Mechanisms underlying the associations between different types of nature exposure and sleep duration: An 18-country analysis.

Whilst green space has been linked to healthier sleep outcomes, the roles of specific types of nature exposure, potential underlying mechanisms, and between-country variations in nature-sleep associations have received little attention. Drawing on cross-sectional survey data from an 18-country sample of adults (N = 16,077) the current study examined: 1) the relative associations between six different types of nature exposure (streetscape greenery, blue view from home, green space within 1 km, coast within 1 km, green space visits, blue space visits) and insufficient sleep (<6 h vs. 7-10 h per day); 2) whether these relationships were mediated by better mental wellbeing and/or physical activity; and 3) the consistency of these pathways among the different countries. After controlling for covariates, neighbourhood nature measures (green space, coast within 1 km) were not significantly associated with insufficient sleep; but nature visible from home (streetscape greenery, blue views) and recreational visits to green and blue spaces were each associated with less insufficient sleep. Significant nature-sleep associations were mediated, to varying degrees, by better mental wellbeing, but not self-reported physical activity. Country-level heterogeneity in the strength of nature-sleep associations was observed. Increasing nature visible from the home may represent a promising strategy for promoting healthier sleep duration at the population level, whilst nature-based interventions encouraging individuals to spend time in local green/blue spaces may be an appropriate target to assist individuals affected by insufficient sleep.

Lower Levels of Vitamin D Are Associated with an Increase in Insulin Resistance in Obese Brazilian Women.

Adult women are more likely to be obese than men. Moreover, there is evidence that obesity is a risk factor for increased insulin resistance (IR) and hypovitaminosis D (VITD), conditions related to metabolic and endocrinologic disturbance. We performed a cross-sectional study with 103 women diagnosed with obesity, recruited between 2009 and 2013, in an obesity referral outpatient clinic in Bahia, Brazil. Laboratory and clinical characteristics were compared between the groups according to the degree of obesity (I, II and III), and levels of 25-hydroxyvitamin D [25(OH)D] were used to define the VITD status (insufficiency and no insufficiency). We calculated the homeostatic model assessment-IR (HOMA-IR) index to assess insulin resistance in the groups. Our analyses revealed that HOMA-IR values and VITD levels were inversely correlated. Furthermore, we observed a distinct expression profile of values of laboratory markers according to 25(OH)D levels. Negative correlations were found between HOMA-IR and body mass index (BMI) in VITD insufficient participants but not in those with the sufficiency. Furthermore, multivariate regression demonstrated independent associations between lower levels of 25(OH)D and increased values of HOMA-IR. These findings suggests that lower levels of VITD are strongly associated with the increased IR in obese women.

Associations between green/blue spaces and mental health across 18 countries.

Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastal-blue spaces); and (b) nature connectedness, across season and country. People who lived in greener/coastal neighbourhoods reported higher positive well-being, but this association largely disappeared when recreational visits were controlled for. Frequency of recreational visits to green, inland-blue, and coastal-blue spaces in the last 4 weeks were all positively associated with positive well-being and negatively associated with mental distress. Associations with green space visits were relatively consistent across seasons and countries but associations with blue space visits showed greater heterogeneity. Nature connectedness was also positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. By contrast inland-blue space visits were associated with a greater likelihood of using anxiety medication. Results highlight the benefits of multi-exposure, multi-response, multi-country studies in exploring complexity in nature-health associations.

Fluorescent Imidazo[1,2-a]pyrimidine Compounds as Biocompatible Organic Photosensitizers that Generate Singlet Oxygen: A Potential Tool for Phototheranostics.

Photodynamic therapy has been used to treat a variety of diseases, however, there is continuing search for new biocompatible photosensitizers. Herein, we demonstrate for the first time that imidazo[1,2-a]pyrimidine compounds are able to generate singlet oxygen species and can act as photosensitizers in the intracellular environment. Our results show that this class of compounds absorb and emit in the 400-500 nm region, present low cytotoxicity in the dark, are efficiently uptaken by cells, are fluorescent in intracellular medium, and generate singlet oxygen upon irradiation, killing cancer cells within 2 h at low concentration (2.0 µm). The imidazo[1,2-a]pyrimidine compounds are a potential new tool for phototheranostics, because they can be simultaneously used for fluorescence imaging and photodynamic therapy.

Infrared thermography reveals surface body temperature changes during proestrus and estrus reproductive phases in Gyr heifers (Bos taurus indicus).

Our aim was to evaluate the application of infrared thermography (IRT) to detect body surface temperature variation of body regions during the proestrus and estrus phases of the reproductive cycle of Gyr heifers and investigate environmental factors that could affect these measurements. Fifty-seven heifers were submitted to an ovulation synchronization protocol. This was followed by monitoring the heifers every 12 h over 60 h. Heifers were monitored for rectal and vaginal temperature using a digital thermometer. The surface temperature of the eye, vulva, and muzzle regions were monitored by IRT. Meteorological data was recorded for temperature and humidity. Observation of sexual behavior was performed to monitor estrus onset. Transrectal ultrasonography was used to identify the dominant follicle and confirm ovulation of all heifers. We observed a decrease in temperature of the rectum and vagina, as well as in the eye and vulva regions within the first 12 h after the completion of the synchronization. This period coincides with the expected proestrus phase of the estrous cycle. A progressive increase in all temperatures was noticed in the following 36 h, which coincides with the estrus phase of the reproductive cycle. The regions evaluated around the vulva and eye exhibited the highest temperature and experienced less environmental distortion than the muzzle area thermographs. Environmental factors, such as rainfall and temperature-humidity index, influenced the IRT readings altering the radiation patterns detected. In conclusion, IRT is an effective method to detect temperature variation during the proestrus and estrus phases in Gyr heifers. Furthermore, biological and environmental effects should be considered when collecting and interpreting IRT data in livestock.

Explant culture: A relevant tool for the study of telocytes.

Telocytes are cells present in the stroma of various tissues including the prostate. The detection of telocytes is still very much dependent on obtaining ultrastructural data that show the presence of telopodes, which are cytoplasmic projections that alternate between dilated regions, the podoms, and thin segments, the podomers. These structures are the distinctive characteristics of the telocytes. Thus, in vitro assays are important for the study of telocytes, which are more easily identified in culture, which also enables the experimental manipulation of these cells. The isolation of telocytes per se does not allow the analysis of the behavior of these cells in relation to other cell types in a given organ. In this sense, in the prostate, explants could be a useful tool for the study of telocytes. The present study obtained prostatic explants and evaluated the influence of recombinant proteins, scattering factor (SCF) and stromal-derived factor 1 (SDF-1), which could impact on the migration of CD34-positive cells. Telocytes migrate out of explants and SDF-1 stimulates the proliferation and formation of telocyte networks in vitro. Telocytes are not smooth muscle cell progenitors in the prostate; on the contrary, they are CD90- and CD44-negative cells and, hence, have limited progenitor capacity. The present study demonstrated that explants are useful tools to elucidate the nature of telocytes and their functions.

Postnatal exposure to finasteride causes different effects on the prostate of male and female gerbils.

The development and maintenance of prostate function depend on a fine balance between oestrogen and androgen levels. Finasteride inhibits 5α-reductase, which is responsible for the conversion of testosterone into its most active form, dihydrotestosterone. Enzymes that metabolize these hormones have a highly relevant role in both the normal prostate metabolism and in the occurrence of pathological conditions. There are few studies on the impact of finasteride on male prostate development and fewer studies on the female prostate and possible intersexual differences. Therefore, we treated male and female gerbils from 7 to 14 days in postnatal life with a high dose of finasteride (500 µg/kg/day); the prostate complexes were then removed and submitted to immunohistochemistry, immunofluorescence and three-dimensional reconstruction. In addition, hormonal serum dosages were administered. Treatment with finasteride resulted in an increased thickness of the periductal smooth musculature in the prostate of both male and female gerbils, such as well as a reduction in the thickness of developing prostate alveoli in both sexes. In addition, intersexual differences were observed as increased epithelial proliferation and decreases in the number of developing alveoli in females. Together, the data indicate that postnatal exposure to finasteride causes greater changes in the female gerbil prostate than in the male.

Prenatal exposure to finasteride promotes sex-specific changes in gerbil prostate development.

Finasteride is a drug that is widely used in the treatment of benign prostatic hyperplasia, hair loss and even as a chemotherapeutic agent in the treatment of prostatic adenocarcinoma. However, its use is known to cause several side effects in adults and it can also cause changes in the embryonic development of the male prostate, which is a cause for concern given the possibility of the accumulation of finasteride in the environment. Nevertheless, no studies have investigated the effects of finasteride on the development of the prostate in females, which occurs in several species of mammals. To evaluate the effects of intrauterine exposure to finasteride (500µgkg-1 day-1) on postnatal prostate development in the Mongolian gerbil in the present study, we used immunohistochemistry, immunofluorescence, serological analysis and three-dimensional reconstruction techniques. Differences were observed in the effects of finasteride on periductal smooth muscle and cell proliferation between the sexes, as well as intersex differences in the presence of the androgen receptor, which was elevated in males, and the oestrogen receptor ERα, which was increased in females. Together, the data indicate that the female prostate has its own hormone dynamics and that there are sex-specific differences in the way in which the female prostate reacts to prenatal exposure to finasteride.

Association of birth weight with functional ovarian reserve during menacme estimated by serum concentration of anti-Müllerian hormone.

To investigate the relationship of birth weight (BW) of females born at full term with functional ovarian reserve (FOR) during menacme, based on serum level of anti-Müllerian hormone (AMH), among women who were 34-35 years old. This prospective birth cohort study assessed all women who were born in Ribeirão Preto City, State of São Paulo (Brazil) between June 1, 1978 and May 31, 1979. The primary endpoint was serum AMH, a marker of FOR, and its correlation with the BW of females classified as small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational (LGA). We included 274 women in this study, 19 were SGA, 238 were AGA, and 17 were LGA. The average of AMH concentration was not significantly different (p = 0.11) among women in the SGA group (2.14 ng/mL), AGA group (2.13 ng/mL), and LGA group (2.57 ng/mL). An analysis of variance indicated that the three groups also had no significant differences in the percentage of women who had adequate AMH levels (1 ng/mL; p = 0.11). There were no significant differences in the serum concentrations of AMH among 34 and 35 year-old women who were born at full term and classified as SGA, AGA, and LGA. Our sample size allowed detection of major differences between these groups (effect size of 0.8). Association of birth weight of females born at full term with functional ovarian reserve during menacme estimated by serum concentration of anti-Müllerian hormone.

Isolamento e perfil enzimático de cães e gatos com dermatofitose atendidos em hospitais veterinários do Recife, Pernambuco / Isolation and enzymatic profile of dogs and cats with dermatofitosis attended at veterinary hospitals in Recife, Pernambuco, Brazil

Os dermatófitos são fungos que podem causar infecções superficiais da pele, cabelo e unhas em humanos e animais. As espécies de dermatófitos mais frequentemente isoladas dos cães e gatos afetados por micoses são Microsporum gypseum e principalmente Microsporum canis. O papel crucial durante o processo de infecção é a produção de enzimas extracelulares essenciais para a invasão e estabelecimento do agente patogênico no tecido do hospedeiro. O objetivo deste trabalho foi isolar dermatófitos de cães e gatos e avaliar o perfil enzimático dos isolados obtidos. Amostras de pelos e escamas epidérmicas foram coletadas de cães e gatos em instalações veterinárias em Recife/PE, e os isolados foram identificados com base nas características macroscópicas e microscópicas. A análise qualitativa das enzimas urease, protease, lipase, colagenase e fosfolipase foi avaliada a partir dos dermatófitos isolados. Durante 10 meses, um total de 106 animais, que compreendeu de 99 cães e sete gatos com sinais clínicos, independentemente do sexo e raça foram avaliados. Apenas oito animais foram confirmados com dermatofitose, principalmente cães (n=7), sendo seis afetados por M. canis e um por M. gypseum, a raça mais afetada foi Yorkshire (n=3). No entanto, apenas um gato foi confirmado com M. canis. Não foi observada predisposição relacionada ao sexo quanto à ocorrência de dermatofitose nos cães e gatos avaliados. Os dermatófitos isolados apresentaram perfis semelhantes para as enzimas urease, lipase, protease, fosfolipase e colagenase, característica importante em infecções patogênicas. O diagnóstico clínico destas zoonoses com base na confirmação microbiológica e uma compreensão dos mecanismos subjacentes é de grande importância para o tratamento e prevenção de doenças fúngicas em animais.(AU)

Dermatophytes are fungi that can cause superficial infections of the skin, hair and nails in man and animals. The most frequent dermatophyte species isolated from dogs and cats are Microsporum gypseum, most notably Microsporum canis. The crucial role during the infection process is the production of extracellular enzymes essential for the invasion and establishment of the pathogen in the host tissue. The objective of this research was to isolate dermatophytes from dogs and cats and evaluate the enzymatic profile of the isolates obtained. Hair samples and epidermal scales were collected from dogs and cats in veterinary facilities in Recife-PE, and the isolates were identified based on macroscopic and microscopic characteristics. The qualitative analysis of the enzymes urease, protease, lipase, collagenase and phospholipase was evaluated from the isolated dermatophytes. During 10 months, a total of 106 animals, comprising of 99 dogs and seven cats with clinical signs, regardless of sex and race were evaluated. Only eight animals were confirmed with dermatophytosis, mostly dogs (n=7), being six affected by M. canis and one by M. gypseum, the race most affected was Yorkshire (n=3). However, only one cat was confirmed with M. canis. No sex-related predisposition was observed regarding the occurrence of dermatophytosis in dogs and cats evaluated. Isolated dermatophytes showed similar profiles for the enzymes urease, lipase, protease, phospholipase and collagenase, important characteristic for pathogenic infections. The diagnosis of this zoonosis based on microbiological confirmation and a better understanding of the underlying mechanisms is of great importance for the treatment and prevention of fungal diseases in animals.(AU)

Artificial oocyte activation to improve reproductive outcomes in women with previous fertilization failure: a systematic review and meta-analysis of RCTs.

STUDY QUESTION: In couples with previous fertilization failure, are reproductive outcomes improved using ICSI followed by artificial oocyte activation (ICSI-AOA) compared with conventional ICSI? SUMMARY ANSWER: There is insufficient evidence available from RCTs to judge the efficacy and safety of ICSI-AOA for couples with previous fertilization failure. WHAT IS KNOWN ALREADY: In cases with previous low fertilization rates or total fertilization failure using ICSI due to sperm-related, oocyte activation deficiency, several methods of AOA have been described, which employ mechanical, electrical or chemical stimuli. Reported fertilization and pregnancy rates appear to be improved after ICSI-AOA compared with conventional ICSI; however, the small studies performed to date make it difficult to assess the clinical efficacy or safety of AOA. STUDY DESIGN, SIZE, AND DURATION: The present systematic review and meta-analysis identified RCTs that compared ICSI-AOA and conventional ICSI. The last electronic search was conducted in August 2014 and there was no limitation regarding language, publication date, or publication status. We included studies that randomized either oocytes or women and included them in two different parts of this review: a women-based review and an oocyte-based review. For the women-based review, the primary outcome of effectiveness was live birth per randomized woman and the primary outcome for safety was congenital anomalies per clinical pregnancy. For the oocyte-based review, the primary outcome was embryo formation per oocyte randomized. PARTICIPANTS/MATERIALS, SETTING, AND METHODS: Record screening and data extraction were performed independently by two authors and risk of bias was assessed by three authors. The effects of ICSI-AOA compared with conventional ICSI were summarized as risk ratio (RR) and the precision of the estimates was evaluated by the 95% confidence interval (CI). MAIN RESULTS AND THE ROLE OF CHANCE: A total of 14 articles were assessed for eligibility and 9 included in the meta-analysis: 2 studies comprised the woman-based review (n = 168 women) and 7 studies the oocyte-based review (n = 4234 oocytes). Only four studies evaluated AOA due to fertilization failure after conventional ICSI: these were included in the quantitative analysis. In two studies evaluating couples with a history of fertilization failure in a previous cycle, ICSI-AOA was associated with an increase in the proportion of cleavage stage embryos (RR 5.44, 95% CI 2.98-9.91) and top/high quality cleavage stage embryos (RR 10.02, 95% CI 2.45-40.95). There was no evidence of effect on fertilization rate (RR 2.97, 95% CI 0.84-10.48). In the two studies that evaluated ICSI-AOA as a rescue method for unfertilized oocytes after conventional ICSI, ICSI-AOA was associated with an increase in fertilization (RR 8.26, 95% CI 1.28-53.32, P = 0.03) and cleavage rates (RR 8.65, 95% CI 2.28-32.77) although there was no significant effect on the likelihood of blastocyst formation (RR 1.97, 95% CI 0.11-34.99). The remaining five studies evaluated ICSI-AOA for reasons other than fertilization failure and were excluded. LIMITATIONS AND REASONS FOR CAUTION: The majority of the studies were not considered to be similar enough for meta-analysis due to different AOA methods and patient inclusion criteria, thus limiting the possibility of pooling studies and achieving a more robust conclusion. Only two studies examined ICSI-AOA in couples with previous fertilization failure, and only one of these included couples with proven male-related, oocyte activation deficiency, which is the primary indication for AOA. The resulting evidence was considered to be of very low quality and should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS: There is insufficient evidence available from the currently available RCTs to judge the efficacy or safety of ICSI-AOA on key reproductive outcomes in couples with previous fertilization failure. Such interventions should be further examined by well-designed RCTs before the introduction of ICSI-AOA as a standard treatment. STUDY FUNDING/COMPETING INTERESTS: No funding was obtained. No competing interests to declare. REGISTRATION NUMBER: PROSPERO CRD42014007445.

Perceived Age Discrimination as a Mediator of the Association Between Income Inequality and Older People's Self-Rated Health in the European Region.

OBJECTIVES: The relative income hypothesis predicts poorer health in societies with greater income inequality. This article examines whether the psychosocial factors of perceived age discrimination and (lack of) social capital may help explain the adverse effect of inequality on older people's health. METHODS: Self-rated health, perceived age discrimination, and social capital were assessed in the 2008/9 European Social Survey (European Social Survey Round 4 Data, 2008). The Gini coefficient was used to represent national inequalities in income in each of the 28 European Social Survey countries. Mediation analyses (within a multilevel structural equation modeling paradigm) on a subsample of respondents over 70 years of age (N = 7,819) were used to examine whether perceived age discrimination mediates the negative effect of income inequality on older people's self-rated health. RESULTS: Perceived age discrimination fully mediated the associations between income inequality and self-rated health. When social capital was included into the model, only age discrimination remained a significant mediator and predictor of self-rated health. DISCUSSION: Concrete instances of age discrimination in unequal societies are an important psychosocial stressor for older people. Awareness that the perception of ageism can be an important stressor and affect older patient's self-reported health has important implications for the way health practitioners understand and treat the sources of patient's health problems in later life.

Subjective social status of older people across countries: the role of modernization and employment.

OBJECTIVES: To test and expand upon modernization theory's account of subjective social status (SSS) of older people in society. It was hypothesized that perceptions of older people's social status should be higher in more modernized countries and that the proportion of older people in employment should moderate the relationship between modernization and SSS of older people. METHODS: Data were from the "Experiences and Expressions of Ageism" module in the fourth round of the European Social Survey. The sample analyzed included 45,706 individuals from 25 countries in the European region. Multilevel modeling was used to test the hypotheses. RESULTS: The SSS of older people (aged 70 years and older) was perceived to be higher in countries with very high levels of modernization and in countries with a higher proportion of older people in employment. The positive association between modernization and SSS of older people was stronger within countries with a lower proportion of older people in employment. DISCUSSION: The proportion of older people who are employed is an important factor that is related to perceptions of the social status of older people in less modern societies. The individual and societal implications are discussed, specifically in relation to policies promoting active aging.

Population-based multicentric survey of hepatitis B infection and risk factor differences among three regions in Brazil.

This multicentric population-based study in Brazil is the first national effort to estimate the prevalence of hepatitis B (HBV) and risk factors in the capital cities of the Northeast, Central-West, and Federal Districts (2004-2005). Random multistage cluster sampling was used to select persons 13-69 years of age. Markers for HBV were tested by enzyme-linked immunosorbent assay. The HBV genotypes were determined by sequencing hepatitis B surface antigen (HBsAg). Multivariate analyses and simple catalytic model were performed. Overall, 7,881 persons were included; < 70% were not vaccinated. Positivity for HBsAg was less than 1% among non-vaccinated persons and genotypes A, D, and F co-circulated. The incidence of infection increased with age with similar force of infection in all regions. Males and persons having initiated sexual activity were associated with HBV infection in the two settings; healthcare jobs and prior hospitalization were risk factors in the Federal District. Our survey classified these regions as areas with HBV endemicity and highlighted the risk factors differences among the settings.

PCR identification of Leishmania in diagnosis and control of canine Leishmaniasis.

Leishmaniases are endemic in many countries, mainly in rural areas. In Brazil, Leishmania infection is responsible for many cases of Leishmaniases, including recent reports in urban regions. Despite their sensitivity, traditional serological and parasitological methods for detecting Leishmaniases have proven inadequate for species discrimination. This study aimed to identify Leishmania species in biological samples by a fast methodology, avoiding "in vitro" cultivation. Knowledge of the Leishmania species is an important tool in regions where both New World visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL) are prevalent. As these new foci appear in areas not traditionally endemic for VL, the main problem is to distinguish between true autochthonous infections and infections acquired in other well-known endemic areas. Since, domestic dogs are known to be the main VL and CL reservoir, they are regularly investigated in endemic areas to prevent, principally, severe and often fatal VL in humans. However, several infected dogs present no clinical signs or clinical signs similar to other canine diseases. Here, we evaluated the ability of PCR to diagnose VL and distinguish L. (L.) chagasi from other Leishmania species in domestic dogs. Samples from 114 dogs from 30 cities (Sao Paulo, Brazil) were divided into two groups: 44 symptomatic and 70 asymptomatic. They were assayed by parasitological methods (culture and microscopic examination) and PCR to determine L. (L.) chagasi, L. (V.) braziliensis; and in some cases, Leishmania spp. Parasitological tests and PCR-L. chagasi were concordant in 105 samples (92%). VL was confirmed in 49 dogs, while 56 had negative results. Of the 114 samples, 9 had discordant results, but were further tested by PCR-Leishmania spp. with positive results. VL was also confirmed in 4 dogs having negative parasitological tests and positive PCR-L. chagasi. Consequently, this PCR was positive for 100% (53/49) of dogs with parasites detected in parasitological tests. Also, PCR demonstrated high specificity detecting 61 dogs negative for VL. Leishmania infection was negative in 56 dogs, and 5 with positive culture and PCR-Leishmania spp. had CL since they were positive in PCR-L. braziliensis. This study shows the importance of including PCR in diagnosis of Leishmaniases by differential diagnosis contributing to the surveillance and control of VL programs.

Avaliaçäo auditiva em músicos de frevo e maracatu / Hearing evaluation in frevo and maracatu's musicians

Objetivos: Medir o nível de pressäo sonora a que säo expostos os músicos dos blocos carnavalescos, especificamente dos ritmos de frevo e maracatu, levantar os níveis mínimos de audiçäo dos músicos, conhecer seus hábitos auditivos e queixas correlatas e comparar os resultados entre os grupos. Forma de estudo: Clínico prospectivo randomizado. Material e método: A casuística constituiu-se de 19 músicos do grupo de frevo e 31 músicos do grupo de maracatu, de 12 a 71 anos de idade. Foi aplicado um questionário com o intuito de conhecer os hábitos auditivos e as queixas correlatas dos músicos e realizada audiometria tonal por via aérea e via óssea. Resultados: Os resultados mostraram que os hábitos mais citados foram os de freqüentar discotecas e o uso de walkman, e as principais queixas relatadas foram tontura e zumbido. A configuraçäo de curvas audiométricas sugestivas de PAIR foi de 42,10 por cento e 16,13 por cento, nos grupos de frevo e de maracatu, respectivamente. No grupo de frevo, a idade, o tempo de trabalho como músico e o tempo de exposiçäo à música influenciaram a ocorrência das alteraçöes auditivas. Conclusäo: É necessária a implantaçäo de Programa de Conservaçäo Auditiva, pela falta de consciência destes músicos aos riscos inerentes de instalaçäo de perda auditiva decorrente da exposiçäo à música intensa na cidade de Olinda-PE