Annual trend of neonatal mortality and its underlying causes: population-based study - São Paulo State, Brazil, 2004-2013.

BACKGROUND: Population-based studies analyzing neonatal deaths in middle-income countries may contribute to design interventions to achieve the Sustainable Development Goals, established by United Nations. This study goal is to analyze the annual trend of neonatal mortality in São Paulo State, Brazil, over a 10-year period and its underlying causes and to identify maternal and neonatal characteristics at birth associated with neonatal mortality. METHOD: A population-based study of births and deaths from 0 to 27 days between 2004 and 2013 in São Paulo State, Brazil, was performed. The annual trend of neonatal mortality rate according to gestational age was analyzed by Poisson or by Negative Binomial Regression models. Basic causes of neonatal death were classified according to ICD-10. Association of maternal demographic variables (block 1), prenatal and delivery care variables (block 2), and neonatal characteristics at birth (block 3) with neonatal mortality was evaluated by Poisson regression analysis adjusted by year of birth. RESULTS: Among 6,056,883 live births in São Paulo State during the study period, 48,309 died from 0 to 27 days (neonatal mortality rate: 8.0/1,000 live births). For the whole group and for infants with gestational age 22-27, 28-31, 32-36, 37-41 and ≥ 42 weeks, reduction of neonatal mortality rate was, respectively, 18 %, 15 %, 38 %, 53 %, 31 %, and 58 %. Median time until 50 % of deaths occurred was 3 days. Main basic causes of death were respiratory disorders (25 %), malformations (20 %), infections (17 %), and perinatal asphyxia (7 %). Variables independently associated with neonatal deaths were maternal schooling, prenatal care, parity, newborn sex, 1st minute Apgar, and malformations. Cesarean delivery, compared to vaginal, was protective against neonatal mortality for infants at 22-31 weeks, but it was a risk factor for those with 32-41 weeks. CONCLUSIONS: Despite the significant decrease in neonatal mortality rate over the 10-year period in São Paulo State, improved access to qualified health care is needed in order to avoid preventable neonatal deaths and increase survival of infants that need more complex levels of assistance.

Serum Vitamin D Levels as Biomarkers in Patients with Autoimmune Uveitis and their Possible Correlation with Disease Activity.

This study investigated the correlation between serum vitamin D levels and intraocular inflammation in patients with autoimmune uveitis (AIU). We evaluated 67 patients with active and inactive AIU and measured their serum 25-hydroxyvitamin D [25(OH)D] concentration, sun exposure habits, number of relapses, and complications. Of the patients evaluated, 85% had significantly lower vitamin D levels, and patients with active uveitis had lower 25(OH)D levels than those with inactive uveitis. The odds of developing active uveitis decreased by 6% with each 1-unit increase in 25(OH)D. Patients with recurrent active AIU had significantly lower 25(OH)D serum levels than inactive forms, indicating that low vitamin D levels may alter the clinical course of intraocular inflammation in AIU. Additionally, the study found that a higher mean BMI increased the chances of an individual having active uveitis by 14%. These results suggest that serum vitamin D concentration could be a prognostic clinical biomarker in AIU.

Temporal Trend, Causes, and Timing of Neonatal Mortality of Moderate and Late Preterm Infants in São Paulo State, Brazil: A Population-Based Study.

Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 320/7-366/7 weeks gestation without congenital anomalies from 2004-2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 320/7-366/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais-Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.

Operational Challenges in the Use of Structured Secondary Data for Health Research.

Background: In Brazil, secondary data for epidemiology are largely available. However, they are insufficiently prepared for use in research, even when it comes to structured data since they were often designed for other purposes. To date, few publications focus on the process of preparing secondary data. The present findings can help in orienting future research projects that are based on secondary data. Objective: Describe the steps in the process of ensuring the adequacy of a secondary data set for a specific use and to identify the challenges of this process. Methods: The present study is qualitative and reports methodological issues about secondary data use. The study material was comprised of 6,059,454 live births and 73,735 infant death records from 2004 to 2013 of children whose mothers resided in the State of São Paulo - Brazil. The challenges and description of the procedures to ensure data adequacy were undertaken in 6 steps: (1) problem understanding, (2) resource planning, (3) data understanding, (4) data preparation, (5) data validation and (6) data distribution. For each step, procedures, and challenges encountered, and the actions to cope with them and partial results were described. To identify the most labor-intensive tasks in this process, the steps were assessed by adding the number of procedures, challenges, and coping actions. The highest values were assumed to indicate the most critical steps. Results: In total, 22 procedures and 23 actions were needed to deal with the 27 challenges encountered along the process of ensuring the adequacy of the study material for the intended use. The final product was an organized database for a historical cohort study suitable for the intended use. Data understanding and data preparation were identified as the most critical steps, accounting for about 70% of the challenges observed for data using. Conclusion: Significant challenges were encountered in the process of ensuring the adequacy of secondary health data for research use, mainly in the data understanding and data preparation steps. The use of the described steps to approach structured secondary data and the knowledge of the potential challenges along the process may contribute to planning health research.

Assessment of Alcohol and Tobacco Use Disorders Among Religious Users of Ayahuasca.

The aims of this study were to assess the impact of ceremonial use of ayahuasca-a psychedelic brew containing N,N-dimethyltryptamine (DMT) and ß-carboline -and attendance at União do Vegetal (UDV) meetings on substance abuse; here we report the findings related to alcohol and tobacco use disorder. A total of 1,947 members of UDV 18+ years old were evaluated in terms of years of membership and ceremonial attendance during the previous 12 months. Participants were recruited from 10 states from all major regions of Brazil. Alcohol and tobacco use was evaluated through questionnaires first developed by the World Health Organization and the Substance Abuse and Mental Health Services Administration. Analyses compared levels of alcohol and tobacco use disorder between the UDV and a national normative sample (n = 7,939). Binomial tests for proportions indicated that lifetime use of alcohol and tobacco was higher in UDV sample compared to the Brazilian norms for age ranges of 25-34 and over 34 years old, but not for the age range of 18-24 years old. However, current use disorders for alcohol and tobacco were significantly lower in the UDV sample than the Brazilian norms. Regression analyses revealed a significant impact of attendance at ayahuasca ceremonies during the previous 12 months and years of UDV membership on the reduction of alcohol and tobacco use disorder.

[Alcohol and alcoholism among Brazilian adolescent public-school students]. / Alcool e alcoolismo entre adolescentes da rede estadual de ensino de Cuiabá, Mato Grosso.

OBJECTIVE: To estimate the prevalence of alcohol consumption and alcoholism among working and non-working adolescents. METHODS: Cross-sectional study with a systematic, stratified sample 993 working adolescents and 1,725 non-working adolescents. The study included students enrolled in 1998 in the state public network schools of a city in Center-Western Brazil. An anonymous, self-administered questionnaire was completed by subjects in the classroom. Univariate and bivariate analyses and logistic regression were used. RESULTS: We found prevalences of 71.3% for alcohol consumption and 13.4% for alcoholism in the total sample, and higher prevalences among working students (81.0% and 14.9%) than among non-workers (65.8% and 12.6%). In addition to the association between alcohol use and work, we found both differences and similarities between the two groups. Alcoholism is not associated with work but is associated with male sex (OR=1.61; 95% CI: 1.18-2.19) and family history of alcohol use among both non-workers (OR=2.19; 95% CI: 1.60-2.99) and workers (OR=2.10; 95% CI: 1.42-3.12). CONCLUSIONS: The results of the present study indicate a high prevalence of alcohol consumption and alcoholism, which is higher among working adolescents. Sociodemographic, family, and work-related factors must be considered when attempting to implement educational measures aimed at changing alcohol-related behaviors in this population.

Tri-iodothyronine differentially induces Kupffer cell ED1/ED2 subpopulations.

Thyroid calorigenesis is carried out by activation of cytochrome-c oxidase, as well as by induction of mitochondrial and nuclear genes that code for cell respiratory apparatus components and uncoupling proteins. These effects operate increments in basal metabolic rate and also lead to increased production of oxygen and nitrogen reactive species in liver parenchymal cells. The hepatic antioxidant system is also compromised, since superoxide dismutase and catalase activities, glutathione content and lipid soluble antioxidants are reduced. Liver macrophages contribute to the hepatic oxidative stress observed in T(3)-treated rats, and both Kupffer cell hyperplasia and hypertrophy are reported. Kupffer cells constitute the main fixed macrophage population in the body and are a heterogeneous group of cells, derived from a less numerous population of local precursors, which are morphologically fairly distinguishable from the mature lineage elements. ED1 and ED2 antigens have been particularly useful in the characterization of Kupffer cell subpopulations. In particular, antibodies against these antigens provided evidence that T(3)- induced Kupffer cell hyperplasia causes a shift on liver macrophage population phenotype, leaning towards younger cell types. Despite the fact that sinusoidal environment itself stimulates the proliferation of macrophage precursors and their differentiation into Kupffer cells, increased Kupffer cell turnover rates modify the sinusoidal environment and may imply further functional effects. Thus, Kupffer cell hyperplasia secondary to increased T(3) levels is potentially a pro-inflammatory event, which involves both, the expansion of Kupffer cell precursor population by means of circulating monocyte recruitment, and the differentiation of preexisting local Kupffer cell precursors into mature liver macrophages.

Avaliação dos aspectos da Personalidade em pessoas idosas na cidade de São Paulo por meio do Rorschach Performance System (R-PAS) / Evaluation of personality aspects in elderly people in Sao Paulo city using Rorschach Performance System (R-PAS) / Evaluación de los aspectos de la personalidad en las personas mayores en la ciudad de São Paulo a través del Rorschach Performance System (R-PAS)

A proposta deste estudo é identificar aspectos da personalidade que predominam em uma amostra de idosos. Foram avaliadas cinquenta pessoas com idades entre 60 e 85 anos residentes na cidade de São Paulo e sem história psiquiátrica. Comparado à amostra normativa internacional de adultos, foi possível verificar uma visão mais simplista e distorcida da realidade, embora sem confusão de pensamento, além de dificuldade cognitiva e necessidade maior de estimulação diante das demandas do ambiente.

The purpose of this study is to identify aspects of personality that predominate in a population sample of elderly individuals. Fifty people aged between 60 and 85 years old with no psychiatric history were evaluated. In comparison with the international normative sample of adults, it was possible to verify a more simplistic and distorted vision of reality, however with no thought disturbance, and some cognitive difficulty, as well as a greater need of stimulation as a result of the environment demands.

La propuesta de este estudio es identificar aspectos de la personalidad que predominan en una muestra de ancianos. Se evaluaron cincuenta personas con edades entre 60 y 85 años residentes en la ciudad de São Paulo y sin historia psiquiátrica. En comparación con la muestra normativa internacional de adultos, fue posible verificar una visión más simplista y distorsionada de la realidad, aunque sin confusión de pensamiento, además de dificultad cognitiva y necesidad mayor de estimulación ante las demandas del ambiente.

Outcomes of laser thermal therapy for recurrent head and neck cancer.

OBJECTIVE: To review the outcomes of a phase II study using laser-induced thermal therapy (LITT) as a palliative treatment for 106 patients with recurrent head and neck tumors. STUDY DESIGN: Retrospective study. SETTING: Tertiary hospital in the United States. SUBJECTS AND METHODS: The primary endpoints were tumor response and survival. Prognostic values were assessed by the Kaplan-Meier method. RESULTS: The best results were seen in oral cavity tumors, in which mean survival was 29.1 months, as compared to neck tumors (mean 14.4 +/- 6.9 months; range 7.5-20.7 months; with a 95% confidence interval). Further analysis showed that clinical factors such as gender, smoking, and alcohol use were not indicators of poor prognosis, whereas neck disease and tumor stage at first treatment were relevant factors. CONCLUSION: In this study, 40 out of 106 patients treated by LITT remained alive at the end of our follow-up, and a complete response was seen in 24 (22.6%) patients. The highest response rate was seen in oral cavity tumors, which suggests that tumor location at this site may be a predictor of favorable outcome with LITT.

Alcool e alcoolismo entre adolescentes da rede estadual de ensino de Cuiabá, Mato Grosso / Alcohol and alcoholism among Brazilian adolescent public-school students

OBJETIVO: Estimar a prevalência de consumo de álcool e do alcoolismo entre estudantes adolescentes trabalhadores e não trabalhadores. MÉTODOS: Estudo transversal, realizado por amostragem estratificada sistemática, composta por 993 adolescentes trabalhadores e 1.725 não-trabalhadores. Foram incluídos os estudantes matriculados em 1998, na rede estadual de ensino de Cuiabá, MT. Aplicou-se, em sala de aula, um questionário de auto-preenchimento anônimo. Utilizou-se as análises univariada, bivariada e regressão logística. RESULTADOS: Verificaram-se prevalências de 71,3 por cento para o consumo de álcool e 13,4 por cento para alcoolismo na amostra total, sendo maior entre os estudantes trabalhadores (81,0 por cento e 14,9 por cento) comparativamente aos não-trabalhadores (65,8 por cento e 12,6 por cento). Além da associação do uso de álcool com o trabalho, observou-se tanto semelhanças quanto diferenças entre os dois grupos. O alcoolismo não está associado ao trabalho, mas ao sexo masculino (RO=1,61; IC 95 por cento: 1,18-2,19) e história de álcool na família tanto entre os não-trabalhadores (RO=2,19; IC 95 por cento: 1,60-2,99) quanto entre trabalhadores (RO=2,10; IC 95 por cento: 1,42-3,12). CONCLUSÕES: Os resultados indicam alta prevalência de consumo de álcool e alcoolismo, sendo maior entre os adolescentes trabalhadores. Os fatores sociodemográficos, familiares e relacionados a trabalho devem ser considerados na implementação de ações educativas nessa população, visando a mudanças de comportamento relacionadas ao consumo de álcool.