Late entry into HIV care: lessons from Brazil, 2003 to 2006.

BACKGROUND: To ascertain the population rates and proportion of late entry into HIV care, as well as to determine whether such late entry correlates with individual and contextual factors. METHODS: Data for the 2003-2006 period in Brazil were obtained from public health records. A case of late entry into HIV care was defined as one in which HIV infection was diagnosed at death, one in which HIV infection was diagnosed after the condition of the patient had already been aggravated by AIDS-related diseases, or one in which the CD4(+) T-cell count was ≤ 200 cells/mm(3) at the time of diagnosis. We also considered extended and stricter sets of criteria (in which the final criterion was ≤ 350 cells/mm(3) and ≤ 100 cells/mm(3), respectively). The estimated risk ratio was used in assessing the effects of correlates, and the population rates (per 100,000 population) were calculated on an annual basis. RESULTS: Records of 115,369 HIV-infected adults were retrieved, and 43.6% (50,358) met the standard criteria for late entry into care. Diagnosis at death accounted for 29% (14,457) of these cases. Late entry into HIV care (standard criterion) was associated with certain individual factors (sex, age, and transmission category) and contextual factors (region with less economic development/increasing incidence of AIDS, lower local HIV testing rate, and smaller municipal population). Use of the extended criteria increased the proportion of late entry by 34% but did not substantially alter the correlations analyzed. The overall population rate of late entry was 9.9/100,000 population, specific rates being highest for individuals in the 30-59 year age bracket, for men, and for individuals living in regions with greater economic development/higher HIV testing rates, collectively accounting for more than half of the cases observed. CONCLUSIONS: Although the high proportion of late entry might contribute to spreading the AIDS epidemic in less developed regions, most cases occurred in large cities, with broader availability of HIV testing, and in economically developed regions.

Tooth loss in Brazilian middle-aged adults: multilevel effects.

OBJECTIVE: To examine the link between tooth loss and multilevel factors in a national sample of middle-aged adults in Brazil. MATERIAL AND METHODS: Analyses were based on the 2003 cross-sectional national epidemiological survey of the oral health of the Brazilian population, which covered 13 431 individuals (age 35-44 years). Multistage cluster sampling was used. The dependent variable was tooth loss and the independent variables were classified according to the individual or contextual level. A multilevel negative binomial regression model was adopted. RESULTS: The average tooth loss was 14 (standard deviation 9.5) teeth. Half of the individuals had lost 12 teeth. The contextual variables showed independent effects on tooth loss. It was found that having 9 years or more of schooling was associated with protection against tooth loss (means ratio range 0.68-0.76). Not having visited the dentist and not having visited in the last > or =3 years accounted for increases of 33.5% and 21.3%, respectively, in the risk of tooth loss (P < 0.05). The increase in tooth extraction ratio showed a strong contextual effect on increased risk of tooth loss, besides changing the effect of protective variables. CONCLUSIONS: Tooth loss in middle-aged adults has important associations with social determinants of health. This study points to the importance of the social context as the main cause of oral health injuries suffered by most middle-aged Brazilian adults.

Organomineral Fertilizer as Source of P and K for Sugarcane.

Sugarcane (Saccharum spp) crop has high social, economic and environmental importance for several regions throughout the world. However, the increasing demand for efficiency and optimization of agricultural resources generates uncertainties regarding high mineral fertilizer consumption. Thereby, organomineral fertilizers are to reduce the conventional sources consumption. Thus, this study was carried out to evaluate the agronomic and economic sugarcane performancies and the residual effect of P and K under mineral and organomineral fertilization. Growth and technological parameters, leaf and soil nutrients concentration in surface and subsurface layers were analyzed from sugarcane planting (plant cane) until the first ratoon. Agronomic and economic sugarcane efficiency were evaluated. At the first ratoon, resin-extractable P provided by mineral and organomineral fertilizers were, respectively, 15 and 11 mg kg-1 in the 0.0-0.2 m, and 28 and 31 mg kg-1 in 0.2-0.4 m layer. However, exchangeable K in the 0.0-0.2 m layer was 1.88 and 1.58 mmolc kg-1 for mineral and organomineral fertilizers, respectively. The yield gains over the control reached with mineral and organomineral fertilizers were, respectively, 10.99 and 17 Mg ha-1 at the lowest fertilizer rate; and 29.25 and 61.3 Mg ha-1 at the highest fertilizer rate. Agronomic and economic organomineral fertilizer efficiencies are more pronounced in plant cane. Summing two harvests, the organomineral is 7% more profitable than mineral fertilizer.

Correlation between the components of the insulin-like growth factor I system, nutritional status and visceral leishmaniasis.

The role of the insulin-like growth factor I (IGF-I) system and nutritional status was studied in 241 children from a Brazilian area endemic for visceral leishmaniasis (VL). Thirty-nine children had the active form, 20 were oligosymptomatic, 38 were asymptomatic and 144 were not infected. Serum concentrations of growth hormone (GH), total and free IGF-I and IGF binding-protein 3 (IGFBP3) were measured by radioimmunoassay. Nutritional status was evaluated by anthropometric indicators and biochemical measurements. Total and free IGF-I and IGFBP3 were significantly reduced in the active form. Z scores for total and free IGF-I and for IGFBP3 were found to be significantly lower for active VL and oligosymptomatic individuals than for asymptomatic individuals, but never reached values

[Evaluation of the usefulness of assessing pulmonary aspiration in a gastroesophageal reflux scintigraphy study]. / Análise da utilidade da pesquisa de aspiração pulmonar no exame de cintilografia para a avaliação de refluxo gastroesofágico.

OBJECTIVE: To evaluate the benefit of routine pulmonary imaging with a five hour delay in gastroesophageal reflux scintigraphy (GERS) to detect pulmonary aspiration. METHODS: 755 cases were analyzed (400 men, 355 women) within a wide range of age (1 month up to 94 years, mean of 5.2 years). Presence of reflux, its frequency, severity, and esophageal extension were investigated. Delayed pulmonary images assessed the presence of radioactivity in the lungs. RESULTS: 307 cases of gastroesophageal reflux were identified, 84 of which with just one episode, 51 with 2 episodes, 45 with 3, 37 with 4, 18 with 5, and 72 with more than 5. Concerning severity of these 307 cases 22 had no evaluation, 179 were mild, 69 intermediate, and 37 severe. Degree of esophageal extension was not recorded for 6 cases; in 46 cases reflux covered the lower third of the esophagus, in 83 cases it reached the central third, in 161 the upper third, and in 11 cases it extended to the mouth. Delayed pulmonary images were available in 753 cases and none showed signs of lung aspiration. CONCLUSIONS: Delayed pulmonary images were negative in all cases regardless of the patients' age or severity of the disease. This is suggestive that either lung aspiration is rare in GERS procedures or delayed pulmonary imaging has a sensitivity that is too low to permit detection.

[Revista de Saúde Pública: forty years of Brazilian scientific production]. / Revista de Saúde Pública: quarenta anos da produção científica no Brasil.

OBJECTIVE: To recognize the characteristics and path taken by the through analysis of the scientific production it has published over the period from 1967 to 2005. METHODS: Scientometric methods were used to analyze reference data on the articles published in the Revista, retrieved from the databases ISI/Thomson Scientific (Web of Science), National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO). RESULTS: The Revista is the only Brazilian publication in the field of public health that is indexed by ISI/Thomson Scientific. It is prominent as a medium for publishing Brazilian scientific production in public health and is displaying a geometric increase in publication and citation, with annual rates of 4.4% and 12.7%, respectively. The mean number of authors per paper has risen from 2 to 3.5 over recent years. Although original research articles predominate, the numbers of reviews, multicenter studies, clinical trials and validation studies have been increasing. The number of articles published in foreign languages has also increased, accounting for 13% of the total, and the leading countries originating these are the UK, USA, Argentina and Mexico. The number and diversity of journals citing the Journal has been increasing, many of which are non-Brazilian. Authorship per author shows good fit to Lotka's Law, but the parameters suggest greater concentration and less dispersion than would be expected. Among the fields of interest of published papers, the following topics account for more than 50% of the total volume: infectious-parasitic diseases and vectors; health promotion, policies and administration; and epidemiology, surveillance and disease control. CONCLUSIONS: The Revista shows great dynamism, without signs of abating or reaching a plateau any time soon. There are signs of progressively increasing complexity in the studies published, and more multidisciplinary work. The Revista seems to be widening its outreach and recognition, while remaining faithful to the field of public health in Brazil.

[Fuzzy logic and logistic regression in the decision making for parathyroid scintigraphy study]. / Lógica fuzzy e regressão logística na decisão para prática de cintilografia das paratiróides.

OBJECTIVE: To develop and compare two mathematical models, the first one based on logistic regression and the second one on fuzzy sets theory, aiming at defining a laboratory testing-based measure of indication for submitting patients to parathyroid scintigraphy. METHODS: One-hundred and ninety-four patients with serum calcium and parathyroid hormone available were identified from the data registry of parathyroid scintigraphy of a diagnostic laboratory in São Paulo, Southern Brazil, in the period between January 2000 and December 2004. The logistic regression model was developed using SPSS and the fuzzy model was developed using MatLab software programs. The performances of both models were compared using ROC curves. RESULTS: The performance of both models were statistically different (p=0.026). The area under the ROC curves were 0.862 (95% CI: 0.811-0.913) for the logistic regression model and 0.887 (95% CI: 0.840-0.933) for the fuzzy model. The latter had the advantage of allowing to making decisions based on parathyroid hormone information within a non-discriminating range of calcium values. CONCLUSIONS: The mathematical model based on fuzzy sets theory seemed to be more useful than the logistic model in the decision making for scintigraphy indication. However, inferences can be made only regarding model comparison and not for parathyroid scintigraphy itself since the data analyzed was not representative of any population.

The psychopathological factors of refractory schizophrenia.

OBJECTIVES: The heterogeneity of clinical manifestations in schizophrenia has lead to the study of symptom clusters through psychopathological assessment scales. The objective of this study was to elucidate clusters of symptoms in patients with refractory schizophrenia which may also help to assess the patients' therapeutical response. METHODS: Ninety-six treatment resistant patients were evaluated by the anchored version Brief Psychiatric Rating Scale (BPRS-A) as translated into Portuguese. The inter-rater reliability was 0.80. The 18 items of the BPRS-A were subjected to exploratory factor analysis with Varimax rotation. RESULTS: Four factors were obtained: Negative/Disorganization, composed by emotional withdrawal, disorientation, blunted affect, mannerisms/posturing, and conceptual disorganization; Excitement, composed of excitement, hostility, tension, grandiosity, and uncooperativeness, grouped variables that evoke brain excitement or a manic-like syndrome; Positive, composed of unusual thought content, suspiciousness, and hallucinatory behavior; and Depressive, composed of depressive mood, guilt feelings, and motor retardation, clearly related to depressive syndrome. CONCLUSIONS: The study reproduced the four factors described in the literature, either in refractory or non-refractory patients. The BPRS-A allowed the distinction of psychopathological factors, which are important in the evaluation of treatment response of patients with schizophrenia.

[Risk factors associated with acute myocardial infarction in the São Paulo metropolitan region: a developed region in a developing country]. / Fatores de risco associados com infarto agudo do miocárdio na região metropolitana de São Paulo: uma região desenvolvida em um país em desenvolvimento.

OBJECTIVE: To identify the risk factors associated with acute myocardial infarction (AMI) and their respective powers of association in the São Paulo metropolitan region. METHODS: The cases comprised patients diagnosed with first AMI with an ST segment elevation. The controls were individuals with no known cardiovascular disease. The study comprised 271 cases and 282 controls from 12 hospitals. Risk factors were as follows: ethnic group; educational level; marital status; family income; family history of coronary artery disease; antecedents of arterial hypertension and of diabetes mellitus; hormonal replacement in women; smoking; physical activity; alcohol consumption; total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, and glucose levels; body mass index; and waist-hip ratio (WHR). RESULTS: The following risk factors showed and independent association with AMI: smoking [odds ratio (OR) = 5.86; 95% confidence interval (CI) 3.25-10.57; P < 0.00001); waist-hip ratio (first vs. third tertile) (OR = 4.27; 95% CI 2.28-8.00; P < 0.00001); antecedents of arterial hypertension (OR = 3.26; 95% CI 1.95-5.46; P < 0.00001); waist-hip ratio (first vs second tertile) (OR = 3.07; 95% CI 1.66-5.66; P = 0.0003); LDL-cholesterol level (OR = 2.75; 95% CI 1.45-5.19; P = 0.0018); antecedents of diabetes mellitus (OR = 2.51; 95% CI 1.45-5.19; P = 0.023); family history of coronary artery disease (OR = 2.33; 95% CI 1.44-3.75; P = 0.0005); and HDL-cholesterol level (OR = 0.53; 95% CI 0.32-0.87; P = 0.011). CONCLUSION: Smoking, waist-hip ratio, antecedents of arterial hypertension and of diabetes mellitus, family history of coronary artery disease, and LDL-cholesterol and HDL-cholesterol levels showed to be independently associated with AMI within the São Paulo metropolitan region.

Obese patients lose weight independently of nutritional follow-up after bariatric surgery.

OBJECTIVE: to examine the association between preoperative body weight, adherence to postsurgical nutritional follow-up, length of postoperative period, and weight loss during the first 18 months among adults who have undergone bariatric surgery. METHODS: a retrospective cohort study was conducted on 241 consecutive patients who underwent open Roux-en-Y gastric bypass (RYGBP) from January 2006 to December 2008, in a teaching hospital in São Paulo (Brazil). Data were collected through hospital records review and the variables analyzed included sex, age, immediate preoperative weight, adherence to postsurgical nutritional visits and length of postoperative period. Proportional body weight reductions during the 18-month follow-up period were examined using generalized estimating equations. RESULTS: 81% (n = 195) of participants were female, with overall mean age of 44.4 ± 11.6 years, mean preoperative weight of 123.1 ± 21.2 kg and mean preoperative body mass index of 47.2 ± 6.2 kg/m2. The overall adherence to postoperative follow- up schedule was 51% (95%CI: 44.5-57.5%). Preoperative body weight and adherence were not associated with proportional weight reduction (Wald's test p > 0.18). Weight loss leveled off at the end of the 18-month follow-up period for both compliant and non-compliant patients (Wald's test p = 0.00). CONCLUSIONS: our study showed that weight loss occurred steadily over the first 18 months after RYGBP, leveling off at around 40% weight reduction. It was associated with neither presurgical weight, nor nutritional follow-up and it may be primarily dependent on the surgical body alterations themselves. This finding may have implications for intervention strategies aimed at motivating patients to comply with early postsurgical and life-long follow-up.

Risk factors for myocardial infarction in Brazil.

BACKGROUND: Approximately three-quarters of cardiovascular disease deaths in the world come from developing countries, and acute myocardial infarction (AMI) is an important cause of death. Brazil is one of the largest countries in Latin America and the contemporary evaluation of risk factors for AMI is crucial for a more efficacious disease management. METHODS: The Acute Myocardial Infarction Risk Factor Assessment in Brazil (AFIRMAR) study is a case-control, hospital-based study involving 104 hospitals in 51 cities in Brazil, designed to evaluate risk factors for a first ST-segment elevation AMI. RESULTS: A total of 1279 pairs, matched by age (+/- 5 years) and sex, were enrolled. The conditional multivariable analysis of 33 variables showed the following independent risk factors for AMI: > or =5 cigarettes per day (odds ratio [OR] 4.90, P <.00001); glucose > or =126 mg/dL (OR 2.82, P <.00001); waist/hip ratio > or =0.94 (OR 2.45, P <.00001); family history of CAD (OR 2.29, P <.00001), low-density lipoprotein-cholesterol 100 to 120 mg/dL (OR 2.10, P <.00001); reported hypertension (OR 2.09, P <.00001); <5 cigarettes per day (OR 2.07, P =.0171); low-density lipoprotein-cholesterol >120 mg/dL (OR 1.75, P <.00001); reported diabetes mellitus (OR 1.70, P =.0069); waist/hip ratio 0.90 to 0.93 (OR 1.52, P =.0212); alcohol intake (up to 2 days/week) (OR 0.75, P <.0309); alcohol intake (3-7 days/week) (OR 0.60, P =.0085); family income R$600 to R$1200 and college education (OR 2.92, P =.0499); family income >R$1200 and college education (OR 0.68, P = 0.0239) CONCLUSIONS: The independent risk factors for AMI in Brazil showed a conventional distribution pattern (smoking, diabetes mellitus and central obesity among others) with different strengths of association; most of them being preventable by implementation of adequate policies.

[The color of death: causes of death according to race in the State of Sao Paulo, 1999 to 2001]. / A cor da morte: causas de óbito segundo características de raça no Estado de São Paulo, 1999 a 2001.

OBJECTIVE: Assuming that ethnicity might be a basis for social differentiation and that such differences might represent vulnerability to sickness, this study attempts to verify whether race or ethnic origin have an effect on mortality patterns. METHODS: The Sao Paulo State death register was examined from 1999 to 2001 in a contingence table of causes according to the 10th ICD and race or skin-color categories (White, Black, Mulatto and others). Chi-square test was used to check the association between skin-color and cause of death; residual analysis was used to elicit statistically significant excessive occurrences when each category of cause of death and skin color was combined; and correspondence analysis was used to examine overall relations among all categories considered. RESULTS: A total of 647,321 valid death registers were analyzed, among which 77.7% were of Whites, 5.4% of Blacks, 14.3% of Mulattoes and 2.6% of others. A significant association between skin color or race and cause of death was found. It may be observed that, although Blacks and Mulattoes present a similar death profile, on the contrary of Whites and others, which could be aggregated into a single category, the former appear in distinct positions on the multidimensional map presented. Except for mal defined causes, which characterize only the deaths of Blacks, the other causes of death within this group are common to both Blacks and Mulattoes, varying however, in intensity and as to the order in which they appear death. CONCLUSIONS: Analysis of mortality according to race or color revealed that death has a color. There is a White death, which has, among its causes, sicknesses, which, although variable, are nothing more than sicknesses. There's a Black death, which is not caused by sicknesses but by external causes, complications in labor and delivery, mental disorders and ill-defined causes.

[National Health Innovation System: relations between scientific fields and economic sectors]. / Sistema Nacional de Inovação em Saúde: relações entre áreas da ciência e setores econômicos.

Health Science and Technology is currently the subject matter of government and university actions. Such actions should converge to the establishment of a National Health Innovation System, which still calls for acknowledgment from the economic sector counterpart. A study was carried out with the purpose of describing the relations between scientific fields and economic sectors as a means of learning more about this System. Records from the Brazilian Directory of Research Groups (version 4.1) were examined and selected when Health was a keyword either to field of knowledge or economic sector. Data were compiled into multiresponse variables and analyzed in contingency tables using residual, correspondence, and cluster analyses. It was found that the Brazilian National Health Innovation System constitutes a sectorial system where competitiveness is more socially than economically-oriented, making this System favorably in tandem with the National Unified Health System as well as responsive to public policies focused on social welfare.

Clinical significance of transient left ventricular dilation assessed during myocardial Tc-99m sestamibi scintigraphy.

OBJECTIVE: To assess the clinical significance of transient ischemic dilation of the left ventricle during myocardial perfusion scintigraphy with stress/rest sestamibi. METHODS: The study retrospectively analyzed 378 patients who underwent myocardial perfusion scintigraphy with stress/rest sestamibi, 340 of whom had a low probability of having ischemia and 38 had significant transient defects. Transient ischemic dilation was automatically calculated using Autoquant software. Sensitivity, specificity, and the positive and negative predictive values were established for each value of transient ischemic dilation. RESULTS: The values of transient ischemic dilation for the groups of low probability and significant transient defects were, respectively, 1.01 0.13 and 1.18 0.17. The values of transient ischemic dilation for the group with significant transient defects were significantly greater than those obtained for the group with a low probability (P<0.001). The greatest positive predictive values, around 50%, were obtained for the values of transient ischemic dilation above 1.25. CONCLUSION: The results suggest that transient ischemic dilation assessed using the stress/rest sestamibi protocol may be useful to separate patients with extensive myocardial ischemia from those without ischemia.

Fuzzy linguistic model for bioelectrical impedance vector analysis.

BACKGROUNDS & AIMS: The boundaries between the categories of body composition provided by vectorial analysis of bioimpedance are not well defined. In this paper, fuzzy sets theory was used for modeling such uncertainty. METHODS: An Italian database with 179 cases 18-70 years was divided randomly into developing (n = 20) and testing samples (n = 159). From the 159 registries of the testing sample, 99 contributed with unequivocal diagnosis. Resistance/height and reactance/height were the input variables in the model. Output variables were the seven categories of body composition of vectorial analysis. For each case the linguistic model estimated the membership degree of each impedance category. To compare such results to the previously established diagnoses Kappa statistics was used. This demanded singling out one among the output set of seven categories of membership degrees. This procedure (defuzzification rule) established that the category with the highest membership degree should be the most likely category for the case. RESULTS: The fuzzy model showed a good fit to the development sample. Excellent agreement was achieved between the defuzzified impedance diagnoses and the clinical diagnoses in the testing sample (Kappa = 0.85, p < 0.001). CONCLUSIONS: fuzzy linguistic model was found in good agreement with clinical diagnoses. If the whole model output is considered, information on to which extent each BIVA category is present does better advise clinical practice with an enlarged nosological framework and diverse therapeutic strategies.

[Prevalence of asthma and risk factors associated: population based study in São Paulo, Southeastern Brazil, 2008-2009]. / Prevalência de asma e fatores associados: estudo de base populacional em São Paulo, SP, 2008-2009.

OBJECTIVE: To assess the prevalence of asthma and risk factors associated in children and adolescents. METHODS: Population-based cross-sectional study with 1,185 female and male children and adolescents carried out in the city of São Paulo, Southeastern Brazil, from 2008 to 2009. Data were collected through home interviews. Respondents were selected from two-stage (census tract, household) cluster random sampling stratified by gender and age. Multiple Poisson regression was used in the adjusted analysis between the outcome and socioeconomic, demographic, lifestyle and health condition variables. RESULTS: Of all respondents, 9.1% (95%CI 7.0;11.7) reported asthma. After adjustment, the following variables were found independently associated with asthma: age (0 to 4 years vs. 15 to 19) (PR 3.18, 95%CI 1.20;8.42); age (5 to 9 years vs. 15 to 19) (PR 6.37, 95%CI 2.64;15.39); age (10 to 14 years vs. 15 to 19) (PR 4.51, 95%CI 1.95;10.40); allergy (yes vs. no) (PR 2.22, 95%CI 1.24;4.00); rhinitis (yes vs. no) (PR 2.13, 95%CI 1.22;3.73); health conditions in the 15 days preceding the interview (yes vs. no) (PR 1.96, 95%CI 1.23;3.11); number of rooms in the household (1 to 3 vs. 4 and more) (PR 1.67, 95%CI 1.05;2.66); and skin color (black and mixed vs. white) (PR 2.00, 95%CI 1.14;3.49). CONCLUSIONS: This study showed the importance of factors associated with asthma including rhinitis and allergy; age between 5 to 9 years old; black and mixed skin color; and household with few rooms. Frequent health problems are seen as a common consequence of asthma.

Respiratory diseases and associated factors: population-based study in São Paulo, 2008-2009.

OBJECTIVE: To assess the prevalence of acute bronchitis, rhinitis, and sinusitis among children and adolescents and identify associated factors. METHODS: This is a population-based, cross-sectional study. A household survey was conducted with 1,185 children and adolescents from the city of São Paulo (Southeastern Brazil), from 2008 to 2009. The participants were selected by means of probability sampling, stratified by sex and age, and by two-stage cluster sampling. For the adjusted analysis, multiple Poisson regression was used. RESULTS: Of the respondents, 7.3% reported acute bronchitis, 22.6% rhinitis and 15.3% sinusitis. After the adjusted analysis, the following characteristics were associated with self;reported acute bronchitis: age 0 to 4 years (PR=17.86; 95%CI: 3.65;90.91), 5 to 9 years (PR=37.04; 95%CI: 8.13;166.67), 10 to 14 years (PR=20,83; 95%CI: 4.93;90.91), allergy (PR=3.12; 95%CI: 1.70;5.73), black and mixed-ethnicity (black and white) skin color (PR=2.29; 95%CI: 1.21;4.35), and living in a household with 1 to 3 rooms (PR=1.85; 95%CI: 1.17;2.94). As to self-reported rhinitis, the following characteristics were associated: age 10 to 14 years (PR=2.77; 95%CI: 1.60;4.78), 15 to 19 years (PR=2.58; 95%CI: 1.52;4.39), allergy (PR=4.32; 95%CI: 2.79;6.70), asthma (PR=2.30; 95%CI: 1.30;4.10) and living in flats (PR=1.70; 95%CI: 1.06;2.73). Concerning self-reported sinusitis, the following characteristics were associated: age 5 to 9 years (PR=2.44; 95%CI: 1.09;5.43), 10 to 14 years (PR=2.99; 95%CI: 1.36;6.58), 15 to 19 years (PR=3.62; 95%CI: 1.68;7.81), allergy (PR=2.23 (95%CI: 1.41;3.52) and obesity (PR=4.42; 95%CI: 1.56;12.50). CONCLUSIONS: Respiratory diseases were more prevalent in population groups with defined characteristics, such as age group, self-reported diseases, type of household and obesity.

H-index of Collective Health professors in Brazil.

OBJECTIVE: To estimate reference values and the hierarchy function of professors engaged in Collective Health in Brazil by analyzing the distribution of the h-index. METHODS: From the Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Portal of Coordination for the Improvement of Higher Education Personnel ), 934 authors were identified in 2008, of whom 819 were analyzed. The h-index of each professor was obtained through the Web of Science using search algorithms controlling for namesakes and alternative spellings of their names. For each Brazilian region and for the country as a whole, we adjusted an exponential probability density function to provide the population parameters and rate of decline by region. Ranking measures were identified using the complement of the cumulative probability function and the hierarchy function among authors according to the h-index by region. RESULTS: Among the professors analyzed, 29.8% had no citation record in Web of Science (h=0). The mean h for the country was 3.1, and the region with greatest mean was the southern region (h=4.7). The median h for the country was 3.1, and the greatest median was for the southern region (3.2). Standardizing populations to one hundred, the first rank in the country was h=16, but stratification by region shows that, within the northeastern, southeastern and southern regions, a greater value is necessary for achieving the first rank. In the southern region, the index needed to achieve the first rank was h=24. CONCLUSIONS: Most of the Brazilian Collective Health authors, if assessed on the basis of the Web of Science h-index, did not exceed h=5. Regional differences exist, with the southeastern and northeastern regions being similar and the southern region being outstanding.

Pertussis booster vaccine for adolescents and young adults in São Paulo, Brazil.

OBJECTIVE: To develop a model to assess different strategies of pertussis booster vaccination in the city of São Paulo. METHODS: A dynamic stationary age-dependent compartmental model with waning immunity was developed. The "Who Acquires Infection from Whom" matrix was used to modeling age-dependent transmission rates. There were tested different strategies including vaccine boosters to the current vaccination schedule and three of them were reported: (i) 35% coverage at age 12, or (ii) 70% coverage at age 12, and (iii) 35% coverage at age 12 and 70% coverage at age 20 at the same time. RESULTS: The strategy (i) achieved a 59% reduction of pertussis occurrence and a 53% reduction in infants while strategy (ii) produced 76% and 63% reduction and strategy (iii) 62% and 54%, respectively. CONCLUSION: Pertussis booster vaccination at age 12 proved to be the best strategy among those tested in this study as it achieves the highest overall reduction and the greatest impact among infants who are more susceptible to pertussis complications.

[Patterns of antiretroviral therapy adoption by the Brazilian public health system]. / Padrão de incorporação de fármacos antiretrovirais pelo sistema público de saúde no Brasil.

OBJECTIVE: The aim of the present scientific study is to evaluate the patterns of antiretroviral technology adoption by the Brazilian Public Health System (SUS). METHODS: Based on previous articles published in scientific medical literature, three indicators to assess antiretroviral technology adoption by SUS were proposed: knowledge-adoption interval; critical mass of knowledge; and validation-adoption interval. Using the databases from the SUS Department of Information Technology (DATASUS) and from the Brazilian Logistic Center for Medication Control (SICLOM), two pharmaceutical groups were selected (antiretroviral medications and a group of high cost medications). RESULTS: Antiretroviral medications were adopted faster than the high cost medication group when assessed on the basis of "knowledge-adoption" interval and "validation-adoption" interval. Yet, they require a lower "critical mass of knowledge" before adoption. CONCLUSION: Antiretroviral medications have been adopted faster and based on a lower number of scientific medical articles than a selected group of high cost medications.