Molecular phylogeny of the subfamily Amphistichinae (Teleostei: Embiotocidae) reveals parallel divergent evolution of red pigmentation in two rapidly evolving lineages of sand-dwelling surfperch.

Pigment evolution was reconstructed in the subfamily Amphistichinae, a six-species clade of the surfperches, family Embiotocidae. Assignment was confirmed for all species within the subfamily, but low levels of differentiation were found among species within the subfamily, suggesting a recent radiation. The new phylogeny differs from previous hypotheses by the placement of the spotfin surfperch Hyperprosopon anale at the base of the subfamily, while still preserving the calico surfperch Amphistichus koelzi and the redtailed surfperch Amphistichus rhodoterus as sister species. Phenotypically, A. rhodoterus, A. koelzi and the silver surfperch Hyperprosopon ellipticum express high levels of red pigmentation. The barred surfperch, Amphistichus argenteus and the walleye surfperch Hyperprosopon argenteum express little to no red pigment, while basal H. anale expresses an intermediate amount of red pigment. Red pigmentation is proposed to have experienced parallel divergent evolution in each genus within the subfamily.

Breastfeeding training for health professionals and resultant changes in breastfeeding duration.

CONTEXT: Promotion of breastfeeding in Brazilian maternity hospitals. OBJECTIVE: To quantify changes in the breastfeeding duration among mothers served by hospitals exposed to the Wellstart-SLC course, comparing them with changes among mothers attended by institutions not exposed to this course. DESIGN: Randomized Institutional Trial. SETTING: The effects of training on breastfeeding duration was assessed in eight Brazilian hospitals assigned at random to either an exposed group (staff attending the Wellstart-SLC course) or a control group. SAMPLE: For each of the eight study hospitals, two cohorts of about 50 children were visited at home at one and six months after birth. The first cohort (n = 494) was composed of babies born in the month prior to exposure to the Wellstart-SLC course, and the second cohort (n = 476) was composed of babies born six months subsequent to this exposure. MAIN MEASUREMENTS: Kaplan-Meier curves were plotted to describe the weaning process and log-rank tests were used to assess statistical differences among survival curves. Hazard ratio (HR) estimates were calculated by fitting Cox proportional hazard regression models to the data. RESULTS: The increases in estimated, adjusted rates for children born in hospitals with trained personnel were 29% (HR = 0.71) and 20% (HR = 0.80) for exclusive and full breastfeeding, respectively. No changes were identified for total breastfeeding. CONCLUSION: This randomized trial supports a growing body of evidence that training hospital health professionals in breastfeeding promotion and protection results in an increase in breastfeeding duration.

[Focus groups: preliminary experiences in educational health programs in Brazil]. / Grupos focais: experiências precursoras em programas educativos em saúde no Brasil.

Since 1989, the public health education section of the University of São Paulo (USP), Brazil, has been using the focus group technique to identify educational problems and evaluate programs being developed. The focus group is a research technique that allows qualitative data to be collected through group sessions involving 6 to 15 persons with some shared trait (for example, sex, age, occupation, role in the community). The group discusses various aspects of a specified subject. This paper describes five research projects in which this technique was used. The projects were carried out by professors in the School of Public Health/USP in the state of São Paulo between 1989 and 1992 with population groups and in health institutions. These experiences showed that the technique is efficient, permitting rapid identification and in-depth analysis of problems from the point of view of the population. Among the drawbacks to the technique is that it uses a small and nonrandom sample, which means that in certain cases focus groups should be considered a complement to quantitative studies. The data described here provide knowledge of perceptions, ideas, opinions, expectations, and social images-in short, the cultural and verbal universe of the population. With this information, educators and administrators can plan and evaluate education programs on the basis of the needs and views of the people they serve, putting into practice the plan to make education more democratic and responsive to the needs of its public.

[Referred morbidity and the utilization of health services in Brazilian urban areas: methodology]. / Morbidade referida e utilização de serviços de saúde em localidades urbanas brasileiras: metodologia.

The reorganization of the Brazilian health system in the last few years has been based on the decentralization of the services and the integration of preventive and curative medicine, then creating new needs in term of the health information needed for health planning. The planning and administration of a regionalized and integrated health system calls for information about the population's morbidity profile, and the description of the pattern of the utilization of the health services, which can be obtained by means of household health surveys. The methodology utilized in a household health survey carried out in the Metropolitan Area of S. Paulo, Brazil, from July 1989 to June 1990, is described. This survey has some distinct methodological characteristics, such as the sampling process that defined the domains by age and sex, allowing an analysis of populational groups less well represented in the general population, as that of less than one year of age and that of aged people, as well as the use of the results of the latest Brazilian Census in 1991 for adjusting the sample.

Capacitacion de profesionales de salud en lactancia natural y reformas institucionales subsiguientes / Breast-feeding training for health professionals and resultant institutional changes

Se evalua un curso de capacitacion sobre la lactancia natural al que asistieron varios profesionales de la salud en el Centro de Lactancia de Santos (CLS), Estado de Sao Paulo, Brasil, y se examina su efecto en la ejecucion de programas para la promocion de la lactancia natural en hospitales de maternidad. Ocho hospitales de este tipo se incluyeron en el estudio. De ellos, cuatro fueron asignados aleatoriamente al grupo experimental y enviaron a tres profesionales de salud a un curso de 18 dias en el CLS; las cuatro instituciones restantes formaron el grupo testigo. Para determinar en que grado se adheria cada hospital a las "Diez medidas para el exito de la lactancia materna" establecidas por la OMS y el UNICEF se calculo un puntaje antes del curso y otro seis meses despues de concluirlo. Las instituciones del grupo experimental tuvieron un mejor puntaje que las del grupo testigo. El curso del CLS fue eficiente porque permitio a los participantes promovieran la practica de la lactancia natural. Sin embargo, para ejecutar con exito los programas correspondientes, los profesionales de salud tambien tienen que aprender a aplicar los conocimientos adquiridos en el curso y lograr que todo el equipo del servicio de maternidad participe en las actividades correspondientes (AU)

Capacitacion de profesionales de salud en lactancia natural y reformas institucionales subsiguientes / Breast-feeding training for health professionals and resultant institutional changes

Se evalua un curso de capacitacion sobre la lactancia natural al que asistieron varios profesionales de la salud en el Centro de Lactancia de Santos (CLS), Estado de Sao Paulo, Brasil, y se examina su efecto en la ejecucion de programas para la promocion de la lactancia natural en hospitales de maternidad. Ocho hospitales de este tipo se incluyeron en el estudio. De ellos, cuatro fueron asignados aleatoriamente al grupo experimental y enviaron a tres profesionales de salud a un curso de 18 dias en el CLS; las cuatro instituciones restantes formaron el grupo testigo. Para determinar en que grado se adheria cada hospital a las "Diez medidas para el exito de la lactancia materna" establecidas por la OMS y el UNICEF se calculo un puntaje antes del curso y otro seis meses despues de concluirlo. Las instituciones del grupo experimental tuvieron un mejor puntaje que las del grupo testigo. El curso del CLS fue eficiente porque permitio a los participantes promovieran la practica de la lactancia natural. Sin embargo, para ejecutar con exito los programas correspondientes, los profesionales de salud tambien tienen que aprender a aplicar los conocimientos adquiridos en el curso y lograr que todo el equipo del servicio de maternidad participe en las actividades correspondientes (AU)

Se publico en ingles en el Bull. WHO. Vol. 73(4), 1995

Breast-feeding training for health professionals and resultant institutional changes.

Assessed is a breast-feeding training course that was attended by health professionals at the Santos Lactation Center (SLC), Santos, São Paulo, Brazil, as well as its impact on the implementation of breast-feeding programmes in maternity hospitals. Eight maternity hospitals were studied--four were randomly allocated to the experimental group and sent three health professionals to attend an 18-day course at SLC; the remaining four institutions constituted the control group. The compliance of all eight hospitals with WHO/UNICEF's "Ten steps for successful breast-feeding" was determined using scores obtained before and 6 months after the training course. Institutions in the experimental group had an improved score, but those in the control group did not. The SLC training course was efficient since it enabled the participants to promote breast-feeding practices. However, in order to succeed in implementing breast-feeding programmes, health professionals require also to develop skills to apply the knowledge they acquire in the course, as well as to involve the whole maternity unit team in the activities.

PIP: A breast-feeding training course was assessed that was attended by health professionals at the Santos Lactation Center (SLC), Santos, Sao Paulo, Brazil, as well as its impact on the implementation of breast-feeding programs in maternity hospitals. Eight maternity hospitals were studied, 4 were randomly allocated to the experimental group with 3 health professionals to attend an 18-day course at SLC; the remaining 4 institutions constituted the control group. The course consisted of 45 units that covered theoretical and practical aspects of breast-feeding over a 133-hour period. The compliance of all 8 hospitals with the World Health Organization (WHO)/UNICEF's 10 steps for successful breast-feeding was determined using scores obtained before and 6 months after the training course. Individual interviews were held 6 months after the SLC course with directors in participating institutions, with administrative managers, and with professionals in charge of antenatal, nursery, and outpatient services. 16 focus group sessions were also held with 6-15 persons of the staff 6 months after the course. Pre- and postcourse test results showed that in general there was improvement in the students' knowledge on breast-feeding (the average number of correct answers were 20.27 precourse and 26.92 postcourse). Institutions in the experimental group had an improved score, but those in the control group did not. Changes were more particularly in relation to steps 2 (train all health care staff in skills necessary to implement this policy) and 10 (foster the establishment of breast-feeding support groups and refer mother to them upon discharge from hospital). Among graduate-level professionals interpersonal conflicts limited the possibilities for change. The SLC training course enabled the participants to promote breast-feeding practices. However, in order to succeed in implementing breast-feeding programs, health professionals also have to apply the knowledge they acquire in the course as well as involve the whole maternity unit team in the activities.

[Effects of previous distribution of documents containing educational objectives on the teaching of pediatrics]. / Efeitos da distribuição prévia de documento contendo objetivos educacionais sobre o ensino de pediatria.

The authors discuss the usefulness of giving to the students of the Department of Pediatrics of the University of São Paulo instructions regarding the educational objectives of the graduation course. An inquiry was carried out with the collaboration of: 1) members of the Departmental Council and of the Commission for Graduation; 2) teachers responsible for the course, and 3) the students. Only 32.9% of the consulted students affirmed that the knowledge of educational objectives had a positive influence on their study.

[Perceptions of the head physician concerning educational activities in Municipal Health Services]. / Percepções do médico-chefe a respeito de atividades educativas em Postos de Assistência Médica.

The results of a research project carried out along with head-physicians of the Municipal Health Services (PAMs) of the city of S. Paulo in order to survey their knowledge, expectations and willingness to participate in and incentivate educational programs in the various PAMs, are reported on. An open-ended questionnaire was answered by 88.6% of the head-physicians. Results showed that the concept of health of the majority of the PAMs' head-physicians (66.3%) was coincidental with that adopted by the WHO. Only 2.9% considered that health is related to quality of life. Health education was seen as the provision of information by 70.0%; only 6.7% recognized their responsibility for the process of social and health change. According to 68.2% of them, health actions were acknowledged to be useful tools for making the users aware of the importance of having the diseases treated. Health actions, their planning, implementation and evaluation were considered to be the responsibility of all who work at the PAMs, but mainly of nurses, social workers and the health educator. Some difficulties in implementing educational activities were indicated; among them being lack of sufficient material and adequate space for their implementation, lack of professional Public Health Educators and, mainly, a lack of motivation on the part of both staff and population. The majority of the head-physicians recognized that educational activities are important, that they are carried out at least by part of their staffs, although frequently hampered by technical and operational difficulties.

The concept of participation in a program of bronchial asthma control.

An experiment involving the participation of mothers of asthmatic children was carried out at the Child Institute of the University of São Paulo, Brazil, a Children's Teaching Hospital. The experiment emphasized an intensive educational program input based on dialogue and problem solving involving both mothers and health professionals. The study demonstrated the possibilities of adoption of an open educational attitude by health professionals which permits participation of patients in a self-care process. It also helped to improve knowledge, attitudes, and practice of the mothers of asthmatic children.