of the Brazilian pattern regarding this matter could be a useful contribution to an understanding of their determinants in our specific reality, as well as enabling us to foresee future trends that would make it possible to plan adjustment in the health system. A morbidity study based on data from the National Household Sample Survey (PNAD/IBGE), was undertaken in ten Brazilian states in 1986 with this in view. Coefficients of the prevalence of perceived morbidity, demand for and utilization of health services according to sex, standardized by age and using the direct method, were built up. As a measurement of the differentials, sex ratios were calculated. The excess of perceived morbidity in women was constant in all the regions. The sex differential in the utilization of health services showed regional variations, suggesting a relationship with the health services supply. Sex differentials were not observed in childhood; the highest values were found during the woman's reproductive period, decreasing sharply after 60 years of age. The pattern is very similar in all regions. In the present study, the findings could be partially explained by the methodology adopted, but they are similar to the findings reported in other countries. The intense transformations in the reproductive pattern and in the social status of Brazilian women probably have a considerable impact on the health status and on the recourse to health services, not as yet evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: Brazilian women have lived longer than men; however, the morbidity of women is higher than that of men. Knowledge of this Brazilian pattern could contribute to an understanding of morbidity determinants as well as help anticipate future trends to plan adjustment in the health system. A morbidity study based on data from the National Household Sample Survey (PNAD/IBGE) was undertaken in 10 Brazilian states in 1986 with this objective. Coefficients of the prevalence of perceived morbidity, as well as demand for and utilization of health services according to sex, were constructed and standardized by age using the direct method. As a measurement of the differentials, sex ratios were calculated. The highest rates of morbidity in both sexes were encountered in the state of Minas Gerais, in the Federal District, and in the state of Sao Paulo. The excess of perceived morbidity in women was constant in all the regions at 20-30%. The women utilized health services more than men, and major differences were found in the states of the north and northeast regions. The sex differential in the utilization of health services showed regional variations, suggesting a relationship with the health services supply. Sex differentials were not observed in childhood, and, up to age 14, the differences were nonexistent; the highest values were found in the 20-29 age segment during the woman's reproductive period, decreasing sharply after 60 years of age. The pattern was very similar in all regions. The findings could be partially explained by the methodology adopted, but they are similar to findings reported in other countries. The intense transformation in the reproductive pattern and social status of Brazilian women probably exerts considerable impact on health status and recourse to health services. More specific studies, which may contribute to the reorganization of a fair and universal health system, are recommended.