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.

A América devora os pretos: teses médicas, manuais de fazendeiros e grandes escravarias / America devours blacks: medical theses, farmer's manuals, and major slavery

Os manuais de fazendeiros, escritos ao longo do XIX, nos ajudam a dimensionar a importância dada ao tratamento dos escravos pelos fazendeiros brasileiros, desvelando um pouco do que pode ter sido a experiência de vida de um escravo de uma zona rural. Nosso intuito era enquadrar a Imperial Fazenda de Santa Cruz no contexto das prescrições e manuais de cuidado escravo; assim poderíamos dimensionar com maior clareza até que ponto a Fazenda Santa Cruz se encaixaria ou não no molde escravista vigente. Poderíamos então historicizar as medidas tomadas por Inácio Garcia, o superintendente da Fazenda em 1860, ao tentar demonstrar como as medidas coercitivas e arbitrárias, baseadas na supressão da oferta de alimentação aos idosos, crianças, doentes e guarnição de serviço do hospital, influenciaram de forma decisiva, o declínio do que poderíamos chamar de certo bem-estar" escravo na fazenda Imperial. Com isso, esperávamos poder responder a questões relevantes como: em que medidas as ações de Garcia, que colidiam com as expectativas da escravaria, teriam sido influenciadas por, talvez, um novo padrão de administração escrava? Como tais modelos foram pensados, elaborados e aplicados na fazenda Santa Cruz? E de que forma isso teria influenciado a vida escrava na fazenda. (AU)

Cirurgia Torácica Robótica: O Desenvolvimento de uma Técnica / Thoracic Robotic Surgery: The Development of a technique

O artigo tem por objetivo trazer à luz aspectos da técnica Cirurgia Torácica Robótica, suas aplicações, detalhes que a tornam diferente das demais técnicas. Aborda ainda a curva de aprendizado, evidenciando números considerados suficientes para que um cirurgião inicie sua prática. A crescente adesão ao método é demostrada em números e percentuais com base nos registros da AATS (American Association of Thoracic Surgeons). É apresentado um comparativo de custo entre as variadas técnicas bem como um comparativo de resultados entre os 3 métodos existentes na prática da Cirurgia Torácica (Toracotomia, Videocirurgia e Cirurgia Robótica).

This article intends to highlight particular features of the Thoracic Robotic Surgery Technique, indications, and aspects that make RVATS an outstanding option t when it comes to precision, postoperative recovery and movement width within the Thorax. RVATS adhesion experiences a growth in the United States in recent years with rates as high as 60% in the number of residents registered in training programs. The learning curve differences and standards have also been studied taking into consideration many international centers data. Further important aspects as cost effectiveness, limiting aspects, multidisciplinary team are mentioned.

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.

Obese patients lose weight independently of nutritional follow-up after bariatric surgery / Pacientes obesos perdem peso independentemente do seguimento nutricional pós-cirurgia bariátrica

Summary 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. .

Resumo Objetivo: examinar a perda de peso nos primeiros 18 meses em pacientes submetidos à cirurgia bariátrica. Métodos: um estudo de coorte retrospectiva foi realizado com 241 adultos submetidos à gastroplastia, entre janeiro/2006 e dezembro/2008, em um centro em São Paulo (Brasil). Foi feita a revisão dos prontuários e as variáveis analisadas foram sexo, idade, peso pré-cirúrgico imediato, adesão ao seguimento nutricional pós-operatório e duração do período pós-operatório. A proporção do peso inicial perdido durante os 18 primeiros meses pós-cirurgia foi analisada pela técnica de equações generalizadas de estimação. Resultados: 81% (n=195) eram mulheres; média de idade 44,4 ± 11,6 anos; média de peso pré-operatório 123,1± 21,2 kg; média do índice de massa corporal 47.2± 6.2 kg/m2. A prevalência de adesão ao seguimento nutricional pós-cirúrgico foi de 51% (IC95% = 44,5-57,5%). Peso pré-cirúrgico e adesão não se mostraram significativamente associados à redução da proporção do peso inicial (Teste de Wald p>0,18). A perda de peso tendeu a diminuir no final do período de 18 meses pós-cirúrgico nos grupos de pacientes aderentes e não aderentes (Teste de Wald p=0,00). Conclusão: nosso estudo mostrou que a perda de peso durante os primeiros 18 meses após a cirurgia chega a 40% do peso. O emagrecimento não foi associado ao peso pré-operatório, nem à adesão ao seguimento nutricional pós-cirúrgico e pode depender, principalmente, das alterações promovidas pelo procedimento cirúrgico em si. Esse achado poderá levar à proposição de intervenções para motivar os pacientes ao seguimento pós-operatório. .

Cirurgia torácica minimamente invasiva: ressecções pulmonares Cirurgia Torácica Vídeo Assistida (CTVA) / Minimally invasive thoracic surgery: pulmonary resections by Video Assisted Thoracic Surgery (VAST)

A Pneumologia e a Cirurgia Torácica, na sua abordagem diagnóstica e terapêutica de várias doenças do tórax, incluindo câncer de pulmão, precisam ter acesso a esta cavidade realizada principalmente por toracotomia aberta. Como a própria toracotomia provoca um grande trauma com ampla resposta imunológicaaumentando a morbidade e mortalidade das doenças abordadas, a necessidade de reduzir este trauma foi sempre uma preocupação. Com o advento da cirurgia laparoscópica e sua evolução nos últimos anos, chegamos à Cirurgia Torácica Minimamente Invasiva/Cirurgia Torácica Vídeo Assistida suprimindo toracotomias abertas e suas consequências sobre um grande número de bordagens, principalmente a lobectomia com dissecção linfonodal e/ou mediastinal.Podem ser utilizadas abordagens convencionais para as ressecções, incluindo toracotomia póstero lateral e toracotomia poupadores de músculos. No entanto, os procedimentos de lobectomia, peneumonectomia e segmentectomia minimamente invasivas são agora comumente usados com resultados superiores.

[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.

Prevalência de asma e fatores associados: estudo de base populacional em São Paulo, SP, 2008-2009 / Prevalence of asthma and risk factors associated: population based study in São Paulo, Southeastern Brazil, 2008-2009 / Prevalencia de asma y factores asociados: estudio de base poblacional en Sao Paulo, Sudeste de Brasil, 2008-2009

OBJETIVO: Estimar a prevalência de asma em crianças e adolescentes e identificar fatores associados. MÉTODOS: Estudo transversal de base populacional com 1.185 crianças e adolescentes de ambos os sexos de São Paulo, SP, de 2008 a 2009. As informações foram coletadas por meio de entrevistas domiciliares e os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade, e por conglomerados em dois estágios (setores censitários e domicílios). Foi realizada regressão múltipla de Poisson na análise ajustada entre o desfecho e variáveis sociodemográficas, econômicas, estilo de vida e condições de saúde. RESULTADOS: Dos entrevistados, 9,1% (IC95% 7,0;11,7) referiram asma. Após análise ajustada, identificaram-se os seguintes fatores independentemente associados ao agravo: idade (zero a quatro anos/15 a 19) RP = 3,18 (IC95% 1,20;8,42), idade (cinco a nove anos/15 a 19) RP = 6,37 (IC95% 2,64;15,39), idade (10 a 14 anos/15 a 19) RP = 4,51 (IC95% 1,95;10,40), alergia (sim/não) RP = 2,22 (IC95% 1,24;4,00), rinite (sim/não) RP = 2,13 (IC95% 1,22;3,73), problemas de saúde nos 15 dias prévios à entrevista (sim/não) RP = 1,96 (IC95% 1,23;3,11), número de cômodos no domicílio (1 a 3/4 e mais) RP = 1,67 (IC95% 1,05;2,66), e cor da pele (preta e parda/branca) RP = 2,00 (IC95% 1,14;3,49). CONCLUSÕES: Os achados do presente estudo apontam a importância da asma associada à presença de rinite e alergia, idade entre cinco e nove anos, cor da pele preta e parda e moradia com menor número de cômodos. Os frequentes problemas de saúde podem ser considerados consequência dessa doença.

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.

OBJETIVO: Estimar la prevalencia de asma en niños y adolescentes e identificar factores asociados. MÉTODOS: Estudio transversal de base poblacional con 1.185 niños y adolescentes de ambos sexos de Sao Paulo, Sudeste de Brasil, de 2008 a 2009. Las informaciones fueron colectadas por medio de entrevistas domiciliares y los participantes fueron seleccionados a partir de muestreo probabilístico, estratificado por sexo y edad, y por conglomerados en dos fases (sectores censitarios y domicilios). Se realizó regresión múltiple de Poisson en el análisis ajustado entre el resultado y las variables sociodemográficas, económicas, estilo de vida y condiciones de salud. RESULTADOS: De los entrevistados, 9,1% (IC95% 7,0;11,7) refirieron asma. Posterior al análisis ajustado, se identificaron los siguientes factores independientemente asociados al agravio: edad (cero a cuatro años/15 a 19) RP = 3,18 (IC95% 1,20;8,42), edad (cinco a nueve años/15 a 19) RP = 6,37 (IC95% 2,64;15,39), edad (10 a 14 años/15 a 19) RP = 4,51 (IC95% 1,95;10,40), alergia (si/no) RP = 2,22 (IC95% 1,24;4,00), rinitis (si/no) RP = 2,13 (IC95% 1,22;3,73), problemas de salud en los 15 días previos a la entrevista (si/no) RP = 1,96 (IC95% 1,23;3,11), número de cuartos en el domicilio (1 a 3/4 y más) RP = 1,67 (IC95% 1,05;2,66), y color de la piel (negra y parda/blanca) RP = 2,00 (IC95% 1,14;3,49). CONCLUSIONES: Los resultados del presente estudio señalan la importancia del asma asociada a la presencia de rinitis y alergia, edad entre cinco y nueve años, color de la piel negra y parda, y a la vivienda con menor número de cuartos. Los frecuentes problemas de salud pueden ser considerados consecuencia de esta enfermedad.

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.

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.

Doenças respiratórias e fatores associados: estudo de base populacional em São Paulo, 2008-2009 / Respiratory diseases and associated factors: population-based study in São Paulo, 2008-2009 / Enfermedades respiratorias y factores asociados: estudio de base poblacional en Sao Paulo (Sureste de Brasil), 2008-2009

OBJETIVO: Estimar a prevalência de bronquite aguda, rinite e sinusite em crianças e adolescentes e identificar fatores associados. MÉTODOS: Estudo transversal, de base populacional. Foi realizado inquérito domiciliar com 1.185 crianças e adolescentes de São Paulo, SP, de 2008 a 2009. Os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade e por conglomerados em dois estágios. Para análise ajustada foi realizada regressão múltipla de Poisson. RESULTADOS: Dos entrevistados, 7,3 por cento referiram bronquite aguda, 22,6 por cento rinite e 15,3 por cento sinusite. Após análise ajustada, associaram-se à bronquite aguda auto-referida: idade de zero a quatro anos (RP = 17,86; IC95 por cento: 3,65;90,91), cinco a nove anos (RP = 37,04; IC95 por cento: 8,13;166,67), dez a 14 anos (RP = 20,83; IC95 por cento: 4,93;90,91), referir ter alergia (RP = 3,12; IC95 por cento: 1,70;5,73), cor da pele preta/parda (RP = 2,29; IC95 por cento: 1,21;4,35) e morar em domicílio com um a três cômodos (RP = 1,85; IC95 por cento: 1,17;2,94); à rinite auto-referida: idade dez a 14 anos (RP = 2,77; IC95 por cento: 1,60;4,78), 15 a 19 anos (RP = 2,58; IC95 por cento: 1,52;4,39), referir ter alergia (RP = 4,32; IC95 por cento: 2,79;6,70), referir ter asma (RP = 2,30; IC95 por cento: 1,30;4,10) e morar em apartamento (RP = 1,70; IC95 por cento: 1,06;2,73); à sinusite auto-referida: idade cinco a nove anos (RP = 2,44; IC95 por cento: 1,09;5,43), dez a 14 anos (RP = 2,99; IC95 por cento: 1,36;6,58), 15 a 19 anos (RP = 3,62; IC95 por cento: 1,68;7,81), referir ter alergia (RP = 2,23; IC95 por cento: 1,41;3,52) e apresentar obesidade (RP = 4,42; IC95 por cento: 1,56;12,50). CONCLUSÕES: As doenças respiratórias foram mais prevalentes em grupos populacionais com características definidas, como grupo etário, doenças auto-referidas, tipo de moradia e obesidade.

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 percent reported acute bronchitis, 22.6 percent rhinitis and15.3 percent sinusitis. After the adjusted analysis, the following characteristics were associated with self;reported acute bronchitis: age 0 to 4 years (PR=17.86; 95 percentCI: 3.65;90.91), 5 to 9 years (PR=37.04; 95 percentCI: 8.13;166.67), 10 to 14 years (PR=20,83; 95 percentCI: 4.93;90.91), allergy (PR=3.12; 95 percentCI: 1.70;5.73), black and mixed-ethnicity (black and white) skin color (PR=2.29; 95 percentCI: 1.21;4.35), and living in a household with 1 to 3 rooms (PR=1.85; 95 percentCI: 1.17;2.94). As to self-reported rhinitis, the following characteristics were associated: age 10 to 14 years (PR=2.77; 95 percentCI: 1.60;4.78), 15 to 19 years (PR=2.58; 95 percentCI: 1.52;4.39), allergy (PR=4.32; 95 percentCI: 2.79;6.70), asthma (PR=2.30; 95 percentCI: 1.30;4.10) and living in flats (PR=1.70; 95 percentCI: 1.06;2.73). Concerning self-reported sinusitis, the following characteristics were associated: age 5 to 9 years (PR=2.44; 95 percentCI: 1.09;5.43), 10 to 14 years (PR=2.99; 95 percentCI: 1.36;6.58), 15 to 19 years (PR=3.62; 95 percentCI: 1.68;7.81), allergy (PR=2.23 (95 percentCI: 1.41;3.52) and obesity (PR=4.42; 95 percentCI: 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.

OBJETIVO: Estimar la prevalencia de bronquitis aguda, rinitis y sinusitis en niños y adolescentes e identificar factores asociados. MÉTODOS: Estudio transversal, de base poblacional. Se realizó pesquisa domiciliar con 1.185 niños y adolescentes de Sao Paulo (Sureste de Brasil), de 2008 a 2009. Los participantes fueron seleccionados a partir de muestreo probabilístico, estratificado por sexo y edad y por conglomerados en dos fases. Para análisis ajustado fue realizada regresión múltiple de Poisson. RESULTADOS: De los entrevistados, 7,3 por ciento narraron bronquitis aguda, 22,6 por ciento rinitis y 15,3 por ciento sinusitis. Posterior al análisis ajustado, se asociaron la bronquitis aguda auto-referida: edad de cero a cuatro años (RP=17,86; IC95 por ciento:3,65;90,91), cinco a nueve años (RP=37,04; IC95 por ciento:8,13;166,67), diez a 14 años (RP=20,83; IC95 por ciento: 4,93;90,91), relatar presencia de alergia (RP=3,12; IC95 por ciento: 1,70;5,73), color de la piel negra/parda (RP=2,29; IC95 por ciento: 1,21;4,35) y vivir en domicilio con uno a tres cuartos (RP=1,85; IC95 por ciento:1,17;2,94); a la rinitis auto-referida: edad de diez a 14 años (RP=2,77; IC95 por ciento:1,60;4,78), 15 a 19 años (RP=2,58; IC95 por ciento:1,52;4,39), relatar presencia de alergia (RP=4,32; IC95 por ciento: 2,79;6,70), relatar presencia de asma (RP= 2,30; IC95 por ciento:1,30;4,10) y vivir en apartamento (RP=1,70; IC95 por ciento:1,06;2,73); a la sinusitis auto-referida: edad de cinco a nueve años (RP=2,44; IC95 por ciento: 1,09;5,43), diez a 14 años (RP=2,99; IC95 por ciento: 1,36;6,58), 15 a 19 años (RP=3,62; IC95 por ciento: 1,68;7,81), relatar presencia de alergia (RP=2,23; IC95 por ciento: 1,41;3,52) y presentar obesidad (RP=4,42; IC95 por ciento: 1,56;12,50). CONCLUSIONES: Las enfermedades respiratorias prevalecieron mayormente en grupos poblacionales con características definidas, como grupo de edad, enfermedades auto-referidas, tipo de vivienda y obesidad.

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.

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 2003­2006 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/mm3 at the time of diagnosis. We also considered extended and stricter sets of criteria (in which the final criterion was ≤ 350 cells/mm3 and ≤ 100 cells/mm3 , 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 30­59 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.

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

OBJETIVO: avaliar o padrão de incorporação de fármacos antiretrovirais pelo Sistema Público de Saúde no Brasil (SUS). MÉTODOS: baseando-se em trabalhos prévios publicados na literatura médica foram propostos três indicadores a serem utilizados na análise da incorporação de fármacos: intervalo conhecimento-incorporação, massa crítica de conhecimento e intervalo validação-incorporação. Utilizando-se as bases de dados do Departamento de Informática do SUS (Datasus) e do Sistema de Controle Logístico de Medicamentos (SICLOM) foram selecionados dois grupos de tecnologias farmacológicas (medicações antiretrovirais e medicações de dispensação em caráter excepcional). RESULTADOS: os medicamentos antiretrovirais analisados foram incorporados de maneira mais precoce que os medicamentos de dispensação em caráter excepcional, tanto no que se refere ao intervalo "conhecimento-incorporação" quanto ao intervalo "validação-incorporação", e apresentam uma menor "massa crítica de conhecimento" para a incorporação. CONCLUSÃO: Os medicamentos antiretrovirais têm sido incorporados de maneira mais rápida, e após a publicação de um menor número de artigos científicos, quando em comparação aos medicamentos de dispensação em caráter excepcional.

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.

Pertussis booster vaccine for adolescents and young adults in São Paulo, Brazil / Avaliação de reforços vacinais contra a coqueluche para adolescentes e adultos na cidade de São Paulo / Evaluación de refuerzos vacunales contra la tosferina para adolescentes y adultos en la ciudad de Sao Paulo, Sureste de Brasil

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 percent coverage at age 12, or (ii) 70 percent coverage at age 12, and (iii) 35 percent coverage at age 12 and 70 percent coverage at age 20 at the same time. RESULTS: The strategy (i) achieved a 59 percent reduction of pertussis occurrence and a 53 percent reduction in infants while strategy (ii) produced 76 percent and 63 percent reduction and strategy (iii) 62 percent and 54 percent, 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.

OBJETIVO: Desenvolver um modelo capaz de acessar resultados de diferentes possíveis estratégias de reforço vacinal contra a coqueluche, na cidade de São Paulo. MÉTODOS: O modelo matemático dinâmico proposto é dependente da idade e considerou perda da imunidade vacinal com o avanço da idade. A matriz "who acquire infection from whom" foi utilizada para inserir as diferentes dinâmicas de contatos entre os grupos etários. Diferentes estratégias vacinais foram testadas, acrescentando reforços vacinais ao atual esquema utilizado, e três diferentes estratégias foram reportadas: (i) 35 por cento ou (ii) 70 por cento de cobertura vacinal na idade de 12 anos e (iii) coberturas vacinais de 35 por cento aos 12 anos e 70 por cento aos 20 anos ao mesmo tempo. RESULTADOS: A estratégia (i) produziu redução de 59 por cento nos casos de coqueluche e 53 por cento de redução entre os menores de um ano; a estratégia (ii) alcançou redução de 76 por cento nos casos e de 63 por cento entre os menores de um ano; a estratégia (iii) reduziu em 62 por cento o total de casos e 54 por cento entre os menores de um ano. DISCUSSÃO: Reforço vacinal contra a coqueluche aos 12 anos é a melhor estratégia dentre as testadas, pois gera maior redução de casos em todas as idades e alcança maior impacto entre os menores de um ano, os mais vulneráveis às complicações da coqueluche.

OBJETIVO: Desarrollar un modelo capaz de acceder resultados de diferentes posibles estrategias de refuerzo vacunal contra la tosferina, en la ciudad de Sao Paulo, Sureste de Brasil. MÉTODOS: El modelo matemático dinámico propuesto es dependiente de la edad y consideró pérdida de la inmunidad vacunal con el avance de la edad. La matriz "who acquire infection from whom" fue utilizada para insertar las diferentes dinámicas de contactos entre los grupos de edad. Diferentes estrategias vacunales fueron evaluadas, añadiendo refuerzos vacunales al actual esquema utilizado, e tres diferentes estrategias fueron reportadas: (i) 35 por ciento o (ii) 70 por ciento de cobertura vacunal en la edad de 12 años e (iii) coberturas vacunales de 35 por ciento a los 12 años y 70 por ciento a los 20 años al mismo tiempo. RESULTADOS: La estrategia (i) produjo reducción de 59 por ciento en los casos de tosferina y 53 por ciento de reducción entre los menores de un año; la estrategia (ii) alcanzó reducción de 76 por ciento en los casos y de 63 por ciento entre los menores de un año; la estrategia (iii) redujo en 62 por ciento el total de casos y 54 por ciento entre los menores de un año. DISCUSIÓN: Refuerzo vacunal contra la tosferina a los 12 años es la mejor estrategia entre las evaluadas, pues genera mayor reducción de casos en todas las edades y alcanza mayor impacto entre los menores de un año, los mas vulnerables a las complicaciones de la tosferina.

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.

Ponseti Brasil: a national program to eradicate neglected clubfoot - preliminary results.

BACKGROUND: After hearing about the reproducible and excellent results of the Ponseti method for clubfoot treatment, a group of Brazilian orthopaedic surgeons organized and participated in a standardized national program to teach the Ponseti technique in 21 different cities across Brazil. METHODS: A total of 21 Ponseti symposiums were organized in a standard fashion from January, 2007 to December, 2008. They consisted of a two-day program with lectures, hands-on cast application, and discussion of local clinical cases presented by orthopaedic surgeons. Thirteen Brazilian orthopaedic surgeons, who had been trained by the University of Iowa or centers recognized by them, taught the method. Financial support for travel was provided by an English charity: La Vida (Vital Investment for Developing Aid in Latin America). The physicians who attended the symposiums answered questionnaires before and after the training. RESULTS: About 7% of the 8000 orthopaedic surgeons in Brazil (556 orthopaedic surgeons) were trained. These orthopaedic surgeons stated that they had treated about 4905 babies in the previous year via other methods, including extensive surgery. Seventeen percent of the surgeons did not know about the Ponseti technique at the start of the symposium. Eighty-eight percent reported they felt able to treat children with the Ponseti technique after the symposium. Ninety-four percent of respondents reported that the symposium changed their way of treating clubfoot CONCLUSIONS: These Ponseti symposiums brought about an exchange of medical information and empowered the participants. This program is a good educational tool which can be used in eradicating neglected clubfoot in Brazil.

Estudo comparativo cefalométrico dos padrões dentofaciais de indivíduos portadores de oclusão normal e de más oclusões de Angle / Comparative cephalometric study of dentofacial patterns of individuals with normal occlusion and Angle malocclusions

OBJETIVO: avaliar os padrões dentofaciais de pacientes portadores de oclusão normal e más oclusões de Angle quanto a possíveis diferenças entre as grandezas estudadas, em relação ao sexo, dentro de cada grupo e entre os grupos. MÉTODOS: a amostra constou de 200 telerradiografias cefalométricas laterais obtidas de jovens brasileiros, de ambos os sexos, na faixa etária de 11 anos e 2 meses a 19 anos e 10 meses, apresentando dentição permanente. O material foi dividido, quanto ao tipo de oclusão, em cinco grupos: um de pacientes portadores de oclusão normal, e quatro de pacientes portadores de más oclusões de Angle, sendo cada grupo dividido igualmente quanto ao sexo. Foram avaliadas grandezas cefalométricas angulares e lineares. RESULTADOS: na grande maioria das grandezas, os sexos masculino e feminino não diferiram; entre os grupos, a posição da maxila não mostrou diferença significativa, o retrognatismo mandibular foi marcante nos grupos de Classe II divisões 1ª e 2ª e foram observados alguns desequilíbrios verticais com diferenças significativas; o padrão foi hipodivergente para os grupos de oclusão normal e Classe II, divisão 2ª, e neutro para os grupos de Classe I; Classe II, divisão 1ª; e Classe III; a compensação dentoalveolar foi evidente nos grupos de Classe III e de Classe II, divisão 2ª; o grupo de oclusão normal apresentou perfil mais convexo que os padrões americanos. CONCLUSÃO: foi possível configurar, de forma geral, algumas características da morfologia facial para alguns tipos de más oclusões. Entretanto, existe a necessidade de avaliar a face individualmente, pois algumas características permeiam entre os diferentes tipos de oclusão.

OBJECTIVE: To evaluate dentofacial patterns of patients with normal occlusion and Angle malocclusions, examining potential differences between specific cephalometric measures as they relate to gender, both intra- and intergroup.METHODS: The sample consisted of 200 lateral cephalometric radiographs obtained from young Brazilians of both genders, aged between 11 years and 2 months and 19 years and 10 months, with permanent dentition. The material was divided according to the type of occlusion into five groups: One group consisted of patients with normal occlusion and four groups of patients with Angle malocclusions, and each group was also divided by gender. Angular and linear cephalometric measures were evaluated.RESULTS: Genders did not differ in most measures. Position of the maxilla showed no significant differences between groups. Mandibular retrognathia was remarkable in groups with Class II, Divisions 1 and 2. Vertical imbalances were observed with some significant differences. The pattern was found to be hypodivergent for groups with normal occlusion and Class II, Division 2, and neutral for groups with Class I; Class II, Division 1 and Class III. Dentoalveolar compensation was evident in groups with Class III and Class II, Division 2. Finally, the normal occlusion group profile was more convex than the patterns found in the US population.CONCLUSIONS: In general, some features of facial morphology were associated with certain types of malocclusion. However, individual assessment of each face is still necessary as some of the features are shared across different types of occlusion.

Doença pulmonar obstrutiva crônica e fatores associados em São Paulo, SP, 2008-2009 / Prevalence of chronic obstructive pulmonary disease and risk factors in São Paulo, Brazil, 2008-2009 / Enfermedad Pulmonar Obstructiva Crónica y factores asociados en Sao Paulo, Sureste de Brasil, 2008-2009

OBJETIVO: Estimar a prevalência e fatores associados à doença pulmonar obstrutiva crônica. MÉTODOS: Estudo transversal, de base populacional com 1.441 indivíduos de ambos os sexos e com 40 anos de idade ou mais no município de São Paulo, SP, entre 2008 e 2009. As informações foram coletadas por meio de entrevistas domiciliares e os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade, e por conglomerados em dois estágios (setores censitários e domicílios). Foi realizada regressão múltipla de Poisson na análise ajustada. RESULTADOS: Dos entrevistados, 4,2 por cento (IC95 por cento 3,1;5,4) referiram doença pulmonar obstrutiva crônica. Após análise ajustada, identificaram-se os seguintes fatores independentemente associados ao agravo: número de cigarros fumados na vida (> 1.500/nenhum) RP = 3,85 (IC95 por cento: 1,87;7,94), cansar-se com facilidade (sim/não) RP = 2,61 (IC95 por cento 1,39;4,90), idade (60 a 69 anos/50 a 59 anos) RP = 3,27 (IC95 por cento 1,01;11,24), idade (70 anos e mais/50 a 59 anos) RP = 4,29 (IC95 por cento 1,30;14,29), problemas de saúde nos últimos 15 dias (sim/não) RP = 1,31 (IC95 por cento 1,02;1,77), e atividade física no tempo livre (sim/não) RP = 0,57 (IC95 por cento 0,26;0,97). CONCLUSÕES: A prevalência da doença pulmonar obstrutiva crônica é elevada e está associada ao uso do tabaco e idade acima de 60 anos. Os problemas de saúde freqüentes e redução da atividade física no tempo livre podem ser considerados conseqüências dessa doença.

OBJECTIVE: To assess the prevalence of chronic obstructive pulmonary disease and related risk factors. METHODS: A population-based cross-sectional study with 1,441 individuals of both sexes aged 40 years or more was conducted in the city of São Paulo, Brazil, between 2008 and 2009. A two-stage (census tract, household) cluster random sampling stratified by sex and age was used and data was collected through home interviews. Multiple Poisson regression was used in the adjusted analysis. RESULTS: Of all respondents, 4.2 percent (95 percentCI: 3.1;5.4) reported chronic obstructive pulmonary disease. After adjustment the following factors were found independently associated with self-reported chronic obstructive pulmonary disease: number of cigarettes smoked in their lifetime (>1,500 vs. none) (PR=3.85; 95 percentCI: 1.87;7.94); easily fatigued (yes vs. no) (PR=2.61; 95 percentCI: 1.39;4.90); age (60;69 vs. 50;59) (PR 3.27; 95 percentCI: 1.01;11.24); age (70 and over vs. 50;59) (PR 4.29; 95 percentCI: 1.30;11.29); health conditions in the last 15 days (yes vs. no) (PR=1.31; 95 percentCI: 1.02;1.77); leisure-time physical activity (yes vs. no) (PR=0.57; 95 percentCI: 0.26;0.97). CONCLUSIONS: The prevalence of chronic obstructive pulmonary disease is high in the population studied and is associated with smoking and age over 60. Frequent health conditions and low leisure-time physical activity are a consequence of the disease.

OBJETIVO: Estimar la prevalencia y factores asociados con la enfermedad pulmonar obstructiva crónica. MÉTODOS: Estudio transversal, de base poblacional con 1.441 individuos de ambos sexos y con 40 años de edad o más en el municipio de São Paulo, Sureste de Brasil, entre 3008 y 2009. Las informaciones fueron colectadas por medio de entrevistas domiciliares y los participantes fueron seleccionados a partir de muestreo probabilístico estratificado por sexo y edad, y por conglomerados en dos fases (sectores censitarios y domicilios). Se realizó regresión múltiple de Poisson en el análisis ajustado. RESULTADOS: De los entrevistados, 4,2 por ciento (IC95 por ciento 3,1;5,4) mencionaron enfermedad pulmonar obstructiva crónica. Posterior al análisis ajustado, se identificaron los siguientes factores independientemente asociados con el agravio: número de cigarros fumados en la vida (>1500/ninguno) RP=3,85 (IC95 por ciento 1,87;7,94), cansarse con facilidad (si/no) RP=2,61 (IC95 por ciento 1,39;4,90), edad (60 a 69 años/50 a 59 años) RP=3,27 (IC95 por ciento 1,01;11,24), edad (70 años y más/50 a 59 años) RP=4,29 (IC95 por ciento 1,30;14,29), problemas de salud en los últimos 15 días (si/no) RP=1,31 (IC95 por ciento 1,02;1,77) y actividad física en el tiempo de ocio (si/no) RP=0,57 (IC95 por ciento 0,26;0,97). CONCLUSIONES: La prevalencia de la enfermedad pulmonar obstructiva crónica es elevada y está asociada al uso del tabaco y edad por encima de 60 años. Los problemas de salud frecuentes y reducción de la actividad física en el tiempo de ocio pueden ser considerados consecuencias de dicha enfermedad.