[Maternal deaths in Belo Horizonte, Brazil: perceptions of quality of care and preventability]. / Mortes maternas em Belo Horizonte, Brasil: percepções sobre qualidade da assistência e evitabilidade.

OBJECTIVE: To analyze maternal deaths in Belo Horizonte from 2003 to 2010 based on the perception of family members of women who died from pregnancy-related causes. METHODS: Maternal deaths were researched at the City of Belo Horizonte Department of Health's Maternal, Fetal, and Infant Death Prevention Committee. Family members of deceased women were recruited by telephone or personally. Sample size was not pre-defined; rather, a saturation criterion was employed. Nevertheless, an attempt was made to include families of women who received both public and private health care. The interviews focused on health history prior to the pregnancy; clinical history in the period from the start of pre-natal care until death; care received by the deceased women before, during and after delivery. After transcription and analysis of all interviews, the NVivo 9 qualitative analysis software was used to categorize and code the interviews. RESULTS: The family members of 11 women were interviewed. The victims were between 16 and 40 years old, died of various causes, and had various occupations. Most were in their first or second pregnancy, and most relied on public health care. Seven women had between 8 and 11 years of schooling, and seven were single. Ten women were white or brown. All the family members interviewed were female, with age ranging from 18 to 66 years. Most were the mothers of the deceased women, had little schooling, were married and worked in the home. The interviewees reported difficulties with the care received during the pregnancy, with little attention paid to the clinical status of the pregnant women. Nine deaths occurred after the delivery. CONCLUSIONS: According to the reports of family members, the maternal deaths recorded in Belo Horizonte between 2003 and 2010 were associated with issues that were possibly preventable, relating to the reproductive rights of women, to pregnancy, delivery, and perinatal care.

Parallels between major depressive disorder and Alzheimer's disease: role of oxidative stress and genetic vulnerability.

The thesis of this review is that oxidative stress is the central factor in major depressive disorder (MDD) and Alzheimer's disease (AD). The major elements involved are inflammatory cytokines, the hypothalamic-pituitary axis, the hypothalamic-pituitary gonadal, and arginine vasopressin systems, which induce glucocorticoid and "oxidopamatergic" cascades when triggered by psychosocial stress, severe life-threatening events, and mental-affective and somatic diseases. In individuals with a genomic vulnerability to depression, these cascades may result in chronic depression-anxiety-stress spectra, resulting in MDD and other known depressive syndromes. In contrast, in subjects with genomic vulnerability to AD, oxidative stress-induced brain damage triggers specific antioxidant defenses, i.e., increased levels of amyloid-ß (Aß) and aggregation of hyper-phosphorylated tau, resulting in paired helical filaments and impaired functions related to the ApoEε4 isoform, leading to complex pathological cascades culminating in AD. Surprisingly, all the AD-associated molecular pathways mentioned in this review have been shown to be similar or analogous to those found in depression, including structural damage, i.e., hippocampal and frontal cortex atrophy. Other interacting molecular signals, i.e., GSK-3ß, convergent survival factors (brain-derived neurotrophic factor and heat shock proteins), and transition redox metals are also mentioned to emphasize the vast array of intermediates that could interact via comparable mechanisms in both MDD and AD.

The Effect of Continuous Low-Intensity Exposure to Electromagnetic Fields from Radio Base Stations to Cancer Mortality in Brazil.

BACKGROUND: this study aims to estimate the rate of death by cancer as a result of Radio Base Station (RBS) radiofrequency exposure, especially for breast, cervix, lung, and esophagus cancers. METHODS: we collected information on the number of deaths by cancer, gender, age group, gross domestic product per capita, death year, and the amount of exposure over a lifetime. We investigated all cancer types and some specific types (breast, cervix, lung, and esophagus cancers). RESULTS: in capitals where RBS radiofrequency exposure was higher than 2000/antennas-year, the average mortality rate was 112/100,000 for all cancers. The adjusted analysis showed that, the higher the exposure to RBS radiofrequency, the higher cancer mortality was. The highest adjusted risk was observed for cervix cancer (rate ratio = 2.18). The spatial analysis showed that the highest RBS radiofrequency exposure was observed in a city in southern Brazil that also showed the highest mortality rate for all types of cancer and specifically for lung and breast cancer. CONCLUSION: the balance of our results indicates that exposure to radiofrequency electromagnetic fields from RBS increases the rate of death for all types of cancer.

Inducible laryngeal obstruction: Endoscopic quantitative analysis of glottic aperture.

OBJECTIVES: Using a method developed for this study, the objective was to perform a quantitative analysis of glottic aperture during the respiratory cycle in subjects suspected of having inducible laryngeal obstruction (ILO) and to compare results to healthy individuals. Correlations between glottic aperture and spirometric parameters were assessed. METHODS: Subjects with high clinical suspicion of ILO and atypical inspiratory findings in spirometry had the images of their laryngoscopy displayed alongside a respiratory flow chart and both were recorded simultaneously. This method allowed detailed analysis of the glottic aperture by measuring the angle of the anterior commissure during inspiration and expiration. Healthy volunteers who performed the same tests and agreed to provide data to this study were used as a control group. RESULTS: All 15 subjects with ILO and 16 healthy participants were evaluated successfully using the proposed method. Measures of the anterior commissure angle in the ILO versus control group were significantly different in all observed parameters and just three ILO subjects had an anterior commissure closure greater than 50% during the respiratory cycle. Inspired volume (FIF50 ) and mid-vital capacity ratio (FEF50 /FIF50 ) had a significant correlation with glottic aperture parameters when considering the evaluation of the subjects all together. CONCLUSION: The proposed method provided precise and quantitative analysis of glottic aperture during the respiratory cycle thus indicating that the usage of equipment that allows for such assessment should be encouraged. Also, the threshold of vocal cords closure accepted as indicative of ILO should be reconsidered, especially during the intercritical period of the disease. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E349-E356, 2020.

Chvostek sign.

Careful anamnesis can act as gasometry in services with few resources. In this clinical case, a detailed clinical history made it possible to suspect the presence of acute hypocalcemia, a biochemical anomaly after confirmed in gasometry. Acute hypocalcemia can be life threatening, necessitating urgent treatment. Sometimes it can be managed with oral ambulatory treatment.

Life expectancy among elderly Brazilians in 2003 according to different levels of functional disability.

The aim of the present study was to estimate disability-free life expectancy for the Brazilian elderly in 2003, by gender and age, based on different concepts of functional disability. The Sullivan method is used to combine the period life tables from the Brazilian Institute of Geography and Statistics (IBGE, 2003) and the prevalence of functional disability according to the 2003 National Sample Household Survey (PNAD 2003). The main results of the study indicate that at age 60, Brazilian men can expect to live 19 years, 39% with mild, 21% with moderate, and 14% with severe functional disability, respectively. At the same age, Brazilian women can expect to live 22 years: 56% with mild, 32% with moderate, and 18% with severe functional disability.

[Profiles of multiple causes of death related to HIV/AIDS in the cities of São Paulo and Santos, Brazil, 2001]. / Perfis de causas múltiplas de morte relacionadas ao HIV/AIDS nos municípios de São Paulo e Santos, Brasil, 2001.

Following the introduction of highly active antiretroviral therapy (HAART), the HIV-related morbidity-mortality profile has changed. Opportunistic infections are not as prevalent as before, and "pre-AIDS" diseases have become more common, related mostly to the side effects of HAART. This study focused on HIV/AIDS-related mortality, based on multiple causes of death among individuals who died of HIV-related causes in the cities of São Paulo and Santos, Brazil, in 2001. Grade of Membership (GoM) analysis was used. Three mortality profiles were detected: (1) causes of death normally observed before the introduction of HAART, marked by opportunistic infections; (2) causes of death with mixed characteristics, both pre- and post-HAART; and (3) a residual profile, which did not contemplate HIV disease, but incorporated causes of death associated with the pre and post-HAART periods. It is hoped that the current study will contribute to the understanding of the HIV/AIDS morbidity-mortality scenario and help improve the treatment and care provided by public health services.

[Unmet needs for contraceptive methods in Bolivia, 1998]. / Necessidade insatisfeita por métodos anticoncepcionais na Bolívia, 1998.

Bolivia, like most developing countries, has experienced a decline in fertility. However, in 1998, as many as 27.6% of all married women in Bolivia were classified as having an unmet need for contraception, of whom 20.6% needed to limit and 7% needed to space an additional child. The current article analyzes the unmet need for contraception in Bolivia. A multinomial hierarchical model was used to identify factors associated with the unmet need for contraception. Variables such as woman's age, number of living children, length of marriage, region, and schooling were strongly associated with unmet need for contraception. Despite the large number of variables in the model, a certain amount of unexplained variation at the individual level still remains, indicating the need to incorporate more detailed analysis at the community level.

Factors associated with the vulnerability of older people living with HIV/AIDS in Belo Horizonte (MG), Brazil. / Fatores associados à vulnerabilidade de idosos vivendo com HIV/AIDS em Belo Horizonte (MG), Brasil.

The objective of this article was to identify the factors associated with the vulnerability of the elderly aged 60 years or older to HIV/AIDS, based on the perspective of older people living with the virus. Interviews were conducted with 20 participants, including 12 women and eight men, who were patients from a public hospital in Belo Horizonte, Minas Gerais, Brazil. The elderly interviewed had a low education level and low income, were currently or previously in a marital union, had perceptions and behaviors grounded in structural gender relations with power asymmetry and had a low capacity to respond to vulnerability. Most of the elderly interviewed were sexually active, but few reported protecting themselves by using condoms, and the lack of information reached all levels of vulnerability studied. The picture revealed by this article is worrying, underscoring the need to demystify the sexual invisibility of the elderly, ensuring them their right to a healthy and continuous sexual life.

Burden of disease in Brazil and its regions, 2008.

The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazil's epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilian's population's health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.

eHealth in Latin America and the Caribbean: development and policy issues.

This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-à-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region.

[Factors associated with sexual and reproductive behavior among adolescents from the Northeast and Southeast regions of Brazil]. / Fatores associados com o comportamento sexual e reprodutivo entre adolescentes das regiões Sudeste e Nordeste do Brasil.

This article calls attention to factors associated with sexual and reproductive behavior among adolescents from the Northeast and Southeast regions of Brazil. The analyses focus on three dimensions of this process: sexual initiation, use of contraceptives in the first sexual relationship, and fertility. Hierarchical models are implemented, because adolescents selected from the same community are more likely to have similar sexual and reproductive behavior than those from different communities. Level of schooling was the most important risk factor in the three analyses. Girls with 5 or more years of schooling were less likely to have their first sexual relationship during adolescence and more likely to use contraceptive methods in this relationship, besides demonstrating less risk of having children than their counterparts with less than 5 years of schooling.

Molecular neuropathogenesis of Alzheimer's disease: an interaction model stressing the central role of oxidative stress.

Alzheimer's disease (AD) exhibits a complex etiology that simultaneously manifests as a complex cellular, neurobiological, molecular, anatomic-physiological and clinical entity. Other significant psychiatric conditions, such as depression and schizophrenia, may also present with complex and concurrent clinical and/or molecular phenotypes. These neuropsychiatric pathologies also originate from both environmental and genetic factors. We analyzed the molecular phenotypes of AD and discuss them with respect to the classical theories, which we integrated into mechanisms that share molecular and/or anatomical connections. Based on these mechanisms, we propose an interaction model and discuss the model in light of studies that refute or support it. Given the spectrum of AD phenotypes, we limit the scope of our discussion to a few, which facilitates concrete analysis. In addition, the study of specific, individual pathogenic phenotypes may be critical to defining the complex mechanisms leading to AD, thereby improving strategies for developing novel therapies.

Fatores associados à vulnerabilidade de idosos vivendo com HIV/AIDS em Belo Horizonte (MG), Brasil / Factors associated with the vulnerability of older people living with HIV/AIDS in Belo Horizonte (MG), Brazil

Resumo Este artigo tem como objetivo definir alguns fatores associados à vulnerabilidade dos idosos ao HIV/AIDS, na perspectiva daqueles que vivem com o vírus. Foram entrevistados 20 idosos, 12 mulheres e 8 homens (todos com idade igual ou superior a 60 anos), atendidos em hospital público de Belo Horizonte, Minas Gerais, Brasil. Os idosos entrevistados apresentam baixa escolaridade, baixa renda, estão ou estiveram unidos, têm percepções e comportamentos fundados em relações de gênero estruturadas com assimetria de poder e baixa capacidade de resposta à vulnerabilidade. A maioria dos idosos entrevistados tem vida sexual ativa, mas poucos deles declaram que se protegem. A falta de informações perpassa todos os níveis de vulnerabilidade estudados. O cenário é preocupante, ressaltando a necessidade de se desmitificar a invisibilidade sexual dos idosos, garantindo-lhes uma vida sexual saudável e contínua, o que lhes é de direito.

Abstract The objective of this article was to identify the factors associated with the vulnerability of the elderly aged 60 years or older to HIV/AIDS, based on the perspective of older people living with the virus. Interviews were conducted with 20 participants, including 12 women and eight men, who were patients from a public hospital in Belo Horizonte, Minas Gerais, Brazil. The elderly interviewed had a low education level and low income, were currently or previously in a marital union, had perceptions and behaviors grounded in structural gender relations with power asymmetry and had a low capacity to respond to vulnerability. Most of the elderly interviewed were sexually active, but few reported protecting themselves by using condoms, and the lack of information reached all levels of vulnerability studied. The picture revealed by this article is worrying, underscoring the need to demystify the sexual invisibility of the elderly, ensuring them their right to a healthy and continuous sexual life.

Mortes maternas em Belo Horizonte, Brasil: percepções sobre qualidade da assistência e evitabilidade / Maternal deaths in Belo Horizonte, Brazil: perceptions of quality of care and preventability

OBJETIVO: Analisar a mortalidade materna em Belo Horizonte, no período de 2003 a 2010, a partir da percepção dos familiares de mulheres que faleceram por causas relacionadas à maternidade. MÉTODOS: Os óbitos maternos foram investigados junto ao Comitê de Prevenção do Óbito Materno, Fetal e Infantil na Secretaria Municipal de Saúde de Belo Horizonte. Os familiares das mulheres falecidas foram recrutados por telefone ou pessoalmente para entrevistas. O tamanho da amostra de entrevistados não foi previamente definido, tendo sido considerada como critério a saturação das informações obtidas. Entretanto, buscou-se a inclusão de famílias de mulheres atendidas tanto pelo sistema público quanto pelo sistema privado de saúde. As questões norteadoras das entrevistas foram: histórico de saúde prévio à gestação; história clínica do pré-natal até o falecimento; assistência recebida pela mulher falecida no pré-natal, parto e puerpério. Após transcrição e leitura de todas as entrevistas, utilizou-se o software de análise qualitativa NVivo 9 para categorização e codificação dos depoimentos. RESULTADOS: Foram entrevistados os familiares de 11 mulheres, que faleceram por causas variadas, possuíam ocupações diversas e tinham idade entre 16 e 40 anos. A maioria estava em sua primeira ou segunda gestação e era usuária do sistema público de saúde. Sete tinham de 8 a 11 anos de estudo; sete também eram solteiras; 10 eram brancas ou pardas. Todos os familiares entrevistados eram do sexo feminino, com idade variando de 18 a 66 anos. A maioria era de mães, com baixa escolaridade, casadas e que exerciam atividades do lar. Foram relatadas dificuldades com a assistência recebida durante a gravidez, com pouca valorização do quadro clínico das gestantes. Nove óbitos maternos ocorreram no período pós-parto. CONCLUSÕES: Conforme o relato dos familiares, os óbitos maternos registrados em Belo Horizonte entre 2003 e 2010 estiveram associados a questões possivelmente evitáveis, relacionadas aos direitos reprodutivos da mulher, à assistência à gravidez, ao parto e ao puerpério.

OBJECTIVE:To analyze maternal deaths in Belo Horizonte from 2003 to 2010 based on the perception of family members of women who died from pregnancy-related causes. METHODS: Maternal deaths were researched at the City of Belo Horizonte Department of Health's Maternal, Fetal, and Infant Death Prevention Committee. Family members of deceased women were recruited by telephone or personally. Sample size was not pre-defined; rather, a saturation criterion was employed. Nevertheless, an attempt was made to include families of women who received both public and private health care. The interviews focused on health history prior to the pregnancy; clinical history in the period from the start of pre-natal care until death; care received by the deceased women before, during and after delivery. After transcription and analysis of all interviews, the NVivo 9 qualitative analysis software was used to categorize and code the interviews. RESULTS: The family members of 11 women were interviewed. The victims were between 16 and 40 years old, died of various causes, and had various occupations. Most were in their first or second pregnancy, and most relied on public health care. Seven women had between 8 and 11 years of schooling, and seven were single. Ten women were white or brown. All the family members interviewed were female, with age ranging from 18 to 66 years. Most were the mothers of the deceased women, had little schooling, were married and worked in the home. The interviewees reported difficulties with the care received during the pregnancy, with little attention paid to the clinical status of the pregnant women. Nine deaths occurred after the delivery. CONCLUSIONS: According to the reports of family members, the maternal deaths recorded in Belo Horizonte between 2003 and 2010 were associated with issues that were possibly preventable, relating to the reproductive rights of women, to pregnancy, delivery, and perinatal care.