Showing papers by "Universidade Federal de Pelotas published in 2005"

The map-based sequence of the rice genome

Abstract: Rice, one of the world's most important food plants, has important syntenic relationships with the other cereal species and is a model plant for the grasses. Here we present a map-based, finished quality sequence that covers 95% of the 389 Mb genome, including virtually all of the euchromatin and two complete centromeres. A total of 37,544 non-transposable-element-related protein-coding genes were identified, of which 71% had a putative homologue in Arabidopsis. In a reciprocal analysis, 90% of the Arabidopsis proteins had a putative homologue in the predicted rice proteome. Twenty-nine per cent of the 37,544 predicted genes appear in clustered gene families. The number and classes of transposable elements found in the rice genome are consistent with the expansion of syntenic regions in the maize and sorghum genomes. We find evidence for widespread and recurrent gene transfer from the organelles to the nuclear chromosomes. The map-based sequence has proven useful for the identification of genes underlying agronomic traits. The additional single-nucleotide polymorphisms and simple sequence repeats identified in our study should accelerate improvements in rice production.

Rapid growth in infancy and childhood and obesity in later life--a systematic review.

Abstract: The association between obesity and morbidity resulting from chronic diseases is well known This systematic review addresses studies of the role of rapid growth in infancy and childhood as possible determinants of overweight and obesity later in the life course We reviewed MEDLINE for studies reporting on growth in infancy and childhood, as well as measures of weight or adiposity in later childhood, adolescence or adulthood The methodological quality of the papers was assessed using the criteria suggested by Downs and Black Sixteen articles that fulfilled review criteria were located There was wide variability in the indicators used for defining rapid growth as well as overweight or obesity The age range in which weight or adiposity was measured ranged from 3 to 70 years In spite of differences in definitions used, 13 articles that reported on early rapid growth found significant associations with later overweight or adiposity Efforts should be made to standardize the definition of rapid growth, as well as that of overweight and obesity in children and adolescents The most frequent definition for rapid growth in this review was a Z-score change greater than 067 in weight for age between two different ages in childhood Regarding obesity, the definition proposed by the International Obesity Task Force also appears to be most appropriate The present results indicate that early growth is indeed associated with the prevalence of obesity later in the life course

Swine and Poultry Pathogens: the Complete Genome Sequences of Two Strains of Mycoplasma hyopneumoniae and a Strain of Mycoplasma synoviae

Abstract: This work reports the results of analyses of three complete mycoplasma genomes, a pathogenic (7448) and a nonpathogenic (J) strain of the swine pathogen Mycoplasma hyopneumoniae and a strain of the avian pathogen Mycoplasma synoviae; the genome sizes of the three strains were 920,079 bp, 897,405 bp, and 799,476 bp, respectively. These genomes were compared with other sequenced mycoplasma genomes reported in the literature to examine several aspects of mycoplasma evolution. Strain-specific regions, including integrative and conjugal elements, and genome rearrangements and alterations in adhesin sequences were observed in the M. hyopneumoniae strains, and all of these were potentially related to pathogenicity. Genomic comparisons revealed that reduction in genome size implied loss of redundant metabolic pathways, with maintenance of alternative routes in different species. Horizontal gene transfer was consistently observed between M. synoviae and Mycoplasma gallisepticum. Our analyses indicated a likely transfer event of hemagglutinin-coding DNA sequences from M. gallisepticum to M. synoviae.

Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness

Abstract: Results: The IMCI strategy was successfully introduced in the great majority of countries with moderate to high levels of child mortality in the period from 1996 to 2001. Seven years of countrybased evaluation, however, indicates that some of the basic expectations underlying the development of IMCI were not met. Four of the five countries (the exception is Tanzania) had difficulties in expanding the strategy at national level while maintaining adequate intervention quality. Technical guidelines on delivering interventions at family and community levels were slow to appear, and in their absence countries stalled in their efforts to increase population coverage with essential interventions related to careseeking, nutrition, and correct care of the sick child at home. The full weight of health system limitations on IMCI implementation was not appreciated at the outset, and only now is it clear that solutions to larger problems in political commitment, human resources, financing, integrated or at least coordinated programme management, and effective decentralization are essential underpinnings of successful efforts to reduce child mortality. Conclusions: This analysis highlights the need for a shift if child survival efforts are to be successful. Delivery systems that rely solely on government health facilities must be expanded to include the full range of potential channels in a setting and strong community-based approaches. The focus on process within child health programmes must change to include greater accountability for intervention coverage at population level. Global strategies that expect countries to make massive adaptations must be complemented by country-level implementation guidelines that begin with local epidemiology and rely on tools developed for specific epidemiological profiles.

The Burden of Obstructive Lung Disease Initiative (BOLD): rationale and design.

Abstract: Quantifying COPD prevalence worldwide is needed to document COPD's effect on disability, health care costs, and impaired quality of life and to inform governments and health planners. As an adjunct to data obtained from population-based studies, and for countries where a fully powered prevalence survey cannot be done, modeling of COPD prevalence and its economic burdens can help estimate potential health care needs and costs. For comparability, standardized methods for prevalence surveys are needed that can be used in countries at all levels of economic development. The Burden of Obstructive Lung Disease (BOLD) Initiative has developed a set of methods for estimating COPD prevalence and a model for assessing its economic impact, and piloted these methods in China and Turkey. The methods were revised to reflect the findings in the pilot studies, and BOLD is now making the standardized methods available worldwide. The BOLD Operations Center provides training, materials, quality control, and data analysis. BOLD emphasizes data quality control at every stage of the process. Data from paper forms completed in the field are entered electronically to a specially designed secure Web platform. Pre- and post-bronchodilator spirometry testing is done on all participants, and all spirometry data are reviewed for quality. Questionnaires are used to obtain information about respiratory symptoms, health status, exposure to risk factors, and economic data about the burden of COPD. BOLD's standardized methods will provide a uniform way to compare COPD burden within and between countries, and where differences are found, to explore explanations for these differences.

Indicador econômico para o Brasil baseado no censo demográfico de 2000

Abstract: OBJETIVO: Propor um indicador economico para o Brasil baseado em bens de consumo usando variaveis presentes no censo demografico de 2000. METODOS: O indicador, denominado Indicador Economico Nacional (IEN), foi desenvolvido a partir de 12 bens e a escolaridade do chefe de familia, por meio de analise de componentes principais. Dados da amostra do Censo Demografico Brasileiro de 2000, realizado pelo Instituto Brasileiro de Geografia e Estatistica, foram usados para gerar o indicador e para o calculo dos pontos de corte dos decis de referencia. RESULTADOS: O indicador, primeiro componente obtido da analise, reteve 38% da variabilidade total e apresentou correlacao de Spearman de 0,74 com a renda total do domicilio e de 0,67 com a renda per capita. Os coeficientes necessarios para calcular o indicador sao apresentados, assim como as distribuicoes de referencia para 27 capitais e Estados, as cinco regioes e o Pais. Apresenta-se um exemplo de como se usa o indicador. CONCLUSOES: Diferentemente de outros indicadores economicos disponiveis, o IEN tem as distribuicoes de referencia publicadas, para capitais, Estados, Regioes, bem como a distribuicao nacional. Torna-se possivel, portanto, comparar a amostra estudada a distribuicao municipal, estadual ou nacional. O numero reduzido de variaveis torna facil o calculo do Indicador Economico Nacional para investigadores envolvidos em pesquisas onde e importante a classificacao economica.

Self-controlled feedback is effective if it is based on the learner's performance.

Abstract: The study follows up on the contention that self-controlled feedback schedules benefit learning, because they are more tailored to the performers' needs than externally controlled feedback schedules (Chiviacowsky & Wulf, 2002). Under this assumption, one would expect learning advantages for individuals who decide whether they want to receive feedback after a trial rather than before a trial. Participants practiced a sequential timing task, and all could decide the trials on which they received feedback. One group (“self-after”) decided after every trial whether they wanted to receive feedback for that trial, while another group (“self-before”) made that decision before each trial. The self-after group showed learning benefits on a delayed transfer test (novel absolute timing requirements) with regard to overall timing and relative-timing accuracy. Thus, self-controlled feedback was more effective when the learner could make a decision about receiving feedback after the trial. This seems to support the vie...

Social and biological early life influences on severity of dental caries in children aged 6 years.

Abstract: Objective: To investigate the relationship between social and biological conditions experienced in very early life and dental caries in children aged 6 years. Methosd: The design was a dental caries cross-sectional study nested in a birth cohort study started in Pelotas, Brazil, in 1993. The cross-sectional study was carried out in 1999. A random sample of 400 6-year-old children was selected from among 5249 live births in 1993. The World Health Organization (1997) criteria were used to diagnose dental caries. Results from the oral health study were linked to the data concerning perinatal and childhood health and illnesses and family social conditions collected at birth, 1, 3, 6 and 12 months, and in the sixth year of life. Dental caries was the outcome measured at two levels of severity (very low: dmft less than or equal to 1; high: dmft greater than or equal to 4). Unconditional univariate and multiple logistic regression analysis were performed. Results: Self-employed and employees/unemployed, fathers with <8 years of education at time child was born, child's height deficit for age at 12 months; child who did not attend day care centre in sixth year of life; brushing teeth less than once a day, and children with sweet consumption of at least once a day at 6 years were risk factors for high dental caries after controlling for possible confounders. Conclusions: Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood.

Fetal, infant and childhood growth: Relationships with body composition in Brazilian boys aged 9 years

Abstract: Early growth rate has been linked to later obesity categorised by body mass index (BMI), but the development of body composition has rarely been studied. We tested the hypotheses that (1) birthweight and weight gain in (2) infancy or (3) childhood are associated with later body composition, in 172 Brazilian boys followed longitudinally since birth. Growth was assessed using measurements of weight and height at birth, 6 months, and 1 and 4 y. Measurements at 9 y comprised height, weight and body composition using foot–foot impedance. Birthweight was associated with later height and lean mass (LM), but not fatness. Weight gain 0–6 months was associated with later height and LM, and with obesity prevalence according to BMI, but not with fatness. Weight gain 1–4 y was associated with later fatness and LM. Weight gain 4–9 y was strongly associated with fatness but not LM. Early growth rate did not correlate positively with subsequent growth rate. Early rapid weight gain increased the risk of later obesity, but not through a direct effect on fatness. Childhood weight gain remained the dominant risk factor for later obesity. The reported link between early growth and later obesity may be due partly to hormonal programming, and partly to the contribution of LM to obesity indices based on weight and height. Whether our findings apply to other populations requires further research.

Epidemiology of leisure-time physical activity: a population-based study in southern Brazil

Abstract: We aimed to measure the prevalence of physical inactivity (PI) during leisure time and to identify variables associated with it in a southern Brazilian adult population. A population-based cross-sectional study was carried out, covering a multiple-stage sample of 1,968 subjects aged 20-69 years. Weekly participation in leisure-time physical activity was addressed. For each activity, energy expenditure was calculated using data on duration, metabolic equivalent, and body weight. Energy expenditures of individual activities were summed to give a weekly total. PI was defined as fewer than 1,000 kilocalories per week. The prevalence of PI was 80.7% (95%CI: 78.9-82.4). After adjusted analyses, the following variables were positively associated with the outcome: female gender, age, living with a partner, and smoking. Schooling and economic status were inversely associated with PI. Chronically undernourished individuals were significantly more likely to be inactive. We found no differences according to skin color or alcohol consumption. In conclusion, the prevalence of PI in this adult population was higher than in populations from developed countries, but the associated variables were similar.

Physical activity in adults from two Brazilian areas: similarities and differences

Abstract: Lack of comparability has been a major limitation in studies on physical activity, due to the utilization of different methodological instruments and inconsistent cut-off points. This study aims to compare the levels of physical activity in adults from two Brazilian areas: (a) Sao Paulo, the richest State in the country; (b) Pelotas, a medium-sized southern Brazilian city. Both sites used cross-sectional population-based designs, with multiple-stage sampling strategies. Level of physical activity was assessed with the short version of the International Physical Activity Questionnaire. Prevalence of sedentary lifestyle was three times higher in Pelotas than in Sao Paulo. On the other hand, the proportion of very active subjects was significantly higher in Pelotas. The proportion of insufficiently active individuals (sedentary + irregularly active) was almost identical between the sites. Socioeconomic status was inversely related to level of physical activity in both sites. Among the insufficiently active subjects, those living in Sao Paulo are at least engaged in a limited amount of activity. On the other hand, among sufficiently active people, those living in Pelotas are more active.

Effectiveness of different techniques for removing gutta-percha during retreatment.

Abstract: Masiero AV, Barletta FB. Effectiveness of different techniques for removing gutta-percha during retreatment. International Endodontic Journal, 38, 2–7, 2005. Aim Toevaluatetheeffectivenessofvarioustechniques for removing filling material from root canals in vitro. Methodology Eighty extracted mandibular premolar teeth were selected for the study. The teeth were root filled using thermomechanical compaction of gutta-percha. After 8 months, the filling material was removed and canals were reinstrumented using the following techniques: group I ‐ hand instrumentation with K-type files (SybronEndo, Orange, CA, USA); group II ‐ K3 Endo System (SybronEndo); group III ‐ M4 system (SybronEndo) with K-type files (SybronEndo); and group IV ‐ Endo-gripper system (Moyco Union Broach, York, PA, USA) with K-type files (SybronEndo). The amount of filling debris remaining on root canal walls was assessed radiographically; the images were digitized and analysed using AutoCAD 2000 software. Total canal area, area of the cervical, middle and apical thirds, and area of remaining filling material were outlined by one operator. The ratios between these areas were calculated as percentages of remaining debris. Thereafter, data were analysed by means of oneway anova and the post-hoc Duncan test to identify differences between the four techniques. Results Multiple comparisons of the percentages of remaining filling material in the entire canal did not reveal any significant differences between the methods of removal. However, when each third was analysed separately, significant differences for remaining debris were present between groups. The apical third had the most remaining material, whilst the cervical and middle thirds were significantly cleaner (P ¼ 0.002). Comparison of the techniques revealed that teeth instrumented with K3 rotary instruments had a lower ratio of remaining filling material in the apical third (P ¼ 0.012). Conclusion In the apical third, K3 rotary instruments were more efficient in removing gutta-percha filling material than the other techniques, which were equally effective for the other thirds.

Validação do peso e altura referidos para o diagnóstico do estado nutricional em uma população de adultos no Sul do Brasil

Abstract: Analisou-se a validade do Indice de Massa Corporal (IMC), calculado por intermedio do peso e altura auto-referidos, para predizer o estado nutricional de adultos. Valendo-se de um estudo transversal de base populacional que inclui 3.934 individuos maiores de vinte anos em Pelotas, Rio Grande do Sul, Brasil, foi sorteada uma subamostra de 140 individuos para mensuracao de peso e altura. A concordância e a validade do peso referido mostrou-se melhor do que a altura referida. Comparando-se os IMC medido e referido calculou-se o erro medio e identificaram-se os fatores associados a esse erro. O IMC "referido" e subestimado por mulheres, independentemente de seu estado nutricional; entre os homens, esse dado mostrou-se confiavel. Em mulheres, idade e renda familiar mostraram-se associadas a subestimativa de IMC apos analise multivariada. A utilizacao do IMC "referido" para predizer o estado nutricional de adultos pode resultar em subestimativa da prevalencia de obesidade e superestimativa do sobrepeso em mulheres. O IMC "corrigido" calculado pela equacao de regressao linear minimiza esse tipo de vies e torna os dados validos. Outra opcao e usar o peso informado com a altura medida para o calculo do IMC.

Context matters: interpreting impact findings in child survival evaluations

Abstract: Appropriate consideration of contextual factors is essential for ensuring internal and external validity of randomized and non-randomized evaluations. Contextual factors may confound the association between delivery of the intervention and its potential health impact. They may also modify the effect of the intervention or programme, thus affecting the generalizability of results. This is particularly true for large-scale health programmes, for which impact may vary substantially from one context to another. Understanding the nature and role of contextual factors may improve the validity of study results, as well as help predict programme impact across sites. This paper describes the experience acquired in measuring and accounting for contextual factors in the Multi-Country Evaluation of the IMCI (Integrated Management of Childhood Illness) strategy in five countries: Bangladesh, Brazil, Peru, Uganda and Tanzania. Two main types of contextual factors were identified. Implementation-related factors include the characteristics of the health systems where IMCI was implemented, such as utilization rates, basic skills of health workers, and availability of drugs, supervision and referral. Impact-related factors include baseline levels and patterns of child mortality and nutritional status, which affect the scope for programme impact. We describe the strategies used in the IMCI evaluation in order to obtain data on relevant contextual factors and to incorporate them in the analyses. Two case studies - from Tanzania and Peru - show how appropriate consideration of contextual factors may help explain apparently conflicting evaluation results.

Condutas na prevenção secundária do câncer de mama e fatores associados

Abstract: OBJETIVO: Avaliar a prevalencia de condutas na prevencao secundaria do câncer de mama e fatores associados. METODOS: Foi realizado estudo transversal de base populacional na cidade de Pelotas, RS, em 2002, com amostra de 879 mulheres de 40 a 69 anos. Foram coletadas informacoes sobre variaveis demograficas, socioeconomicas, comportamentais, biologicas e referentes ao manejo medico. A analise estatistica das variaveis foi realizada utilizando o metodo de regressao de Poisson. RESULTADOS: A prevalencia do "habito de realizar o auto-exame" encontrada foi de 83,5% (IC 95%: 80,9-85,9), sendo que, dessas mulheres, 80,4% (IC 95%: 77,3-83,2) o realizavam ao menos uma vez ao mes. A prevalencia de "exame clinico de mamas" foi de 83,3% (IC 95%: 80,6-85,7). "Mamografia alguma vez na vida" mostrou prevalencia de 70% (IC 95%: 66,8-73,0), sendo que 83,7% (IC 95%: 80,5-86,6) realizaram a ultima mamografia ha dois anos ou menos. Das entrevistadas, 62% (IC 95%: 58,7-65,2) consultaram ginecologista ao menos uma vez no ultimo ano. Os fatores associados a maiores prevalencias das condutas na prevencao secundaria do câncer de mama foram: pertencer as classes sociais mais altas; ter a maior combinacao de fatores de risco para neoplasia mamaria; ter historia familiar de câncer de mama; fazer uso de terapia de reposicao hormonal e ter sido submetida a biopsia por patologia mamaria. CONCLUSOES: As medidas preventivas para o câncer de mama vem sendo bastante utilizadas quantitativamente; entretanto, os dados apontam para limitacoes em relacao a sua adequacao. O nivel socioeconomico parece ser o principal determinante do acesso a consulta ginecologica e, consequentemente, as demais condutas na prevencao secundaria do câncer de mama.

Prevalence of chronic obstructive pulmonary disease and associated factors: the PLATINO Study in São Paulo, Brazil

Abstract: Chronic obstructive pulmonary disease (COPD) is now a major public health concern; deaths attributable to COPD in Latin America have increased by 65.0% in the last decade. This study was aimed at evaluating COPD prevalence and associated factors in adults (> 40 years) living in Greater Metropolitan Sao Paulo, Brazil. The study is part of the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (The PLATINO Project), a multi-center survey on COPD burden in Latin America, with Sao Paulo as the first center where the project has been carried out. A population-based sample was selected in multiple stages. Spirometry tests were performed in each subject pre- and post-bronchodilator and COPD was mainly defined as the ratio of forced expiratory volume to forced vital capacity below 70.0% (fixed ratio definition). Other spirometric criteria were also used for the diagnosis of COPD. COPD prevalence was 15.8% (95%CI: 13.5-18.1) using the fixed ratio definition. COPD was positively associated with age and smoking and inversely with body mass index. Utilization of different COPD spirometry criteria resulted in different percentages of COPD, but similar associated factors.

Improving quality and efficiency of facility-based child health care through Integrated Management of Childhood Illness in Tanzania.

Abstract: Objectives: To assess the effect of Integrated Management of Childhood Illness (IMCI) relative to routine care on the quality and efficiency of providing care for sick children in first-level health facilities in Tanzania, and to disseminate the results for use in health sector decision-making. Design: Non-randomized controlled trial to compare child health care quality and economic costs in two intervention (> 90% of health care workers trained in IMCI) and two comparison districts in rural Tanzania. Participants: For quality measures, all sick children presenting for care at random samples of first-level health facilities; for costs, all national, district, facility and household costs associated with child health care, taking a societal perspective. Results: IMCI training is associated with significantly better child health care in facilities at no additional cost to districts. The cost per child visit managed correctly was lower in IMCI than in routine care settings: $4.02 versus $25.70, respectively, in 1999 US dollars and after standardization for variations in population size. Conclusion: IMCI improved the quality and efficiency of child health care relative to routine child health care in the study districts. Previous study results indicated that the introduction of IMCI in these Tanzanian districts was associated with mortality levels that were 13% lower than in comparison districts. We can therefore conclude that IMCI is also more cost-effective than routine care for improving child health outcomes. The dissemination strategy for these results led to adoption of IMCI for nationwide implementation within 12 months of study completion.

Surtos de tripanossomíase por Trypanosoma evansi em eqüinos no Rio Grande do Sul: aspectos epidemiológicos, clínicos, hematológicos e patológicos

Abstract: Cases of trypanosomiasis by Trypanosoma evansi were diagnosed in horses in the state of Rio Grande do Sul, Brazil, between 2003 and 2004. In one stud farm (Farm A) with 125 horses, 52 died. Additionally, around 80 mares were sent to Farm A to be bred. Of those, 66 became ill and 56 died after being returned to their farms of origin. Twenty one horses clinically affected by the disease were observed. Clinical signs included loss of weight (despite voracious appetite), lethargy, incoordination and instability of hindlimbs, atrophy of the large muscles of the hindlimbs, muscle weakness and paleness of mucosae. Specimens of T. evansi were detected in the blood drawn from four affected horses. Normocytic normochromic anemia with PCVs ranging from 15 to 31%, leucocytosis due to lymphocytosis associated to large atypical lymphocytes was observed in several affected horses. High levels of antibodies against T. evansi were detected in the serum of six horses from Farm A. Eight horses presented encephalic neurological signs such as circling, ataxia, blindness, excitation, falls, listlessness, proprioception deficits and head tilt. One horse assumed a "dog-seating position". Necropsy findings included muscle atrophy, enlargement and lymphoid hyperplasia of the spleen and lymphnodes, edema and softening of the white and grey matter of the brain. Histologically, an overwhelming necrotizing panencephalitis was observed in the seven horses with encephalic signs. This panencephalitis was characterized by marked edema, demyelination and necrosis and perivascular infiltrates of 6-10 layers of lymphocytes and plasm cells affecting both the white and gray matter. Several plasm cells in the inflammatory infiltrate contained numerous eosinophilic globules in their cytoplasm (Mott cells). Similar histological lesions were observed in the spinal cord of the horse with the "dog-seating position". The brains of five horses with the encephalic signs were submitted to immunohistochemistry stain by the streptavidin-biotin technique. In all of those five brains moderate to abundant specimens of T. evansi in the perivascular spaces and neuropile were marked by the specific antibody. Epidemiological, clinical, hematological, and pathological aspects of equine trypanosomiasis caused by T. evansi are discussed.

Sintomas de distúrbios osteomusculares em bancários de Pelotas e região: prevalência e fatores associados

Abstract: Este estudo objetivou conhecer a prevalencia de sintomas de disturbios osteomusculares em bancarios de Pelotas e regiao e investigar fatores associados. O estudo foi transversal e os dados foram coletados atraves de questionario auto-aplicado no local de trabalho. O desfecho foi relato de dor osteomuscular com frequencia em tres ou mais de dez regioes anatomicas (Questionario Nordico de Sintomas Osteomusculares - QNSO). De 502 bancarios estudados, 60% da amostra mencionaram dor musculo-esqueletica no ultimo ano, 43% referiram nos ultimos sete dias, 19% tiveram que evitar o trabalho devido as dores e 40% relacionaram esta dor com a atividade que realiza no seu trabalho. Dor com frequencia foi relatada por 39% dos bancarios. Maiores prevalencias foram observadas em mulheres, pessoas que nao praticavam atividade fisica, usuarios de terminal on-line e maquinas autenticadoras, aqueles que referiram seu ritmo de trabalho como "acelerado", aqueles que trabalhavam na maior parte do tempo sentados e aqueles que classificaram seu ambiente de trabalho como "inadequado".

Prevalence of Helicobacter pylori infection and associated factors among adults in Southern Brazil: a population-based cross-sectional study

Abstract: Helicobacter pylori (Hp) infection is associated with several upper gastrointestinal disorders. Local data on the epidemiology of the infection are scarce in Brazil. The purpose of this study is to measure the prevalence rate and to explore the associated factors among the adult population living in Pelotas, a southern Brazilin city. This was a population-based cross-sectional study. Through a multi-stage sampling method all individuals 20 years and over living at the selected households at the urban area of the city were interviewed regarding past and current socio-economic indicators; demographic characteristics; nutritional and behavioural habits; and history of upper gastrointestinal symptoms.Hp infection was ascertained through the 13C-UBT. Due to the high prevalence, data were analysed through robust Poisson regression. All analyses took into account the family clustering of the data. Among 563 eligible individuals, 363 agreed to perform the 13C-UBT (refusal rate of 35.5%). Refusals were associated with female sex, consumption of mate drinking, and presence of upper gastrointestinal symptoms. The prevalence rate of H. pylori infection was 63.4% (95%CI 59.3%–69.3%). In crude analyses, prevalence was associated with increasing age, non-white skin colour, lower current family income, lower education level, higher size of the family, low socio-economic conditions in childhood, higher number of siblings and attendance to day-care centres in childhood, and presence of dyspeptic symptoms. In adjusted analysis the level of education of the father was inversely associated with the infection, whereas number of siblings and attendance to day-care centre in childhood were directly associated with it. Non-white skin colour remained significantly associated with increased prevalence even after allowing for past and current socio-economic characteristics, age and sex. Compared to non-symptomatic individuals, those reporting dyspeptic symptoms presented a higher prevalence of the infection even after allowing for current and past socio-economic conditions, ethnicity, age, and sex. Hp infection is as common among adults in southern Brazil as it is in other developing countries. Socio-economic conditions in childhood besides ethnicity and presence of dyspeptic symptoms were the factors significantly associated with the infection.

Pesticides and respiratory symptoms among farmers

Abstract: OBJECTIVE: Despite the intensive use of pesticides in agriculture there are few studies assessing the risk of respiratory conditions from this exposure. The study aimed at quantifying the prevalence of respiratory symptoms among farmers and evaluating its relationship with occupational use of pesticides and the prevalence of respiratory symptoms. METHODS: A cross-sectional study was conducted among 1,379 farmers from two municipalities of Southern Brazil in 1996. Frequency and type of chemical exposure and pesticide poisoning were recorded for both sexes. All subjects aged 15 years or older with at least 15 weekly hours of agricultural activity were interviewed. An adapted questionnaire developed by the American Thoracic Society was used for the assessment of respiratory symptoms. Multivariate logistic regression analysis was carried out. RESULTS: More than half (55%) of interviewees were male. The prevalence of asthma symptoms was 12% and chronic respiratory disease symptoms was 22%. Higher odds ratios for both asthma (OR=1.51; 95% CI: 1.07-2.14) and chronic respiratory disease (OR=1.34; 95% CI 1.00-1.81) symptoms were found in women. Logistic regression analysis identified associations between many forms of exposure to pesticides and increased respiratory symptoms. Occurrence of pesticide poisoning was associated with higher prevalence of asthma symptoms (OR=1.54; 95% CI: 1.04-2.58) and chronic respiratory disease symptoms (OR=1.57; 95% CI: 1.08-2.28). CONCLUSIONS: In spite of causality limitations, the study results provide evidence that farming exposure to pesticides is associated with higher prevalence of respiratory symptoms, especially when the exposure is above two days per month.

Scaling up integrated management of childhood illness to the national level: achievements and challenges in Peru.

Abstract: This paper presents the first published report of a national-level effort to implement the Integrated Management of Childhood Illness (IMCI) strategy at scale. IMCI was introduced in Peru in late 1996, the early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report on a retrospective evaluation designed to describe and analyze the process of taking IMCI to scale in Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of Peru's 34 districts, interviewed district health staff and reviewed district records. Findings show that IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and 2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to implement the community component of IMCI began with the training of community health workers in 2000, but expected synergies between health facility and community interventions were not realized because districts where clinical training was most intense were not those where community IMCI training was strongest. We summarize the constraints to scaling up IMCI, and examine both the methodological and policy implications of the findings. Few monitoring data were available to document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute to programme improvement. Even basic indicators recommended for national monitoring could not be calculated at either district or national levels. The findings document weaknesses in the policy and programme supports for IMCI that would cripple any intervention delivered through the health service delivery system. The Ministry of Health in Peru is now working to address these weaknesses; other countries working to achieve high and equitable coverage with essential child survival interventions can learn from their experience.