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Objectives: Restless legs syndrome (RLS) is a frequent comorbid condition associated with distinct unrelated diseases. While the incidence of RLS has not been definitively confirmed, RLS-like symptoms have been reported in a section of Asian population who also had hyperthyroidism. The prevalence of RLS is generally low in Asian populations. Under these circumstances, we hypothesized that in a population where RLS is common, such as in Brazil, RLS could manifest as a comorbid ailment alongside Graves' disease, a common hyperthyroid condition., Methods: In a cross-sectional survey, 108 patients who presented with Graves' disease were analyzed for restless legs or associated symptoms., Results: Twelve patients (11.1%) displayed symptoms of RLS prior to the incidence of Graves' disease. These patients experienced worsening of the symptoms during their hyperthyroid state. Six patients (5.6%) developed RLS, consequent upon the incidence of Graves' disease as per the consensus of the panel of the experts. Fifteen patients (13.9%) also presented with RLS-like symptoms without any discernible circadian feature of the syndrome., Conclusion: Our findings confirm that Graves' disease might trigger restless legs-like symptoms, while the condition of hyperthyroidism could also be complicated by definite RLS.

Background: Knee extensor strength assessment has been especially emphasized in older people, but lack of reference values limits its usefulness in geriatric evaluation., Aims: The aim of this study was to develop a reference equation for knee extensor isokinetic strength standards in older women., Methods: Knee extensor isokinetic tests at 60°/s were performed in 390 Brazilian older women aged 60-84 years (67.38 ± 5.56 years) and in a separate validation sample of 110 women (67.94 ± 6.13 years). A regression equation for peak torque (PT) was derived and compared to commonly used formulas: the equations of Neder and Gross. Age, weight and height were the only significant predictors (multiple R = 0.55; R 2  = 0.30; p < 0.001). The proposed equation was examined in the independent sample. Percent from predicted values was calculated and Bland-Altman plots were constructed., Results: Both the Neder and Gross equations significantly underestimated predicted PT values (both p < 0.001); mean bias were 6.79 and 6.75, respectively. The proposed equation [PT = 39.72 - (1.24 × age) + (0.44 × weight) + (69.70 × height)] was matched with the independent sample, with a percent predicted isokinetic strength of approximately 95%, a mean bias approximately 40% lower 4.23 than the other equations, and stable across all age groups., Conclusions: Available equations for knee extensor isokinetic strength are not adequate for older women. The equation developed in the present study provided considerably lower average error and thus with more suitable reference values.

Solanum paniculatum is popularly known as "jurubeba-verdadeira". In folk medicine, its roots, stems, and leaves are used as tonics, anti-inflammatories, carminatives, diuretics, and for gastrointestinal disorders. This species is listed in the Brazilian Pharmacopoeia and belongs to the "Relação Nacional de Plantas Medicinais de Interesse ao SUS". Based on folk medicine data of the Solanum genus, we decided to investigate whether the crude ethanol extract from S. paniculatum aerial parts presents toxicological, antidiarrheal, and spasmolytic activities. The crude ethanol extract from S. paniculatum aerial parts did not produce in vitro or in vivo toxicity and showed dose-dependent antidiarrheal activity, inhibiting equipotently both the defecation frequency (ED50 = 340.3 ± 35.1 mg/kg) and liquid stool formation (ED50 = 370.1 ± 19.4 mg/kg) in mice. Conversely, the crude ethanol extract from S. paniculatum aerial parts did not inhibit normal intestinal transit, even though it has shown a dose-dependent reduction of both the castor oil-induced intestinal transit (Emax = 36.9 ± 1.3 %, ED50 = 242.0 ± 8.6 mg/kg) and intestinal fluid content (Emax = 74.8 ± 2.4 %, ED50 = 328.9 ± 15.9 mg/kg). Additionally, the crude ethanol extract from S. paniculatum aerial parts was approximately 2-fold more potent in antagonizing the phasic contractions induced with histamine (IC50 = 63.7 ± 3.5 µg/mL) than carbachol 10(-6) M (IC50 = 129.3 ± 14.1 µg/mL). Therefore, we concluded that the crude ethanol extract from S. paniculatum aerial parts presents antidiarrheal activity in mice related to the inhibition of small intestinal motility and secretion as well as nonselective spasmolytic activity on the guinea pig ileum., (Georg Thieme Verlag KG Stuttgart · New York.)

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.

The coastal plain of the state of Rio Grande do Sul, in southern Brazil, includes four barrier-lagoon depositional systems formed by successive Quaternary sea-level highstands that were correlated to marine isotope stages (MIS) 11, 9, 5 and 1, despite the scarcity of absolute ages. This study describes a sea-level highstand older than MIS 5, based on the stratigraphy, ages and fossils of the shallow marine facies found in coastal barrier (Barrier II). This facies outcrops along the banks of Chuí Creek, it is composed of fine, well-sorted quartz sand and contains ichnofossils Ophiomorpha nodosa and Rosselia sp., and molluscan shells. The sedimentary record indicates coastal aggradation followed by sea-level fall and progradation of the coastline. Thermoluminescence (TL) and electron spin resonance (ESR) ages from sediments and fossil shells point to an age of ∼220 ka for the end of this marine transgression, thus correlating it to MIS 7 (substage 7e). Altimetric data point to a maximum amplitude of about 10 meters above present-day mean sea-level, but tectonic processes may be involved. Paleoceanographic conditions at the time of the highstand and correlations with other deposits in the Brazilian coasts are also discussed.

The population of the northeast of Brazil is characterized by high rates of endogamy and disabilities. An epidemiological cross-sectional study using the informant method was conducted in eight communities in the hinterlands of Paraiba to describe genetic and acquired diseases that cause disabilities and to estimate the costs of specialized services such as physiotherapy and the acquisition of technological assistential equipment. From a population of 48,499 inhabitants, 338 individuals were screened and 123 (0.34%) were clinically, genetically and functionally assessed by a multidisciplinary team of specialists. Genetic factors were responsible for 58.5% of the disabilities, with some clusters of prevalent diseases being found within the sampled communities, namely progressive spinal muscular atrophy, spinocerebellar ataxia, muscular dystrophy and Spoan syndrome. The socioeconomic profile and the demand for rehabilitation services and technological assistance highlight the need to introduce and implement specific public health policies in these communities.

Objectives: The aim of this study was to identify communities at high risk of transmitting recessive genetic disorders by measuring levels of endogamy and offspring's rate of disabilities., Methods: In a house-to-house population based-survey in the state of Paraíba, 20,462 couples were interviewed regarding kinship relation, number of siblings and offspring affected by mental or physical disabilities., Results: The rate of consanguineous unions in the communities ranged from 6.0% to 41.14%, showing an average value of 20.19% ± 9.13%. The overall average inbreeding coefficient (F) was 0.00602 ± 0.00253, ranging from 0.00134 to 0.01182. Communities situated on the backlands had an increased average value of F compared to those closer to the seashore (P = 0.024). The average rate of disabled offspring varied from 2.96% ± 0.68% for unrelated unions to 10.44% ± 16.86% for related couples at the level of double first cousins or uncle-niece. The Spearman correlation coefficient between the overall rate of disabled offspring from all couples together and F was 0.510 (P < 0.01)., Conclusion: Inbreeding increases the risk of disability which is unevenly distributed, varying considerably even in neighboring communities with similar Human Development Index and population density. Higher inbreeding communities are mostly located on the more economically underdeveloped backlands than on the coastal region. The identification of communities at high risk for genetic disorders could serve as basis for the establishment of Community Genetics programs., (Copyright © 2012 Wiley Periodicals, Inc.)

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.

Background: In a classical study, Durkheim mapped suicide rates, wealth, and low family density and realized that they clustered in northern France. Assessing others variables, such as religious society, he constructed a framework for the analysis of the suicide, which still allows international comparisons using the same basic methodology. The present study aims to identify possible significantly clusters of suicide in the city of São Paulo, and then, verify their statistical associations with socio-economic and cultural characteristics., Methods: A spatial scan statistical test was performed to analyze the geographical pattern of suicide deaths of residents in the city of São Paulo by Administrative District, from 1996 to 2005. Relative risks and high and/or low clusters were calculated accounting for gender and age as co-variates, were analyzed using spatial scan statistics to identify geographical patterns. Logistic regression was used to estimate associations with socioeconomic variables, considering, the spatial cluster of high suicide rates as the response variable. Drawing from Durkheim's original work, current World Health Organization (WHO) reports and recent reviews, the following independent variables were considered: marital status, income, education, religion, and migration., Results: The mean suicide rate was 4.1/100,000 inhabitant-years. Against this baseline, two clusters were identified: the first, of increased risk (RR=1.66), comprising 18 districts in the central region; the second, of decreased risk (RR=0.78), including 14 districts in the southern region. The downtown area toward the southwestern region of the city displayed the highest risk for suicide, and though the overall risk may be considered low, the rate climbs up to an intermediate level in this region. One logistic regression analysis contrasted the risk cluster (18 districts) against the other remaining 78 districts, testing the effects of socioeconomic-cultural variables. The following categories of proportion of persons within the clusters were identified as risk factors: singles (OR=2.36), migrants (OR=1.50), Catholics (OR=1.37) and higher income (OR=1.06). In a second logistic model, likewise conceived, the following categories of proportion of persons were identified as protective factors: married (OR=0.49) and Evangelical (OR=0.60)., Conclusions: This risk/ protection profile is in accordance with the interpretation that, as a social phenomenon, suicide is related to social isolation. Thus, the classical framework put forward by Durkheim seems to still hold, even though its categorical expression requires re-interpretation.

Considering the negative impact anxiety can exert over dental treatment, the scope of this study was to determine the prevalence of predictors of anxiety regarding dental treatment among Brazilians. A cross-sectional study was carried out using the Corah dental anxiety scale to assess the degree of anxiety regarding dental treatment among 3000 patients. The results reveal that two out of every eight Brazilian patients manifest moderate to severe anxiety regarding dental treatment. In this sample, the degree of anxiety was higher among females (p=0.007), over 20 years of age (p=0.006), without access to the Internet and/or newspapers (p=0.016), with a low frequency of oral hygiene (p=0.001), for whom the reason for the dental appointment was curative treatment, pain or another problem rather than a check up (p=0.047) and those suffering from toothache (p<0.001). Fear and anxiety regarding dental treatment indeed exist in the Brazilian population and the findings of this study suggest that, besides the lack of economic resources, negligence with respect to oral health, gender and age may increase the degree of anxiety.

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.

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.

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.

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.

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% (95%CI: 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%CI: 1.87;7.94); easily fatigued (yes vs. no) (PR=2.61; 95%CI: 1.39;4.90); age (60;69 vs. 50;59) (PR 3.27; 95%CI: 1.01;11.24); age (70 and over vs. 50;59) (PR 4.29; 95%CI: 1.30;11.29); health conditions in the last 15 days (yes vs. no) (PR=1.31; 95%CI: 1.02;1.77); leisure-time physical activity (yes vs. no) (PR=0.57; 95%CI: 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.

Objective: To estimate reference values and the hierarchy function of professors engaged in Collective Health in Brazil by analyzing the distribution of the h-index., Methods: From the Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Portal of Coordination for the Improvement of Higher Education Personnel ), 934 authors were identified in 2008, of whom 819 were analyzed. The h-index of each professor was obtained through the Web of Science using search algorithms controlling for namesakes and alternative spellings of their names. For each Brazilian region and for the country as a whole, we adjusted an exponential probability density function to provide the population parameters and rate of decline by region. Ranking measures were identified using the complement of the cumulative probability function and the hierarchy function among authors according to the h-index by region., Results: Among the professors analyzed, 29.8% had no citation record in Web of Science (h=0). The mean h for the country was 3.1, and the region with greatest mean was the southern region (h=4.7). The median h for the country was 3.1, and the greatest median was for the southern region (3.2). Standardizing populations to one hundred, the first rank in the country was h=16, but stratification by region shows that, within the northeastern, southeastern and southern regions, a greater value is necessary for achieving the first rank. In the southern region, the index needed to achieve the first rank was h=24., Conclusions: Most of the Brazilian Collective Health authors, if assessed on the basis of the Web of Science h-index, did not exceed h=5. Regional differences exist, with the southeastern and northeastern regions being similar and the southern region being outstanding.

The main objective of this study was to determine if there are variations in the level of improvement of the palmar and plantar hyperhidrotic symptoms, as well as the incidence and intensity of the sudomotor reflex, throughout the seasons of the year, after thoracic sympathectomy for hyperhidrosis. The study also looks for the real impact of these variables in the long-term satisfaction. A cohort of 75 patients was followed through distinct seasons. A multivariate analysis was performed to identify possible variables responsible for dissatisfaction. Both the palmar (P=0.002) and plantar (P<0.001) symptoms and the presence and the intensity of the sudomotor reflex varies significantly throughout the seasons of the year. The sudomotor reflex was the main factor associated with low satisfaction in our patients in the summer (P=0.025) and winter (P<0.001) but in spring the lack of improvement in the hyperhidrosis in the foot was the unique factor related to dissatisfaction (P<0.001). The sudomotor reflex is the main negative factor in the summer and in the winter, independent of its intensity. However, at least in spring, the lack of removal of the plantar symptoms had a negative impact on satisfaction.

Background & Aims: We evaluated the ability of Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA) to predict malnutrition related to poor clinical outcomes., Methods: We assessed 705 patients at a public university hospital within 48 h of admission. Logistic regression and number needed to screen (NNS) were calculated to test the complementarity between the tools and their ability to predict very long length of hospital stay (VLLOS), complications, and death., Results: Of the patients screened, 27.9% were at nutritional risk (NRS+) and 38.9% were malnourished (SGA B or C). Compared to those patients not at nutritional risk, NRS+, SGA B or C patients were at increased risk for complications (p=0.03, 0.02, and 0.003, respectively). NRS+ patients had an increased risk of death (p=0.03), and SGA B and C patients had an increased likelihood of VLLOS (p=0.008 and p<0.0001, respectively). Patients who were both NRS+ and SGA C had lower estimates of NNS than patients who were NRS+ or SGA C only, though their confidence intervals did overlap., Conclusions: The concurrent application of SGA in NRS+ patients might enhance the ability to predict poor clinical outcomes in hospitalized patients in Brazil., (Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

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.

Objective: To evaluate the evolution of scientific papers published on digestive tract surgery in Brazilian journals in 20 years and examine whether the level of evidence in the studies has improved, as well as the incorporation of statistical procedures and their proper application., Methods: We selected all original articles related to digestive tract surgery published in the years of 1987 and 2007 in 4 leading Brazilian surgical journals. Studies were divided according to the level of evidence (I: prospective, controlled and randomized, II: prospective without control or randomization and III: retrospective) and compared them to assess whether there was an improvement in the level of evidence between these two years surveyed. We also assessed whether there was increased use of analytical statistics and correct application of statistical procedures., Results: Comparing the articles published in 1987 with those of 2007, we observed no improvement with respect to the level of evidence, with more than half of the articles published being case series and retrospective studies (56.14%). There has been a significant increase in the use of analytical statistics (70.4% in 2007 vs. 40% in 1987) in the 20 years, however 16.7% of the studies published in 2007 did not correctly apply or adequately describe the statistical analyses used., Conclusion: In this study, we observed no improvement in the level of evidence presented in publications on digestive tract surgery in the last 20 years. There was an increased use of statistical analysis, but there is a need to correctly apply statistical procedures.

Background and Study Aims: Magnifying colonoscopy with indigo carmine dye and the analysis of the capillary and the pit patterns by computed virtual chromoendoscopy (Fujinon Intelligent Color Enhancement, FICE) with magnification are effective for the differential diagnosis of neoplastic and non-neoplastic lesions. This study aimed to compare the accuracy of virtual and real chromoendoscopy in differentiating neoplastic and non-neoplastic colorectal lesions., Patients and Methods: A prospective randomized trial of magnification colonoscopy with targeted FICE (Group I - 72 patients/111 lesions) versus magnification colonoscopy with targeted indigo carmine dye (Group II - 72 patients/137 lesions) was performed in consecutive patients with lesions 1 cm or less. Histopathology of the specimens was regarded as the gold standard., Results: In group I, 86 (77.5%) lesions showed an intense vascular pattern (positive capillary meshwork), of which 80 (93%) were histologically confirmed as adenomas. From 25 lesions with negative capillary meshwork, 23 (92%) were non-neoplastic. Sensitivity, specificity, accuracy, positive and negative predictive values of the capillary meshwork for the differential diagnosis of these lesions was 97.8, 79.3, 92.8, 93 and 92%, respectively. The same parameters for pit pattern analysis by FICE were 92.7, 82.3, 90.1, 93.8 and 80%, respectively. Indigo carmine magnified chromoscopy showed sensitivity, specificity, accuracy, positive and negative predictive values of 97, 88.9, 94.9, 96.1 and 91.4%, respectively in the discrimination between neoplastic and non-neoplastic lesions., Conclusion: Magnified virtual chromoendoscopy is as accurate as indigo carmine magnified chromoendoscopy in distinguishing between neoplastic from non-neoplastic small colorectal lesions.

Objective: To examine the link between tooth loss and multilevel factors in a national sample of middle-aged adults in Brazil., Material and Methods: Analyses were based on the 2003 cross-sectional national epidemiological survey of the oral health of the Brazilian population, which covered 13 431 individuals (age 35-44 years). Multistage cluster sampling was used. The dependent variable was tooth loss and the independent variables were classified according to the individual or contextual level. A multilevel negative binomial regression model was adopted., Results: The average tooth loss was 14 (standard deviation 9.5) teeth. Half of the individuals had lost 12 teeth. The contextual variables showed independent effects on tooth loss. It was found that having 9 years or more of schooling was associated with protection against tooth loss (means ratio range 0.68-0.76). Not having visited the dentist and not having visited in the last > or =3 years accounted for increases of 33.5% and 21.3%, respectively, in the risk of tooth loss (P < 0.05). The increase in tooth extraction ratio showed a strong contextual effect on increased risk of tooth loss, besides changing the effect of protective variables., Conclusions: Tooth loss in middle-aged adults has important associations with social determinants of health. This study points to the importance of the social context as the main cause of oral health injuries suffered by most middle-aged Brazilian adults.

Objectives: To estimate the prevalence and clustering of cardiovascular risk factors (hypertension, smoking, physical inactivity, excessive use of alcohol, inadequate diet, and central obesity) and investigate the association of these factors with health self-evaluation after adjustment for sociodemographic features and clinical diagnosis of diabetes and ischemic heart disease., Methods: We studied 9 211 Brazilians with age between 30 and 69 years, residents of 16 state capitals, included in a cross-sectional population-based study carried out by the Ministry of Health (Inquérito Domiciliar sobre Comportamentos de Risco e Morbidade Referida de Doenças e Agravos Não Transmissíveis, 2002-2003). The response variable was the score of cardiovascular risk factor clustering, which ranged from zero to 3: no exposure or exposure to 1, 2, and 3 or more risk factors. Data were analyzed using multinomial logistic regression, having as reference the category of zero risk factors, with and without hypertension., Results: The prevalence of all risk factors except alcohol consumption was higher than 25%. The presence of two or more risk factors occurred in 47.49%; 17.91% of the participants presented zero risk factors. The clustering of risk factors was inversely associated with income and schooling and higher in the age group between 50 and 59 years, without significant differences between sexes. Health self-evaluation was worse in participants with more risk factors. The inclusion of hypertension in the score resulted in a worsening of the risk profile with increase in age and in a significant association with reported ischemic heart disease and diabetes., Conclusions: The high prevalence of cardiovascular risk factors in Brazilian adults underscores the importance of policies aimed at reducing these factors. The association between worse self-perception of health and a higher number of cardiovascular risk factors calls attention to the importance, broadness and complexity of this subjective health marker in population surveys and suggests that self-perception of poor health is not sufficient to encourage healthy attitudes.

Background: In Brazil, population-based information on risk factors and their relationship with cardiovascular diseases in the elderly is scarce., Objective: To estimate the prevalence and clustering of risk factors and investigate their association with ischemic heart disease (IHD) in elderly people., Methods: All subjects > or = 60 years of age participating in the "Inquérito domiciliar sobre comportamentos de risco e morbidade referida de doenças e agravos não transmissíveis" (Household Survey on Risk Behaviors and Reported Morbidity of Non Transmissible Diseases and Health Conditions) carried out by the Ministry of Health, in 2002/2003 in 15 capitals and the Federal District were included. The prevalence of risk factors (smoking, alcohol consumption, lack of physical activity, inappropriate diet, and obesity) and reported morbidity (hypertension, hypercholesterolemia, and diabetes) was assessed, as well as the association between IHD and clustering of these factors using the Poisson regression model., Results: Elderly individuals represented 13.4% (3,142/23,457), 59.4% women and 40.6% men. The mean age of the participants was 69.5 years. Approximately 50% of participants reported having hypertension, 33% hypercholesterolemia, and 18% diabetes. Smoking and hypercholesterolemia dropped significantly with age. Hypertension, physical inactivity, obesity, and hypercholesterolemia were more prevalent among women. Clustering of two or more factors was observed in 71.3% of the elderly, and diminished with age. Elderly subjects with IHD had a four-fold higher prevalence of clusters with four or more factors (PR=4.1; 95% CI: 2.6-6.4)., Conclusion: The relationship between IHD and a larger clustering of risk factors probably represents a greater accumulated risk throughout life, but it also indicates the need to improve the risk profile of these elderly people.

The role of the insulin-like growth factor I (IGF-I) system and nutritional status was studied in 241 children from a Brazilian area endemic for visceral leishmaniasis (VL). Thirty-nine children had the active form, 20 were oligosymptomatic, 38 were asymptomatic and 144 were not infected. Serum concentrations of growth hormone (GH), total and free IGF-I and IGF binding-protein 3 (IGFBP3) were measured by radioimmunoassay. Nutritional status was evaluated by anthropometric indicators and biochemical measurements. Total and free IGF-I and IGFBP3 were significantly reduced in the active form. Z scores for total and free IGF-I and for IGFBP3 were found to be significantly lower for active VL and oligosymptomatic individuals than for asymptomatic individuals, but never reached values

Objective: To recognize the characteristics and path taken by the through analysis of the scientific production it has published over the period from 1967 to 2005., Methods: Scientometric methods were used to analyze reference data on the articles published in the Revista, retrieved from the databases ISI/Thomson Scientific (Web of Science), National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO)., Results: The Revista is the only Brazilian publication in the field of public health that is indexed by ISI/Thomson Scientific. It is prominent as a medium for publishing Brazilian scientific production in public health and is displaying a geometric increase in publication and citation, with annual rates of 4.4% and 12.7%, respectively. The mean number of authors per paper has risen from 2 to 3.5 over recent years. Although original research articles predominate, the numbers of reviews, multicenter studies, clinical trials and validation studies have been increasing. The number of articles published in foreign languages has also increased, accounting for 13% of the total, and the leading countries originating these are the UK, USA, Argentina and Mexico. The number and diversity of journals citing the Journal has been increasing, many of which are non-Brazilian. Authorship per author shows good fit to Lotka's Law, but the parameters suggest greater concentration and less dispersion than would be expected. Among the fields of interest of published papers, the following topics account for more than 50% of the total volume: infectious-parasitic diseases and vectors; health promotion, policies and administration; and epidemiology, surveillance and disease control., Conclusions: The Revista shows great dynamism, without signs of abating or reaching a plateau any time soon. There are signs of progressively increasing complexity in the studies published, and more multidisciplinary work. The Revista seems to be widening its outreach and recognition, while remaining faithful to the field of public health in Brazil.

The concept of relative risk (RR) as an incidence rate ratio is extended to a ratio of derivatives of cumulative occurrences of events with respect to any continuous variable whose domain is partitioned in sub-domains of study and referent groups to be contrasted. RR, thus expressed as a function, allows the identification of key values of the independent variable through which effect, as a relation between sub-domains, is modulated. The effect of sex over age of occurrence of myocardial infarction in a sample of Brazilian patients is analysed. Male sex, as contrasted to female, is acknowledged as a risk factor for the disease but it is known that this risk wanes with aging. Derivatives of cumulative occurrences with respect to age are calculated for men and women. Given the normal distribution of these occurrences, derivatives are found to be very similar to the corresponding normal density functions, with difference not greater than 0.005. This provides an easy way of identifying the derivatives whose ratio is likewise easily calculated. Results suggest that, in the Brazilian sample of patients studied, the greatest men to women RR is 1.9 at the age of 23.5 years and that at the age of 61.2 years risks become evens.

Objective: To identify the risk factors associated with acute myocardial infarction (AMI) and their respective powers of association in the São Paulo metropolitan region., Methods: The cases comprised patients diagnosed with first AMI with an ST segment elevation. The controls were individuals with no known cardiovascular disease. The study comprised 271 cases and 282 controls from 12 hospitals. Risk factors were as follows: ethnic group; educational level; marital status; family income; family history of coronary artery disease; antecedents of arterial hypertension and of diabetes mellitus; hormonal replacement in women; smoking; physical activity; alcohol consumption; total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, and glucose levels; body mass index; and waist-hip ratio (WHR)., Results: The following risk factors showed and independent association with AMI: smoking [odds ratio (OR) = 5.86; 95% confidence interval (CI) 3.25-10.57; P < 0.00001); waist-hip ratio (first vs. third tertile) (OR = 4.27; 95% CI 2.28-8.00; P < 0.00001); antecedents of arterial hypertension (OR = 3.26; 95% CI 1.95-5.46; P < 0.00001); waist-hip ratio (first vs second tertile) (OR = 3.07; 95% CI 1.66-5.66; P = 0.0003); LDL-cholesterol level (OR = 2.75; 95% CI 1.45-5.19; P = 0.0018); antecedents of diabetes mellitus (OR = 2.51; 95% CI 1.45-5.19; P = 0.023); family history of coronary artery disease (OR = 2.33; 95% CI 1.44-3.75; P = 0.0005); and HDL-cholesterol level (OR = 0.53; 95% CI 0.32-0.87; P = 0.011)., Conclusion: Smoking, waist-hip ratio, antecedents of arterial hypertension and of diabetes mellitus, family history of coronary artery disease, and LDL-cholesterol and HDL-cholesterol levels showed to be independently associated with AMI within the São Paulo metropolitan region.

Objective: Assuming that ethnicity might be a basis for social differentiation and that such differences might represent vulnerability to sickness, this study attempts to verify whether race or ethnic origin have an effect on mortality patterns., Methods: The Sao Paulo State death register was examined from 1999 to 2001 in a contingence table of causes according to the 10th ICD and race or skin-color categories (White, Black, Mulatto and others). Chi-square test was used to check the association between skin-color and cause of death; residual analysis was used to elicit statistically significant excessive occurrences when each category of cause of death and skin color was combined; and correspondence analysis was used to examine overall relations among all categories considered., Results: A total of 647,321 valid death registers were analyzed, among which 77.7% were of Whites, 5.4% of Blacks, 14.3% of Mulattoes and 2.6% of others. A significant association between skin color or race and cause of death was found. It may be observed that, although Blacks and Mulattoes present a similar death profile, on the contrary of Whites and others, which could be aggregated into a single category, the former appear in distinct positions on the multidimensional map presented. Except for mal defined causes, which characterize only the deaths of Blacks, the other causes of death within this group are common to both Blacks and Mulattoes, varying however, in intensity and as to the order in which they appear death., Conclusions: Analysis of mortality according to race or color revealed that death has a color. There is a White death, which has, among its causes, sicknesses, which, although variable, are nothing more than sicknesses. There's a Black death, which is not caused by sicknesses but by external causes, complications in labor and delivery, mental disorders and ill-defined causes.

Health Science and Technology is currently the subject matter of government and university actions. Such actions should converge to the establishment of a National Health Innovation System, which still calls for acknowledgment from the economic sector counterpart. A study was carried out with the purpose of describing the relations between scientific fields and economic sectors as a means of learning more about this System. Records from the Brazilian Directory of Research Groups (version 4.1) were examined and selected when Health was a keyword either to field of knowledge or economic sector. Data were compiled into multiresponse variables and analyzed in contingency tables using residual, correspondence, and cluster analyses. It was found that the Brazilian National Health Innovation System constitutes a sectorial system where competitiveness is more socially than economically-oriented, making this System favorably in tandem with the National Unified Health System as well as responsive to public policies focused on social welfare.

This article analyzes the results of an epidemiological survey on the occurrence and distribution of lymphatic filariasis in Cavaleiro, a district in the city of Jaboatão dos Guararapes in Greater Metropolitan Recife, Pernambuco State, Brazil. The district was divided into 12 areas, and a cross-sectional technique was used to examine 9,520 individuals, of whom 2.2% were found to be infected. There were positive cases in 11 of the areas. The prevalence rate ranged from 0% to 5.15%. The majority (64.3%) of infected individuals were males (p < 0.05). Infected individuals were identified in all age groups. The results show that lymphatic filariasis is still an important public health problem in the Cavaleiro district and that it deserves attention by municipal authorities and health planners.

Background: Approximately three-quarters of cardiovascular disease deaths in the world come from developing countries, and acute myocardial infarction (AMI) is an important cause of death. Brazil is one of the largest countries in Latin America and the contemporary evaluation of risk factors for AMI is crucial for a more efficacious disease management., Methods: The Acute Myocardial Infarction Risk Factor Assessment in Brazil (AFIRMAR) study is a case-control, hospital-based study involving 104 hospitals in 51 cities in Brazil, designed to evaluate risk factors for a first ST-segment elevation AMI., Results: A total of 1279 pairs, matched by age (+/- 5 years) and sex, were enrolled. The conditional multivariable analysis of 33 variables showed the following independent risk factors for AMI: > or =5 cigarettes per day (odds ratio [OR] 4.90, P <.00001); glucose > or =126 mg/dL (OR 2.82, P <.00001); waist/hip ratio > or =0.94 (OR 2.45, P <.00001); family history of CAD (OR 2.29, P <.00001), low-density lipoprotein-cholesterol 100 to 120 mg/dL (OR 2.10, P <.00001); reported hypertension (OR 2.09, P <.00001); <5 cigarettes per day (OR 2.07, P =.0171); low-density lipoprotein-cholesterol >120 mg/dL (OR 1.75, P <.00001); reported diabetes mellitus (OR 1.70, P =.0069); waist/hip ratio 0.90 to 0.93 (OR 1.52, P =.0212); alcohol intake (up to 2 days/week) (OR 0.75, P <.0309); alcohol intake (3-7 days/week) (OR 0.60, P =.0085); family income R$600 to R$1200 and college education (OR 2.92, P =.0499); family income >R$1200 and college education (OR 0.68, P = 0.0239), Conclusions: The independent risk factors for AMI in Brazil showed a conventional distribution pattern (smoking, diabetes mellitus and central obesity among others) with different strengths of association; most of them being preventable by implementation of adequate policies.

Objective: Infant mortality in the state of São Paulo has decreased in the last years and it seems to be leveling off at a limit beyond which further reductions are challenging. Early neonatal causes account for 50% of these deaths and the remaining are mostly due to pneumonia and diarrhea. This study is to assess the impact of breastfeeding over death reduction., Methods: Fourteen municipalities of greater São Paulo were studied. Data on breastfeeding was collected through surveys conducted on national immunization campaign days and mortality data was taken from 1999 and 2000 official records. Drawing from literature parameters on risk for death from respiratory infection and diarrhea in non-breastfed infants, fractions of mortality preventable by breastfeeding were calculated. These figures applied to the number of recorded deaths allowed assessing the impact of breastfeeding over mortality for each municipality., Results: Fractions of respiratory infection mortality preventable by breastfeeding varied according to locality and age group between 33% and 72%. As to diarrhea, variation was between 35% and 86%. The impact of breastfeeding over infant mortality was an average reduction of 9.3% with values raging from 3.6% to 13%, depending on the locality considered., Conclusions: Breastfeeding in the first year of life might be the most feasible strategy to further reduce the current levels of infant mortality in the state of São Paulo.

Objective: To perform a screening, follow-up and comparative evaluation of depression and anxiety symptoms in a group of 59 first-year internal medicine residents of a teaching hospital and evaluate the influence of their rotation, nature of rotation, subgroup, sex and the time of year on these symptoms., Methods: We used the Spielberger State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), applied seven times, in the last week of every rotation., Results and Conclusion: We obtained two identical averages (P=0.98) of trait-anxiety, six months apart one from the other. There was a significant correlation (R=0.65, P < 0.001) between the indexes of state-anxiety and depression. Women had higher levels of symptoms of both anxiety and depression (P < 0.001) compared to men. A cluster of three subgroups of residents with higher trait-anxiety levels (P=0.001) also showed significantly higher levels of symptoms of state-anxiety and depression (P < 0.001). The time of the year and the nature of the rotation (emergency or not) did not interfere with the levels of depression (P=0.47). We detected rotations where there was greater frequency of residents with symptoms compatible with moderate and severe depression. There were 2.1% of residents with symptoms compatible with severe, 4.2% with moderate and 27% with mild depression. It was possible to graduate symptoms of anxiety and depression in residents, evaluate factors involved in their genesis and locate residents with moderate and severe depression.

Introduction: Morbidity information is easily available from medical records but its scope is limited to the population attended by the health services. Information on the prevalence of diseases requires community surveys, which are not always feasible. These two sources of information represent two alternative assessments of disease occurrence, namely demand morbidity and perceived morbidity. The present study was conceived so as to elicit a potential relationship between them so that the former could be used in the absence of the latter., Methods: A community of 13,365 families on the outskirts of S. Paulo, Brazil, was studied during the period from 15/Nov/1994 to 15/Jan/1995. Data regarding children less than 5 years old were collected from a household survey and from the 2 basic health units in the area. Prevalence of diseases was ascertained from perceived morbidity and compared to estimates computed from demand morbidity., Results: Data analysis distinguished 2 age groups, infants less than 1 year old and children 1 to less than 5. The most important groups of diseases were respiratory diseases, diarrhoea, skin problems and infectious & parasitical diseases. Basic health units presented a better coverage for infants. Though disease frequencies were not different within or outside these units, a better coverage was found for diarrhoea and infectious & parasitical diseases in the infant group, and for diarrhoea in the older age group. Equivalence between the two types of morbidity was found to be limited to the infant group and concerned only the best covered diseases. The odds of a disease being seen at the health service should be of at least 4:10 to ensure this equivalence., Conclusion: It was concluded that, provided that health service coverage is good, demand morbidity can be taken as a reliable estimate of community morbidity.

A sample of 153 children was drawn from a teaching hospital in Säo Paulo, Brazil. It comprised 51 pneumonia cases and equal number of non-respiratory and healthy controls matched by age and sex. Age ranged from 1 month to 7 years. They were all submitted to a standard protocol to investigate clinical symptoms and signs, and diagnosis of pneumonia was supported by X-ray images. Univariate data analysis contrasting pneumonia and non-pneumonia subjects suggested that the best pneumonia indicators would be chest auscultation, history of breathlessness, history of cough, chest in-drawing and fast respiratory rate, in descending order. A multivariate approach including also data from X-ray investigation was then tried with the application of multiple discriminant analysis to study the separation of pneumonia cases, non-respiratory patients and healthy children. It revealed that when many items of information are considered the performance of individual symptoms and signs change. The best predictors of pneumonia were then identified as chest in-drawing, chest auscultation, X-ray, history of breathlessness and toxaemia. Clinical symptoms taken all together contribute more than signs and equal X-ray in importance. Accordingly, it is concluded that any attention to X-ray should be secondary to clinical investigation, and it is suggested that the WHO's guidelines could profit with the inclusion of at least one clinical symptom, namely history of breathlessness which was found more useful than the WHO recommended breath count.

Introduction: An urgent need for the management of science and technology production in the health field has been recognised in Brazil since 1994, when the Federal Government called a National Conference on the subject. The present study presents a methodology for the identification of items of priority in planning such management., Material and Method: A survey was conducted in the research institutes belonging to the S. Paulo State Health Department among a sample of research professionals with a view to collecting data on two different scenarios: present and expected situation. Eighteen concepts, assembled in four different groups, were assessed is terms of an average percentage approval or disapproval, for each scenario. Consistency for the measurement of each of these groups was examined by the use of Cronbach's alpha coefficient and inconsistent concepts were disregarded in the analysis. The average percentage of approval/disapproval was further calculated as scenario co-ordinates for each concept and institute entering the study so that priority maps for concepts and institutes could be constructed., Results: Results suggest that the present situation meets with disapproval, though not strongly so, while a high degree of expectation is expressed with significant emphasis as regards research infrastructure management. The main priorities are given as: acknowledgement of performance, support for publication, resource allocation by research project and methodological advice for research analysis., Conclusion: It is concluded that the study methodology was helpful in eliciting management priorities and could be applied elsewhere with due adjustment of content regarding selection of concept and their grouping.

The Health Department of the State of S. Paulo has implemented a management strategy on research and development (R&D) for its research institutes which comprises three different items: 1) project registration, 2) support and 3) promotion of R&D activities. The present study explores the ability of this R&D management system to provide information and evaluates the performance of the third item which has been responsible for the assignment of research grants to professionals whose projects are selected through a peer review. The assessment of the grant's distribution was conducted by comparing the mean scientific production recorded in literature data bases for grant holders and equal an number of controls matched by institute of origin. The ability of the system to produce information was studied by the application of Cluster Analysis. The results show that grant holders have a scientific production significantly higher than their controls. Concerning information production, it is shown that proper raw data processing may render suggestions for decision making and that the institutes may be grouped in clusters of those that adopt similar management strategies.

This work presents the results of a time series study relating air pollution and respiratory mortality in children under 5 years of age in the metropolitan area of São Paulo, Brazil. Daily records of mortality (excluding neonatal mortality) for the period May 1990 to April 1991 were collected along with daily records of relative humidity, temperature, SO2, CO, particulates (PM10), O3, and NOx concentrations. Using multiple regression methods we demonstrated a significant association between mortality due to respiratory diseases and the NOx levels. After controlling for weather and season effects, the odds of dying due to respiratory diseases, considering the mean levels of NOx in São Paulo, was estimated at 1.3 (+/- 0.13). This result is in accord with previous animal studies conducted by our group and indicates that air pollution in São Paulo has reached levels high enough to have adverse health effects on the exposed population.

Our objective is to determine the opinions and knowledge of intensive care unit physicians toward organ donation. All physicians working in all 13 hospitals of Curitiba with intensive care unit for adults participated of the study. Of a total of 81 physicians, 75 (92.6%) answered the questionnaire. All physicians were favorable to organ donation, 74 (97.7%) were willing to donate their own organ and 72 (96%) to donate the organs of their relatives. Sixty-three (84%) did not know the present law on organ donation. Forty-one (54.7%) did not know the medical and legal criteria for organ donation. Five (6.7%) did not know that the patient had to have brain death in order to donate an organ, 3 (4%) thought that the patient had to have heart death in order to donate an organ, and 44 (58.7%) did not know how to explain brain death. Most physicians did not know the patient survival after transplantation of several organs. It is concluded that almost all intensive care unit physicians in Curitiba are favorable to organ donation and are willing to participate actively in obtaining consent of family members for donation. The basic knowledge of Brazilian law and several medical subjects on organ transplantation is unsatisfactory.

The results of a cross-sectional (prevalence) study of high blood pressure, carried out in 1987 in Araraquara County in the north of S. Paulo State, Brazil are presented. The group studies numbered 1,199 people, including 533 men and 666 women, of from 15 to 74 years of age. The results show a high prevalence of the disease (32.0% for men and 25.3% for women), with a tendency to increase with age, up to the 40's (men) and the 50's (women). There was also a greater percentage of hypertensives in the mulatto and black groups, in the obese, and among those of lower family income, with a lower level of schooling and with less well remunerated jobs. However, the logistic regression showed very small odds ratios associated with these risk factors, which could be attributed to the way these factors were considered.

A programme for the control of respiratory diseases in children was conceived for the State of S. Paulo, Brazil, in 1986. Its progress thereafter and the epidemiology of the diseases concerned are examined. Apart from an inquiry into the 64 existing State local health authorities, a sample of 18,255 cases of children assisted by the programme at different levels, including both in-patient and outpatient care, is analysed. Each case record included information about identification (child, doctor and health facility), reasons for calling, diagnoses made and outcome of treatment. Further data were also sought from hospitals and from State mortality records. The programme was found to be poorly implemented in the State but, where implemented, it showed itself capable of resolving problems (only 0.5% of the cases could not be handled) as also of changing ongoing trends (more than 50% reduction in hospital admission rates). Individual assessment of each item of the programme indicated its bottlenecks. Regarding the epidemiology of respiratory diseases, it is observed that the major burden to health services comes from children aged less than five, and that the most important diseases are wheezing illnesses and pneumonia. Moreover, they were found to be significantly associated (p = 0.000) so that a child in the community presenting wheezing diseases is 5 times more likely to develop pneumonia than a child with any other respiratory diagnosis. Similarly, among the under five deaths it was found that the risk for pneumonia is 3 times greater for children who died presenting wheezing diseases than it is for children with any other sort of diagnosis. In conclusion, the programme is deemed to be efficient and effective but its efficacy is marred by administrative flaws. The successful control of respiratory problems in childhood is related to a proper appreciation of the importance of wheezing diseases.

The main contamination areas in Goiânia were exposed soil surfaces, and with the first rainfalls, 137Cs quickly reached the Meia-Ponte River, the main local waterway. Regular measurements of bottom sediment, surface water, and fish were begun 3 wk after the accident. In the first survey, 137Cs was detectable in sediments up to 12 km downstream from the accident area. Maximum 137Cs concentrations found in sediments of the Meia-Ponte River were 1.3 kBq kg-1 dry weight and 200 Bq kg-1 fresh weight for fish. Cesium-137 was always less than 10 Bq L-1 in surface waters plus suspended particulates, even in the most contaminated creeks. Because it was the beginning of the rainy season, downstream sediment transport was enhanced. This resulted in a decrease of 137Cs concentrations in sediments of the urban area by a factor of approximately 20, 5 wk after the accident. The main sedimentation area for suspended sediments in this portion of the river is the Rochedo Reservoir, which is 80 km downstream from the accident area. In a survey performed 10 mo after the accident, 137Cs concentrations in the reservoir were up to 14 Bq kg-1 for fish, 1 Bq kg-1 for aquatic plants, and 100 Bq kg-1 dry weight for bottom sediments.

In September 1987, a powder radioactive source was removed from a teletherapy machine in Goiânia, Brazil. Subsequently, it was ruptured in a residential garden causing the dissemination of 137Cs throughout the city. Soil resuspension processes and burial of contaminated house waste in unused gardens were the major contributors to the Cs dissemination in soils at the secondary contaminated sites. Only locations within a radius of 50 m from the primary contaminated sites presented the need for remedial action. The radiation dose-rate measurements and the soil profiles were good indicators of the extent of the secondary contamination and were fundamental for the decisions taken regarding decontamination procedures. In cases of surface contamination, 60% on average of the total activity remained in the upper 1.5-cm layer over the first 5 mo after the accident, and topsoil removal proved to be an effective procedure for decontamination.

The evolution of medicine from an applied science to the extension of specialized medical care delivery, has had a bearing on the student's early decision, influenced by a specialist teacher, to chose specialization in a given field. The author gives current explanations of the specialization process in order to conclude that, in Brazil, one of its leading determinants is a policy of the social welfare system that favors the specialist. Other factors cited are the (not always justified) preference of patients--at least of those who can afford it--for physicians who work with sophisticated equipment, the vested interests of the industry that produces or owns that equipment, and the desire of the young physician to escape the stiff competition he would encounter in general practice, while at the same time separating himself from the somewhat negative image of the general clinician who does not keep abreast of developments in medicine. The author examines the question in light of sociological theories of social and technical division of labor, and asserts that the process has led to the atomization of responsibilities among physicians who have become incapable, because of overspecialization, of viewing the patient as a biological, psychological, social and cultural whole.