Factors associated with preventable infant death: a multiple logistic regression.

OBJECTIVE To identify and analyze factors associated with preventable child deaths. METHODS This analytical cross-sectional study had preventable child mortality as dependent variable. From a population of 34,284 live births, we have selected a systematic sample of 4,402 children who did not die compared to 272 children who died from preventable causes during the period studied. The independent variables were analyzed in four hierarchical blocks: sociodemographic factors, the characteristics of the mother, prenatal and delivery care, and health conditions of the patient and neonatal care. We performed a descriptive statistical analysis and estimated multiple hierarchical logistic regression models. RESULTS Approximatelly 35.3% of the deaths could have been prevented with the early diagnosis and treatment of diseases during pregnancy and 26.8% of them could have been prevented with better care conditions for pregnant women. CONCLUSIONS The following characteristics of the mother are determinant for the higher mortality of children before the first year of life: living in neighborhoods with an average family income lower than four minimum wages, being aged ≤ 19 years, having one or more alive children, having a child with low APGAR level at the fifth minute of life, and having a child with low birth weight.

Factors associated with preventable infant death: a multiple logistic regression

ABSTRACT OBJECTIVE To identify and analyze factors associated with preventable child deaths. METHODS This analytical cross-sectional study had preventable child mortality as dependent variable. From a population of 34,284 live births, we have selected a systematic sample of 4,402 children who did not die compared to 272 children who died from preventable causes during the period studied. The independent variables were analyzed in four hierarchical blocks: sociodemographic factors, the characteristics of the mother, prenatal and delivery care, and health conditions of the patient and neonatal care. We performed a descriptive statistical analysis and estimated multiple hierarchical logistic regression models. RESULTS Approximatelly 35.3% of the deaths could have been prevented with the early diagnosis and treatment of diseases during pregnancy and 26.8% of them could have been prevented with better care conditions for pregnant women. CONCLUSIONS The following characteristics of the mother are determinant for the higher mortality of children before the first year of life: living in neighborhoods with an average family income lower than four minimum wages, being aged ≤ 19 years, having one or more alive children, having a child with low APGAR level at the fifth minute of life, and having a child with low birth weight.

[Impact variables on the decline in infant mortality in the state of São Paulo, Brazil: 1998-2008]. / Variáveis de impacto na queda da mortalidade infantil no Estado de São Paulo, Brasil, no período de 1998 a 2008.

This is an ecological, analytical and retrospective study comprising the 645 municipalities in the State of São Paulo, the scope of which was to determine the relationship between socioeconomic, demographic variables and the model of care in relation to infant mortality rates in the period from 1998 to 2008. The ratio of average annual change for each indicator per stratum coverage was calculated. Infant mortality was analyzed according to the model for repeated measures over time, adjusted for the following correction variables: the city's population, proportion of Family Health Programs (PSFs) deployed, proportion of Growth Acceleration Programs (PACs) deployed, per capita GDP and SPSRI (São Paulo social responsibility index). The analysis was performed by generalized linear models, considering the gamma distribution. Multiple comparisons were performed with the likelihood ratio with chi-square approximate distribution, considering a significance level of 5%. There was a decrease in infant mortality over the years (p < 0.05), with no significant difference from 2004 to 2008 (p > 0.05). The proportion of PSFs deployed (p < 0.0001) and per capita GDP (p < 0.0001) were significant in the model. The decline of infant mortality in this period was influenced by the growth of per capita GDP and PSFs.

Variáveis de impacto na queda da mortalidade infantil no Estado de São Paulo, Brasil, no período de 1998 a 2008 / Impact variables on the decline in infant mortality in the state of São Paulo, Brazil: 1998-2008

Trata-se de estudo ecológico analítico, retrospectivo, composto pelos 645 municípios do Estado de São Paulo, cujo objetivo foi verificar a relação entre variáveis socioeconômicas, demográficas e modelo de atenção, em relação ao coeficiente de mortalidade infantil, no período de 1998 a 2008. Foi calculada a proporção de variação média anual para cada indicador por estrato de cobertura. A mortalidade infantil foi analisada segundo modelo de medidas repetidas no tempo, ajustado para as variáveis de correção: população do município, proporção de PSF implantado, proporção de PACS implantado, PIB per capita e IPRS (índice paulista de responsabilidade social). A análise foi realizada por modelos lineares generalizados, considerando a distribuição gama. Comparações múltiplas foram realizadas pela razão de verossimilhança com distribuição aproximada qui-quadrado, considerando-se nível de significância de 5%. Houve diminuição da mortalidade infantil no decorrer dos anos (p < 0,05), não havendo diferença significativa de 2004 a 2008 (p > 0,05). A proporção de PSF implantado (p < 0,0001) e o PIB per capita (p < 0,0001) foram significativos no modelo. A queda da mortalidade infantil no período analisado foi influenciada pelo crescimento do PIB per capita e pelo modelo Saúde da Família.

This is an ecological, analytical and retrospective study comprising the 645 municipalities in the State of São Paulo, the scope of which was to determine the relationship between socioeconomic, demographic variables and the model of care in relation to infant mortality rates in the period from 1998 to 2008. The ratio of average annual change for each indicator per stratum coverage was calculated. Infant mortality was analyzed according to the model for repeated measures over time, adjusted for the following correction variables: the city's population, proportion of Family Health Programs (PSFs) deployed, proportion of Growth Acceleration Programs (PACs) deployed, per capita GDP and SPSRI (São Paulo social responsibility index). The analysis was performed by generalized linear models, considering the gamma distribution. Multiple comparisons were performed with the likelihood ratio with chi-square approximate distribution, considering a significance level of 5%. There was a decrease in infant mortality over the years (p < 0.05), with no significant difference from 2004 to 2008 (p > 0.05). The proportion of PSFs deployed (p < 0.0001) and per capita GDP (p < 0.0001) were significant in the model. The decline of infant mortality in this period was influenced by the growth of per capita GDP and PSFs.

Chemical immobilisation of free-ranging Pampas foxes (Pseudalopex gymnocercus): Assessment of ketamine-xylazine and tiletamine-zolazepam combinations.

Two protocols to immobilise free-ranging Pampas foxes for ear-tagging or radio-collaring were evaluated. One hundred fifteen foxes were injected with ketamine-xylazine (K-X) and thirteen with tiletamine-zolazepam (T-Z). The use of both T-Z and K-X combinations typically resulted in a smooth induction and recovery. In 86% of the cases K-X protocol was judged effective (mean±SD, K: 10.7±3.3mg/kg, X: 1.0±1.0mg/kg) while T-Z protocol was judged effective in 92% of the cases (T: 3.6±1.05mg/kg, Z: 3.6±1.05mg/kg). The primary differences between the two drug combinations were that the time necessary for the complete recovery was longer with T-Z, and thermic problems were found more frequently with K-X. Additionally, our results suggest that thermic stress may be a relatively frequent complication for Pampas foxes. This study provides baseline data on some physiologic variables in Pampas foxes captured with different methods and drugs in field conditions.

[Vasculitis assessment with [18F]FDG positron emission tomography]. / Place de la tomographie par émission de positrons (TEP) au [18F]FDG dans l'exploration et la surveillance des vascularites.

[18F]fluorodeoxyglucose positron emission tomography (PET) is a noninvasive metabolic imaging modality that is well-suited to the assessment of activity and extent of large vessel vasculitis. PET imaging has demonstrated its usefulness in diagnosing giant cell arteritis (notably in its silent form), Takayasu's arteritis, and unclassified aortitis. PET imaging could be more effective than magnetic resonance imaging in detecting the earliest stages of vascular wall inflammation. The visual grading of vascular [18F]FDG uptake makes it possible to discriminate arteritis from active atherosclerosis, providing therefore high specificity. High sensitivity can also be achieved provided scanning is performed during active inflammatory phase, preferably before starting corticosteroid treatment. Prospective studies are needed to determine the exact value of PET imaging in assessing other vasculitis subsets, infectious aortitis, and large vessel vasculitis outcome and response to immunosuppressive treatment.

Evaluation of at-home phlebotomy for iron overload: feasibility and satisfaction of patients and healthcare workers.

OBJECTIVE: This study aimed to evaluate at-home phlebotomy and the satisfaction of iron-overload patients and healthcare workers with the procedure. METHODS: Forty-two patients underwent at-home phlebotomy between 2003 and 2006. The phlebotomy was performed by the patient's nurse, who was trained by the private healthcare firm that also took charge of the disposal of the blood products. Data concerning these phlebotomies were collected via telephone interviews with all 42 patients, as well as 35 nurses and 40 primary-care physicians. The Limousin Regional Health Observatory processed the data collection. RESULTS: Ninety percent (38/42) of the patients, 80% (28/35) of the nurses and 67% (27/40) of the primary-care physicians responded. For 80% of the patients, phlebotomy volume and frequency were as prescribed. Patients chose home phlebotomy for personal reasons, or because of the limited availability of French Blood Establishment facilities (68%), or in response to being offered it by their hospital physician (32%). For 81.6% of the patients, at-home phlebotomy was more satisfactory than phlebotomy in hospital or at the French Blood Establishment and, for 84%, the constraints required were fully acceptable. The nurses considered that these homecare procedures were within their area of responsibility (100%), but felt that the remuneration was insufficient (65%). Ninety-six percent of the primary-care physicians said they were correctly informed, but only 40% felt that they were truly committed to the procedure. CONCLUSION: At-home phlebotomy is feasible, less costly than institutional phlebotomy and improves patient comfort.

Sleeping site preferences in tufted capuchin monkeys (Cebus apella nigritus).

The characteristics and availability of the sleeping sites used by a group of 27 tufted capuchin monkeys (Cebus apella nigritus) were studied during 17 months at the Iguazu National Park, Argentina. We tested different hypotheses regarding possible ultimate causes of sleeping-site selection. Most sleeping sites were located in areas of tall, mature forest. Of the 34 sleeping sites the monkeys used during 203 nights, five were more frequently used than the others (more than 20 times each, constituting 67% of the nights). Four species of tree (Peltophorum dubium, Parapiptadenia rigida, Copaifera langsdorfii and Cordia trichotoma) were the most frequently used. They constituted 82% of all the trees used, though they represent only 12% of the trees within the monkeys' home range which had a diameter at breast height (DBH) > 48.16 cm (1 SD below the mean DBH of sleeping trees). The sleeping trees share a set of characteristics not found in other trees: they are tall emergent (mean height +/- SD = 31.1+/-5.2 m) with large DBH (78.5+/-30.3 cm), they have large crown diameter (14+/-5.5 m), and they have many horizontal branches and forks. Adult females usually slept with their kin and infants, while peripheral adult males sometimes slept alone in nearby trees. We reject parasite avoidance as an adaptive explanation for the pattern of sleeping site use. Our results and those from other studies suggest that predation avoidance is a predominant factor driving sleeping site preferences. The patterns of aggregation at night and the preference for trees with low probability of shedding branches suggest that social preferences and safety from falling during windy nights may also affect sleeping tree selection. The importance of other factors, such as seeking comfort and maintaining group cohesion, was not supported by our results. Other capuchin populations show different sleeping habits which can be explained by differences in forest structure and by demographic differences.

Seabirds drive plant species turnover on small Mediterranean islands at the expense of native taxa.

The analysis of long-term floristic changes was conducted on nine west-Mediterranean limestone islands (size range: 2-95 ha) which have recently undergone a severe demographic explosion in their yellow-legged gull Larus cachinnans colonies. A comparison of past and present plant inventories was used to quantify extinction-colonization events, both from a classical biogeographical perspective (per island approach) and a metapopulational perspective (per species approach). In the first approach, floristic turnover intensity was negatively related to island area and positively to gull nesting density, but was independent of island isolation. In the second, species turnover rate was compared with a set of plant species life history traits (dispersal mode, Grime CSR strategy, growth form, biogeographical type). Plants which exhibited the highest turnover rate were primarily ruderal, annual, wind-dispersed species with a wide geographic range. The severe disturbance induced by seabird activities has tended to select and favour some adapted plant species groups at the expense of indigenous island taxa. The relationships between specific turnover intensity and plant life history traits justify using the metapopulation approach and point to the importance of interspecific variations in extinction-colonization patterns.

La colangiografía operatoria en el paciente sin signos de litiasis coledociana / The operative cholangiography in the patient without choledeco lithiasis

Con el propósito de investigar si la colangiografía operatoria puede ser utilizada en forma selectiva en la litiasis biliar, obviándola en los casos sin indicadores preestablecidos de patología coledociana, se estudiaron prospectivamente 330 pacientes con litiasis biliar, operados consecutivamente por laparotomía. Doscientos quince (65,1%) no presentaban ningún indicador de litiosis coledociana. En 135 de éstos se realizó colangiografía operatoria, y se halló litiasis coledociana insospechada (0,75%). En los 80 sin colangiografía no hubo complicaciones quirúrgicas y postoperatorias por la ausencia del estudio, y no se detectaron signos de litiasis residual en ninguno de los 78 casos seguidos durante 1 a 2 años. Se concluye que la colangiografía operatoria en la litiasis biliar puede utilizarse con ventajas en forma selectiva, siempre que se siga un criterio estricto en la selección de casos, evitándola en los pacientes sin ningún parámetro indicador de patología coledociana