Performance and health of Holstein calves fed different levels of milk fortified with symbiotic complex containing pre- and probiotics.

The objective of this study was to evaluate the performance and health of Holstein calves fed low or high milk supply (MSP) with or without symbiotic complex (SYM) supplementation, consisting of prebiotics, probiotics, and fibrolytic enzymes. Thirty-two Holstein calves with body weight (BW) of 34 ± 7 kg were distributed in a randomized block design in a 2 × 2 factorial arrangement. Treatments consisted of low and high MSP: 10 % of BW from 1st to 8th weeks after birth (low) and 20 % BW from 1st and 2nd weeks after birth, 15 % BW for the 3rd and 4th weeks after birth, and 10 % BW from 5th and 8th weeks after birth (high). Solid ration was supplied in addition to milk. Intake, ADG, diet digestibility, and fecal consistency index were evaluated. Low and high MSP groups tended (P < 0.10) to differ in calf growth, final BW (69 vs. 73 kg), post-weaning average weight gain (548 vs. 788 g/day), and final average weight gain (549 vs. 646 g/day) in low and high MSP calves, respectively. There was an interaction between MSP level and SYM on the digestibilities of dry matter (DM) and neutral detergent fiber (NDF) (P < 0.10). In the low MSP group, inclusion of SYM increased digestibility of DM (0.720 to 0.736 g/kg) and NDF (0.758 to 0.783 g/kg). The inclusion of SYM improved calf health (P < 0.10) with a fecal score of 0.31 compared to 0.42 without SYM. Milk-feeding level was an important factor in calf performance, while SYM supplementation improved diet digestibility and animal health.

Health care reform and quality initiatives in Brazil.

BACKGROUND: The pursuit of equity in health care and universal entitlement to access of services, as health care reform concerns, were addressed at a Brazilian national health conference in 1986, in a new constitution in 1988, and in subsequent legislative and administrative actions. However, in the early 1990s, economic policies affected the federal government's ability to fund the necessary services. QUALITY IMPROVEMENT (QI): In 1994 the Ministry of Health introduced a formal QI program, whose main purpose was to disseminate a culture of QI among health care providers, payers, and users of health services. The minister of health then established a national commission on QI, which played an important role in making QI activities an important activity. A NATIONAL ACCREDITATION PROGRAM: Efforts to create an accreditation program began in 1986. Since 1994 work has proceeded on organization of a nongovernmental accreditation agency, development of national standards and procedures for the accreditation of health services, and dissemination of methods and procedures for health care quality management. QI PROGRAMS: Examples of QI programs that have been successfully implemented include those at the State of Rio de Janeiro Blood Center and the National Institute of Cancer. Since 1996, many national societies have begun to produce consensus statements and guidelines. Progress has also been made in consumer rights and protection. CONCLUSIONS: The public, health care professionals, providers, and the government are increasingly aware of the need to strengthen and develop QI initiatives for health care in Brazil. Awareness of the opportunities for improvements in health care which outcomes trigger should help contribute to their application.

[Susceptibility to chemotherapeutic agents of Schistosoma mansoni isolates from patients treated with oxamniquine and praziquantel and not cured]. / Suscetibilidade aos agentes quimioterápicos de isolados de Schistosoma mansoni oriundos de pacientes tratados com oxamniquine e praziquantel e não curados.

Ten inhabitants of Itaquara, Bahia, Brazil treated with oxamniquine and subsequently praziquantel were not cured. Schistosoma mansoni isolates derived from these patients were studied. Snails were infected with miracidia derived from the feces of these patients and the cercariae produced used to infect albino mice. The animals were then treated with a single oral dose of oxamniquine (25, 50 and 100mg/kg) or praziquantel (100, 200 and 400 mg/kg). The response to chemotherapy was significantly different in some of the isolates although it was not possible to characterize any of them as resistant. In addition, DNA analysis of the isolates by means of "Random Amplified Polymorphic DNA" indicated a low degree of variability as compared with a laboratory strain, LE. Thus, it was not possible to characterize these organisms at a genetic level as a distinct strain.

[Strategies for the development of local health systems in the State of Rio de Janeiro, Brazil]. / Estratégias para a construção de sistemas locais de saúde no estado do Rio de Janeiro, Brasil.

The organization of health services has undergone large-scale changes since the beginning of the 1980s, as may be seen in the organization of local health systems, the introduction of integrated health actions, and the establishment of the unified and decentralized health system. These changes are aimed at municipalizing the services. In Rio de Janeiro, particularly in the Baixada Fluminense, the public and private network categories have ceased to exist, having been replaced by a single municipal network. Delay in the transfer of INAMPS services is impeding the formation of a fully unified network. Complete organization of the decentralized system demands the elimination of political and bureaucratic obstacles.